19 September 2003
Widespread private provision of acute care in England came a step nearer at the end of last week and brought with it the inevitable debate on privatisation and dire warnings for the future of the NHS.
Health Secretary John Reid announced a short list of seven preferred bidders, only two of which are UK-based, that will provide around 160,000 non-urgent operations a year.
The operations will be provided in purpose-built accommodation, refurbished NHS hospitals or in one of two new mobile ophthalmology units. They will be known as Treatment Centres (TCs) – under the previous health secretary they were to be called Diagnosis (or Diagnostic) and Treatment Centres.
As well as these mobile units, where cataract operations will be performed, the companies will offer diagnoses and general surgery, including orthopaedics.
The preferred bidders are UK-based Mercury Health Ltd and Birkdale Clinic, the South Africans Netcare UK and Care UK Afrox, Nations Healthcare and New York Presbyterian from the US and Anglo Canadian (Canada). The contracts will run for five years and be worth around £2bn.
The Department of Health hopes some of the TCs will be up and running by early next year. An announcement of a further short list of companies to provide another 80,000 elective operations a year will be made soon.
The announcement has drawn the wrath of Unison. Although the private providers will eventually be expected to charge at NHS rates, initially they will be given higher payments to reflect the cost of establishing the services.
Karen Jennings, Unison's head of health, said this will lead to ward closures and nurse redundancies. 'If the companies were interested in putting patients before profits they would not have demanded preferential treatment, with five-year binding contracts that force each primary care trust into paying over the odds for every operation,' she added.
Nigel Edwards, NHS Confederation policy director, said the argument about privatisation missed the point. 'We have lots of mental health care provided by the private sector as well as continuing care, so we have done this before.
'The NHS needs to show it can deliver improved waiting times and, while many people would like this to be NHS provision alone, we are where we are.'
He added that NHS managers were more worried about ensuring the contracts were appropriate to local conditions.
He said: 'We must not be hung up on who provides the care, but it does mean that it is extremely important that the contractual arrangements are robust. There is a concern about whether or not the services are being procured in the right place.'
Even supporters of the initiative are concerned that NHS capacity will be reduced as its clinical staff are lured to the new private treatment centres. Despite ministers' claims that the private companies will be contractually barred from poaching NHS staff, there is still some scepticism.
British Medical Association chair Dr James Johnson has welcomed the initiative but he claims to have seen unpublished Department of Health guidance allowing a trust to send up to 70% of its staff on secondment to TCs.
'There is no point in having up to 70% of the staff in TCs coming from the NHS, if that leaves hospitals short of doctors to carry out all the other work that trusts provide,' he said.
NHS managers are also concerned about the new private TCs taking away their staff.
Edwards said: 'The whole point of TCs is to get additionality, and if you don't get that it will be a wasted opportunity that will probably increase costs to the NHS.'
He added that it is no surprise that most of the winning bidders were either overseas health providers or consortiums that include such a firm. These companies should be able to bring in new doctors and nurses to complement existing NHS staff.
That will be the acid test – building new wards and operating theatres, whether privately or publicly provided, is the relatively easy part of expanding capacity. But waiting lists will not come down and stay down unless there are enough staff to carry out the extra operations needed.
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