Health bill will destroy NHS, says union

BMJ 2011; 342 doi: (Published 01 February 2011) Cite this as: BMJ 2011;342:d701
  1. Clare Dyer
  1. 1BMJ

Hospitals will close, tens of thousands of staff will be made redundant, and healthcare will become more expensive if the UK government’s plans for controversial reforms to the NHS in England go ahead, the country’s biggest union claims.

In a briefing for MPs and media to coincide with the second reading debate on the Health and Social Care Bill, the union Unite said that the biggest shake up in the history of the NHS would herald the “slow-motion privatisation” of the service.

Gail Cartmail, assistant general secretary of the union, said, “This bill will destroy the NHS. It will allow NHS staff, skills, buildings, and resources to be snatched by profit hungry companies. It will shove NHS patients to the back of the queue, as private greed will leapfrog health need every time.

“It will open up huge ravines of inequality in our communities as GP businesses close their doors to those with costly care needs. It will encourage the sort of bloated rewards for the health privateers we see at the top end of banking.”

The reforms will abolish the primary care trusts and strategic health authorities that currently oversee healthcare at local and regional level. Consortiums of GPs will spend 80% of the NHS budget on a mix of public and private providers of services.

In a detailed analysis Unite says, “By ensuring that the consortia commission ‘any willing provider’ and allowing patients to insist upon doing so as individual consumers, they open the door to private providers to compete directly with the NHS in a healthcare market.”

The union argues that the reforms will create a conflict of interest between GPs’ role as budget holders and commissioners and their role as clinicians, which could lead to rationing of care. It says that one of the “most alarming features” of the bill is the power to set a maximum price rather than a national tariff, opening the door to competition on the basis of price rather than quality.

Unite highlights proposals that could see private companies paid more than the NHS would get for doing the same work. Companies have to pay corporation tax, have to access capital through private borrowing, and have higher costs in providing pension benefits. A study report by the accountancy firm KPMG for the Department of Health (Fair Playing Field, 2009) said that a private sector provider’s cost base is 14% higher than the NHS equivalent.

The health department’s impact assessment for the bill says that under the reforms Monitor, the economic regulator, will advise on “barriers to competition/fair playing field” and propose solutions. This could mean “setting different prices for different providers in order to recognise different levels of implicit subsidies.”

Unite’s briefing coincided with a call from the Medical Defence Union, the UK’s largest medical indemnity organisation, for the government to spell out where the responsibility will lie to compensate patients if treatment commissioned by GPs goes wrong. MDU’s professional services director, Matthew Lee, said, “It seems likely that responsibility for clinical negligence claims will lie with the providers and not the GPs commissioning the services.

“But this is far from clear, and before entering into any agreements GP consortia will need to be satisfied that providers take responsibility for compensating any patients who are negligently harmed by them.”

A YouGov poll commissioned by Unison, the country’s biggest public sector union, found that only 27% of the public who were polled supported GPs using private companies to provide NHS services.


Cite this as: BMJ 2011;342:d701


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