Some of the most dedicated, diligent, friendly people you work with or will soon get to work with don’t work for the NHS. Chances are whoever cleans the wards, prepares and serves the food, fixes the lights, and keeps the car parks secure is not an NHS employee. Does it matter?
In years past, they would have been. A hospital had very few people working in it who were not also working for it. But then came the dawning of the ‘internal market’ and the ‘purchaser-provider split’. Started by governments before Blair but enthusiastically carried forward by the Blair government. And every government since. Then we saw the creation of Foundation Trusts and the Health and Social Care Act 2012 (HSCA). All part of the same process, which is outsourcing: giving bits of what the NHS used to do to private companies. Does it matter?
If it had stopped at sandwiches and security guards, arguably not. But it didn’t. The HSCA extended that process to every part of the NHS, making it a legal obligation for CCGs (the bits of the NHS dishing out the money; more on them below) to insist every part of the NHS, clinical work included, should be made available to competitive tendering while guaranteeing, in law, that the Minister for Health no longer held direct responsibility for the quality of work carried out. Which means now in theory every clinical service could be given over to an external provider. There were a few early disasters: Hinchinbrooke Hospital was outsourced in its entirety, given to Circle Health, a corporate healthcare giant with roots in the USA. It flopped. Within a few years Circle pulled out, leaving the taxpayer to clean up the mess. They are far from the only example. But did this slow the process down, give governments pause for evidence-based thought? No. Ideology driven outsourcing continues apace. Now we see the very structure of the NHS shifted to accommodate more: CCGs are being phased out, we are told, to be replaced with Integrated Care Providers. To allow easier integration of services, we are told. But what could be a better path to integration could equally be a shorter path to privatisation. Outsourcing spiralled down to its remorseless conclusion: mass privatisation, handing over of entire swathes of the NHS to large private companies. Who are you going to work for? Will that NHS badge mean anything beyond a front for outsourced contracts?
What started with Starbucks coffee and Serco security ends with the NHS as little more than a branded logo, a smiling mask hiding rafts of outsourced sectors and what is left of the NHS, the non-profitable bits no private company wants, struggling to cope in an increasingly fragmented, less efficient service. With private companies pocketing eye-watering sums to give to their shareholders.
Far fetched? Would any government dare? They already have. Take ‘NHS Test and Trace’. Or rather, take the NHS mask off. There you will see Serco, Sitel, Deloitte and a host of smaller companies taking in billions of pounds of public money. And in return? A system that reaches barely half of the people targeted, and hands over vital local information to local, public-health tracers only when that data is days old and next to useless. The call-centre model, applied to Covid. Great if you’re selling phones. But people’s lives? Is ‘private always better’? Clearly not. And even on the small scale, outsourcing still matters, and not in a good way. Handing over ‘estates’ contracts to private firms, for example, completely ignored the reality that most hospitals do not lend themselves to easy solutions. Changing the light often means knowing about arcane wiring and mysterious electronic systems. Which ‘home-grown’ expertise got to know but which the incoming private company does not. Less efficient, not more.
Outsourcing need not be an evil. But the ideology driving it, favouring private enterprise above public service as an assumption despite the evidence, is hostile to the NHS. Doctors for the NHS opposes the outsourcing of clinical contracts and calls for an ending to the HSCA and the changes it is causing. We welcome medical students. A better tomorrow will need to be fought for.
Communications Manager, Doctors for the NHS