Should the bill be passed in its current form there will be an increase in private providers.
Why is this bad?
Here are 10 of the reasons why I am worried
- Competition occurs in markets - the idea being it will drive prices down- think ASDA. TESCO etc, what happened to the small shops and the big ones that could not compete? (Think KWIKSAVE, SAFEWAY) they were bought out or folded up, what happened to the staff? Unemployed, working elsewhere).
- Private companies pick and choose the easy, safe bits of work.
I read a BMA report that said that research indicates some independent treatment centres run at less than full capacity yet get money for running at 100%
- Private companies are not obliged to share information in the same way as NHS bodies.
Private healthcare providers cannot be compelled in the same way to release information - so what happens when things go wrong? Thinking about all the inquiries into failures in healthcare recently.
- Major changes are taking place on the ground before the Bill has completed its passage through Parliament.
Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs) are to be abolished, it's not clear what shape the new bodies are to take, guidance keeps coming out but it?s incomplete. As no one is clear about the final shape there are concerns about how to plan the hand over to an organisation in an unknown form that is due to exist by April 2013...
- There are real worries about the doctor-patient relationship being eroded if the PCT no longer buys your care.
For e.g. If your GP is buying your care- he will need it to be cheap, close and good, but how then can you be sure when you see him for a problem and he decides to refer -( or not refer you) if he is being unbiased in his choice? Remember he has between 1500- 5000 patients overall, of that number he sees maybe 20% regularly. His budget allowance will probably be accounted for that number. A PCT on the other had has people who have been buying in care on a regional basis for ages, have an eye to which providers do what and how good they are. Large cover - better buying power and less bias. (I am oversimplifying a major concern here about ethics and a doctor?s duty of care to his patient first rather than to a commercial provider and indeed his ability to choose)
- Keeping people with less, getting less, and the rich getting the rich pickings, widening health inequalities, call it what you will.
'Choice' is all well and good but those who can afford private care will always go to the top of the queue; will be better informed and so always get the best available. The problem is that those who cant suffer indirectly as a result. A surgeon who is contracted to spend 37.5 hours in the NHS may choose to spend his 'sparetime' doing private ops- so he is tired the next day seeing NHS patients or if the person had a complication- it's back to the NHS which means someone waiting for a routine op gets bumped. Less perceptible is the little things that add up, the secretary does private referral letters in NHS time cos it's only one or two, the GP prescribes medicine to a private patient as it's extra cost to get that private too, so they delay doing a home visit for a few minutes, but it all adds up such that those who don't pay get a slightly worse deal, but on a population level it's massive. When a hospital is doing private and non private work how do they draw the line between the two?
- There are a whole range of worries about who will train the next generation of doctors- it's sort of been fudged over in the Bill, who will deal with outbreaks and other public health emergencies. Think- if SARS came or a teacher had TB in school or a child came to school that later had meningitis or went to a farm and then got poorly with E.coli. Who steps in to sort it and has an overview of who needs what?
- Before any new policy is released it is reviewed and its pros and cons looked at, something called a risk register is produced which basically tells the Government what the downsides are of a new policy being put into force. Despite repeated FOI request the Risk register on the Bill is yet to be released!
- Concerns about missing words or the wording of the Bill that fundamentally change it from being about the NHS providing care for ALL to having discretion over whom to provide care for....Doctors leaders are fighting for that to be amended
- NHS hospitals will be able to devote half their beds to private patients, (well 49%). What?s that going to do to waiting times? Even if everyone on the waiting list could afford to ?go private? the waiting times won?t improve!
At the moment the NHS gets along and its pretty clear who should do what. Under the new Bill the distinctions become far less clear.
Maybe we will end up with a totally pay-for health services with only those on very low / no incomes being allowed a free service. How easy is it to get dental care, or glasses, this is what will happen to healthcare. As for the 'less sexy' bits where no profits can be made {{shudder}}
These are just off the top of my head; there is far more definitive stuff here:
bevansrun.blogspot.com/p/welcome-to-bevans-run.html
www.38degrees.org.uk/page/content/NHS-legal-advice/ explains the bit about removing the Secretary Of State?s Duty to Provide
www.gponline.com/News/article/1106584/DoH-will-not-release-documents-NHS-reform-risks/ WHY?????