The British Medical Association (BMA) on Monday launched a public campaign against the privatisation of the NHS.
The BMA press statement said it is stepping up its activity to publicise its concerns about government reforms that have created a market in healthcare and allowed commercially run firms to provide NHS care.
The ‘Look After Our NHS’ campaign has been launched to gather examples of the impact and cost of market-driven reforms, show where public money is being wasted, and the adverse effects this has had on patient care and doctors’ working lives.
The BMA has long argued that government policy to reform the NHS in England by introducing a market-based system of healthcare will have a negative impact on local health economies and services for patients.
Using private money to fund new hospital buildings has resulted in crippling debts for NHS Trusts.
Introducing competition between NHS providers, including hospitals and GP surgeries, and arranging costly deals with private companies to run independent sector treatment centres, is having an adverse effect on many existing services.
Dr Hamish Meldrum, the BMA’s Chairman of Council said: ‘A market economy is based on winners and losers. We’re not prepared to allow parts of the NHS to fail.
‘We want to get rid of the market in healthcare and allow our hospitals and GP surgeries to work together, not be forced to compete against each other for business.
‘Worse still it leads to unnecessary duplication, encourages gaming and there is no good evidence that it drives up quality.’
The BMA is calling on doctors to sign up to a set of key principles that argue for an NHS which is publicly funded, publicly provided, and publicly accountable.
It should use public money for quality healthcare, not profits for shareholders, and put the care of patients before financial targets.
Doctors’ training also needs protection since there is little incentive for commercial providers to deliver training to junior doctors.
A series of activities is being planned to encourage doctors to speak out about local concerns and to give their views on how the market is affecting patient care in their area.
A branded, interactive website, newsletter, campaign pack and publicity at BMA conferences are just some of the activities that will commence in June 2009, aid the BMA.
The ‘Look After Our NHS’ feature ‘Where market reforms are failing most’ says:
The imposition of market reforms has had a negative impact on both the finances of the NHS, with money that could have been spent on patient care going to private companies, and on the freedom of clinicians to act in the best interests of their patients:
Private Finance Initiatives
PFI schemes in the NHS aim to secure capital from the private sector, typically to fund the building of new hospitals. Contracts typically last 30 years, over which time the public sector leases back the building.
• The cost of the PFI tendering process in the NHS places additional burdens on PCTs.
Rather than the private sector bearing the risk as claimed, hospitals themselves are having to pay an additional ‘risk premium’ to ensure projects run to time and budget.
• The imperative to pay back the private sector is making many hospitals’ financial difficulties worse, leading to cuts in services.
• Private sector bidders are themselves facing financial difficulties. They are often bailed out using Government funding – taxpayers money – to ensure contracts already in the pipeline continue.
• PFI contracts bind hospitals into a pattern of service provision which could prove inappropriate for future health needs of the local community.
Independent Sector Treatment Centres (ISTCs)
Independent sector treatment centres (ISTCs) are privately owned units, providing surgical and diagnostic procedures to NHS patients.
Typically they undertake less complex, planned work such as hip replacements, cataract operations or MRI scans rather than more complex and expensive operations.
• Private companies running ISTCs have been paid large amounts of taxpayers’ money up front to deliver large volumes of work, which in many cases has not been carried out.
Recent research in the British Medical Journal suggested that the NHS in England may have overpaid the first wave of independent sector treatment centres (ISTCs) by as much as £927 million.
• More than half (62 per cent) of clinical directors working in NHS trusts in England are concerned about the quality of care provided by ISTCs.
• The Health Select Committee has said that the government has failed to provide evidence that the benefits gained from contracting out operations to Independent Sector Treatment Centres (ISTCs) outweigh the likely benefits of using the extra money given to the private companies to enable the NHS to provide the same service.
Purchaser-provider split
A key element of market reforms has been to split the NHS between purchasers and providers of care.
Funds are allocated to purchasers, such as Primary Care Trusts, who have the task of ‘buying’ (often from acute hospital trusts) services that patients require.
The intention was to create a market, in which hospitals have an incentive to offer competitive services and high quality.
• Little incentive for commissioners and providers to work together in the planning and delivery of healthcare.
• Commissioners and planners have two opposing objectives – the need for commissioners to manage costs, and providers to generate income.
• Payment by Results (PbR) also has opposing policies – hospitals are encouraged to treat more patients, while GPs are encouraged to use secondary care less.
This can act to prevent the development of co-ordinated services that deliver the best care for patient.
Transforming Community Services initiative
The Transforming Community Services (TCS) programme forms a major part of the government’s strategy for primary and community care, and means Primary Care Trusts – the bodies entrusted with overseeing the NHS in local communities – are expected to stop providing services directly to its local communities.
• PCTs are now required to separate their provider and commissioning functions which means additional administrative costs and bureaucracy.
• Local services will become further fragmented threatening the continuity of NHS patient care.
The website goes on to list Our Principles:
We want to see the NHS restored as a public service working co-operatively for patients, not a market of commercial businesses competing with each other. That’s why the BMA is calling for an NHS which:
1. Provides high quality, comprehensive healthcare for all, free at the point of use.
2. Is publicly funded through central taxes, publicly provided and publicly accountable.
3. Significantly reduces commercial involvement.
4. Uses public money for quality healthcare, not profits for shareholders.
5. Cares for patients through co-operation, not competition.
6. Is led by medical professionals working in partnership with patients and the public.
7. Seeks value for money but puts the care of patients before financial targets.
8. Is fully committed to training future generations of medical professionals.
