In Louis de Bernieres’s book, Captain Corelli’s Mandolin, one of the characters, Old Stamatis, has had a pea stuck in his ear since childhood causing him deafness. His relief at getting it removed turns quickly to dismay as he can now hear his wife’s constant remonstrations, to which he had been oblivious for all those years.
There seems to have been a serious case of collective auditory impediment when it comes to the issue of the private sector’s involvement in the health service. During the two month pause on reform of the NHS, the Government removed the proverbial pea from the nation’s ear and suddenly the words privatisation and competition seem to be the only words people can hear.
Why this irrational fear of either or both P and C words? Currently, the combined private and voluntary sectors provide around 5% of NHS services – far less than people probably imagine. So, the fact remains that 95% of the NHS is still run for and by NHS providers. And, despite the undoubted good things it does, it has to be said – well, whispered – that in many cases, the NHS is not particularly well run and performs badly. There are still huge regional discrepancies in the quality of care you receive and health inequalities are still a huge problem. Things have to change and the bits of the NHS that are not delivering need to be challenged.
Occasionally, bad performers are outed as in the case of the Mid-Staffs shocker. But, compare the outcry about that particular hospital and the current noise in the media about Southern Cross – one of those terrible independent sector organisations! Similar private sector-bashing went on over the independent sector treatment centre (ISTC) programme’s perceived shortcomings despite the fact that they made a significant contribution towards reducing waiting times for common operations. Yes, there is a risk to patient care if a private sector provider goes bust. But does that mean they pose any more risk to people than many bad, inefficient hospitals such as Mid Staffs or dangerous NHS GPs for that matter?
Much of the recent debate around the proposed reforms has centred on the P and C words yet I have seen very few journalists take anyone to task on the fact that NHS GPs are independent contractors and hospital consultants can be considered private business operators. That’s right. GPs and consultants, many trained at our expense, can, and do, make profit from the NHS or take on private patients without a backward glance – and apparently without incurring anyone’s displeasure.
Avoiding the obvious anachronism here, what becomes apparent is that the whole notion of competition in the NHS really does polarise people and organisations like nothing else and leads to no little hypocrisy. While the BMA has stated openly that competition will increase costs and bureaucracy and threaten the values of the NHS (sic) the Future Forum’s mantra now is that there is a place for competition to “support integration, cooperation and collaboration” and their report recommends that Monitor does not now have to “actively” promote competition. So does that put an end to the debate on competition? I doubt it. As The Times’s Camilla Cavendish opines, the British public remain “allergic” to competition despite the growing evidence that it lifts standards. But there is hope!
As with much of the NHS Future Forum’s report, contentious issues have been watered down with careful re-wording rather than actual propositional changes.
Sir Stephen Bubb, a member of the NHS Future Forum, proposes that health monopolies will be broken open from the bottom up by giving patients “the right to challenge” poor service from any provider – at the same time giving people their right under the NHS Constitution to demand more say and more choice in their healthcare provision.
That sounds like a healthy case of competition to me.
The NHS Future Forum’s key recommendations to the Government are:
• Reinstatement of the legal responsibility of the health secretary for the overall performance of the NHS
• Scrapping the primary role of the regulator, Monitor, to promote competition – and focusing on improving patient choice instead
• Relaxing the 2013 deadline for the new GP commissioning arrangements to be introduced
• Strengthening the power of health and well-being boards, which are being set up by councils, to oversee commissioning and giving patients a greater role on them
• Retaining a lead role for GPs in decision-making, but boosting the role of other professionals such as hospital doctors and nurses alongside them