LibLink: Sal Brinton: Ministers must protect our NHS against privatisation

This week, Sal Brinton and others argued in the House of Lords that action was needed to ensure that Brexit didn’t open the door to privatisation of the NHS.

She wrote about the issue for The House magazine:

If you asked most people what effect Brexit would have on our health service, regardless of how they voted in the Referendum, I suspect they will cite that large red bus from the Leave referendum campaign stating the EU costs the UK £350m per week, which on leaving could be invested in the NHS. Not only was this untrue, but there are now figures to show that the cost of leaving to our economy could be equal to £350m per week. And, at a time of unprecedented pressure on the NHS, it needs urgent and real investment to prevent it crumbling.

However, one of the lesser known pillars of protecting our NHS is also at risk with Brexit. With more and more parts of its services being put out to tender, the NHS has been protected by the EU Directive on Public Health Procurement. This directive governs the way in which public bodies purchase goods, service and works and seeks to guarantee equal access and fair competition for public contracts in the EU markets. It was approved in 2014 and includes protection for clinical services and more legal clarity on the application of procurement rules.

She also looked at some of the wider impacts on the Health Service that Brexit will have:

So I am seeking for confirmation from the government that they will stand by their words in 2014, and re-enact these procurement rules for public services into UK law, to continue to protect the NHS from future trade agreements.

Another key element of these procurement rules that needs to be protected is accessibility. This has meant that public money should no longer be used to introduce or maintain inaccessible structures, systems or services. It is essential for disabled people that these accessibility rules continue.

There are many other issues that are affecting the health and welfare of people in the UK which I know will be covered in the debate. The reduction of EU workers is already having an impact on our hospitals and social care services, from clinical to support staff. Leaving Euratom risks supplies of radioactive material required for treatment and research. The loss of the European Medicines Agency headquarters from London, and our influence over it will be very serious.

You can read the whole article here.

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  • David Evershed 30th Mar '18 - 11:15am

    Most GPs are private businesses with the doctors being a mixture of business partners and employees of the practice.

    Is it Lib Dem policy to eliminate all private businesses from health care – nationalise GPs, nationalise pharma companies, nationalise medical equipment companies, only use nationalised hospital builders and so on?

    Beveridge recommended health treatment being free at the point of delivery but this does not mean everything having to be provided by government organisations. Surely liberals believe in free markets?

  • I recall seeing references a while back to the EU/USA trade discussions where the USA had made it clear it wanted full access to “the healthcare market” here for its healthcare firms. I worry a lot more about that than about chlorinated chicken.

  • I’d actually prefer the European model to be honest. Less centralised and they have the best healthcare in the world.

  • Tony Greaves 30th Mar '18 - 3:45pm

    No, Liberals believe in markets where appropriate. Opening the NHS to anyone and everyone to run everything is neither sensible nor Liberal. It is however an inevitable direction as a result of the provisions of the 2012 Health and Social Care Act. Unfortunately.

  • “The 2012 Health and Social Care Act.”

    Sadly, passed with Liberal Democrat support to the party’s eternal shame.

    Opposed by the great majority of hospital doctors, three quarters of GPs., the British Medical Journal, Health Services Journal, and the Nursing Times. So did leading experts in the King’s Fund, the universities, the Royal Colleges and professional associations, the NHS Confederation, the Patients Association, and the health trade unions.

    Why ? Here’s a link to the Kings Fund Report :

    [PDF]Never again? The story of the Health and Social Care Act 2012…/never-again-story-health-social-care-nicholas-timmin..

  • Has she spoken to Norman Lamb MP? He was quite involved in the Health & Social Care Act in 2012, which was very much about liberalising the healthcare sector

    As David Evershed points out, delivery of healthcare in the UK is already a mixture of market and state facilities, with primary care (GPs) almost exclusively privately provided (even though it’s publicly financed and free at the point of use, which makes some people think it is state delivered). Hospices are mostly privately delivered (as not-for profits).

