3 Jul 2014

Staffordshire NHS: innovation or backdoor privatisation?

A process that could see private companies running cancer care and end of life services in Staffordshire has been condemned by the union Unison, but is it really the thin end of the wedge?

In Stoke-on-Trent the number of people with cancer and cancer death rates are higher than average, while South Staffordshire also has higher than average rates for both cases of breast cancer and deaths from breast cancer, according to the Macmillan cancer charity, which has invested £4m in cancer services in Staffordshire and Stoke-on-Trent in the past five years.

Local NHS bosses recognise that their services are not as good as they could be.

Andrew Donald, chief officer of Cannock Chase and Stafford and Surrounds Clinical Commissioning Group (CCG) said: “Patients have told us… about not knowing who to turn to in a crisis, leading to inappropriate and unneccessary admissions into hospital.

“We have heard from patients and carers who have been lost in the system, or who have struggled to get the support when and where they need it – this is clearly not acceptable.”

John Sneddon, a lay member of the board overseeing the Staffordshire procurement process said currently “what we want for good care for patients just dribbles away” into the cracks between NHS, social service and voluntary provision locally.

Four CCGs in Staffordshire are working together on a new type of contract that they say will “co-ordinate the provision of cancer care services in a more integrated and seamless way.”

‘Dangerous experiment’

Rather than having several CCGs and NHS England each commissioning individual services on individual contracts, the plan is to appoint one organisation or consortia to be a prime provider responsible for co-ordinating cancer care in new ways “to improve outcomes and meet patients expectations.”

The contracts for running both cancer care and end of life care are worth £1.22bn, according to the Guardian newspaper, far surpassing the £500m contract awarded to Virgin Care for services in Surrey. Christina McAnea of Unison warned: “This is by far the biggest procurement process in the NHS and is a dangerous experiment.

“We are talking about £1bn of taxpayers money and contracts lasting 10 years in vital cancer services and end-of-life care. CCGs are potentially handing over all decision-making on these crucial services to private companies.”

Unison also condemned the “secrecy over health tendering in Staffordshire”, saying it was against public interest: “Patients, the public and staff have a right to see all relevant documents about the business case and strategy behind the decision to outsource these services.”

The process has been public knowledge for some months.

The project is one of the government’s pioneer initiatives, announced last November, to integrate health and care services, and, with the involvement of Macmillan, has undertaken a series of workshops and roadshows involving local doctors, patients, family members and carers.

As part of the procurement process potential bidders will have more than one meeting with stakeholder groups including patients and Macmillan. The contract is due to be in place by July 2015.

Thin end of the wedge?

Consultant cancer specialist Dr Clive Peedell, who co-founded the National Health Action Party, described the outsourcing plan as “reckless”, and a “dramatic indication of the rapidly increasing commercialisation and privatisation of the NHS”. He told Channel 4 News: “This is just one cancer service, but that sets the precedent,” and he warned of the impact on the NHS if private providers cherry-pick contracts: “there will never be full privatisation because the private sector will only want to do the profitable work.”

The NHS budget is divided between generalists - known as primary care (doctors, dentists, etc), and specialists - known as secondary care (consultants, cardiologists, psychologists, etc). According to the Nuffield Trust over two-thirds of the budget is spent on secondary care - around £70bn of the total £102bn NHS budget. 
In 2012-13 around 9 per cent of that £70bn was spent in the private sector. A further 1 per cent was spent in the voluntary sector.

Some areas of care are seeing a marked shift from NHS to private provision.

The latest Nuffield Trust research finds that one pound in every five spent by commissioners on community health services in 2012-13 (eg physiotherapy or treatment at home) was spent on care provided by independent sector providers – an increase of 34 per cent in one year alone. Nearly one third of the £9.75bn the NHS spends on community health services is now with non-NHS providers, including the voluntary sector.

So should we be worried?

Experts point out that it is possible to get very bad service from state provision – as the scandal at the Mid-Staffs hospital made only too clear. The vital question is how sophisticated the NHS is at commissioning and managing the purchase of care from outside providers.

Nuffield Trust Chief Executive Nigel Edwards told Channel 4 News “the evidence is that [the NHS] is not as clever as it ought to be, and therefore you might be cautious here, but there’s nothing intrinsically bad about private or public sector provision”.