A leaked version of the new NHS White Paper has confirmed the government’s plan to remove the much criticised competition rules, which allow commercial companies to bid for a vast array of NHS contracts and were a keystone of the Tory health reforms of 2012.


Commenting on the leak, Jeremy Hunt – who was health secretary for much of the time the policy was in place, was shameless in his agreement that scrapping the rules “is the right change” admitting that the policy had caused fragmentation; but the private sector now has a strong foothold in the NHS so what difference will the change make to the scale of NHS outsourcing?


In the short term the answer is not much. Of course it is to be welcomed that the NHS will no longer have to waste time and money on this bureaucratic whirligig, but the reality is that the private sector has already won £20bn in contracts throughout the competition era, according to figures from the NHS Support Federation, and there is no sign of these contracts being transferred back into the NHS.


For this to happen would need extra investment to fill the gaping hole in NHS capacity. The NHS is 90,000 short on staff at the last count, but predicted to need 250,000 more by 2030, 


Hand in hand with the policy to encourage more deals with the private sector was a cynical government squeeze on NHS funding. Recent uplifts in health spending are welcome but not enough; short on staff and dealing with a vast backlog in repairs the NHS is ill prepared to cope with the post covid surge – so support wil be needed if the NHS is to take back commercial contracts.


The Royal College of Surgeons points to the scale of private sector involvement in some areas – stating that a third of all hip operations and a quarter of knee replacements are performed by outside providers


Figures from the Independent Healthcare Partners Network, which represents non-NHS health organisations, say that in 2018, 21% of all gastroenterology, trauma and orthopedic NHS patients were treated by independent providers (both private and not-for-profit). Over 500,000 non-urgent operations and surgical procedures were carried out by private clinicians for the NHS, about 6% of the total, but these numbers are set to soar. 


The NHS is on the verge of signing a four year deal with private hospitals to help it confront an NHS waiting list that estimates say could soon reach 10 million. Whilst we must find care for all NHS patients, this deal should be examined carefully, as it has the look of a more long-standing arrangement, and should not deprive the NHS of the properly funded 10 year workforce plan that it surely must be a priority.


The pandemic has heaped more pressure on struggling mental health services, but here too the NHS will be heavily reliant on the private sector. Already, 44% of spending on child and adolescent mental health goes to private providers. Commercial domination is most complete in the provision of controversial ‘locked ward rehabilitation’, in which a massive 97% of a £304m market in 2015 was held by private companies.


In local terms NHS commissioners have signed contracts with private companies and charities to provide a range of home care, nursing and community healthcare.  On average they spend 15% of their health care budget on non-NHS providers, however there are a group of 18 CCGs who spend over 20%. 


The pandemic has also already seen a massive rise in public investment in the private sector. The budget for test and trace is now £20bn and has funded the building of privately driven Lighthouse labs, bypassing the existing network of NHS labs. Matt Hancock has already indicated that the Lighthouse facilities will form the hubs for the country’s future diagnostic network – so permanently resting it in private hands then?


Certainly, some private health providers were financially revived by their new “support role” for the NHS and the commercial sector, like the Health Secretary is keen for this relationship to continue.


Talking about the prospect of new legislation David Hare CEO of the Independent Healthcare Provider network said “it’s vital that these new systems build on the partnership working that has taken place during the pandemic,” 


So the removal of the flawed competition rules is a welcome shift and some reward for years of public campaigning but it does not yet translate into full protection for NHS services from privatisation, or mean that ministers are fully backing a plan to raise NHS capacity so that it can handle demand and take back control of the supply of public healthcare.

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