11 reasons why forced competition in the NHS could increase costs

There is already a lot of competition within the NHS. Anyone who knows will know that private hospitals can compete for routine planned care treatment pathways via the "Choose and Book" system, for outpatients and surgery, as long as they work within the NHS Tarriff. Patients are free to choose whichever hospital they want.

I myself am managing the roll out of a community service where we will be going out to "Any Qualified Provider", which is likely to include the private sector as well as the NHS. This is now very common now in procurement and service redesign in the NHS.

The problem with the Health and Social Care Bill is the risk that competition will be forced upon us, and that a free for all will operate. It is not just that any provider could legally challenge for business, but also that private companies could be doing the commissioning.

GPs will not be doing the commissioning - they don't have the time or the skills. They will be contracting out to commissioning support organisations. If these are run by private providers, this will also increase the risk. At least at the moment there is no profit reason in commissioning - the only drivers in commissioning at the moment are value for money (the maximum health gain for each health pound), meeting targets and balancing the books. If you add creaming off a profit from commissioning to that list, and no moral imperative to get maximum health gain, then this is a problem. Moreover, the only doctors who are trained to commission (the 50 or so health services sub-specialist public health doctors) are being moved out of the NHS into local authorities, even though all of their work is NICE type work for the NHS. [I think this is not deliberate, but due to ignorance of what this group of docs do behind the scenes. Others sense a conspiracy here.]

The reason why Andrew Lansley says there won't be an unplanned market free for all, but Martin McKee's papers written with international lawyers say there will be is because the Bill is so big, so incomprehensible, and has had so many amendments, it is now like the Bible - you can quote from it to make any point you want. I'm sure that both AL and the other side believe what they are saying. What the courts will make of it when we start getting legal challenges is another matter - and not worth the risk of finding out, in my mind. The Bill is so complex that there is a real risk of unintended consequences once the lawyers get hold of it.

Here are my 11 reasons why there is a real risk that the Health Bill will probably increase costs to the taxpayer, with no improvement in services:

1. Increased supplier induced demand where not significant or real health need. Eg direct marketing to patients to stimulate demand for services they don't need or could be provided by local GP etc.
2. Increased admin costs to deal with & monitor multiplicity of providers. NHS spends 5% of budget admin, US spends 25%. Big markets need more bureaucracy do deal with all the providers including safety and value for money monitoring.
3. Increased legal costs due to provider challenges for pieces of the pie/ market share etc.
4. Provider failures eg PIP, Southern Cross. Will have to then pay twice and increase bureaucracy in dealing with consequences.
5. Commissioning support withdrawal by private providers if they are unable to make profit. Consequences destabilise commissioning and planning of health care, providers will be unchecked, gaps in services.
6. Alternative to 5 is that commissioning support providers make a profit & taxpayers money goes to shareholders.
7. Commissioning support conflict of interest - could be buying from their own companies etc.
8. GP Commissioning conflict of interest - ditto 7, plus more. I already know of a few instances.
9. The only docs trained to commission, review evidence, trained in health economics (a subspecialist group of public health doctors) being moved to LAs who won't want them working as a free good to the NHS - especially as sometimes they have to make politically difficult decisions on best value for meeting health needs.
10. Providers cherry picking bits of pathway or specific types of patients thereby increasing costs elsewhere.
11. Destabilisation of services that provide emergency care when they lose a lot of routine care contract share. Will require bail outs to keep them afloat (or shutting down of A&Es and acute emergency provision).

So that is why an uncontrolled market in health care will probably increase costs. There should be competition, and private providers can be very useful. But this is already happening in the NHS. And commissioners need to use competition in a planned way, not forced to open up to a free for all.

My recommendations are: Commissioners must not take a profit and therefore best to keep in NHS. Health care public health (local NICE-type) should be kept in the NHS (the other bits could go to Local Authoritie s if they insist). And very importantly, commissioners must make their own decision as to how much of each bit of market to open up and how. There is no need for the Bill, as there is already competition and it is expanding, and GPs and other doctors can take over from NEDs on PCT Boards.

