The Health and Social Care Bill is the Privatisation of the NHS

The initial concept behind the NHS was based on the need to increase health equality for the population in the UK. The principle that everyone can access good quality health care, regardless of individual finances, is why any degree of privatisation of the NHS is extremely concerning. In 1948 the NHS was founded with the objective, to provide health care that was free of charge and determined by returning patients to ‘good health’ regardless of symptoms, diagnosis, or treatment required. What many people don’t know is that Bupa private healthcare was founded first in 1947; highlighting the need for the government to  ensure everyone, regardless of age, gender or means could access clinically appropriate treatment, centred around high-quality care. 

  Overseen by the National Health Service in July 2000 the NHS needed modernisation to match the range of services and high standards, available from the ever-growing private sector. One of the main aims of the modernisation of the NHS was to provide staff with the support and resources to improve and minimise errors. The aim was not to increase the use of external staff from private companies or allowing private companies, such as Medinet under the label of ‘NHS Service Providers’ to arrange medical initiatives, utilising NHS Consultants, to make profits for their directors and shareholders.

  The impact of using ‘NHS Service Providers’ is far reaching. NHS Consultants are no longer available to work overtime within their own NHS Trusts and patients lack continuity of care, especially important if complications arise following a surgical procedure. Over the longer term, allowing a private company to make a profit using NHS consultants, working in NHS facilities is not a sound economic strategy. The detrimental impact of allowing private companies into the NHS is the steady integration of the private sector which the NHS currently relies on to continue to function. 

 ‘… an over-reliance on high-cost private agencies when there are other options available is not good for patients or for the NHS’s finances.’ Ian Dalton, Chief Executive, NHS Improvement 31/08/2018  NHS.UK

Private Companies Profiting in the NHS

The commitment by the UK government to provide free healthcare to everyone and create health equality was an ambitious goal. Over the past 30 years, we have witnessed the NHS changing with an increase in the use of private companies and waiting list times growing alarmingly, in numerous specialties. Medical practitioners have increasing volumes of patients and often lack of staff means patient safety is at risk and patient care is compromised. 

Currently, maximum wage rates are in place for agency staff from private companies, and the cost of medical initiatives arranged by ‘NHS Service Providers’ are controlled by the NHS national tariff. Yet this does not stop ‘NHS Service Providers’ generating significant profits by paying NHS Consultants to work for a different NHS Trust, often over a Saturday and Sunday, to the Trust they are employed by. This concept produces positive short term results, by reducing patient waiting times and providing surgical procedures using underutilised NHS theatre capacity. However, over the longer term, the results of allowing a private company to make a profit using NHS consultants, working in NHS facilities, is destroying the very foundation of the NHS.

‘The NHS could free up £480m to reinvest into NHS services and improve patient care if trusts filled temporary vacancies with workers from a ‘staff bank’ instead of using expensive staffing agencies.’ 31/08/2018 NHS.UK 

The Integration of Private Companies into the NHS

The reliance on private companies has led to agency staff, working alongside NHS staff, who are often being paid less per hour. Even worse by allowing private, profit-making companies to become ‘NHS Service Providers’, NHS Consultants and nurses are persuaded to work overtime at weekends, for a considerably higher rate of pay in comparison to their NHS salaries. I believe that the whole system needs a complete overhaul, ‘NHS Service Providers’ should be abolished and the use of private companies should be strictly regulated. Even the Shadow Health Secretary, has criticised the government’s decision to introduce the bill instead of focusing efforts on “…resourcing the NHS sufficiently to bring down the record waiting lists for surgery, mental health and cancer care or giving our NHS workers the proper pay rise they deserve.”

Over the past three decades, private companies have been infiltrating the NHS and taking between 7% to 11% of the NHS budget, with the sole purpose of generating profits. There is no question that the cost of using private companies to provide staff and reduce waiting times, has been damaging to the NHS as a whole. The government has already recognised the impact of using private companies to provide staff and even state in the government guidance on their own GOV.UK website, ‘NHS provider spending on agency staff has been rising year-on-year and is a significant driver behind the deterioration in NHS providers’ finances.’ GOV.UK

 Impact of Covid 19 on NHS Care and Resources

  The COVID 19 pandemic brought the impact of health inequality into sharp focus. The influx of patients requiring treatment and intensive care put great pressure on other essential services provided by the NHS. Cancer treatment, such as chemotherapy and radiotherapy was postponed and waiting times for ‘elective surgery’ such as hip and knee replacements or ‘non-urgent surgery’ such as hernia procedures, have increased significantly. 

This has further contributed to the divide between the care provided to NHS patients and care that can be accessed privately. As health inequality grows and the government leans on the UK’s independent hospital sector to ‘prop’ up the services provided by the NHS; it is not surprising that the government are trying to introduce The Health and Social Bill which will silently and gradually lead to the privatisation of the NHS.

The Health and Social Care Bill 2021 Key Points

  The Health and Social Care Bill will significantly increase the percentage of the NHS budget, that is awarded to private companies, whose primary function is to make a profit. The pressure on private companies to provide continuous annual profits for shareholders could influence decisions around who receives treatment, based on profit margins.

It is likely this will also result in NHS patients having no say in who they are treated by or where they may receive treatment. NHS patients with chronic conditions who currently are treated by one consultant may only be able to access long term treatment from various consultants and therefore lack the continuity and standard of care they deserve. In the longer term, The Health and Care Bill could result in high numbers of NHS consultants becoming demoralised and leaving the NHS to work with private companies, that offer higher rates of pay. 

Removal of Regulations on Private Company Charges

The Health and Care Bill is in the committee stage and once it is passed the damage done, will be difficult to reverse. The current regulations limit how much private companies can charge. This safety net will be abolished by The Health and Social Care Bill. Tariff limits for private companies and the tender process to ensure the lowest cost is achieved, when utilising private companies, will end. At the British Medical Association (BMA) briefing it was agreed that “the proposed reforms are insufficient to fully protect the NHS from unnecessary private sector involvement and could, under the Provider Selection Regime, allow contracts to be awarded to private providers without proper scrutiny or transparency.”

Without the current tender process that drives competition and reduces charges, private companies will be able to charge higher rates. In addition, NHS Trusts will be grouped into Integrated Care Systems (ICSs). Integrated Care Systems ICSs will include board members from private companies, who are run for the benefit of shareholders and company directors. Consequently, the very concept of the NHS, to ensure health equality in the UK, will be destroyed forever.

Under the Health and Social Bill, (Clause 66 inserts Schedule 10) the national tariff will be replaced with a new NHS payment scheme. The Explanatory Notes state that this change is devised to provide the NHS with versatility, by removing the tender process, to speed up the acceptance of private contracts. If private firms are given seats on the Integrated Care Systems and current restrictions are removed on how private companies are awarded contracts and what they can charge, fraud and corruption are almost inevitable.  

The government should be looking to apply a bill that further limits the use of private companies. Permitting private companies to profit from the provision of public healthcare, is unethical and negatively impacts patients who rely on NHS care. This bill sounds the death knell of the NHS as we know it today. This bill undermines the past 73 years of public health care, which at one point was considered the best in the world and could destroy any resemblance of health equality in the UK. 

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Resources

Universality, equity, and quality of care NCBI

The Health and Care Bill [Bill 140 of 2021-22]

A new health and care bill: what you need to know RCP