The government has now opened up 39 community health services to competition. Private companies and charities can now apply to join a list of approved health providers alongside existing NHS services. The idea is that NHS patients are given a choice of providers - with the help of their GP. Each provider, including existing NHS services will be paid according to how many NHS patients choose their service. The Government say this competition will improve the quality of treatment and provide patients wilth more choice. We believe the evidence already suggests that it will worsen care and cause huge problems for the NHS and its staff. This policy is known as Any Qualified Provider
1. Patient care will worsen
Two media stories show how patients have been affected by outsourcing NHS services to private companies.
“Six people are feared to have suffered irreversible sight loss because of the failings of a privately run clinic at an NHS hospital”, reports the Guardian, “permanent damage may have been inflicted on some patients with serious eye conditions because of a lack of follow-up care after treatment.”
In a second worrying example, dangerous delays affected the patients of a privatised out-of-hours GP service in Cornwall. Serco, the company involved was found to be failing to meet legal requirements on staffing. In both cases our concern is that corners were being cut, the services were compromised and patients' health put at risk.
Baroness Barbara Young at diabetes UK gave another example to the Guardian about how care is fragmenting.
" outsourcing their many different services is breaking the diabetic care pathway. Take podiatry: diabetics risk amputated feet if inexperienced high street commercial clinics treat them, with no knowledge of their history and give no feedback to their doctors. "They need their feet checked by experts, looking for vascular problems." But she is told new contracts can't oblige providers to share data and communicate with diabetic care networks. "Everything is fragmenting."
2. It will shrink the NHS and increase privatisation
Existing NHS services could lose important funding if more patients are treated by private providers. This will lead to staffing cuts and the closure of NHS units. Introducing more competition in this way is very likely to speed up the transfer of NHS services to the private sector – an expansion of privatisation. In the longer term the NHS will suffer if increasingly its role is to provide the services that the private sector cannot make profit from.
3. This kind of patient choice doesn’t work
Many patients will not be able to investigate the merits of each provider. Most will just trust their doctor. GPs do not have the time to go through this choice in a meaningful way with each patient.
Worryingly some GPs could even have a financial interest in some of the providers. Patients could also be subject to marketing from providers through their local family doctor.
4. Poor evidence to show that competition works
There is very little evidence to back up the belief that financial competition improves the quality of care. What exists has been hotly debated. Most bodies who are in favour say it has limited use
Although the government want providers to compete on a fixed price, some the local bodies organising local care will be under huge pressure to manage their budget and could be tempted by companies offering to do the work for less.
Competition could be hard to maintain, as smaller providers will quickly drop out of the market if they fail to make enough profit. Larger companies will be able absorb losses and there is a danger that one provider will become dominant and control much of the supply.
Although a choice of provider has been offered for many hospital treatments (under Choose and Book) it has often been arranged under contracts which guarantee income to the provider. This will change as AQP is introduced here too. The impact could be falling income for some NHS hospitals.