While the nation’s attention was focused on Murdoch’s appearance before MPs last week, the Government sneaked out the news that from next April, National Health Service (NHS) services worth £1bn will be opened up to ‘any qualified provider’.
Patients in England are currently given a choice of hospital for non-urgent treatment. Now patients’ choice will be extended into some community and mental health services. Patients will still need a referral, but they will be able to choose where to go for the service from a list of registered organisations, which includes some private companies. And the NHS will pay for the service they chose.
In a letter to the NHS, the Department of Health (DoH) says this is all part of an effort to meet ‘patient demands for greater choice and control’.
Internal document
But the Bureau has been passed an internal document which outlines the expected impact of this move. And there is a strong suggestion that cost-cutting is the real agenda.
The ‘impact assessment’ report on the extension of any qualified provider is dated July 14 2010, but NHS watchers suggest this is a mistake. There are a number of references to events that took place months after July 2010.
‘The objective of Any Qualified Provider is … to generate genuine contestability to ensure providers deliver services that are more efficient.’
Department of Health report
The report starts off echoing the DoH letter with claims that the policy will ‘improve outcomes for patients’, ‘improve responsiveness of services to patients’ and ‘increase patient choice and control’. But it soon becomes clear that money saving is the policy’s real aim.
The section of the document dealing with the supposed benefits of the policy concentrates on ‘procurement cost savings’ and ‘improved efficiency of provision’.
Later on the report argues that: ‘The objective of Any Qualified Provider is … to generate genuine contestability to ensure providers deliver services that are more efficient.’
Cost cutting
The NHS could save millions, the report says. But the figures seem to have been plucked from the air. The policy will supposedly cost £5m over five years, while saving £17.7m on administration costs for commissioners. These savings will somehow be achieved by commissioners pooling ‘procurement resources’ and knowledge. It’s not clear how that total was arrived at, or why more providers have to be available for that to happen.
On top of this, the document estimates ‘efficiency savings’ of £12m to £17m per year for every £1bn of services procured. The basis for this estimate is a piece of research (Bloom et al, 2010) that found more competition was associated with better management practices.
The report adds that ‘a key assumption for the delivery of innovative services and greater efficiency is that the proposed policy reforms will create credible threats of new providers contesting existing healthcare services’.
What this means is anyone’s guess. But the word ‘threat’ and ‘existing healthcare services’ in the same sentence won’t give much comfort to opponents of the policy such as Unison, which says that any extension of Any Qualified Provider will lead to a privatised, market-driven NHS, where cost becomes a central focus.
And clearly if the points raised in this leaked, internal document are to be believed, there are people in the government who believe that too, though on what basis they can argue costs are to be saved is as yet unclear.
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July 25th, 2011 at 6:15 pm (#)
this is absolute rubbish,they were not elected to do this it was not in their manifesto.we should tell them to f??? off.
July 26th, 2011 at 9:51 pm (#)
Cost saving is one of the aims, but there is an underlying obsession with privatising public services. Unfortunately the NHS ‘reforms’ are part of this agenda.
Will the marketisation, competition and private sector involvement promised in the Health Bill save money? It seems extremely unlikely. All the international evidence is that market-driven health care is of worse quality and is more expensive as well as less equitable than state-provided healthcare.
http://www.oxfam.org/sites/www.oxfam.org/files/bp125-blind-optimism-0902.pdf
http://www.pnhp.org/publications/competition_in_a_publicly_funded_healthcare_system.php
July 27th, 2011 at 8:22 am (#)
… and I meant to add that privatisation of other public services
http://www.christianwolmar.co.uk/books/on-the-wrong-line/
http://www.independent.co.uk/opinion/leading-articles/leading-article-the-markets-not-working-2319941.html
has not saved money or provided a better service. In the case of the railways there are several parallels with health. It appears that anyone that knew anything about railways (railwaymen, engineers, for example) were completely ignored. Maybe Mr Lansley should read Christian Wolmar’s book and start listening to the BMA, RCP, RCN, Unite, retired cardiac tsar Sir Roger Boyle….to name but a few!
July 27th, 2011 at 12:11 pm (#)
The document is clear. At the moment, most NHS services are bought on a block contract basis from local monopolies (broadly, the local primary care trust guesses how many of a certain treatment it will need and tells the local hospital or district nurse service or whatever that it will pay for that many treatments… or more likely, it just says ‘we’ve done this for ten years, keep doing it’). This leads to less responsive, lower quality and more expensive outcomes than it might (the hospital has no incentive to make patients happy, it gets paid anyway, it has no particular incentive to make sure the treatment is good, it gets paid anyway, and it doesn’t have to worry over much about the cost, because it gets paid anyway). So… the government wants to introduce more compeition/choice, to address these shortcomings… but just asking PCTs to go out and set up contracts with lots of different suppliers/hospitals isn’t on, because they wouldn’t know where to start, this would be very expensive (it would mean lots of PCTs spending lots of time setting up lots of complicated contracts with lots of suppliers), and there aren’t necessarily alternative suppliers out there, anyway (since most towns only have one hospital, or district nursing service, or whatever). So the government is going to set up a framework to help, by saying which services PCTs should look at, and how they should go about commissioning effectively (that’s the savings bit) to get the potential benefits, either by bringing in more suppliers or suggesting to existing suppliers that they will (that’s the ‘threat’ bit). You can agree or not agree with all this. You can say that the evidence base supports some bits of the argument and not others(the evidence for quality improving when health services open in the open / with choice is quite good… the savings bit less so… and this document pushes both bits of the literature further than it should go). You can laugh at a young civil servant sticking in refs to Adam Smith from his or her politics degree. But to suggest it’s in any way mysterious or promoting a hidden agenda is hilarious.
(Editor’s note: The first part of this post was removed for being unnecessarily offensive).