Sunday 1 September 2013

Everything changes yet everything stays the same.


The Internet is a funny thing – very useful as a research tool at times, sometimes weird.

Last week Google News threw up something spooky from leftfield – I homed in on it because I thought it was another new privatisation, then I realised it was a very old article from 2006 and it seemed to have been put out by the Guardian by accident. I’ve put my comments at the end;

 

A secret plan to privatise an entire tier of the NHS in England was revealed prematurely yesterday when the Department of Health asked multinational firms to manage services worth up to £64bn.

The department's commercial directorate placed an advertisement in the EU official journal inviting companies to begin "a competitive dialogue" about how they could take over the purchasing of healthcare for millions of NHS patients.

The advertisement should not have appeared until after ministers announced the policy next month.

Unison called on the TUC to convene an emergency meeting to respond to the government's "fundamental breach of trust". Frank Dobson, the former health secretary, said: "If this is not privatisation of the health service, I don't know what is. It is about putting multinational companies in the driving seat of the NHS."

Lord Warner, the health minister, defended the policy in a statement to the Guardian at 3.46pm yesterday but had changed tack at 6.05pm. He said he was withdrawing the advertisement to correct "a drafting error", but insisted the contracting out of NHS management would go ahead.

The advertisement asked firms to show how they could benefit patients if they took over responsibility for buying healthcare from NHS hospitals, private clinics and charities. The plan would give private firms responsibility for deciding which treatments and services would be made available to patients - and whether NHS or private hospitals would provide them.

Under the present system, this commissioning work is handled by local NHS managers employed by primary care trusts. Under the new system, the PCTs would contract out the commissioning to big healthcare management consortiums with greater purchasing muscle.

Contenders for the contracts are likely to include big US companies such as United Health and Kaiser Permanente. They may be joined by British insurers such as Bupa and PPP and their EU rivals.

The advertisement, in the Official Journal of the European Union, said the NHS was making a "step change from a service provider to a commissioning-led organisation". The PCTs would be able to contract out procurement, financial management and human resources. Initially there would be a four-year framework agreement covering the whole of England, but the value would depend on how many PCTs agreed to the scheme. It was not clear last night how much pressure there would be on them to do so.

 

Karen Jennings, head of health at the public service union Unison, said: "This is such a fundamental breach of trust that we are asking the TUC to get together a meeting of all health unions to thrash out a strategy. It is a contract to privatise the whole of primary care across the UK.

 

"There is a real danger that contracts will be awarded to the bidder promising the largest savings. It is a fundamental change in Labour party policy. It is a disgrace that jobs of health visitors, community midwives, occupational therapists and district nurses are under threat or may be transferred to the private sector."

Lord Warner said: "The government has no plans to privatise the NHS." He added that the contract advertised in the official journal would give PCTs access to expert help to improve commissioning of services, without going through expensive and time-consuming local tenders.

Now, I would never have searched this out unless it had been thrown out randomly. What’s interesting is that the policy (as far as I know) was never carried out by the then Labour Government of Tony Blair, it was drowned in protests.

What is interesting is that, with a bit of tweeking, this is roughly what happened this year; the Primary Care Trusts were abolished at enormous expense and with the loss of all those years experience in organising medical services. In their place came the CCG’s – commissioning groups of local Doctors’s but, in reality controlled by central guidelines and forced to put all NHS services out to tender.

Which in effect, is the privatisation of that segment of healthcare revealed by accident in 2006 – it’s just that it won’t be managed by efficient multinationals but by amateurish groups of busy doctors.

Different government, slightly different proposals, same effect. The common theme is the civil servants of the Department of Health and the bureaucrats of the NHS – like Sir David Nicholson. And that nobody ever voted for any of this.

Everything changes yet everything stays the same.

(Proust)

Neil Harris

(a don’t stop till you drop production)

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