5 May 2015
The last Labour government created an “internal market” in the NHS this meant there were people employed to commission services required (commissioners) and those employed to develop and deliver services (providers). The commissioner - provider relationship is a model which has been used by the conservative government to drive the NHS at speed towards the place it is today: a market where anyone can bid to provide NHS services which are put up for tender.
This sell off is already happening, examples include the former walk-in centre in Alma Road run by “3-well medical” and the community endoscopy service run by a company called InHealth in Thistlemoor Road. Contractors bidding for services may or may not be former NHS employees. The services need to provide a business proposal which sets out their terms of contract and how they will deliver the commissioned service, clinical governance and other related issues. They bid for the funding required to do so.
There is always a danger that those winning the bid may do so because they are the cheapest (rather than the best) or that the business proposal may not deliver everything that it claims it will in the glossy plan. In reality companies may develop amazing business cases with all the right rhetoric but not translate that into quality patient care. Companies may run on a not for profit basis but they are of course free to set their own salaries and expenses.
The internal market encourages the dividing of NHS services into separate contracts and the easier to provide services which may balance the books without a headache are being carved away from traditional providers, such as the hospitals and delivered in alternative settings. This threatens the funding of big providers such as the hospitals as they are left to provide complicated services and procedures that are costly whilst being stripped of the funding from simpler procedures, which were financially more lucrative and helped them balance the books.
In response to this NHS providers are having to think more like businesses and refuse to provide services unless they secure the funding for these. As a patient you may experience this in terms of a less joined up patient journey. For example if you have a problem with your right hand and are referred to an orthopedic consultant for assessment they may well assess you an identify that you have a similar problem with your left hand. In the past they would have listed your for treatment of both your hands, now with internal market forces they will treat the right hand that you were referred for only; you will be advised to return to your GP for a second referral for the other hand and will need to face the waiting list again before your receive the necessary treatment. This will secure a second payment for services and then you will obtain treatment for the other hand. In the past had you been referred to a consultant who felt that your problem could be dealt with better by a colleague from a separate discipline, your consultant would simply have made a consultant to consultant referral, now it’s back to the GP for a second referral and this attracts another referral payment.
This of course in reality is a waste of time for the patient, delays treatment and creates more demand, workload and access problems for the GP appointments. I do not criticize the hospital consultants for doing this, they work in an internal market and therefore need to secure the funding to provide services. This way of commissioning services encourages dysfunctional working practices and is not a good way to treat people and use tax payer’s money.
There is a real danger that patients are not treated holistically by looking at their whole health and treating their needs to improve health as sadly workers are only able to provide the service they are funded for. In the past colleagues would not only treat the health need a patient was referred for but also help deliver additional care at the time of contact because the health need was present and preventative care is important. Going “the extra mile” for patients which makes a huge difference to lives and individual experience is fast becoming a thing of the past.
Services are being cut to the bone and workers are struggling to provide the basics. An example of this is the district nursing teams in our city. For years teams were attached much more closely to your GP surgery and district nurses could be counted on to visit the elderly population and deliver care to those who were elderly, frail and in need. A time and motion study was performed on the district nursing teams in Peterborough and following this the service was commissioned in a different way. District nurses are now thinner on the ground and only commissioned to provide specific cares and only to the absolutely house bound.
Another area damaged by commissioning (or covert privatisation) is in training and development. NHS workers need to maintain lifelong learning and we frequently learn together passing on good practice, sharing and collaborating to provide quality. Fragmenting services fragments opportunity for continued learning.
The training opportunities for community nurses have diminished considerably since the dawn of the internal market, training services are, of course, commissioned separately now and your employer has to pay for you to attend, availability and funding possibilities have diminished. I was advised by one hospital service that should I wish to visit for the purpose of learning, my employer would have to pay to “buy” the right to this opportunity for my development. This in my opinion was particularly dysfunctional and I am glad most colleagues do not support this approach; we all work for the same tax payers!
I am proud to have worked as a nurse in the city for 18 years and I have worked with some amazingly dedicated staff in both the hospital and the community. Working together we have served our community and I am sad when I see our health service divided up and damaged by the current political ethos. I am not opposed to change and feel we always need to consider the ways in which we work and whether we can do things better to deliver safe and effective care. However I believe the NHS should remain in public ownership, sadly both Labour and Conservative policies support the continued privatisation of our health service; because of this they will not get my vote. If we don’t halt the creeping privatisation in the NHS we risk fragmented service delivery, dysfunctional behaviour and the leaking of money from the NHS to private interests.
Please support 38 degrees campaign to halt the privatisation of the NHS and check out Green Party policy on the NHS, we can’t afford not to vote for change.
Green Party policy on the NHS: is to Take back our NHS
this letter was published on 30th April, 2015 in the Peterborough Telegraph