Andy Burnham has set out his vision for the NHS and at its heart is a commitment to a publicly funded and publicly managed service. The private sector would be confined to a “supporting” role while the voluntary or not for profit sector would be given preferential contractual treatment.

His vision is one in tune with core Labour values and will resonate with the public who want the NHS to remain free at the point of delivery and available to all when and where they need it.  The NHS is a national treasure and is an institution that captures the sense of fairness that can be regarded as the essence of being British.  Its heart and soul should be preserved and be invested in.  But it should not be preserved in aspic.  It must move with the times and be confident enough to embrace high quality services wherever they may be located.

I welcome Burnham’s plan for integrated care based from home and treating the whole person, and I welcome his commitment to greater homecare services for end of life care provided on the NHS.  However there are two serious flaws in his vision.  What does a “supporting” role for non NHS providers mean in practice and why should a voluntary organisaton be given preferential treatment over a private company.

The notion that voluntary or not for profit organisations are somehow deserving of preferential treatment is misguided.  There is nothing intrinsically “better” about the service arm of a major charity than many private companies or statutory sector departments.  At present charities compete ruthlessly for contracts, poach staff from within the public sector and from each other and often have no better, if not worse, terms of employment.  The service arms are rarely delivered by volunteers and many charities are replicating the characteristics of both the public and private sectors.

In my field of home medicines, it is currently only private companies that are able to deliver cost savings to the NHS through reclaiming VAT on medicines; only private companies that can meet the very high quality and governance standards needed for dispensing medicines; and only private companies that have the logistical networks to deliver medicines and services to peoples homes anywhere in the UK.

It is hard to imagine any voluntary organisation being able to provide homecare medicines to the expected standards – it is hard enough for current providers to meet the demands – or to have the financial resources to underpin a high-cost, low-margin business, or to take such a business risk without contravening their charitable objectives. The NHS shows no appetite to directly deliver the service and would be unable to take advantage of VAT generated cost savings if it tried to do so.

Clinical homecare provides high cost medicines and nursing services to people’s homes at no cost to the patient – in doing so it improves patient experience, reduces pressure on outpatient pharmacy and delivers real cash savings on expensive drugs – all of which are top priorities for the NHS.  Currently approximately 230,000 patients receive clinical homecare and while there are many pressures on services the sector is expanding and regularly generates very high levels of patient satisfaction. And it is 100% delivered by the private sector.

Clinical homecare is an example of where using the private sector makes sense – where private firms can deliver a clinical service for the NHS and in doing so improve patient care and make real cash savings.  If the NHS is to become a service where staying at home is the first option then clinical homecare providers should be encouraged to do more not less.

Private is not always bad, voluntary is not always good and an incoming Labour Secretary of State should be sophisticated enough to recognise this.

Dave Roberts

Dave is the CEO of the National Clinical Homecare Association but writes here in a personal capacity

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2 Comments

  1. This article sums up the problems of fragmentation, little by little those with their eyes open can see that there is an agenda running, based on competition, although Andy Burnham is keen to suggest that it is not.

    The NHS is a much loved institution because people are aware that dedicated NHS staff are there to serve them when they are at their most vulnerable. When the NHS was first set up they did not ask the question which provider should we use and based their judgments on need.

    The idea that people are happy so long as it is free at the point of use and available to all is a Neo-Liberal interpretation and distorts why the NHS was set up in the first place.

    When socialists talk of the NHS they say, they want the private sector in all it’s forms out of the NHS, we want a soley publicly funded, publicly owned NHS free at the point of use.

    The one point that stood out in this article was the revelation, that private companies can be more competitive than the voluntary or not for profit sector because they can claim back the VAT that those sectors can’t.

    Once again socialism for the rich and capitalism for the poor.

  2. Christine Gale says:

    Anyone who thinks private health insurance. Could be a way we pay for our healthcare should get a quote. I did : over £2000.00 per year. Compare this with the £400.00 that each household is promised if TTIP is enacted.

    Are you able to afford this? Read the small print the exclusions. I asked what would happen if I had a serious accident. The reply was”I would be taken to the nearest A&E because that would be the BEST place for me to be and I could be transferred to a private hospital when I was well enough!!”

    I would have to pay for all my medication and quite a few conditions are not covered.

    Private healthcare is good for the YOUNG, HEALTHY and WEALTHY,
    And who else? The SHAREHOLDERS of private. Healthcare companies and CHARITIES overpaid directors.

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