Health policy debate
4 to 15 November 2005
Plurality
Hewitt says two-star trusts can apply for foundation status
Monitor said it would not ‘lower the bar’ when considering trusts for foundation status’ [go to note 17].
NHS Alliance say foundation trusts should only provide primary care as a last resort
In his annual conference speech, NHS Alliance chair, Michael Dixon said the introduction of foundation trusts into primary care provision would not increase contestability.
He said the answer to the question, ‘who eventually might be the future providers in primary care?’ was ‘surely frontline clinicians…whose heart and soul is in their local communities’.
He told delegates, ‘we must not allow them to become serfs in a system run by bigger boys’. He warned of a danger that bringing in too many private providers would ‘swallow the front line rather than support it’ [go to note 18].
Would private-commissioning lead to two tier rights in the NHS?
The above questioned is posed by a Christopher Newdick, a reader in health law at Reading University. He cites Barbara Clark’s claim for Herceptin as an example. What if, he asks, a private-commissioner had made a decision to refuse the drug, what legal redress would she have?
‘Normally, Ms Clark could use judicial review, which allows the courts to supervise public authorities. Because private-commissioners are not created by statute, it is not their first duty to serve the public interest. Although some cases have begun to suggest companies providing public services can be subject to judicial review, the law is underdeveloped. It is not clear that the company is subject to NICE guidelines.
Because of commercial sensitivities, it may not be possible to reveal the nature of the contract the company has been awarded in gaining commissioning status. Neither does the Human Rights Act necessarily apply because it would have to be judged that they are providing ‘functions of a public nature’.
He ends, ‘does private commissioning present the prospect of two-tier rights in the NHS’? Would patients have greater protection within statutory PCTs? These are big questions. Let’s get them out in the open’ [go to note 19].
Thames Valley SHA postpones plans to contract out commissioning
For now, these questions are academic as on November 11 (the same day Patricia Hewitt was speaking to the NHS Alliance) Thames Valley SHA announced they would be postponing plans to contract out commissioning. Its chief executive, Nick Relph had been preparing to advertise in the EU’s official journal next month, but withdrew the plan after Lord Warner had told MPs, “I am not an advocate for this”. A new PCT will decide how services should be reorganised when it is appointed, next June [go to note 20].