Health and Care Bill

Written evidence submitted by Janice Bray.

(HCB85)

I am very worried about aspects of this Bill which enables parts of the NHS to be run by the private sector. I have no problem with non clinical work, namely IT services which are generally appalling, slow, and do not link to common IT platforms; grounds maintenance being run by commercial partners; the word partners is key.

It is ESSENTIAL  that Clinical decisions remain with the range of well qualified and experienced professionals who should only have patients' interests at heart. The Government listened to professionally qualified clinicians during the pandemic so I urge them to do it again.

if savings need to be made then correct, thorough procurement is essential. Too often essential items are much more expensive using NHS procurement than they would be if procured through open competition, however procurement of clinical items need to be fit for purpose and informed by clinical practises. The pandemic has required NHS to use its ingenuity and that is both welcome and shows that within the NHS there are people with excellent ideas eg Northumbria NHS Trust has established its own  site where various items of PPE are manufactured thus establishing control of supply which should prevent shortages as well as creating jobs for local people. In the Peterborough area, eye specialists have established a specialist centre for a range of services including cataract surgery, and which has resulted in substantial reductions in waiting times for patients, surely a fine example of privatisation led by specialist eye practitioners. I'm sure there are other specialisms where this kind of approach could work but it has to come from within, not directed from above.

My conclusion is that this Bill is yet another attempt to remodel the NHS yet NHS problems are frequently created by lack of clarity of government intentions, a vast amount of paperwork which can and must be simplified, too many managers to deal with the paperwork, and a lack of long term planning, for example, throwing large amounts of money won't result in immediate increases in doctors and nurses or specialist staff. Time is needed to ensure that individuals are correctly trained so that their expertise may be trusted and they are useful. It would be worth examining new models of training such as those by the University of Sunderland in partnership (that partnership word again) with the local Foundation Trusts which seem to work very well. I struggle to see how a private sector organisation would invest in that kind of training when making money is their objective.

Finally, there is ample evidence of government attempts at involving commercial organisations in delivery, most of which have failed. Within the NHS there are many examples of failures of Hospitals run by the private sector, and the local Foundation Trust has had to take over the running of the failed hospital.

Rather than being driven by political dogma, as this Bill appears to be, I recommend implementation of enabling legislation which allows local Trusts especially clinical professionals to identify ways of better delivering services, and if savings can be made without negatively affecting outcomes for patients then they could be ploughed into other areas needing development.

In management terms, if organisations don't know how to resolve their problems, re-organisations take place, or to simplify, the old adage of rearranging deckchairs on the Titanic. Instead of imagining that the private sector generally can do things better (cheaper) than the NHS I urge that 3 actions take place:

1. Scrap this Bill;

2. Enable NHS organisations to think of their own solutions, which may include 'privatisations' from within

3. Aim to reduce the paperwork which is unhelpful to the NHS, by, say, 50% by the end of this current Parliament, and which should result in reduction of staff needed to monitor centrally.

In support of this submission, I am a former Chief Executive of a County Careers Service which ran for over 10 years following privatisation in the 1980s. I know we prepared a superb bid using our senior staff, one of the best in the country, and beat off competition from at least 2 large private companies. Our model was a formal agreement between the County Council and the Training and Enterprise Council, which enabled the new organisation and its staff to remain within the County Council yet operate in a businesslike way. We reduced costs especially IT significantly, while increasing turnover from £3m to £12m by securing contracts for non government work, which enabled services to be expanded, as well as staffing to deliver. I worked with the Department for Education for many years in relation to simplifying business planning and was awarded an MBE in 2000.

Since retirement I have volunteered at a Hospice, and for the last 5 years as a good Trustee of the Charity which supports the Hospice. There continue to be many frustrations, for example, IT (yet again), long waits for internal redecoration (which could surely be carried out more swiftly by an external contractor). The Charity currently funds approximately 25% of Hospice costs including clinical staff, so that our patients are able to receive the palliative and end of life care they need and deserve. 

I have a postgraduate qualification in Strategic Business Management and remain a member of the Institute of Management. 

Yours sincerely,

Janice Bray

Wednesday 22nd September 2021.