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16th August 2016

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Ed Smith

Chair of Not-Monitor, or whatever it's called. In conversation with Roy L

Good conversation, networking and a glass of wine. What's not to like! Tickets are slipping away! Get yours.

Details here

Yes I do

News and Comment from Roy Lilley

It never ceases to amaze me, how stupid politicians are. Or, perhaps I could put it another way; it never ceases to amaze me how stupid politicians think we are.

There's something else; how deeply unscrupulous they are and how alike they are.

If I said Labour leadership contender, Owen Smith, is out of the same mould as Boris Johnson you'd say I'd lost it.

They are more alike than you'd think. Ambitious, determined and dangerous. They are both prepared to tell falsehoods, create fabrications and frankly, lie.

Did Boris know; pledging to Brexit and give the NHS Ł350m a week from the proceeds was undoable. Did he know the Ł350m figure was a deception? Did he realise Ł350m is a spit in the bucket for a service that costs Ł2bn a week to run?

If he didn't he is a fool and should be nowhere near high office.
If he did, he is a liar and should be nowhere near high office.

Using the NHS as a political football is not just a Boris trick. Labour-leader-wannabe Owen Smith is doing the same thing.

Smith is telling us the Tories have a dark plot to privatise the NHS and prays-in-aid some figures on the growth of NHS dependency on the private sector. Privatisation being the juju-phrase to get everyone worried they might end up having to produce their Visa Card in A&E.

Let's look at 'privatisation'.

Definition: The transfer of ownership, property or business from the government to the private sector is termed privatisation. The government ceases to be the owner of the entity or business.

Smith is deliberately confusing contracting with privatising.

It is true we depend on contributions from providers outside the NHS magic circle. Macmillan nurses are an obvious example. Surrey Central Health, a social enterprise, is another.

The ability to flex services and cope with spikes in demand brings the private sector into play. Private ambulances are an example. Similarly some highly specialised services such as rehab and mental health are provided by the private sector and are commissioned by GPs in CCGs.

None of this is an example of mammon taking over the NHS, neither is it a Machiavellian plot. The decisions are made by GPs.

Who invented the idea of the internal market in healthcare? How did it all come about?

In 1990 the NHS and Community Care Act introduced a separation; health authorities managed their own budgets, to 'buy' healthcare from provider hospitals and other health organisations. It was a way of introducing some clarity into the real cost of healthcare.

'Provider' hospitals had to become Trusts; semi dethatched from the DH and able to manage their own affairs.

It wasn't until 2002 during a Labour government that the 'market' kicked-off under the direction of Alan Milburn and the newly created Primary Care Trusts.

These days contracting is tightly controlled. Outside providers are obliged to offer services at 'tariff' (the same price as the NHS), with, mainly, NHS staff on TUPE'd conditions, identical to the NHS.

The exercise has become pointless and competitive tendering an expensive farce. I can see no future for CCGs.

As an aside; it is increasingly obvious most of the private contracts are under pressure because the private sector can no more provide services on NHS tariffs than can the NHS.

What better example is there than the only near-privatisation experiment at Hinchinbrook Trust; handed to venture-cap backed Circle to run, racked up Ł5m of debt and they paid Ł2m in penalties to get out of the contract.

Smith headlines some scary numbers; 'contracts with the private sector have doubled'. Leaving to one-side contracting is not privatising... according to Full-Fact; private providers made up 4.9% of NHS spending in 2010/2011 and 6.1% in 2013/2014.

The full fiddle and fudge is unpicked by the BBC here.

Look at the graph; there has been a steady growth each year since 2006, roughly 0.6%. In my view, entirely in line with growth in demand and budgets.

Do I think the NHS is being privatised by stealth, no, because it isn't.

Do I hate politicians that take me for a fool... yes I do.

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roy.lilley@nhsmanagers.net

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