21 July 2006
The latest reforms of NHS commissioning have put the health service on 'a slippery path' to fragmentation, Unison said this week.
The trade union's claim was prompted when ministers published a tender in the Official Journal of the European Union inviting private sector interest in consultancy contracts with NHS commissioners.
The advertisement was controversial – three weeks ago an initial draft was withdrawn after it implied that private companies could provide services currently offered by primary care trusts.
The redrafted version said companies would be used only in a consultancy role. Health Secretary Patricia Hewitt said the tenders would lead to a national framework contract that would allow PCTs to choose from a menu of firms with specialist skills.
A PCT might ask a company with actuarial skills to help with population assessment, for example. The tender is likely to attract interest from medical insurers, international health care providers and consultants.
But Unison's head of health, Karen Jennings, said PCTs could still contract out provision. 'This advert is just as dangerous as the original. We had a fundamental disagreement with the previous one and there's little change in this one. This and the secretary of state's latest commissioning framework is an extremely slippery path to the fragmentation of the NHS.'
The commissioning framework Jennings referred to was also published this week. It will give patients a greater say in how their local services are organised and run but it also envisages more private sector provision. The framework encourages PCTs to hold open tenders for services that are failing or not present.
Foundation trusts could bid for this work alongside private firms. The service provider arms of PCTs (such as district nursing services) could be split off to become community foundation trusts.
The framework said PCTs should accelerate the switch to GP practice-based commissioning by establishing local incentive payments alongside the national one. King's Fund acting policy director Richard Lewis said this was 'encouraging'.
But he added: 'The requirement for PCTs to reach financial balance is in danger of undermining this march towards practice-based commissioning – commissioners will need to be assured that if they are successful in commissioning they will be able to use the savings they make.'
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