The risk of the Bill is that it might legally open up the NHS to a free for all, a can of worms that can't be resealed.

Say NO to 70 Million UK Population - Sign the Petition

The UK population is now expected to hit 70 million in only 16 years. Two thirds of the increase will be due to immigration - that is 5 million or five times the present population of Birmingham.

The impact on our public services, our environment and our society will be huge.

Now at last - your chance to speak.

Sign Migration Watch's petition to the Prime Minister at: http://epetitions.direct.gov.uk/petitions/19658

Send it viral - send this information to your contacts.

For more info, contact

Migrationwatch UK, P.O. Box 765, Guildford, GU2 4XN e-mail:info@migrationwatchuk.org

Lib Dems breaking their Manifesto commitment - and this Time they can't Blame the Tories

The Lib Dems said IN THEIR MANIFESTO that they would, if in government, arrange an in-out EU referendum.

It appears they are the ones blocking the vote (or even a compromise) in the Commons on this very matter.

The hypocrisy is a sad reflection of a party that has been exposed by being in government as having no core values at all.

Shame on Hamas - Gilad Shalit looks like a Ghost

Gilad Shalit (released today after five years in captivity - for 1000 prisoners) looks like a ghost. I know a sick person when I see one - I'm a doctor. I can spot them on the other side of the room usually quite easily. He was also like a rabbit in the headlights. What he has been through is something I can't bear to think about. Denied Red Cross visits, denied any human rights.

Contrast that to the suicide bombers who were released today - looking pretty healthy, and having had all the human rights the rule of a democratic state has given them.

I'm sorry - whatever your views on Israel and Palestine - this is unforgivable barbarity. Please can we hear the voice of the ordinary Palestinian people saying "not in my name, there is no excuse for doing this to an innocent boy of 19" (he was only 19 when captured five years ago.

And don't come back with relativist arguments - just because the other side might not be perfect is not a reason to do this to an innocent young boy. Full stop.

PS - quote from Wiki says it all:

At the start of the Gaza War, Hamas claimed that Shalit had been wounded by Israeli fire. On 11 January 2009, Abu Marzuk, Deputy Chief of the Hamas Political Ministry, told the London-based Arabic daily Al-Hayat that:

"Shalit may have been wounded, and he may not have been. The subject no longer interests us. We are not interested in his well-being at all, and we are not giving him any special guard since he is as good as a cat or less."

Says it all, doesn't it?

Red Ed's Really Red

Ed Miliband's speech to the Labour party conference was naive and uninspiring.

One thing I think it did confirm to all of us however, is that he harks back to a time before 1979 - when the country was the sick man of Europe, when the unions led to the winter of discontent, when the Great really had been taken out of Britain.

When I come across neo-communists like him (and let's face it, he learnt from his immensely rich Marxist father), I cannot ever understand whether they are aware that the poor are poorer in real terms in countries that redistribute so much that the rich's pips are squeezed so that they explode or leave. Is he just stupid and believe that this won't happen, or does he think poverty for all is a price worth paying for pay equality?

As Winston Churchill said: "The inherent vice of capitalism is the unequal sharing of blessings; the inherent virtue of socialism is the equal sharing of miseries".

Complain to Sky News Now

The "inside story" from rioters running on Sky News betrays the socialist views of the reporter. I can just about cope with that, but stark misinformation is not acceptable.

I just heard the reporter say (at the end of the 7:30 news round) that they were upset about the rise in tuition fees. He implied these kids being interviewed (one a 16 year old father and some saying their mums are on benefits) would be put off of considering university because of tuition fees.

LET'S GET THIS VERY CLEAR - THESE KIDS WOULD GET FREE TUITION AND EVEN A GRANT. Also no-one has to pay back a loan/ tuition fees if they don't reach £21,000 earnings (rising with inflation). It is the kids of the middle class that will have to pay.

Get your facts right, Mr Biased Sky News Reporter.

You can complain here - http://news.sky.com/home/static-pages/feedback