A THIRD of NHS contracts have been awarded to private sector providers since the Health and Social Care Act came into force, finds an investigation by The BMJ today (Wednesday 10 December).
The analysis of 3,494 contracts awarded by 182 Clinical Commissioning Groups (CCGs) in England between April 2013 and August 2014 – disclosed to the BMJ under the Freedom of Information (FOI) Act – showed that in total, non NHS providers have secured 45% of contracts awarded since April 2013.
A total of 1,149 contracts (33%) were awarded to private sector providers, 335 contracts (10%) were awarded to voluntary and social enterprise sector providers, while 100 contracts (2%) were awarded to other providers, such as joint ventures or local authorities.
A further 1,910 contracts (55%) were awarded to NHS providers, including NHS hospitals, community and mental health providers and general practices.
The analysis examined different types of contract to provide NHS clinical services, including those awarded to a single provider without an open tender, those awarded via a competitive tendering process, and those awarded to multiple providers under Any Qualified Provider (AQP), a government policy that opened up a wide range of community based NHS services to different providers from outside the NHS.
Private sector providers were most successful at winning contracts awarded via competitive tender – 80 (41%), compared to 59 (30%) won by NHS providers.
Private firms were also more likely to win smaller contracts on an AQP basis, for services such as diagnostics, audiology, and podiatry in the community.
The BMJ also found concerns among health professionals about fragmentation of care and a lack of transparency over where NHS funds were being spent.
The BMJ requested financial details for all contracts to see where NHS funds are being distributed.
In many cases CCGs were unable or unwilling to provide figures. CCGs did disclose the full value of 1349 contracts worth £10bn in total.
Of these, NHS providers were awarded £8.5bn (85%), voluntary and social enterprise providers were awarded £690m (7%), private sector providers were awarded £490m (5%), while other providers were awarded £330m (3%).
The figures reflect the fact that many of the most high value contracts in this sample were awarded to NHS providers to provide acute care.
While NHS leaders said that the proportion of care being provided by private companies remains at the margins, campaigners said the findings provided further evidence that the government’s reforms are gradually accelerating the privatisation of the NHS.
Simon Stevens, chief executive of NHS England, recently told The BMJ that the proportion of NHS care being provided by the private sector was ‘at the margins’ and unlikely to increase much in the next few years.
But Clive Peedell, a consultant oncologist and co-leader of the National Health Action Party, a political party set up to oppose the health reforms, warned that if the private sector continues to win a third of the contracts awarded long term, ‘then the NHS gets diluted as you’ll get more and more private sector involvement over time’.
David Hare, chief executive of the NHS Partners Network, which represents private sector companies that provide NHS services, said The BMJ’s analysis suggested that commissioners were increasingly placing trust in the private sector.
Meanwhile, Annual NHS spending on management consultancy has doubled from £313m to £640m between 2010 and 2014, despite a promise by Health Secretary Andrew Lansley to ‘slash’ spending after the 2010 election, reveals an article in The BMJ this week.
This is enough to run three medium sized hospitals or employ about 2000 extra nurses, says David Oliver, a former clinical director at the Department of Health, who obtained the figures through a Freedom of Information request.
‘In times of war, arms dealers, rebuilders, and racketeers profit from the chaos,’ he writes.
‘Disruptive innovation’ has led to similar spoils for management consultants, with taxpayers’ money diverted from already struggling health and care services.
The health sector regulator Monitor, meanwhile, has placed contracts worth about £32m with the ‘big four’ management consultancy companies, though its work was done with a fraction of such spending before the election, explains Oliver. It also often helps install ‘interim’ executives on eye watering daily rates.
Senior partners charge £3000-£4000 a day – the amount that a senior doctor earns in two weeks, he says.
Meanwhile, Oliver points to a ‘constantly revolving’ door between the Department of Health, NHS England, Monitor, 10 Downing Street, and the consultancy firms, ‘creating commercial advantage’.
He also points out that consultancy firms ‘are unaccountable and can walk away from bad or damaging advice with no consequences’.
With about a million staff and 10% of gross domestic product, the NHS has experienced clinical and organisational leaders, writes Oliver.
‘If these well paid individuals lack the skills to solve most local problems in-house, or by learning from other NHS colleagues, perhaps they shouldn’t be leading at all.
‘Let’s ensure that all consultancy is subject to a rigorous audit of value and impact and whether it needed to be contracted out at all,’ he concludes.
‘It’s time for management consultants to face the same transparency and accountability as the rest of us.’
• Only one in five doctors are satisfied with their current careers, a BMA survey has revealed.
The association’s quarterly tracker survey of views across the medical profession shows that morale has declined year on year.
GPs have the lowest satisfaction with their work-life balance but consultants saw the largest drop in reported satisfaction with the split between free and work time.
BMA council chair Mark Porter said: ‘The survey findings highlight the impact of the immense pressures on the NHS with three out of four GPs and half of consultants describing their workload as unmanageable.
‘Morale has also plummeted further since last year, leaving only one in five doctors stating they are satisfied with their current careers and many GPs and consultants considering early retirement.
‘The government has pledged an additional £2bn for the NHS, which is a welcome move but must be part of a long-term investment programme to recruit and retain doctors to ensure patients get the highest quality of care.’
Job-security concerns
The key findings from the BMA quarterly tracker survey, Current View from Across the Medical Profession, include:
• Three in 10 respondents were working less than full-time and these doctors were most likely to be GPs
• Around three-quarters of GPs and more than half of consultants report an unmanageable or unsustainable workload
• 50 per cent of respondents described their morale as low or very low, up from 40 per cent last quarter
• GPs and staff, associate specialist and specialty doctors were the most concerned about job security, with junior doctors being the least concerned
• More than half had seen an increase in waiting times for patients and 35 per cent have seen a breach in the four-hour emergency medicine target at their hospitals or one nearby in the three months up to September
• Of those who reported unmanageable or unsustainable workloads, 90 per cent had considered retiring early, working less than full-time, working overseas or leaving the profession altogether
• One in 10 of the doctors who raised concerns about the standards of patient care in their workplace felt they had been penalised for doing so. This figure has not changed since September 2013 despite attempts to encourage NHS whistleblowing.
The survey was sent to 1,020 doctors of which 451 responded.
