Private providers have been given the chance to bid for thousands of NHS services for the first time due to new European Union competition rules.
While the recent Brexit decision has been largely condemned by health service sources, it could be suggested that this is the sort of decision which demonstrates that Brexit may not be all bad for the NHS.
NHS England has published “prior information notices” for its specialised services contracts in the Official Journal of the European Union this month, in line with new EU regulations introduced in April.
The notices say NHS England’s buying department is “looking for potential suppliers” to contact them with bid applications.
This national body is responsible for commissioning about £15 billion worth of specialised services, and has created 278 contract “lots”, which encompass suites of services to be provided in specific geographies.
The public notices signal an intent to award whole contracts for 2017-19 to the incumbent providers, unless expressions of interest are received from alternative operators, triggering a competitive process.
Expressions of interest must be received within 21 days of 14th October, when the notice was initially published.
A private sector source, who asked not to be named, said non-NHS providers “already do more specialised work than is sometimes acknowledged”, often in partnership with an NHS trust.
But they added that “the tight timetable does make it difficult to forge the partnerships that might be needed. There may still be interest but it’ll be at the margins.”
Services such as specialised cancer, diagnostics, cardiac and renal care may be targeted as these are already contracted to private providers in some areas.
In a note sent to providers of specialised services earlier this month, NHS England noted that the arrangement is very much a new initiative.
“This will be the first time the new rules have applied to the contracting round for NHS specialised services. The regulations set out a new light touch regime, which allows commissioners flexibility to design an appropriate, proportionate process.”
This means the contracts must be publicly advertised where they are worth more than €750,000, the process must be transparent and bidders treated equally, and the criteria must not artificially constrain competition or specify organisational form, among other conditions.
The note also outlined more information about the prior information notice.
“The prior information notice will also include notice of our intent to explore the opportunities for longer than two year contracts where this affords opportunities for significant improvements in service quality and efficiency facilitated by using the NHS standard contract option to extend term for up to two years.”
Commenting on the issue, an NHS England spokeswoman outlined the advantages of this approach.
“Setting out our contracts for existing services in this way enhances transparency and provides an opportunity to ensure the NHS and our patients are getting the best value and quality of care.”
Jeremy Hunt recently stated that the NHS in England will become “self sufficient” in doctors after Brexit.
Figures released via a Freedom of information request have revealed that health boards in Scotland have paid private firms a record £82.5 million in order to treat patients.
This represented a significant increase from the £75 million figure for the same services acquired in the previous fiscal year.
Public spending on private healthcare has more than doubled since the turn of the century.
The increase in spending has occurred despite the statements of First Minister Nicola Sturgeon, who promised to reduce the level of privatisation of the NHS in Scotland.
Yet the picture gleaned from this information is that regional health trusts in Scotland are increasingly relying on private firms in order to carry out everyday operations.
Waiting time targets are thought to be a particular issue for the health service, and the major reason that the NHS is turning to private contractors.
Speaking on the controversy, Scottish Labour public services spokesman Dr Richard Simpson said: “These figures reveal the hypocrisy of the SNP around our NHS. They will campaign in elections against privatisation of our NHS while handing over increasing amounts of taxpayer cash to private health firms.
“Spending more taxpayer cash on private health services is an indication of the problems experienced by our NHS. It is clear they don’t have the capacity to deliver the care patients across Scotland need.”
Although the figures in Scotland are separate to those of NHS England, they can nonetheless be placed in the context of the health service suffering from massive deficits.
Already it has been predicted that NHS England will accumulate a deficit of £2 billion by the end of the financial year, and the suggestion that it is necessary for the health service to rely on private firms in order to deliver every day care further sullies this picture.
Yet Simpson also suggested that the level of expenditure could be cut via efficiency savings.
“The spending is also wasteful, as locum doctors and agency nurses as well as private procedures are inevitably charged at a higher rate than they would be in the public sector. Despite this increase in private sector spending, the SNP still can’t meet their own treatment time guarantee, which gave patients a legal right to be seen within 12 weeks.”
One must emphasise that Simpson is naturally motivated to some extent by political manoeuvring, but David Forbes, regional organiser for Unison, was certainly in agreement with his opinion.
“There has been an over-use of the private sector, who have been making obscene profits out of the public purse. That has been partly due to the unintended consequences of meeting very tight waiting time targets. Cuts are having to be made to balance the books because so much money is leaching out from the NHS into these private companies.”
The Conservative government in England has been accused of privatising the NHS by the back door, but these figures also indicate that regardless of political persuasion this remains a logistical issue across Britain.