Feature

Why we’d rather go public

Though it admits competitive tendering has failed, New Labour still seems to believe in private health care, says Steven Weeks

Unison welcomes the recent recognition by the government that compulsory competitive tendering has had destructive effects on the quality of services in the NHS. Health secretary Alan Milburn told the Labour Party conference that compulsory competitive tendering had been ‘a failure’, with adverse effects on quality and on staff. We agree – and have long argued for it to be scrapped.

Alan Milburn also announced that a new policy – to be known as Better Value for Patients – would be introduced this year, to be based on the principles of ‘Best Value’ already familiar to local government. It will include benchmarking NHS costs against average performance and, in some circumstances, going out to tender – for example, where services are not meeting the output specification or are failing quality targets. Cost should not be the only criterion for award of contracts. In addition, the new policy will also allow contracted-out services to be returned in-house where there are problems with quality. There have been a few examples of this already. Forexample, at Pinderfields Hospital in Yorkshire, the local Unison branch successfully negotiated for a contract operated by Initial to be returned in-house. We will be arguing that this should happen in all contracted out services.

Unison welcomes the new approach and believes that there should be fairer approaches to benchmarking. In particular, contracted-out services should not be used to set a price against which the NHS must then compete. We believe that NHS services are best provided by NHS staff.

The government has proposed that there should be national cleaning standards for the NHS, and a national franchise has been proposed for catering. The National Plan also sets out proposals for nursing staff – so-called ‘modern matrons’ – to have day-to-day responsibility for ward cleaning. The new emphasis on quality in support services and the announcement of new investment in training for support workers are both welcome, and we are working to help these initiatives succeed through our ‘Return to Learn’ programme. But all these positive developments will be lost if there is continuing contracting-out of support staff. Despite TUPE protection, staff affected by contracting-out suffer as a result, and new staff tend to be employed on poorer terms. They no longer feel part of the team and are excluded from NHS employment initiatives. We believe that all health staff have a essential role to play in the health team.

Despite mounting evidence of problems and higher long-term costs, the government continues with its PFI programme. In June 1999, the government announced that in future staff would no longer have to be included in PFI schemes, but in practice only one large-scale scheme has been advertised without staff being included (Blackburn Royal Infirmary). Current rules are loaded toward inclusion of services, and we are pressing for the exclusion of staff from all schemes. Unison is currently involved in a long running strike at the Dudley Group of Hospitals to prevent staff transfer. But if staff are transferred, the new staff should be on NHS terms and should benefit from NHS pension rights.

Recent press reports suggested that the Institute for Public Policy Research working group on the NHS would recommend an extension of PFI to clinical services, although both the IPPR and the government have denied this. Given that the PFI has failed to deliver the promised benefits so far, Unison remains strongly opposed to any extension of PFI.

In the recently announced ‘concordat’ with the private sector, the government set out plans for a new relationship between the NHS and the private sector – and, in particular, national arrangements to use private sector capacity to treat NHS patients in order to meet waiting list targets. We would argue that this is only acceptable as a short-term measure while NHS capacity is increased. The concordat also encourages authorities and trusts to enter into partnerships with the private sector for other types of care, such as critical care and mental health, and in the longer term, trusts will be able to commission care directly from the private sector. Unison is strongly opposed to this reinvention of the market in health services and we will continue to argue for services to be commissioned from within the public sector, working, where necessary, alongside the voluntary sector.

In the NHS Plan, the government also announced more beds for ‘intermediate care’ (post-hospital support outside of patients homes, such as respite beds), and it clearly believes the private sector should provide many of these beds. But we believe that the NHS (and local authorities), with a strong track record of intermediate care schemes, are better placed to provide such services. Nursing home operators are not well suited to develop this type of provision and we will be campaigning to prevent contracting-out of this area of care. Long term care of the elderly has already been privatised – intermediate care must not be.

Unison has launched a ‘Positively Public’ campaign to argue for the direct provision of public services. We recently carried out an opinion poll which showed 68 per cent of the public agree with this approach. All the experience of the last 20 years confirms that direct public provision is essential to ensure accountability, enhance quality and protect staff.

Positively Public Campaign: for more details, contact s.weeks@unison.co.uk.