What’s happening to the NHS?

The NHS is changing.

Some of these changes you can see, like the new computer system ‘Choose and Book’ which lets you to choose which hospital you go to if you need an operation. Other changes you can’t always see but are just as important because they could change the way the NHS is run and the quality of care it provides.  The recent White Paper for the NHS continues to emphasise a role for the market and private providers.  One proposal is to abolish the cap on the amount of income foundation trusts may earn from other sources (e.g. private patients), and the paper advocates an ‘any willing provider ‘model for NHS services.

The BMA believes market reforms are costing the country money it can’t afford, are not always in the best interests of patients and could threaten the public service ethos on which the NHS depends. Many have been introduced either without proper public consultation, or in the face of public opposition.

Whilst the NHS is not perfect it is appreciated by and depended on by many people – for some it’s a much loved institution. Its success is due in part to doctors and other health professionals working together in the best interests of their patients and the personal relationships between doctors, patients and their communities, often going back many generations.

But all this could be at risk if the changes in the way you receive your healthcare continue.

We want to tell you about some of these changes and why doctors, with the backing of the British Medical Association are worried about them.

• Companies from the private sector are allowed to bid for contracts to supply NHS patient care on behalf of the NHS. This could be a local GP practice, hospital or community health service such as health visitors.
• These are generally large, multinational companies. They are attracted to providing NHS patient care because they see it as being profitable for them.
• Any profits they make from providing NHS patient care may not always be invested back into the NHS. As profit-making companies they need to make profits to pay dividends to their shareholders. So it is their shareholders who benefit, not the NHS.
• Private providers who run treatment centres are allowed to ‘cherry-pick’ the clinical services they provide which means they concentrate on those that are most profitable for them. This tends to favour the more routine treatments, like hip replacements and cataract operations, leaving the NHS to pick up the more complex, costly treatments.
• These treatment centres have been guaranteed payments even if they don’t treat the numbers of patients they have been paid to. Millions of pounds have been wasted this way – money which could have been spent directly on patient care.
• As they have to pay dividends to their shareholders, there is even less incentive for commercial providers to invest money in training or research. The advancements in health care and the quality of today’s NHS doctors is a result of yesterday’s research and training. If that investment is reduced today, it could affect the quality of healthcare in the future.
• As well being affected by lack of investment, doctor training could also be affected by lack of opportunity. As NHS hospitals lose routine procedures to commercially-run clinics, students and junior doctors are losing out on opportunities for practical training.
• Allowing commercial companies to provide NHS care, in addition to the NHS itself, means there are now more providers of patient care. In some areas of the country  there are more than are actually needed, which is wasteful and an expense the country can’t afford.
• It can also lead to unwelcome competition as NHS organisations compete with each other, and against private providers, for patients. Some NHS Trusts may advertise to attract patients, money which should and could be spent on patient care.
• Patients are now able to choose where to have any elective treatment (ie. treatment their GP says they need to have). Included in this choice will be commercially-run clinics or private hospitals which are contracted to provide NHS work, as well as traditional NHS hospitals.
• If a patient chooses – or their GP makes the choice for them – to have that treatment in one of these private hospitals or clinics, the funding for that treatment goes with them – i.e. it is taken out of the NHS.
• Private providers are encouraged to take on more routine NHS work to reduce the burden on the NHS and so help cut waiting times. If NHS hospitals lose too much of the routine work to commercially-run clinics, and the funding that goes with it, it can mean that some may not have enough money or patients to justify keeping certain departments open, or they may have to cut their services.
• If NHS hospitals lose too much funding, it can make it difficult for them to plan their services as they don’t always know how much money they’ll have.
• Some GP services have been affected. Every Primary Care Trust (PCT) has to set up a ‘Darzi centre’ – also known as a GP-lead health centre or, in London, polyclinic – in its area. But this is regardless of cost, need or local views, and many are set up in areas where there are perfectly good existing GP practices. Some struggle to attract patients. This is another example of how public money is being wasted.
• Some GP practices are now run by profit-seeking companies. Their contracts are short term which means that turnover of doctors and other staff may be more frequent, with the risk that patients lose that valuable doctor-patient relationship – particularly important for the elderly and those with long-term health problems.
• The private sector is also involved in the building and running of NHS hospitals in England under a complex scheme called PFI. The Private Finance Initiative was originally introduced by [the] government as a way of funding expensive public sector building projects such as hospitals, schools and roads, using private sector money and expertise. They build the hospitals which the NHS then pays for over a period of 25-30 years – a bit like a mortgage. But these costly contracts have left many hospitals with crippling debts which, it is feared, may lead to cuts in healthcare services as hospitals struggle to make their PFI payments
• Some of these private developers are also struggling to meet their financial commitments (they often need bank loans to fund the projects) – but instead are saved by a government which would rather use public money to bail them out than see their unpopular PFI policy fail. So what was once promoted as the answer to funding public projects is increasingly discredited.
• Some GP practices are now run by commercial companies. Their contracts are short term which means the turnover of doctors and other staff may be more frequent, with the risk that patients lose that long-term relationship and trust that they value so much with their doctor.
  
• Every Primary Care Trust (PCT) in England has been told by the Department of Health to set up a ‘Darzi centre’ – also known as a GP-led health centre or, in London, a polyclinic – in its area. But these have been set up regardless of cost, need or local views, and many are set up in areas where there are perfectly good existing GP practices. Commercial companies have been encouraged to run these new centres. This is wasteful and potentially damaging to existing practices.
  
• Many patients value their district general hospitals (DGHs) which are easily accessible. DGHs provide consultant-based care in the main specialties (e.g. 24-hour A&E, surgery, anaesthetics and intensive care) and for that reason provide safe, all-round care. Private treatment centres often lack the back-up of key departments such as intensive care and so cannot provide the same levelof care as DGHs. DGHs also provide training for junior doctors and other NHS staff.

The NHS is likely to face cuts as the recession bites. Doctors want the government to cut the cost of private sector involvement in the NHS, and the cost they see this as having on patient care.