New Labour never gives up on forcing the market on the NHS. But who, I wonder, was aware that last month was the date by which the Department of Health required Primarty Care Trusts (PCTs) across the country to split their commissioner and provider functions under separate governance structures, in order to make another giant step towards developing the market in the NHS? It is being done as quietly and secretly as possible because this latest plan revisits the highly contentious ‘Commissioning a Patient-led NHS’ proposals of 2005 which were introduced without consultation and triggered such anger across the health service that Patricia Hewitt was forced to back down. Since then the Government has said repeatedly that there will be no further reorganisations in the NHS. Yet what is being proposed now is that the delivery of school nursing, stroke rehabilitation or community mental health services is being put out to the private sector or new organisations like social enterprises. Yet again the Government, hardly in the strongest position politically, is picking a fight which can only increase its unpopularity.

The fundamental argument against this idea is that fragmenting primary care services, where providers are forced to compete against each other, will be detrimental to the NHS. The obvious truth is that integrated, joined-up services are best delivered where NHS trusts co-operate with one another, sharing information and best practice. By contrast, this so-called Transforming Community Services programme – a typical New Labour euphemism – will break up and sell off the NHS, with local primary care services including GPs and health centres shunted off to the private sector. The result will be that a single patient may have to deal with a series of different providers – one for district nursing, another for occupational therapy services and a third for GP services.
Nor is this latest exercise being subject to consultation any more than the earlier botched one, largely perhaps because the same Departmental official who is fixated on competitive marketing of health services is still in charge and is being given his head to push through these outsourcing measures without apparently even considering any NHS options. One can only wonder: where are the Ministers who are supposed to be responsible for upholding NHS principles? Little or no staff consultation has been conducted, not surprisingly perhaps when the overwhelming majority of NHS staff want to remain part of the NHS. So what is the point of New Labour government which behaves just like the Tories?
What lies behind all this is the new Co-operation and Competition Panel. Though Alan Johnson, according to the Health Service Journal, “urged the panel to ensure it valued co-operation as well as competition in its assessment of public and patient interest”, clearly the rhetoric has not been followed up by action. This panel is already a monster out of political control. It is a scandal that on the advice of officials it can dictate Government policy. If Ministers are so complacent (though we intend to take a delegation to see them), every effort should at least be made locally to ensure that proper staff and trade union consultation does take place and that NHS options are fully considered as alternative provider models.

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