If you continue without changing your settings, we’ll assume you’re happy to receive all cookies from the BMA website. Find out more about cookies
When you visit any web site, it may store or retrieve information on your browser, mostly in the form of cookies. This information might be about you, your preferences or your device and is mostly used to make the site work as you expect it to. The information does not usually directly identify you, but it can give you a more personalised web experience.
Because we respect your right to privacy, you can choose not to allow some types of cookies. Click on the different category headings to find out more and change our default settings. However, blocking some types of cookies may impact your experience of the site and the services we are able to offer.
These cookies are necessary for the website to function and cannot be switched off in our systems. They are usually only set in response to actions made by you which amount to a request for services, such as setting your privacy preferences, logging in or filling in forms.
You can set your browser to block or alert you about these cookies, but some parts of the site will not then work. These cookies do not store any personally identifiable information.
These cookies are required
These cookies allow us to know which pages are the most and least popular and see how visitors move around the site. All information we collect is anonymous unless you actively provide personal information to us.
If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance.
These cookies allow a website to remember choices you make (such as your user name, language or the region you're in) and tailor the website to provide enhanced features and content for you.
For example, they can be used to remember certain log-in details, changes you've made to text size, font and other parts of pages that you can customise. They may also be used to provide services you've asked for such as watching a video or commenting on a blog. These cookies may be used to ensure that all our services and communications are relevant to you. The information these cookies collect cannot track your browsing activity on other websites.
Without these cookies, a website cannot remember choices you've previously made or personalise your browsing experience meaning you would have to reset these for every visit. In addition, some functionality may not be available if this category is switched off.
Our websites sometimes integrate with other companies’ sites. For example, we integrate with social networking sites such as Twitter and Facebook, to make it easier for you to share what you have read. These sites place their own cookies on your browser as a result of us including their icons and ‘like’ or ‘share’ buttons on our sites.
Some people say ideology has no place in the National Health Service. That isn’t quite correct; the health service not only has an ideology, but is an ideology. It’s quite a simple one – all the best ones are – about providing healthcare based on need, rather than the ability to pay.
What I think they mean is that ideology should never take precedence over evidence. The traditional model of the NHS has to pass this test. Is it not only moral to extend healthcare to everyone rather than a privileged few, but also efficient? Yes, according to the Commonwealth Fund, an international research body, which regards the NHS as the most efficient healthcare system of all those it studies.
Could the private providers to which the NHS turns in increasing numbers satisfy the same test? Do they make the NHS and the care it provides better, more efficient? I think that what will surprise many people is not that the private providers pass or fail this test, but that they never even had to take it.
This government can seem terribly interested in detail. It allows the Care Quality Commission to operate in a manner that is, frustratingly, both painstakingly detailed and incompetent. Every form, every fridge, every fragment of care carefully audited on a long and familiar journey to never getting it right.
Yet when it comes to the private sector, the government puts its curiosity to one side, and the wrinkled brow of perpetual concern forms into an indulgent grin. No questions asked, no comebacks, no returns allowed.
In this case, the ideology – that private provision is mysteriously, inherently, consistently better than public provision – has taken precedence over the evidence. Unfortunately, in some cases this has been all too evident and when things have gone wrong, quality of care is threatened in the fall-out.
Our new report is the clanging alarm clock for the government and some commissioners in their selective slumber, and poses the questions they should always have been asking on behalf of those who are cared for and who pay for the service - does the private sector provide value for money, and comparable quality and safety to patients, and how does it impact on other services?
This is a matter of concern to our members. More than two thirds of those surveyed were uncomfortable with the provision of NHS services by independent providers, which in our definition includes the commercial and private sector, independent sector treatment centres and social enterprises.
A major source of this unease is the growing roll-call of private sector fiascos.
We are not saying in the report that private sector involvement always comes to grief. But when it does, it exposes such fundamental faults in the commissioning and delivery that the proponents seemed to be following a mantra rather than their own best instincts.
That mantra, ‘private is best’, seemed to influence those who handed control of Hinchingbrooke Hospital in Cambridgeshire to Circle. The Commons public accounts committee said there had been inadequate risk assessment of the bid and that Circle had been encouraged to make ‘overly optimistic and unachievable savings projections’.
