Why do we need to ‘look after our NHS’?

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 policies designed to encourage profit-making businesses to provide patient care and create a market within the NHS is threatening that public service ethos, and the founding principle that the NHS should be publicly provided.

These are just some of the changes doctors, and the BMA, are concerned about:

• 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 often 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 have to 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.
• 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 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.
• 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.