NHS first, patients second

Yesterday was an inauspicious day for Virgin Group to renter the primary healthcare market. It bought a 75 per cent stake in Assura, the medical services group that forms collaborative joint venture partnerships with NHS GP practices to provide primary care, urgent care and outpatient services, diagnostics and day-case procedures in the community. On the same day the Department of Health ordered primary care trusts across the east of England to suspend procurement for community services.

The unstated intention of the DoH is to halt the independent investigation by the department’s Co-operation and Competition Panel into the legality of Health Secretary, Andy Burnham’s, policy that NHS bodies should be the “preferred providers” of health services before it ruled against his policy.

This is bad news for outside providers, who will see their market shrink. But it is also bad news for patients, as it will reduce choice and leave them with no option but to use an NHS provider, even if they get a poor service from it.

As a special adviser in the Department of Health, I was involved in discussions on Labour’s manifesto for the 2005 election. The final version, on which the Government was elected, committed the NHS to use new providers from the independent and voluntary sectors to provide health services. The purpose for doing so was to add capacity, promote innovation and to drive competition, or “contestability”, within the NHS. The ultimate goal, of course, was to improve the quality of patients’ healthcare.

Burnham’s speech last year to the King’s Fund, in which he stated that the NHS should be the preferred provider of health services, sent a signal that opportunities for the private and voluntary sectors were being closed down. NHS officials in one east of England primary care trust were not slow to get the message and abruptly excluded private and voluntary organisations from tenders.

A final determination of the legality of this move will come after the 2010 election. This is just as well for the Government since the motivation behind it is clearly political. Burnham’s move is designed to appease unions, like the BMA and Unison, who have never been wholly reconciled to the involvement of the private sector in the provision of NHS services. It also helps position him slightly to the left for any future Labour leadership election.

Labour’s manifesto for the 2010 election will not be as welcoming of alternative providers, but there will still be scope for them to provide NHS services. It is clear though, that the independent and voluntary sectors still have a lot of persuading to do to overcome resistance from within the NHS. This will be the case even under a sympathetic Conservative administration.

A determined campaign by private and voluntary providers will need to begin the moment the election campaign finishes.

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