    Secondary care (hospitals) haven’t lent themselves well to claimed efficiencies when privately delivered but publically financed here, mostly due to the organisationsal complexity of secondary care. Though with advancing health informatics and automation, this may reduce complexity in so we shouldn’t discount the possibility that privately delivered hospitals funded publicly might become more efficient in the future.

  • Like other responders, I am not sure this issue is clearly understood by the electorate, some of whom confuse the outsourcing of some services (still paid for by the NHS) with being told that a particular service is now ‘privatised’ in the sense that you have to pay for it – leading to the eventual disappearance of a ‘free at the point of delivery’ service.
    The idea that the US medical industry is eyeing up the UK for a post-Brexit bonanza is very alarming, but one would hope that services provided by US companies would have to pass a test – is it of acceptable quality, and cheaper than we can do it? The NHS is a giant organisation, and there is little doubt that it could be improved; one possible improvement might be to make it concentrate on core activities, and outsource some other things. This ought not to be ruled out.
    The obvious danger would be that a commercially focused US (or other) medical corporation might want to ‘buy into’ the UK market with a relatively cheap bid for a particular medical procedure, and then hike up its prices a few years later, after the NHS had lost its expertise in that field.
    As with many aspects of health care, there is an overwhelming case for a cross-party body to manage the NHS, in order that bold decisions can be taken without the risk that anything resembling a mistake will be used as evidence when the next General Election happens.

  • Something that seems to get scant attention in this debate is that it has always been the case that senior doctors in NHS hospitals spend part of their time doing private work. Some private patients are the very rich, or people with health insurance, but many are ex-NHS patients who opt for private treatment because they can afford it, and because they think it will be better than they are getting from their NHS doctors. In some cases the doctor is the same one who was treating them in an NHS hospital, but when they are being paid privately they find have more time for the patient.
    I am not any kind of expert on the extent of this, but I do have personal experience of this happening to a family member. The privatisation debate is therefore a little more complicated than simply being about foreign medical corporations poaching business off the NHS. NHS doctors are already doing this themselves, to some degree.

  • Privatisation, outsourcing and offshoring have all benefitted the customer immensely. If this party really believes that nationalisation and state control are the way forward in 2018, then they should join Corbyn’s mob of RMT/ASLEF/PolFed Red UKIP communist luddites.

  • @Andrew Daer
    “”””The idea that the US medical industry is eyeing up the UK for a post-Brexit bonanza is very alarming, but one would hope that services provided by US companies would have to pass a test – is it of acceptable quality, and cheaper than we can do it?””””

    So far, the evidence of improved efficiency from the Clinical Commissioning Groups (CCG) and their predecessors Primary Care Trusts (PCTs), contracting independent sector (private) providers to do clinical procedures has been been quite the opposite (except for certain organisationally simple procedures such as screening and pathology analysis). The fact the independent sector providers cream off the easiest (i.e young and/or healthy) patients, don’t participate in training medical staff, dont pick up the costs of later complications of the procedure, are some of the reasons they end up costing the NHS more. The organisational complexity and diverse user (patient) is the reason it’s so difficult for the NHS to efficiently contract most medical procedures at scale. But as health informatics and automation improves over time, this may change.

    “”””I am not any kind of expert on the extent of this, but I do have personal experience of this happening to a family member. “”””

    It happens but is pretty rare to the point of having a negligible impact on the overall system (I am a doctor). And it’s occurring less frequently. Health informatics now makes it extremely difficult now for hospital consultants to game the NHS system with their private patients

  • @Stimpson
    “”””Privatisation, outsourcing and offshoring have all benefitted the customer immensely. “”””

    Very true. But it doesn’t work in every sector and for every business aspect of a sector. Where it works, great. Where it doesn’t work, don’t proceed. That’s the essence of pragmatism. And so far the sheer complexity of so much NHS activity means it often works out less efficient for it to be privately provided than state provided. That might change in the future with improving health informatics and automation, so we should always be open to shifting the position. It’s this reason that I dislike Sal’s misinformed, dogmatic and Corbynite attitude that we “must stop privatisation”. I also dislike the misinformed and dogmatic attitude that the private market will always work better in every situation. Both ends of the dogmatic spectrum are wrong

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