David Wrigley: Standing up against the fragmentation of the English NHS

david_wrigleyOn a little known website an advert popped up recently that didn’t catch the eye of many people. Those that did see it realised the implications of it when they read the details.

The website is called Supply2Health and is the location for all outsourced tenders for services in the English NHS. It is a veritable goldmine for the private sector wishing to take over profitable services and get their hands on a piece of the juicy NHS £120bn pie.

You may remember the debate last year over Section 75 of the Health and Social Care Act. That piece of pernicious legislation in effect means that local commissioners are forced to put services out to tender once the current contract expires. If they don’t offer them to the market then clinical commissioning groups (CCGs) and commissioning support units (CSUs) are open to costly legal action (that they cannot afford) when the private sector says “you can’t just give that to the NHS, we want to bid for it.” So the safe route is taken and services are put up for sale on the Supply2Health website. This is the reason why NHS campaigners are so keen for the NHS to become the “preferred provider” of services to give them first bite at the cherry of any contract.

Bidding for these contracts are huge undertakings. The complex tender documents to be completed run to hundreds of pages. Local charities and small organisations, and even hard pressed NHS organisations, just do not have the resources to complete such applications. However you can be sure the global health firms with rooms full of lawyers, accountants, and experts are willing, able, and expert at completing such tender documents. This NHS contract playing field is about as level as the Winter Olympics downhill slalom course.

The advert that caught my eye was one of the biggest NHS contracts on offer in recent times. This contract puts up for sale the design and provision of cancer services in the East Midlands and it is worth a mammoth £687million. That is a contract that would make the City of London firms salivate at the prospect of winning. The opportunities to asset strip, cut corners, and make “efficiency savings” will be huge—and of course any savings made will make more profit for the lucky shareholders of the private healthcare company.

If this service was run by the NHS proper as a public service, then any surplus funds would be ploughed back into patient care. Surely this is the ethos that the NHS was built upon and has thrived upon in its sixty six year history. Scotland has gone down the route of ruling out any private company running and profiting from their NHS and if we don’t adopt such a system very soon in England it may well be too late to prevent the NHS being run by a huge mixture of corporate entities.

The role of the BMA here is paramount in highlighting the disastrous changes occurring in the English NHS—nothing short of a major publicity campaign will suffice. We cannot rely on the media, and especially not the BBC who were hopeless at highlighting the privatising Health and Social Care Bill during its long and tortuous passage through parliament in 2010-2012.

Another interesting fact is that the East Midlands cancer contract is on a 10 year basis. Most NHS contracts on offer in England are for three to five years, but we now see this doubled to 10 years, meaning contracts are in place for much longer and therefore are much harder to reverse.

Most readers will be astonished to see the sale of NHS services that provide care to cancer patients. We know that multiple unconnected providers in any system leads to poorer care due to fragmentation and lack of communication between providers. This can only mean bad news for patients who want to have continuity of care. It also makes it harder for NHS staff who do not have easy ways of contacting all the different providers.

It is another example of the fragmentation, privatisation, and ideological destruction of the English NHS. As doctors we must stand up and speak out—it is our moral duty when our patients are affected by ideologically unsound political policy.

Competing interests: I declare that I have read and understood the BMJ Group policy on declaration of interests and I have no relevant interests to declare.

David Wrigley is a GP in Lancashire and a member of the BMA GP Committee. He also speaks for the campaigning group Keep Our NHS Public which is an apolitical organisation seeking to bring about a publicly funded, publicly provided, and publicly accountable NHS. He contributed to the recent book “NHS SOS.”