Politics: NHS privatisation

30/12/2019

"Private firms invited to run NHS services with cancer and kids treatments on sale", squeals the Sunday Mirror, thus perpetuating a Labour Party meme that the government is secretly planning to sell off the NHS.

In lurid terms, the body copy tells us that NHS cancer care and kids' treatments are up for grabs in a "stealth" Tory sell-off. As revealed by the Sunday Mirror, "private firms are being invited to bid for chunks of our health service – in complete contrast to Boris Johnson's repeated election campaign denials".

The paper goes on to tell us that cardiology, gynaecology, paediatrics and oncology are among the services being offered to companies. Thus, "a new framework drawn up by NHS Shared Business Services will see hospital trusts buying clinical care from a list of suppliers. It could lead to deals worth up to £117 million being handed out over four years".

This, of course, is just one of hundreds of politically-inspired articles aimed at instilling dread into the public discourse, sharpened up by the onset of Brexit where the prospect of a trade deal with the United States is being used to assert that the NHS is being fattened up for sale to American healthcare corporations.

What makes this particular article especially delicious, though, is the paper's casual reference to NHS Shared Business Services (SBS), as it decries the conclusion of deals for clinical services with the private sector worth £117 million over four years.

The point at issue here is that SBS is a private limited company, jointly owned by the NHS and the French consultancy firm Sopra Steria, with the commercial company holding a 51 percent share.

Sopra Steria, with a multi-billion annual turnover, provides services for many UK government organisations including the Scottish Government. Amongst these are the provision of cyber security services to HM Government, in a scheme administered by the Department for Business, Innovation and Skills.

For the NHS, via the SBS, the company employs about 1,000 staff providing finance, procurement, ICT and employment services to around 40 percent of the NHS, totalling over 140 healthcare providers and arm's length bodies, including every single commissioning organisation in the country – the very bodies which will be parcelling out the clinical services contracts.

And according to the latest annual report, SBS turned over £76 million in 2018, generating an operating profit of nearly £9 million and returning £1.5 million in tax before paying a dividend of £4 million to its shareholders. For their money, they claim to be saving the NHS millions.

Over the next four years, given expected growth, the company will generate a turnover of roughly £300 million from SBS, most of it absorbed in administrative costs paid to what amounts to a subsidiary of a French company. But the ultimate joy here is that SBS was incorporated on 8 November 2004 and started operations in 2005, both dates falling within Blair's Labour administration.

Before squealing about a mere £177 million being directed to private companies by the evil Tories, therefore, the Mirror ought to look at the performance of previous Labour administrations and their approach to privatisation.

In fact, when in November 2011, I took a short break from blogging to have open heart surgery, I was operated on in the Nuffield Leeds Hospital, a private facility providing services on contract to the NHS in an arrangement made under the Labour government. Throughout my stay, I was treated in exactly the same way as a private patient, complete with private room, silver service meals when I was fit enough to eat, and free Wifi.

Notably, the stay didn't cost me a penny and actually cost us less than if I'd had the operation in Leeds General Infirmary, as Mrs EUReferendum would have had to pay parking charges when she came visiting. Thus, the central tenet of the NHS was preserved, that medical services should be provided which are free at the point of delivery.

Shortly after my operation, the NHS underwent a major reorganisation, driven by the Health and Social Care Act 2012, under the Cameron coalition government. This formally recognised the principle adopted by the previous Labour government, where provision of clinical services was opened up to all-comers while maintaining the ethos of free treatment at the point of delivery.

The Act led on 1 April 2013 with the replacement of Primary Care Trusts with Clinical Commissioning Groups (CCGs). These are clinically-led statutory NHS bodies responsible for the planning and commissioning of health care services for their local areas. As of 1 April 2019 there were 191 CCGs in England. And it is these bodies which are responsible for managing the provision of clinical services within their respective areas.

Here, the accent is on commissioning services, "driving new and innovative models of care by putting the patient at the heart of the system". From the user end, it is interesting to see how this works in practice – for which I can vouch from personal experience. Over the last few years, I have been troubled with the most intense pain in my stomach, a useful condition which has enabled me to keep up the level of acerbity necessary for writing this blog.

Eventually, however, my GP practice – concerned at my industrial level of opiate consumption – decided at last that it might be a good idea to investigate why I was needing to drug myself into oblivion (after writing my nightly blog). Earlier (inconclusive) investigations back in 2010 were carried out in the NHS facility in Bradford Royal Infirmary (BRI), a time-consuming process in an ancient, decrepit annex. Nine years later, the experience could not be more different.

Initial diagnostics and consultations have been conducted at the Eccleshill Treatment Centre, a purpose-built facility on the edge of the city, with easy access and ample free car parking. The facility, though, is not NHS operated. Rather, it is owned and managed by Westcliffe Health Innovations, an offshoot of Affinity Care, a privately-owned group GP practice.

Additional, more complex diagnostics – including an MRI scan and multiple X-rays - have been carried out at the Yorkshire Clinic, part of the Ramsay Health Care group, a service so efficient that, when I turned up early one day, I was done and back on my way home before the time set for my appointment.

With the procedures now complete – fast, efficient and friendly – with not a penny paid by me, I'm now to be handed back to the NHS at BRI for a surgical procedure. This is a seam-free process which delivers a service that bears no comparison with the doom-laden press which was the staple fare of the election campaign. This "privatised" NHS is not one I would recognise from the publicity we have been getting.

Going way back, I have had previous experience with Leeds General Infirmary. In my cleaning contracting days, I won a contract to clean a multi-story food hoist shaft which over the years had become encrusted with spilt food.

This was an incredibly difficult job as all the electric connections to the heated shelves were exposed in the shaft. But I had developed a special expertise in waterproofing electrics, in order to pressure wash installations – which was what was needed. The job was a success but, if we take the current propaganda into account, it should have been done in-house by NHS staff.

At which point, though, do you draw the line? It seems perfectly acceptable to contract out millions of pounds-worth of back-office functions; the private sector has successfully been carrying out complex heart surgery for years, and it is providing supremely efficient diagnostic services.

If the Clinical Commissioning Groups are performing their functions effectively, and remain accountable, and patients are treated free at the point of delivery, what is the problem? Mr Blair thought it was the way forward, and I am not inclined to disagree.