Tender sticks

Philip HuntPhil Hunt on the pressure now being put on GPs by the Coalition’s drive to marketise the NHS

The enactment of the 2012 Health and Social Care Bill was one of the most fought over and controversial pieces of legislation in the 65 years of the NHS. Labour constantly raised concerns that the Bill had as its core purpose the forcing of competition into every part of the NHS, without offering any evidence on the benefits. And also that the Bill risked both the fragmentation of core activities and private sector cherry-picking, in turn threatening the viability of more complex, expensive services. 

We were also very worried about the huge costs involved in the restructuring – an initial £3bn, with the continuing costs of the inevitable bureaucracy involved in the marketising and tendering out of services. All of this at a time when a record number of NHS Trusts were piling up financial deficits. 

In Parliament, Ministers could not have been clearer. They said that Clinical Commissioning Groups would not be forced to put services out to competition. They also claimed that a fundamental principle of the Bill was that it would be commissioners, not the Secretary of State nor the regulators, who should decide when and how competition should be used to serve patients interests. 

But the reality is so different. Pulse magazine recently reported that since April, over 63 % of contracts to provide NHS services had been put out to tender. When challenged on why many CCGs have done this, the GP-run organisations said that they had been advised that they had no option because of what was contained in Section 75 of the Act – something that essentially enforces a competitive market on the health service. Meanwhile, the deputy Chair of the BMA's GP Committee has recently said that CCGs are concerned about competition law and feared being challenged by large corporations in the courts. 

So much time and energy will now have to be devoted to the tendering process, when it would be better used on improving services. The costs of legal advice and the legions of accountants involved are already mounting up, with consultancy firms rubbing their hands at the rich pickings on offer. 

Some of the key players in the new system are already taking fright. David Bennett, chief executive of the regulator, Monitor has said it would be mad to enforce competition regulations in a way that leaves commissioners spending all their time running competitive processes because they are terrified of getting into trouble if they don't. 

But that is the reality of what is now happening. The government needs to stand by its assurances to Parliament and put a stop to this nonsense. Otherwise the NHS will devote itself to an ever more wasteful tendering bureaucracy at the expense of patient services. 

Lord Phil Hunt of Kings Heath is a Shadow Health Minister and Labour’s Deputy Leader in the Lords

Published 9th October 2013

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