Lowdown readers will have seen the widespread outrage about the latest revelations around Horizon and the Post Office, but many who have campaigned against privatisation and outsourcing won’t be too surprised.

This is an opportunity to once again look at the issue and also to do so in the context of our NHS and what is emerging as the likely approach of a Labour government taking over the total mess in 2024.

Labour has said unequivocally that it will retain the NHS model of universal, comprehensive, free and tax funded. However it also sees a continuing role for private for-profit providers – even while it also signals the intention to expand NHS capacity to reduce dependency on non NHS providers, and to end the ludicrous Lansley regime of compulsory competitive tendering.

(It is not clear about how far Labour will go in rolling back the almost totally privatised provision of social care, but some signs are hopeful.  The immediate priority will be on step changes to workforce terms and conditions through sectoral collective bargaining and that will have major implications.)

Back at the Post Office, the fact that the scandal had its roots in privatisation has to be broadcast loud and clear.  It appears obvious now that the Post Office, pretending to be a business (having been privatised), was very naïve in its contracting with the main IT supplier.  A vast new system largely went in based on trust – with far too little actual user testing, wholly inadequate training and support.

But most concerning – and the real lesson – is how the commercial arrangements led to secrecy, lying and a total culture shift from public service.  Protecting the “brand” and defending the reputation of the “business” was seen by both the Post Office and by Fujitsu as far more important than justice, fairness or even basic decency.

Another alarming warning for the NHS is that, despite the huge evidence base of wrongdoing, nobody has been held properly accountable, especially for signing up to such a terrible deal in the first place.

False statements were made in Court. Tactics were used to deliberately pervert the search for justice, and nobody has been prosecuted for that.  Somehow hundreds of millions of public money was spent on defending the indefensible – someone authorised that.

Nobody has been blamed for the failures to monitor delivery; nobody blamed  for failures/refusal to listen to complaints and recognise the IT supplier was lying, nobody has been held responsible for the total absence of basic governance with independent verification and audit.

Was this entirely incompetence or did it shade into corruption? How can we ever trust arrangements made through privatisation when we are lied to?

All of this is grimly familiar in the NHS. Many in the most senior NHS management ranks are more likely to cheerlead for the status quo than to be honest and open.

And of course, there are multiple scandals around dodgy deals and crony contracts as well as totally inept deals with private providers who know how to contract for their own advantage.

The NHS, just like the Post Office, even wound up with a contract with Fujitsu, as part of the bungled £12 billion plan for NHS IT in the 2000s, which it took ten years of legal wrangles to get out of, at a cost of over £400m.

We know that even modest requests for information on contracts and the performance of contractors are routinely denied by NHS bodies, and that those who ask too many questions are leant on.

Being realistic, there is no possibility of (ever) achieving an NHS without any private involvement and indeed (sharp intake of breath) some may be welcomed.  In areas like pharmacy, construction, IT, and medical equipment, the NHS has never provided, and cannot provide what is needed: so it has to get far better at getting the right deals.

In life sciences and research the NHS has to be better at partnerships across public/private ventures.  Much of primary/community care is delivered by non-NHS organisations, such as GPs, physiotherapists, podiatrists, ophthalmologists … and then there is dentistry!

This is all a mixed economy of supply, some delivered under contract by for profit organisations, that has to be effectively managed locally by ICBs. And currently (especially after recent daft management cuts) they are not good at doing this.

The new Provider Selection Regime moves in correct directions but needs to be extended so it also covers services such as catering, cleaning and porters, to once more allow in-house, or shared services provision with staff directly employed by the NHS; reducing outsourcing as opportunities arise.

So what should campaigners push for?

  • Push very hard for honesty from the government. The era of markets and competition in healthcare is over – it does not work. End the pretence of bits of the NHS being autonomous businesses.
  • Extend the Provider Selection Regime (PSR) to cover all services that are patient focused (i.e. where the majority of the cost is on staff).
  • Restore the provisions that prevented any two-tier workforce arrangements (ending for example the scandal that many outsourced staff don’t automatically get improved Agenda for Change benefits in line with NHS staff). Ban the tax dodging subcos and again prevent outsourcing internally (use of shared services etc) unless there is a dynamic alignment on terms and conditions (or staff are seconded).
  • Open up all Boards and policy decision-making to public scrutiny, ensuring public, patient and staff representation is real: and publish all papers. The PSR requires analysis to be done to justify all procurement decisions – so publish it.  Publish in full any case for significant change in service delivery, and allow comments: ensure these must be addressed before decisions are made.  There should be no ‘commercial confidentiality’ opt out any more.
  • No more reliance on management consultants: employ qualified and experienced contract negotiators and managers so as to get better deals and to closely monitor delivery against contracts. Here, too, performance has to be fully open to public scrutiny.  Hold commissioners and contract negotiators to account for bad deals.

And – None of this would cost money!  It would save a lot.

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