With the pace of privatisation, soon we’ll be depending on whistleblowers to monitor NHS services
The coalition justified bulldozing through the health and social care bill with the mantra that the private sector would deliver the service better and more cheaply. However, the bill’s opponents were not surprised at the news that Serco, a leading private health company, was being investigated over an accusation of running an “unsafe” GP service. (Serco and NHS Cornwall primary care trust deny that patient safety was ever put at risk.) Serco, described as the company running Britain, delivers outsourced transport, detention, defence, education and now health services on behalf of government and local authorities. It has even been awarded a contract to run a first-point-of-contact service for the British Medical Association, some of whose members are likely to become – if they are not already – Serco employees.
Serco, contracted to run OOH (out of hours) GP services in Cornwall, has been accused by employees and MPs of having too few staff, resulting in long queues of patients for telephone advice and triage. Serco points to surveys that suggest high patient satisfaction with their service. It is also alleged that data and logs were manipulated to make it appear that Serco had met quality standards; but Serco says these allegations are not new and have been rejected by an independent audit. The Care Quality Commission is investigating, but we may never know the truth.
One casualty of the “reforms” is a sharp loss of public accountability. It will be increasingly difficult to penetrate the screen of “commercial confidentiality” that protects the private sector, which has moreover been exempted from having to comply with freedom-of-information legislation. And staff transferred to private providers have little incentive to expose problems as DoH guidelines on whistleblowing will not apply to them. Serco has already begun an investigation of emails to trace the “leak” – to protect patient confidentiality, it says – despite having previously promised greater accountability in delivering services.
It is a fallacy that public services are better delivered by the private sector. Staff costs account for a significant slice of the NHS budget, and private companies will naturally seek to reduce them by cutting staff, downgrading them or both. In January Serco was criticised by the Royal College of Nursing for proposing a 48% cut in nursing hours in Cornwall’s OOH service. The PCT said it was none of the RCN’s business as long as patient services weren’t affected.
Elsewhere GP practices taken over by private companies have seen nurses replacing doctors, consultation times cut and fewer specialist referrals. A director of Deloitte’s UK Centre for Health Solutions says that face-to-face GP consultations, the cornerstone of primary care, are no longer sustainable and urges GPs to adopt new business models and incentives. The language of the market, of consumers rather than patients and GPs as “care navigators”, is increasingly familiar as management consultants like McKinsey take over as NHS gurus.
The Serco story is a reminder of how quickly privatisation is progressing – though it is not always apparent to the public as the private sector operates under the NHS logo and is cosily embraced as part of the “NHS family”. Virgin has a role in rewriting the NHS constitution, and Virgin partners on commissioning groups will be responsible for spending £60bn of NHS funding. Serco has a community health contract in Suffolk and is in dispute with unions over a hospital contract in Plymouth. Both Virgin and Serco are shortlisted for children’s services in Devon, the contract to be awarded to the “most economically advantageous bid”, and those awarding it will no doubt bear in mind the fact that after losing a similar contract Virgin took NHS York to court, accusing the NHS bid of predatory pricing – ie not charging enough for services and so not being intent on making a profit.
Under Andrew Lansley’s act organisations like Serco, “the biggest company you’ve never heard of”, will increasingly deliver NHS services. The Care Quality Commission can’t monitor all private sector involvement, as the Bristol care homes scandal showed, and we are likely to see more cuts to staff and services, less accountability and transparency and more scandals. We will have to rely on whistleblowers, the media and an alert public to know when things go wrong. The fight for the NHS is not over.
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