As the slicing and dicing of Foundation Trusts and their services intensifies, Maxine Vaccine takes a look at the commercial future of the NHS brand.
This week, the NHS news has been dominated by the struggles of NHS trusts to achieve Foundation Trust status.
Firstly, the shutdowns. South London Healthcare NHS Trust went into administration after running up deficits of more than £150m. Mid Yorkshire Hospitals NHS Trust said it was considering service closure options after seeing its deficit soar from £19.2m to £44.2m in a year. NHS North of England declared it would delete inpatient surgery and A&E services from Trafford General Hospital, the ‘birthplace of the NHS’.
Secondly, the bailouts. Andrew Lansley told Parliament that the £19m owed by NHS North Yorkshire and York would be written off to enable the new CCGs to commence doing business without legacy debts. A National Audit Office report revealed that NHS trusts have received bailouts totalling more than £1bn over the past six years. In 2010–11, the DH paid out £76m to help ailing trusts manage their deficits. In 2011–2, the figure rose to £253m. The NAO predicts that next year it will reach half a billion.
On the one hand, the Government is willing to shut down services in order to ensure that hospitals behave more like businesses. On the other hand, it’s willing to prop them up with public money if that helps them to creep through the Foundation Trust gates. The priority is neither saving money nor maintaining services: the priority is making sure that NHS Trusts disappear from the landscape.
Another clue to what is taking place can be found in the recent statement by Health Education England that it will allow commissioners to create flexible workforces that meet their own local needs. This followed an earlier statement that it would put healthcare employers “in the driving seat” to create a “demand-led workforce”. Don’t be misled by the word ‘flexible’. Of course clinicians need to be flexible – that’s not the issue. What HEE is promising is that terms and conditions, job definitions and professional grades will be flexible depending on the local employer. In other words, the NHS will no longer have a national employment framework.
What these changes are all about is grooming the NHS for private sector takeovers at a local level – the kind illustrated by this week’s announcement that Virgin Care will be running children’s health and social care in Devon for the next three years. Branson’s company declared its one-year experience of working with charity Kids’ Company means it is fully equipped to provide core NHS services to the young.
National agreements, like legacy debts, would be off-putting to potential franchisers. What they want is lucrative services, straightforward tenders, no headaches. That’s exactly what the Government is making sure they find when they come to the NHS. But what will drive the takeovers? As the Devon contract illustrates, it’s not that NHS providers cannot offer the same services. It’s the power of healthcare corporations like Virgin Care, Circle and Serco to achieve economies of scale and to drive down costs by imposing the terms and conditions of private sector employment.
And no, Andrew Lansley wasn’t lying when he said the Government wasn’t planning to sell the NHS. At the local level, the level of CCGs and Foundation Trusts, the NHS is selling itself. All the Government did was slice it up, wrap it in plastic and put it on the shelf. If companies then come along and buy it, that’s purely a local decision.
Key account managers in the pharma industry need to find out everything about the private health providers who are bidding for segments of the NHS brand. The future of UK healthcare belongs to them.
Maxine’s views are not necessarily those of Pharmaceutical Field.