A CCG in Nottinghamshire chose an independent-sector treatment centre to provide dermatology services over the NHS provider. The thing about dermatology services is that they need dermatologists, and the CCG did not appreciate that the NHS consultants would not share their enthusiasm about transferring to a private provider. Only three out of 11 did, with some of the remainder moving elsewhere. Dermatology services in the city have never really recovered.
But given that more than £6 billion a year is spent on independent sector providers, there must be some good examples? There probably are, but we have no means of knowing. More worrying still, the Department of Health has shown little sign of even wanting to find out.
Providers in the independent sector are subject to far fewer patient safety and performance rules than those in the NHS. They too should be subject to the same requirements as NHS providers for transparent reporting of both patient safety incidents and performance, have their data officially published, and be covered by both freedom of information legislation and the ombudsman.
It is often not even possible to judge the independent sector on its supposed raison d’être – offering value for money – given that so many of its contracts are bound up in ‘commercial sensitivity’.
Even if and where the independent sector can demonstrate that it offers value, there has been a damaging lack of consideration as to its overall impact.
We have a health service in this country, and must not allow it to become an atomised array of providers. The care we provide works best for our patients when it is integrated. Achieving this is one of the great challenges we face in the health service. It is an ambition the government claims to share, and yet renders immeasurably more difficult to achieve by permitting an unplanned, uncontrolled development of the independent sector.
Many people fear that the private sector will be allowed to cherry-pick profitable, high-volume work, leading to a destabilising effect on the wider NHS. In some cases it may be enough to push trusts already facing record deficits to the point of collapse. This betrays a complete lack of strategic sense as to how an integrated and effective health service should be run.
The NHS exists to provide the highest quality care for its patients. Anyone who doesn’t accept that, or gets in the way of achieving it, should not be allowed near it. That’s true for anyone who works in the health service, and it’s also true for any individual or company providing services within it.
The BMA believes in a publicly funded, publicly provided health service. But if there have to be independent sector providers, is it not reasonable to ask of them what we would ask of any new porter, nurse or doctor coming to work in the NHS?
It’s not our job to support their shareholders. It’s their job to support our shareholders – every man, woman and child in the UK who uses the NHS.
Mark Porter is BMA council chair
Find out more about the issue and read our report
I suppose it was not advisable to mention the vested interests in private healthcare that are clearly contributing to decisions made to award contracts to private healthcare companies. However, vested interests are definitely informing some of the decision making at government level and amongst the Tory supporters wheeled in to the upper echelons of the NHS heirarchy.
Please add one further requirement for the private providers:
when their patients suffer mishaps which the NHS has to rectify, the private provider must pay all relevant costs back to the NHS.
Finally the BMA speaks out on the 25 year old elephant in the room.
A well reasoned piece
I AGREE WITH YOUR COMMENTS AND AS WE ARE IN THE RUN UP TO A CQC INSPECTION ,IT WOULD SEEM ONLY FAIR THAT ALL PROVIDERS GO THROUGH SUCH FUN!! I AGREE WITH YOUR REMARKS ABOUT TRANSPARENCY.
KEEP UP THE GOOD WORK.
Our local services in barking and dagenham have just announced a new dermatology service provided by a 'private company which will train local GPs with interest .....' However a year ago when the local Gps put forward a plan to provide the same service it was declined by the CCGs which are supposed to provide services to the community. Hence this service has been unavailable for years in our area. Patients in our area mostly cannot afford private care. But then the NHS can afford private care. Or what?
I agree that Independent Providers should be held accountable. I was part of a TUPE Transfer outsourced to a private company which was not commissioned by my NHS employer, but by NHS Ltd Companyr. We have been with the Private provider for six months and in that time they have wrongly issued our P45's and not paid our Tax for four months to HMRC, every month they mess up our pay and to top it all they wrongly denied us access to NHS Pension Scheme by mistake. We are no longer CQC compliant and neither do we have to follow the National Standards of Cleanliness. It's heart breaking and soul destroying knowing there is nothing that can be done about it. Who do you complain too because no one wants to listen and then your jobs on the line because you complain about the miss use of public funded money..