Agreed by Labour Party Conference September 2005

On July 28, the NHS Chief Executive issued instructions to Primary Care Trusts (PCTs) and Strategic Health Authorities. This document sets out a programme for the opening of primary care to private providers. Primary Care Trusts currently provide the full range of community health services such as district nursing, health visiting and occupational therapy. The DoH communication specifies that PCTs will become “commissioning-led organisations with their role in provision reduced to a minimum” and directs that a range of providers be introduced to ensure competition. This marks a very significant change in the way community health services are to be delivered, threatening job losses and a major expansion of the private sector into our NHS. The instructions also set an impossible timetable for submissions and implementation. Conference believes that this crucial change in policy has not been debated within the Labour Party, repeating the mistakes made in the announcement of Foundation Hospitals, and is poorly understood by the public.

Labour came to power in 1997 pledged to abolish the NHS internal market and deliver world class public services through sustained investment and reform. A programme of reform has been implemented alongside the large sums spent on public services. The NHS is delivering the vision of modernisation set out in the NHS Plan. The staff in the NHS are meeting the targets and reducing waiting list times and their contributions are consistently praised by ministers and Labour MPs.

However, since 2002 reforms have centred on increasing the role of the private sector and the creation of markets, rather than empowering NHS staff to work together to bring about desired improvements. PFI and contracting out have continued and markets have been introduced in the NHS, through pricing mechanisms, competition and the development of foundation hospitals. Conference is concerned that in its third term our Government has accelerated the implementation of the policy of establishing a full-scale market system in health. In addition the government with its ‘choice’ agenda is insisting that every patient requiring routine surgery is given the choice of five or six providers, at least one of which must be a private health care company. These latter companies generally do not have the intensive care back-up facilities should an operation go wrong. In such situations, the patient has to be transferred to the NHS and to the NHS budget.

The 28 July announcement included the notification of the roll out of foundation trust status to all hospitals and to the ambulance service. This follows the decision by the Secretary of State to give £3 billion to the expansion of independent sector treatment centres (lSTCs). In addition there are inexplicable plans to further outsource successful services such as NHS Logistics and. decontamination services, demoralising hard working, dedicated staff who have delivered for the NHS and patients..

In the future Health Services are to be delivered by a range of different providers, who, rather than collaborating together to exchange good practice and plan services, will compete to attract the most profitable users. Hospitals are being made independent of Government, and left to stand or fall on their ability to break even, with those that are not able to being allowed to close. In place of public accountability, decisions about the nature and pattern of service provision will increasingly be driven by profitability and the logic of the market.

Conference is convinced that these changes risk undermining service quality, and will lead to greater inequality of access by replacing the principle of service provision based on need with service provision based on profitability. Time and time again in our public services – from the railways to residential care, school meals to the NHS internal market – we have seen the way in which outsourcing and the creation of markets has led to higher costs, service failure and fragmentation, and worse terms and conditions for staff.

There can be no doubt that the 28 July instructions to PCTs represent a clear direction of travel – towards fragmenting the NHS and embedding a marketised system of providing public services with a substantial and growing role for the private sector.

Surveys have shown that a large majority of the public are opposed to the increasing privatisation of the NHS (Including a June YouGov poll showing that 89% of voters believe that public services should be run by the government or local authorities rather than by private companies and a Which? survey published on 1 August showing that 89% of respondents agreed that access to a good local hospital was more important that the. Government giving people more hospitals to choose from).

The adverse effects of Government policies were recently highlighted in a report in the Which? magazine. This report concluded that: ‘Choice is likely to foster differential access to care which will exacerbate existing inequalities in health and access to health care and may even create new ones depending on the individuals’ desire or ability to make or take up choices. Relying on market mechanisms and the operation of Payment by Results to stimulate new capacity is no guarantee that any additional capacity is actually what is needed or is provided where it is needed.’

Conference believes that there has been no adequate assessment of the way in which this process is being carried out and of the longer-term consequences of these decisions. Conference therefore calls on the Government to:

Consult with representatives of all levels of NHS management, the NHS unions and patient and professional bodies to clearly identify the practical shortcoming that are emerging with the ‘choice’ and market policies in the NHS.
Institute an urgent joint review into the mix of private sector provision in the NHS and the role, limits and regulation of markets in our public services.
Suspend the introduction of competition of providers into primary care services, and the stipulation that the role of PCTs as service providers be minimised, pending the outcome of such a review .
Suspend any further expansion of the role of the private sector into the NHS
Suspend the second wave of Independent Sector Treatment Centres until an evaluation of the first wave is completed
Moved: Unison Seconded: Luton North CLP

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