NHS market reforms pose risk to services, warn professionals

Social care professionals may be still trying to get their heads around the 367-page Health and Social Care Bill published last week, but their health colleagues appear to have already made up their minds.

“Extremely risky and potentially disastrous,” chorused six unions representing doctors, nurses, physiotherapists, health visitors and midwives in a letter to The Times published the day before the bill.

The Royal College of Psychiatrists and Royal College of General Practitioners also weighed in with their concerns following the bill’s publication.

Their chief target was government plans to open up the NHS to much greater competition, significantly increasing the level of provision by private and voluntary organisations and allowing providers to compete for commissioners’ business on price, as well as quality. Unions and health professional bodies fear this will lead to a “race to the bottom” on price, damaging patient care, and handing an advantage to big private companies.

These changes promise to be dramatic, including for social workers.

“I think inevitably any profound change to our health colleagues is going to affect social workers and social care workers because we work so closely together,” said Ruth Cartwright, joint manager for England at the British Association of Social Workers. “I can see it all becoming more chaotic.”

The government’s view is that competition is key to driving up quality and efficiency in the NHS.

“There is very clear evidence from across services and countries that competition produces superior outcomes to centralised management and monopoly provision,” the Department of Health’s impact assessment on the bill said.

Patients have been able to choose between “any willing provider” in elective acute services, such as routine operations, since 2008, while in some healthcare areas, services are put out to tender.

However, a significant majority of publicly-funded healthcare in England is still delivered by public bodies: NHS trusts, foundation trusts or primary care trust community providers. The government believes that NHS providers have certain advantages – more affordable employee pensions costs, for instance – that enables them to shut charitable and private providers out of the market, to the detriment of patient care.

However, health professionals believe the government’s proposals (see box) will have the opposite effect to that desired.

Dr Laurence Mynors-Wallis, registrar of the Royal College of Psychiatrists, said he feared they would fragment mental health services, citing the impact of competitive tendering for drugs services in the past.

“What you’ve got is a pathway of care that is very fragmented, with one provider for detoxification services, one for social support etc. Writ large across the NHS that would lead to a real deterioration of care. Would you want one provider for community psychiatric nurses? Would you want another one for psychological input? Integrated services could collapse.”

Royal College of GPs chair Dr Clare Gerada warned that the government’s plans risked “destabilising the NHS and causing long-term harm to patient outcomes, particularly in cases of children with disabilities, those with multiple co-morbidities and the frail and elderly”.

Major concerns surround the introduction of maximum prices for certain services, rather than fixed tariffs.

Mynors-Wallis pointed to the risk that this will damage quality, given the need for the NHS to make £15bn to £20bn in savings over the next four years.

“[Maximum prices are] a real worry. When there are billions to be saved how are the commissioners going to save money other than by going for the cheapest bidder?”

Health research body the Nuffield Trust said the decision to allow maximum pricing “had to be reversed”. “International evidence shows that price competition in hospital care is associated with a reduction in quality of care,” it said.

The government has said quality will be safeguarded by the fact that all providers will have to be registered with the Care Quality Commission – ensuring minimum standards of quality and safety.

But, as the bill starts its journey through Parliament next week, health professionals remain unconvinced, and their concerns are providing a useful line of attack for Labour, whose shadow health secretary John Healey has warned that the bill’s purpose “lies in opening up all parts of the NHS to private health companies”.

A battle royal is on the cards and social workers will want to pay heed to it.

More from http://healthandcare.dh.gov.uk/

Plans for NHS competition

● Increase significantly the volume of services in which patients have choice over providers, including in mental health, end-of-life care and long-term conditions.

● Introduce maximum, rather than fixed, prices enabling providers to compete on price as well as quality.

● Monitor to become economic regulator with duty to promote competition for NHS-funded services.

● Require commissioners to put certain services out to tender.

● All NHS providers to become foundation trusts with access to loans, but not subsidies, from the taxpayer.

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