It had always been the Thatcherite/Blairite dogma of service provision that the big private companies – whether the likes of Capita, G4S, Serco, A 4E, Atos or the huge US healthcare multinationals – wouold provide all the health services, but the commissioning would be done by the independent public sector. Now even that split, with the public sector confined to a relatively marginal role, is being done away with and the carving up of the NHS in all its various roles by these private behemoths is now all but complete. For the first time the NHS under Tory ideological control is asking the private sector to undertake the buying of billions of pounds worth of services for hospitals and GPs. NHS England has just advertised for companies to compete (or share out the booty) for £5bn or more of work advising the new GP-led clinical commissioning groups (CCGs) which spend more than two-third of the NHS budget (some £70bn) buying care for patients.
They will advise on patient care ‘reforms’, finances, drug purchasing, negotiating hospital contracts, handling NHS patient care data, and outsourcing services to private care providers. Apart from the last, these were of course all functions provided by the Primary Care Trusts up till 2010, but they were disbanded in order to hand the responsibility to the CCGs ostensibly on the grounds that “they knew best what was in their patients’ interests”. As we can now see, this was just a cover partly because many CCGs didn’t want this administrative commissioning role in the first place, but mainly because the Tory intention all along was to close the circle of private sector control by by giving the big private companies the commissioning role on the grounds that the CCGs didn’t have the expertise (so why were they given this role in the first place?).
Even more remarkable there are already 17 commissioning support units which were set up in 2012 to provide services to CCGs, so why are new bidders like Serco and the US United Health needed at all? Obviously there has been a concerted lobbying effort by the big behemoth providers to take full control of the whole process without having to negotiate with other parties. But the costs of this stitch-up will be enormous. There will be huge new transaction costs which, it is well to remember, take up at least 30% of total health care costs in the US. It will obviously fragment the service further, which is clearly the Tories’ intention. Above all it will produce monstrous conflicts of interest as the big private healthcare providers advise on the commissioning of services of which they are themselves major providers. There is also the very sensitive issue of handing over the handling of NHS patient care data into private hands. Much of this, it can be said with assurance, will certainly backfire on the Tory machinators and come back to haunt them.