In Conservative, Liberal Democrat and Blairite circles there has always been an opinion of “why does it matter who owns the hospital, as long as the care is free”. It does matter. It matters because a publicly owned hospital and a publicly owned community health service are part of the community and they have a responsibility for the community. This commitment to the community means that there is a continuity of care: patients know that their NHS hospital, their GP, their district nurse will always be there for them.
The government knows that they cannot put up “For Sale” signs on hospitals and clinics around the country; they know that if they did this, MPs of the two parties in the Coalition would be ousted at the next election. Instead, the Conservative part of the government have produced a far more cunning plan. It is called Any Qualified Provider, and it will fragment the NHS through the use of many different private companies. These companies will mostly be for-profit, although some will be not-for-profit. None of these companies will have the long term commitment to the community that the NHS has. Private for-profit companies are driven by the need for short-term profit making rather than a long term commitment to patient care.
Under AQP when a patient’s GP recommends treatment they will give the patient the “choice” of any healthcare provider from a list of registered “qualified providers”. The patient will not be told who owns the provider or whether the provider is for-profit or not-for-profit. The government will even allow private providers to use the NHS logo, so patients may think they are using the NHS when they are not. The new for-profit and voluntary sector providers will not be subject to the same regulations of transparency and accountability that NHS providers have to follow. This will mean that patients who use these new providers will not be able to question their business practices.
The government says that “patient choice” is at the centre of the new NHS they are creating. The choice that a patient makes will determine the future of their local hospital and it will determine the availability of specialist and expensive care at NHS hospitals. When a patient chooses a non-NHS provider it means that the money that pays for their care will go to the alternative provider (and potentially some of it will end up as a profit paid to shareholders as a dividend). The result will be that the income of NHS providers – hospitals and community health services – will be cut.
About half of the work that hospitals do is paid using a fixed pricelist called tariff that is determined by the Department of Health. In practice, some treatments will cost a hospital less than tariff to provide and so the hospital makes a surplus, but the hospital may also provide a treatment that costs more than tariff and this creates a deficit. Hospital managers work hard to make the surpluses equal or exceed the deficits and this cross-subsidy is important because without it deficit-making services provided as a social benefit for the community will close. For-profit companies are more likely to perform treatments that generate surpluses: they need to do this to make a profit. When a patient has their treatment by such a non-NHS provider, it threatens the viability of the deficit-generating services at the NHS hospital they would have used, and ultimately the hospital may have to stop providing the service and the community will be deprived of that service. A patient’s choice for a simple procedure may affect many other patients who depend upon a difficult, expensive service.
Private and voluntary sector providers do not suffer this issue because as Any Qualified Providers they can choose the services they provide: and that will inevitably mean they will choose services that are cheap and easy to provide and will send patients with complicated conditions back to the NHS. Private and voluntary sector providers do not provide emergency treatment: A&E, intensive care units and the skills that the staff need to treat emergencies are costly and these are costs that the private and voluntary sector do not have to bear.
The privatisation of the NHS will not occur as the sale of an NHS hospital trust; instead it will occur when departments within a hospital close because there are not enough patients to cover costs. The government is encouraging this situation by cutting the income of hospitals. David Cameron said that he would not cut the NHS, yet in April this year the government cut tariff by 1.5%, which means that hospital incomes have been cut. Some hospitals will attempt to generate more income by taking on private patients. This will be self-defeating, since it will create a two-tier system where NHS patients will be second in the queue to private patients. NHS patients, fed up with a second rate service compared to private patients will inevitably use their “patient choice” to use another hospital, most likely a private one. The privatisation planned by the government will be gradual, but irreversible.
The Health and Social Care Bill provides the legal framework for this privatisation by creating the unelected NHS Commissioning Board, so that our elected representatives will not be able to halt privatisations. The Bill will also turning Monitor into an economic regulator (with a mandate to “prevent anti-competitive behaviour”, ie promote competition) who will force privatisations through.
We must do everything we can do defeat the Bill and prevent these privatisations. But in the unpalatable situation of the Bill being passed, there is a simple message here. If you value the specialist services that your local NHS hospital provides then you should choose to have all of your treatment at that NHS hospital since any treatment you have at an Any Qualified Provider will put at risk the NHS hospital. Our NHS: Choose it, or lose it.
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