New regulations will reduce some forms of outsourcing in the NHS, but there are significant gaps which a UNISON campaign is aiming to fix.

A reduction in the competitive tendering for NHS contracts is expected to follow the introduction of the new procurement regulations –  the Provider Selection Regime (PSR) which came into force in January 2024. 

Not covered by the new rules though are contracts for facilities, such as catering, cleaning, administration, and IT. 

The risk of further contracting out in NHS remains while existing outsourcing contracts keep some of the lowest-paid workers tied to poor rates of pay, earningless than those whose jobs are in-house”

This is one of the stated reasons Unison’s campaign – Bringing Services Home, launched last July – is focused on preventing outsourcing and bringing services that are currently outsourced back in-house. 

It can take time, but in the case of the workers outsourced to Serco at Barts NHS Trust, where it was only around a year from the point at which local union officials found out about the break clause in the contract, sparking a campaign, mobilising members on the issue and pushing for negotiations with the trust and resulting in an eventual transfer of staff back into the NHS.

The advantages for the staff of being bought under the NHS umbrella include improvements in their pay and employment conditions – sometimes quite dramatically and include access to the attractive NHS pension scheme.

Transfers in-house also address long-standing unfairness and inequality. Very often workers in out-sourced sectors, such as cleaning and catering, are women, from minority ethnic groups, or migrants, groups that historically have been treated poorly by companies and have had little power to fight back and demand better pay and conditions. 

The benefits are felt more widely too. Accountability helps to control standards and staff become an integrated part of the NHS team, more able to respond to the changing needs of service users. In the public sector, funding remains an issue, but gone is the need to generate profits which has often compromised the service provided by outsourcing firms.

Policymakers have been slow to respond to the evidence of the damage  A 2017 study of 126 NHS trusts – “Outsourcing cleaning services increases MRSA incidence”, provided shocking proof that outsourcing undermined the public interest and cost lives. 

In some parts of the NHS unions will be pushing at a door that is at least ajar. The Chief Executive of Epsom and St Helier University Hospitals Trust recognised the issues outsourcing was having on lower-paid ethnic minority workers: “Some 40 per cent of our cleaning, catering and portering staff are from Black, Asian and minority ethnic: communities already hit particularly hard by COVID-19. This is absolutely the right time to welcome these teams back to the NHS family, with all of the benefits that brings.”

Campaigns to take services back in-house often need political support to succeed, however, particularly in local councils. A case in point is Barnet Council, which as a Conservative-controlled council outsourced vast sections of its services back in 2012 to Capita. Despite the contract being mired by a multi-million-pound fraud and being vastly over budget, it was not until the takeover of the council by Labour in 2022 that the move for services back in-house could begin with 330 workers moving back in April 2023.

Support is now also needed on a national level to end the culture of outsourcing and privatisation of services. Is the Labour Party willing to support making public services publicly owned again? Last June Lisa Nandy speaking at a Unison event said Labour was ‘inspired’ by Unison’s work on insourcing, bringing services back into local authority control. Whether being inspired translates into serious action if they gain power is another thing.

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