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BMA report calls for safeguards against fragmented NHS

The independent sector should be subject to the same robust standards as NHS providers and managers must be wary of the health service becoming fragmented, a BMA report says.

The association’s first report on privatisation in the health service is published today and calls for Government and health bosses to implement a series of recommendations aimed at protecting the NHS from being destabilised.

It also urges commissioners and health chiefs to consider the possible negative effects of privatisation on training and recruitment and says the taxpayer must not be saddled with the costly legacy of private firms leaving contracts, as was the case at Hinchingbrooke Hospital in Cambridgeshire.

BMA council chair Mark Porter said: ‘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.


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‘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.’

Several examples of cases in which private involvement in NHS care has led to problems are highlighted in the report, including the problems at Hitchingbrooke, which was taken over by private firm Circle Partnership in 2012 before being handed back to the NHS three years later in special measures and with severe financial pressures.

The report also highlights problems at Nottingham University Hospitals NHS Trust, which lost its adult dermatology work to Circle Partnership, leading to consultants leaving the area and the service collapsing.

Another example cited comes from West Sussex where commissioners gave a £235 million contract for musculoskeletal services to Bupa – before a study revealed the deal would plunge the local hospital trust into deficit.

As a result of these, and other issues, the BMA is calling for eight recommendations to be enacted:

  • NHS England should collect data on levels of independent sector provision of NHS services by sector.
  • Before any independent sector provider is chosen as a preferred bidder, there should be a thorough impact analysis taken to ensure that the decision will not destabilise existing NHS services or cause disruptions to the patient pathway.
  • During any procurement process that involves an independent sector bidder, CCGs (clinical commissioning groups) should carry out a full risk assessment for what might happen if NHS staff do not wish to TUPE (transfer of undertakings) to an independent sector provider and how this might affect the continuity of service provision.
  • Independent sector providers of NHS services should be subject to the same requirements as NHS providers in relation to transparent reporting of both patient safety incidents and performance.
  • The CQC (Care Quality Commission) should develop a more standardised approach to regulating independent sector providers in line with NHS providers.
  • Safeguards should be introduced to protect NHS patients and services if contracts are terminated early by independent sector providers.
  • The Department of Health should carry out a regular review of admissions from independent sector providers to the NHS to determine the nature and cost of these incidents.
  • The NHS Standard Contract should be amended to include a clause requiring independent sector providers to contribute towards the education and training of the NHS workforce — either financially or by virtue of making available suitable opportunities.

The report reveals that the level of privatisation in the service is still relatively small, with private firms being paid £6.9bn in 2014/15, a 5.4 per cent increase on the previous year.

In context, the total NHS budget is currently around £116bn.

Despite the figures, BMA members remain concerned — in response to an association survey, more than two-thirds said they are uncomfortable with private firms being involved in the NHS.

Dr Porter said: ‘Privatisation remains a major concern for our members because it has seemed to be a thread through the previous three Governments.

‘But one of the key things we’ve discovered is that while members are very concerned about it and it’s penetrated some areas, there’s not the wholesale privatisation of the NHS today that we might have expected.

‘This needs to be monitored carefully and not something that’s brushed under the carpet and forgotten about.’

Find out more about the issue and read the report

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