Act now against new NHS competition regulations
BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f1819 (Published 20 March 2013) Cite this as: BMJ 2013;346:f1819All rapid responses
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I totally agree with this letter.
The core of the marketisation of the NHS is the purchaser/provider split which sets primary against secondary/tertiary care (and distances ministers from their responsibilities). This was invented by the previous Conservative government and supported and extended by Labour. Most of my colleagues see the present changes as the beginning of the end for a cherished institution and feel powerless to reverse the trend.
This happens as the risks of PFI and contracting out are just starting to be recognised at Hinchingbrooke (1), Greenwich, and with GSTS pathology (2) and others.
The financial risk of privatisation is ultimately taken by the taxpayer which is why it is so commercially attractive and lobbied for by private industry.
Wren Hoskyns
Consultant Paediatrician
Leicester
refs;
1 http://www.parliament.uk/business/committees/committees-a-z/commons-sele...
2 Private Eye 1336 (and passim) 31.
Competing interests: No competing interests
In 1968 Garrett Hardin [1] wrote of ‘The Tragedy of the Commons’ a social/economic dilemma exploring the tension between common cost and private profit. Broadly speaking the example concerns a common patch of grazing land shared by a number of herdsmen. Each individual acts rationally and independently to maximise their own benefit, by maximising the number of cattle they graze on the common land. This however is at the cost of permanently damaging the common land through over-grazing to the cost of all. The private gain of the individual by grazing an extra cow is at the common cost of the entire group.
Before the introduction of the internal market most people working within the NHS had the common ‘profit’ of wanting the NHS to give an excellent standard of patient care with a maximum utilisation of its limited resources – we had common costs and shared the common profit. The internal market and allowing private companies to enter the ‘common land’ of the NHS [2] will lead to a common cost: private profit scenario, which may well result in the tragedy of the commons for the NHS.
Dr S J McNulty
Consultant Endocrinologist
The author has no conflict of interests to declare
Ref
1. Hardin G. The Tragedy of the Commons. Science 1968;162:1243-1248
2. Davies J, Banks I, Wrigley D, Peedall C et al. Act now against new NHS competition regulations. BMJ 2013;346:f1819
Competing interests: No competing interests
Legal advice to 38 Degrees on the government’s amendments to Section 75 found the thrust of creating a competitive market had not been changed.
Without urgent action the process of reconfiguring the NHS into a competitive market will be sealed on 1 April. CCGs will then find themselves unable to fulfill their first duty as doctors, making the care of their patients their first concern.
Support the appeal to the BMA and the Academy of Royal Medical Colleges to make a joint public statement in opposition to the amended Section 75 regulations.
Competing interests: No competing interests
Agreed. The manoeuvres currently being employed by the UK government on the NHS in England are clearly headed towards more private sector involvement in care, at the very least.
This is based on the assumption that private sector methodology and competition will result in more efficacious and cheaper health care provision, and the further assumption that health workers are finance driven.
There is no hard evidence to support these assumptions.
Competing interests: No competing interests
The British Association of Dermatologists shares the concerns of the authors of this letter. Already people with skin disease have been disadvantaged by egregious commissioning and their interests seem further compromised by the unconscionable prospects of the amended Section 75 regulations.
Competing interests: No competing interests
Competition law, at home, in the EU and through the WTO is formulated to act as a one-way valve to allow limitless privatisation but obstruct any return to collective, public ownership.
Patients' needs and interests are subordinated to commercial interests, and to the "right" of "Any Qualified Provider" to provide – with minimal if any regulation – irrespective of the consequences.
This was always the kernel of the Health & Social Care Bill, and was partly diluted to get the Bill through Parliament, partly withheld, with the intention of getting these regulations through with minimal discussion after the debates were over.
Thwarting these clauses will at least impede the progress of the marketisation of the NHS by the Act. Doctors who willingly allow the clauses to go through are undermining any possibility of genuine clinical leadership of commissioning, and putting the lawyers, accountants and companies in the driving seat. They are signing the death warrant not only of the NHS as we know it, but of professional practice in medicine.
If you have any professional self-respect and see yourself as anything other than a businessperson, oppose these clauses and support the campaigns to force their removal.
Competing interests: No competing interests
This letter, restricted to essentials by space, gives a realistic summary of the situation, cutting away the ‘spin’. Our professional organisations, colleges and bodies, if they are committed to clinical need directing care, have to take the stand against these regulations and their intentions. Collectively and individually we have to take responsibility for what we do not do, as well as for what we do. Our organisations urgently need to represent us, our professional commitment and honour, and what is right for the majority of people in this country, as patients.
Competing interests: No competing interests
I agree and can cite examples of the harm of competitive tendering from my own experience.
When we needed to expand our chemotherapy unit we were told this could be done by classifiying it as an ISTC, which followed the competitive tendering process overseen by the Department of Health, who tried to force through an expensive solution with impressive new buildings but which would not provide the same level of service--i.e. they would not accept responsibility for the complications of treatment which are an everyday ocurrence of chemotherapy.
The plans were scrapped by the Minister for Health and an in house solution was found later.
The learning experience was that the competitive tendering process could result in a choice of best of a bad bunch of suggestions, none of which meet the necessary quality standards.
We are learning about defining quality standards on our feet as they have previously been implicit in medical ethics - first do no harm - and have not prevoiusly been threatened in the way that commercial interests are beginning to do now.
Competing interests: No competing interests
Re: Act now against new NHS competition regulations
I think McNulty has misunderstood the lessons from the Tragedy of the Commons.
For example, the overexploitation of common land in England was solved by enclosing the common land and awarding control of the enclosed areas to individual farmers. They then had a strong incentive not to overgraze (only they would suffer if they did). This proved a more effective mechanism for improving agricultural output than the social controls required to avoid exploiting common land. Two advantages: everyone has a personal incentive to improve; the stupid only hurt themselves by overgrazing. These incentivize improvement and limit the damage of stupidity and greed.
It is a rather free-market solution, though, and I doubt it is anything like the author's intended solution for the NHS. If anything, it argues for a more competitive, more commercialized system.
In reality, even believers in markets in the NHS won't find useful lessons from it though, as the problems of the NHS are too complex to be understood by simple analogies (especially when the point of the analogy is not understood).
Competing interests: I have worked for PA Consulting for nearly 2 decades. Clients of this global management consulting firm, headquartered in the UK, have included the Department of Health, NHS providers and NHS commissioners. The views expressed here are personal opinions and not those of PA Consulting.