Health and Social Care (Re-committed) Bill

Memorandum submitted by members of the public (HSR 32)

I would like to submit the following comments on the competition aspects of the health bill.

Even after the government's changes there will be a huge increase in profit-motivated activity in the NHS. Although the timetable has slowed, the policy of "any qualified provider" remains. The policy direction is therefore the same, despite an obvious shift in presentation. "Choice" is in and "competition" is out – now tainted by public disquiet and controversy. Yet the two are inextricably linked in policy terms and it is misleading to suggest otherwise.

Worryingly, we are advancing competition policy despite the considerable evidence that it will have a negative impact. Only one UK-based study has been cited in support of the government’s plans. Given the level of concern, we need to limit the role of competition in the English NHS until it can be properly evaluated.

Specific issues raised by the competition amendments

1. What protection is there against a Southern Cross style situation? What prevents essential public services being threatened by the way commercial companies choose to run and finance their business? The potential danger of allowing the private sector to control large parts of our healthcare services has not been adequately thought through.

2. It is unrealistic for the government to claim to be able to stop 'cherry-picking'. Any company trying to maximize its return for shareholders will always seek low-risk, or high-return contracts. How can the government change this fundamental aspect of commercial activity? Its plan to do this through the tariff is untested and complex. The risk of 'cherry-picking' will surely increase with the number of private providers.

3. The government’s stated intention to shift towards integration and away from competition is not reflected in the amendments. The bill is now unclear in the way it sets out the functions it creates. For instance, Monitor will take on the current role of the Cooperation and Competition Panel, but only one of their guiding principles relates to collaboration. The emphasis is still therefore very much weighted towards promoting competition.

4. The government is removing Monitor’s power to specifically open up areas to competition, yet there is no recognition that EU law may force the NHS to allow private sector bidding for contracts. Private providers have made it clear they will pursue this issue into the courts. This was side-stepped by the Future forum, but has been repeatedly raised – notably by independent legal opinion. It should now be properly addressed.

5. The bill should keep in place the limit on the amount of money NHS hospitals can make from private patient income. It is inevitable that removing the cap will lead to NHS staff and beds being used to secure income from private work. It will also raise inequity with richer NHS patients being given the chance to jump the queue.

6. The government has stated that it will block non-tariff competition, where there is no fixed tariff. How will the government ensure the lowest priced provider is not chosen and avoid falling standards in quality? This possibility is not reflected in the amendments to the bill.

It is shocking that the government wants to proceed with these plans, with little or no evidence that they will improve NHS provision, and a lot of evidence that there is no protection from private companies exploiting the NHS for profit, to the detriment of the best quality care for ALL patients.

July 2011

Prepared 11th July 2011