Private treatment centres grab NHS funds

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PRIVATE Treatment Centres have become a key element in the Labour Government’s plans to privatise the National Health Service (NHS).

They are being used in conjunction with the forcible diversion of NHS patients into the private sector ‘patient choice’ and the introduction of the market, to destroy NHS hospitals.

They are a public-private partnership, in which the government assists the private sector take over the ‘NHS core business’ and make money out of it.

The original reason the government gave for inviting in external providers was to reduce waiting times and provide more choice for patients.

The public were repeatedly told that more capacity was needed to bring down waiting times.

This story is still being told.

When Jonathon Dimbleby interviewed Patricia Hewitt just after the election and asked her why an extra £2.5bn was being spent on private provision, she said that more capacity was needed.

When he asked why the money could not be given to NHS hospitals, she said that the private sector was more ‘innovative’.

When the government invited external providers to bid for the contracts, the Department of Health (DoH) outlined their requirements (Growing capacity, A new Role for External Providers in Britain, 2002)

The new sector would be different in three ways:

1. They would be ‘additional to existing publicly owned NHS care provision’.

2. They would be ‘radically different . . .not least in the fact that the NHS, as a public sector partner and purchaser will be the core business of units of this sector’.

3. ‘These services will be managed and operated as independent sector units’.

Other characteristics of these schemes would be the highest levels of productivity which were to be ‘trailblazing’, and competitive unit costs.

On the issue of higher productivity the DoH pamphlet Treatment Centre: Delivering Faster; Quality Care and Choice for NHS Patients brings out exactly what is meant by this.

The pamphlet boasts that the centres ‘stimulate innovative models of service delivery and drive up productivity’.

‘Treatment centres are pioneering new approaches that make the most effective use of staff skills, free up senior clinicians skills to spend more time with patients and break down traditional boundaries between professions.

‘The new roles in development include peri-operative specialist practitioners, advanced nurse practitioners/advisors and healthcare assistants (HCA) technicians in radiology, ophthalmology and surgery.’

They are piloting the paying of the surgeon and all other staff by ‘fee for service’.

In other words, the patient is hardly pre-assessed, spends minimal time with staff who are incentivised to rush through the list on fee for service and all sorts of HCAs are doing the work of trained staff.

The DoH website on Treatment centres carries a section on ‘Workforce Role Redesign’.

It says: ‘Most concern the efficient movement of patients and visitors at the least consumption of time and cost.’

They do not keep figures on patients returning with complications, or long-term complications.

It becomes clear that the ‘revolutionary’ new methods and ‘innovation’ that Hewitt is talking about is nothing more than the old speed-up and productivity and break down of demarcation, that have always been used by unscrupulous employers in factories.

Hewitt told Health Service Journal: ‘I’m not saying you can run a hospital like a factory but there are management techniques you can take, and we are starting to take from world-class factories.’ (16.6.05.)

ISTCs undermine teaching and training. The above scenario explains why it is that private treatment centres can never train junior doctors.

It is simply impossible to maintain ‘trailblazing’ throughput of patients and let young surgeons learn to operate on patients at the same time as make a profit.

The government did a deal with the private treatment centres (Growing capacity p10).

It said: ‘In broad terms each party will be expected to assume those risks which it is best placed to manage.

‘The NHS will therefore retain responsibility for patient flows, while the private sector will retain responsibility for achieving agreed patient throughput.’

So the DoH guarantees sufficient NHS patients to ensure that the ISTCs optimise their capacity and their profits.

This has led to devastating consequences in a number of NHS hospitals.

For example, in Southampton, the PCT was forced to send patients out of town to the private treatment centre, which led directly to the closure of an elective orthopaedic ward at Southampton General Hospital.

In Hammersmith, in 2004, the diversion of patients away to the private sector led to the underuse of the NHS Ravenscourt orthopaedic treatment centre, which eventually led to debts of £9m and its partial closure.

The centre is capable of performing 5,000 operations per year, but the PCT referred 9,000 patients to the private sector, which was paid for by the NHS out of central funding.

There was a similar story with the NHS ACAD treatment centre at Central Middlesex.

Carol Dove, the Director of NHS Elect said: ‘Our four NHS treatment centres could treat 15,000 more patients per year and they work best when they work at capacity.

‘But it is the old story that waiting lists exist because there is not enough money in the system. There is a big story to be told out there in unused capacity in the NHS.’

The latest news is that Ravenscourt and other NHS treatment centres could be sold off to the private sector!

The DoH’s invitation to tender for the £2.5bn second wave of independent treatment sector treatment centre contracts, says ‘bidders will deliver 250,000 procedures’ from ‘new and existing facilities, including NHS hospitals and treatment centres’. (HD 26.5.05)

In March, the DoH said: ‘PCTs will not need to direct patients to particular providers’, (Creating a patient-led NHS) as they had to under the “patient choice” initiative.

‘But from December 2005, if a waiting time for an outpatient appointment of 13 weeks is not met, the patient will not be able to wait longer to go to their local hospital.’ (HD 26.5.05. p7)

The government are now using waiting times as a weapon to propel patients into the private sector whether they wish to go there or not.

It becomes clear from this:

1. There is in fact sufficient capacity within the NHS to perform all the operations required and get waiting lists down, but what is lacking is the funding.

So the original justification (lack of capacity) for the introduction of private treatment centres was spurious.

2. That in order to ensure that NHS patients are diverted into the private sector and to justify the massive expense (£2bn in the first wave and a further £2.4bn in the second wave announced this year), that the government is actively cutting capacity in the NHS by insisting that NHS units ‘save’ millions to get in the black.

The ISTCs are also given an advantage by allowing them greater costs.

The DoH promised: ‘These contracts will offer reasonable return to the service provider, so in the initial phase, agreements are expected to need to recognise the start-up costs of delivering additional capacity . .’

The tariff for the ISTCs is higher than for NHS providers to make sure they make a profit.

The DoH told Health Service Journal that the government will ‘hold the risk’ on ‘guaranteed volumes’ of patients.(19.5.05)

The favoured treatment of the private sector is starting to have a destabilising effect on NHS hospitals.

Derek Smith, the Chief Executive of Hammersmith Hospital Trust said: ‘We welcome the ISTCs to the market place, but we would prefer a level playing field.

‘There is a large difference between them and us.

‘Their work is contracted nationally and guaranteed for five years, where we in the NHS are in a less advantageous position, with multiple contracts negotiated annually.’ (HD June 2004)

What we have here is an ideologically driven agenda to favour private sector provision at the expense of the NHS.

The capacity was in the NHS, what was lacking was the funding.

It is clear that to maintain a comprehensive universal health service, which is planned for the needs of the population it must be a publicly owned and provided NHS.

All health staff, their unions and the whole trade union movement, representing millions who rely on the NHS, must ensure an end to the privatisation of the NHS, where billions are being handed over by the government to multinational corporations guaranteeing them huge profits.