By Antonis Tofias (SfGH NC Training Director 2020/21)

One silver lining of the COVID-19 pandemic is that I have read significantly more than I otherwise would have.  Among all the books and blogs read, one of the most outrageous, yet not surprising, is the BMA’s report on the role of private outsourcing in the COVID-19 response published in July 2020[1].

The UK’s strategy of managing the pandemic’s first and now second wave has been heavily criticised. During the pandemic we witnessed the NHS struggling to treat patients and to ensure the safety of its staff. Sadly, this inability of the healthcare sector in the UK to respond to the pandemic was not surprising – it was known since 2016. In 2016, exercise Cygnus has reported crucial gaps in the UK’s ability to plan and prepare for a pandemic. The recommendations were largely ignored by the government.

Such failures cannot be viewed in isolation – they have occurred on a background of increasing marketisation and restructuring of the NHS, as well as budget cuts.  Following the Health and Social Care Act 2012 and the dissecting of the NHS to several locally managed trusts, the quality of care and facilities preparedness has  depended heavily on local management teams. Outsourcing (the use of private companies to provide key NHS services) has led to further fragmentation of the NHS and reduced its agility and ability to quickly respond to emergencies. Continued budget cuts have further crippled the healthcare sector by forcing many services to be shut down. These changes and restructuring of the NHS represent the neoliberal economic management policies and austerity that have infiltrated the public services of many countries.

Outsourcing to private companies, rather than using established NHS networks, has become a strong feature of the government’s response to the pandemic. There now exists a complex network of private companies, to which the government has awarded health-related contracts. Contracts for procurement and  stockpiling (e.g., for personal protective equipment [PPE]) have been awarded to DHL, Unipart, Clipper Logistics and Movianto by the Ministry of Justice and DHSC at £25m and £120m. Yet, A BMA survey carried out at the end of April 2020 completed by over 16,000 UK doctors found that half of the respondents claimed that they resorted to purchasing their own PPE. A second example is the £133m contract awarded to diagnostics company Randox that was discovered to be providing home testing kits that were not up to standard and had to be withdrawn.

Last and definitely not least, a £108m contract was awarded to Serco and Sitel for the Test and Trace operations. In 2012 Serco admitted that it presented false data to the NHS 252 times on the performance of its out-of-hours GP service in Cornwall. In England, government figures indicated that approximately one third of positive cases transferred into the Test and Trace system were not contacted by call handlers, who in turn reported inadequate training. All of this while established public services, such as local public health and contact tracing teams, could have been invested in and strengthened in response to the pandemic.  Instead, during the struggles of the first and second waves the primary care system and local public health agencies have been reporting that they were often not involved enough or ‘not kept in the loop’.

Outsourcing during the pandemic has raised concerns over transparency and accountability. Many contracts were not awarded via the expected tendering processes and many contracts have been awarded without full disclosure of the amount of money agreed. Neoliberalism, austerity and outsourcing have forced the NHS to its knees. With climate change adding further weight on population health the NHS needs to be stronger than ever. Without agility and preparedness, we cannot hope to tackle the challenges of the future. There is only one way forward: A publicly funded, publicly provided and publicly accountable NHS.


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