Dr Chris Day writes:
The NHS internal market will mean that commissioners who allocate the budget and providers who do the work are effectively part of the same organisation. This is a recipe for conflicts of interest. Patients will not know why they are being refused care or where the money has gone that would have been available in the past.
Lansley has ensured that, as far as possible, all services will be provided through this market. This is because when commissioning is put through markets in this way companies who provide the services get rights under European law.
This will lead to increasingly large amounts of money being lost to pay for legal disputes, administration, marketing, contracts and public relations. The central aim of the providers will change from providing health care to making money. Taxes, VAT etc will be used to pay for healthcare plus profit rather than simply for healthcare. Big companies are looking for easy profits from public budgets as they persuade officials to let them in on easy terms. Financial interests will increasingly be able to suck more money out of the system (e.g. Calderdale’s PFI contract has traded 9 times, each time with a profit for the seller). These companies will try to sell care that is easy for them to provide and which will not necessarily be needed by the patient (supplier induced demand).
The unstated aim of this process is to move from a mutual social contract pooling of resources to a limited guarantee of some sort of minimal healthcare provision from government topped up mainly by insurance. The Clinical Commissioning Group (CCG) is already a funded insurance administrator, given pots of money that are doled out in a number of ways. GPs prescribe and CCGs decide if it is OK. Money coming in to the CCG has to cover costs or the CCG will fail.
There are 3 methods by which CCGs are allowed to fund secondary care services (hospitals etc.). Tenders can be accepted, old tenders can be renewed or more individualised care can be provided through Any Qualified Provider (AQP). The Department of Health (DH) has revealed a list of 39 services that it plans to allow any qualified provider (AQP) to deliver immediately. If a service is put out to AQP, providers can be from the NHS, private or voluntary sectors. It leaves the patient to choose the provider of their care from a list, all of which have to be Choose and Book compliant (approved for use by the CCG). Budgets will be transferable between CCGs and other bodies nominated by the patient (such as to an insurance company for top up insurance). If £2000 are allocated per patient some will require little care in that year. When patients are given control of their budgets in this way a relatively wealthy patient with no healthcare problems will be offered incentives to move their allocation into private insurance schemes (e.g. a free gym subscription) that may have nothing to do with health care needs (supplier induced demand). Others who are very sick may require care costing tens of thousands. This will then not be available for most people.
To the individual, services will be free at the point of use but as increasing amounts of money are leeched out to big private companies, patients will be forced to turn increasingly to private insurance. Poorer patients with health problems will not get insurance cover.
Private companies will continue to work to manipulate the market. (Listen to this audio link from a talk by Lucy Reynolds for more details on this process)
The most efficient providers have consistently been dedicated NHS services who concentrate on healthcare and do not have large numbers of staff sitting around ready to make bids. If they fail in a bid they will be lost forever. Only large multinationals will have the resources to win bids and small efficient NHS services will quickly be forced out. Those who go under will never return. GPs who don’t want the problems of increased administration will be offered easy options when private companies bid for this work. The big companies will continue to look for ways to employ staff more cheaply, using increasingly less skilled workers. This de-skilling will be a longer term destructive process that will be a disaster for future generations.
We are already in a near crisis situation with health care provision. Some instances have been reported where people who go in to have cataracts removed are being told they can only have one eye repaired free of charge. It’s not hard to see how little time it will take before serious needs are being denied and a rush for top up insurance begins. This will lead to a rapid shrinking of the money available to the CCG which will become increasingly irrelevant. Private insurance companies will become increasingly dominant. People who are sick will be denied insurance as they are a bad risk. As in America, much of our health care will become increasingly available only to those who can afford it and this will cause widespread suffering. It is likely, for example, to become a major source of bankruptcies, as it is over there at the moment.