5. What place for private companies?
Inner North Central London Branch
(MFD) That this meeting of RCN Congress discusses the increasing role of private companies in both the commissioning and delivery of NHS services as a consequence of health and social care reforms
Debate report
This matter for discussion, proposed by the Inner North Central London Branch, generated a range of opinions from delegates. Dominic Walsh from the proposing branch asked “if adding additional complexity into our system would ultimately slow care down?” He was particularly worried about the role of private providers in commissioning.
Mike Travis stated NHS care is “free at the point of delivery” and that private providers were there “for profit, not for the good of society.” Debra Nicholson, Greater Bristol branch spoke from personal experience saying that she used to share best practice but now with private providers, information is classed as ‘business sensitive’ and this is having an impact on patient care.
Some members said they are scared of the role that the private sector will have in the future of the NHS due to conflicts of interest, and that decisions are being made on the cheapest tariff. However Jason Warriner, Public Health Forum stated that with private or third sector providers you get autonomy and power and urged Congress “not to judge all of us by a few organisations”.
There was a call for unity from Neil Thompson, who said that we need the voluntary and private sectors, and the NHS to deliver the best possible patient care, while Gerry Bolger talked about the need for a balance in how private providers support the NHS and that the most important aspect is that the patient gets the right care.
Background
The UK is facing an unprecedented challenge in relation to the delivery of quality health and social care services while simultaneously tackling debt, and meeting rising health and social needs. This has led to a discussion on whether different models of provision enabled by ‘smarter’ commissioning (involving the essential tasks of needs assessment, planning and managing providers - applicable to all UK health care systems regardless of whether ‘commissioning’ is in operation or not) could meet the challenge.
The discussion has included a debate on the role of not-for-profit and commercial organisations, and recent examples of failures in care have raised concerns about the implications of ‘putting profit before care’. These include Southern Cross Care Homes, where a commercial provider became financially unsustainable; Mid Staffordshire NHS Foundation Trust, where failure in care resulted following a strong focus on finances; and Winterbourne View Care Home, where a commercial provider failed to safeguard residents.
In Northern Ireland, there is limited private health care and no private involvement in commissioning, but concerns have been raised when commercial providers have been used in waiting list initiatives. In Wales, the Welsh Government believes NHS care should be state provided and while there is occasional pragmatic use of the private sector, it is a point of policy to avoid using the private sector. Similarly, in Scotland the Government is committed to the NHS as a publicly funded and publicly delivered service.
However, England is a much more plural market in terms of both provision and commissioning. Proposed changes to legislation may encourage a yet more diverse set of providers and commissioners; foundation trusts may be able to raise income from private patients while more local level organisations may become commissioners, drawing on outside expertise to help them in this role. This has led to concerns being raised in relation to the fragmentation of services, and a ‘race to the bottom’ if price competition is introduced.
RCN is not ideologically opposed to the role of the private and independent sector in delivering health services and over a quarter of our members work outside the NHS. However the RCN is firmly committed to the principles and values of the NHS and believes reforms to the delivery and commissioning of healthcare must be entirely consistent with these.
However, the RCN is clear on the point that all such decisions should be guided by quality of care for patients and that there should be appropriate checks and balances in place – with effective regulation and early intervention being key - for whoever provides this care in the NHS.
References and further reading
Royal College of Nursing (2010) Policy briefing 07/2010: competition in the NHS in England, London: RCN. Available to download (accessed 5/3/12).
Royal College of Nursing (2010) Policy briefing 1/2010: the Independent Sector in Health and Social Care in England in 2009 and Prospects for the Future, London: RCN. Available to download (accessed 5/3/12).
