While NHS England works to tighten the strings that bind so-called Integrated Care Systems to central control and regional NHSE bureaucracy, the DIS-integration of local services continues with the contracting out of more services … driven by NHS England itself.

The Lowdown has reported the various moves towards privatisation in the new pathology and imaging networks that are included in the Long Term Plan.

NHS England has also set up a list of accredited companies plus a few NHS providers to offer trusts and CCGs a range of services that can “support the move to integrated models of care based on intelligence-led population health management”.

The services on offer are:

Of the 83 accredited suppliers for these services, 76 are private companies, almost a third of them (23) US-based. Only 7 are NHS organisations.

Among the big American corporations are McKinsey, Optum, a branch of the giant UnitedHealth (former employers of NHS England boss Simon Stevens) IBM, Centene, Cerner, Deloitte and GE Healthcare.

McKinsey has been influential in the NHS for decades, and Optum has already won contracts for a range of data-based services for the ICS programme.

But while these no doubt profitable (but questionably useful, see box) services are confined to the back offices of trusts and CCGs, just before Christmas NHS England’s provisional privatisation wing, Shared Business Services, widened the net to include clinical care and invited providers, including NHS, non-profit and for-profit companies, to apply to be included in a ‘Framework agreement’ for the supply of outsourced clinical services, including Cardiology, gynaecology, paediatric and oncology services.

This is intended to make it easy for trusts to award contracts for various services.

NHS SBS invites in various private and other providers into networks of approved outsourced suppliers, from whom trusts can buy in services without themselves going through a full process of competitive tendering – by simply choosing a supplier from the list (or conducting a ‘mini-competition’ between a few already authorised suppliers.)

In other words it is batch privatisation, aimed at encouraging NHS trusts to outsource services (with the lure of varying possible “discounts”) – or “insource” them, by bringing contractors into Trust premises to deliver services – rather than providing them themselves (and paying staff on NHS terms and conditions.)

This could in some cases mean contracting out whole units or services (and presumably transferring existing trust staff, or making them redundant).

This is at present on a relatively small scale (£117m over 2 years for clinical services, compared with an NHS England budget of around £115 billion) but clearly the aim is for this to be the start of something bigger.

Because SBS conducts all of this procurement and sets up the “framework” of privatisation centrally, allowing trusts to make OJEU-compliant appointments from its lists of 800+ “approved suppliers”, it also ensures there will be even less chance of any local public discussion or consultation of the outsourcing, which might otherwise take place if decisions are made through the Trust boards, which meet in public.

The continued growth of NHS Shared Business Services and its eager promotion of private providers is a further reminder of the commitment of the Tory government to the fragmentation of the NHS and salami-slicing profitable contracts for the private sector under the banner of “integration” — while the taxpayer foots the bill, and the NHS takes the blame for the gaps and failures in an under-funded system.

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John Lister
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