NHS "right to request": privatisation by another name

Submitted by Matthew on 5 March, 2010 - 4:34 Author: Johnnie Byrne (personal capacity)

Probably the most insidious threat facing the National Health Service is the “right to request”. Enshrined in the High Quality Care For All: NHS Next Stage Review Final Report of June 2008, it allows groups of frontline health professionals “the freedom to use their talents to find innovative ways to improve quality of care for patients” — by taking their services out of the NHS. We are now seeing the effects of that reform in Kingston, south London.

The “right to request” is a development of the Thatcher government's internal market. Primary care trusts (PCTs) are now supposed to separate commissioning and provision of services. And groups of PCT community specialists — health visitors, therapists, district and school nurses and the like — are being encouraged to set up social enterprise companies, outside the NHS, to run their services themselves. The PCT remains as the commissioning body and “buys back” the provision from the clinicians.

Let’s be clear: a social enterprise is a private — though not-for-profit — company. Any surplus is ploughed back into services. The company has some protection, at least in its initial contract. After that, who knows?

Contracts generally run for three years but can be for five. However, in the latter model, a percentage of the work has to be “market-tested” or “retendered”. The community is “represented” on the board of the company — by non-elected individuals. It is no substitute for democratic public control.

NHS Kingston, Kingston’s PCT, is on the point of setting up just such a company, Your Healthcare, due to start trading on 1 April 2010 with a five-year contract.

The local Labour Party and Trades Council first heard of the plan last September from anxious members of the union Unite, and agreed to run a joint campaign against it. We are now in the process of setting up a branch of “Keep Our NHS Public”, in the first instance to prevent this break-up, then to tackle the many other problems facing health provision locally.

The initiative for a social enterprise is supposed to come from the workers. In the case of Kingston, the request seems to have been pushed by managers, brought in specially for the purpose. Workers are too scared to speak openly against it, but many don’t want to leave the NHS.

Although their employment conditions will have the theoretical protection of TUPE regulations, their pensions won’t. They have been given assurances that they can take their NHS pensions with them — but they won’t be able to bring them back should they seek to return to the NHS. NHS Kingston has refused to hold a staff ballot and have refused any public consultation.

In order to create a surplus and be financially viable, Your Healthcare intents implementing “cost improvement plans”. We fear this is a euphemism for cuts. The Company’s business plan mentions that recruitment, to replace the expected 10% turnover, will be from outside the NHS or from the lower grades of the NHS. This will surely have an immediate effect on the level of professional expertise available to the local community.

The Kingston project is a pilot for the rest of London, and perhaps nationally.

One could argue that social enterprise might have a place in helping people with innovative ideas for combatting unemployment — not in running the basic public service infrastructure of the country.

Why should any small group of individuals, be they ever so professional, well-intentioned and enthusiastic, have the right to destroy our National Health Service?

• Johnnie Byrne is Secretary of Kingston Labour Party

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