Feature

Stemming the ‘second wave’

Government efforts to extend privatisation to NHS labs should be vigorously resisted, says John Chowcat

The UK’s largest health authority, Greater Glasgow health board, shocked NHS staff across the country last autumn with its sudden announcement of plans to privatise all its medical laboratory services, substantial components of its X-ray departments and all its hospital pharmacies.

The impact was all the greater given the way the news surfaced. Earlier promises of full consultation with staff interests were simply ignored. Instead, formal invitations to the private corporations to tender for these key services were placed in the official gazette of the European Community.

Following the disturbing saga of NHS ancillary services suffering privatisation and frequently deteriorating quality in England and Wales since 1983, it was now clear that Scotland was the government’s chosen base for launching the “second wave”, extending competitive tendering to clinical support services on which the lives and health of many patients depend. Bad food in a privatised hospital canteen can disrupt a patient’s recovery, but a mistake in a laboratory blood-matching can kill.

Clues relating to this planned widening of the privatisation process had been emerging for some time. In March 1987, an indiscreet Wirral health authority document listed pathology among services to be opened to competitive tendering, adding “this is part of a process to be implemented throughout the NHS... there is no discretion for individual authorities to ‘opt out’ of examining the feasibility of seeking competitive tenders”.

Later that year, John Moore, then health secretary, confirmed to the Royal College of Pathologists in careful ministerial language: “It is the case that we encourage individual health authorities to consider the possibilities for securing greater cost effectiveness in the provision of all NHS services... (they could) take the view that the objective could be further advanced by changes in the way in which their pathology services are provided”.

So it was not a total surprise when the white paper Working for patients included in paragraph 9.12 an open invitation to health authorities to extend competitive tendering “beyond the non clinical support services which have formed the bulk of tendering so far”. Glasgow, with few Conservative parliamentary seats to lose, is obviously the first testing bed, with other Scottish boards set follow speedily. The Ayrshire and Arran health board has reported to the Scottish Home and Health Department on hospital pharmaceutical services, referring to “discussion with representatives of leading UK pharmaceutical companies” and describing “clear evidence of an interest within the private sector tendering”.

However, organised opposition to the “second wave” became apparent at an early stage. MSF, as the main union representing staff in the threatened departments, found its criticisms widely shared across a range of local organisations inside and outside the health service, ranging from the Scottish BMA to patients’ and users’ groups.

Under this pressure Greater Glasgow health board declared that its formal invitations to tender had only been designed to “test the waters” of private sector interest and that privatisation was not yet definite policy.

A series of internal studies of the various services involved were then initiated by management. Finally, severe but in-house rationalisation programmes were announced for Glasgow medical laboratories, with the competitive tendering proposals now officially “placed on the back burner”.

Once again resistance was considerable. The Scottish press has widely reported staff concerns that the move to concentrate laboratory services at two main acute hospitals could put patients at serious risk.

For example, surgeons conducting operations in other hospitals would have to wait for the results of urgent tests on frozen sections while vans carried the specimens on half hour journeys to and from the newly centralised laboratories. Traditionally, such results are available within minutes from laboratories located inside the same hospital premises, enabling the surgeons to continue their work almost immediately.

Nor was the morale of the health board management assisted by leaking of a secret report from consultants Peak Marwick McLintock, which confirmed that private contracting would reduce quality control and generate insufficient laboratory material for research and development. The “second wave” has met with a very shaky start.

Elsewhere in the UK, clinical support staff of the same type are being encouraged to become involved with local “income generation” proposals. Again, however, NHS professionals are waking up to the dangers. Even a group of management consultants, writing in the NHS Management Bulletin of August 1989 on private European laboratory companies wishing to move into the NHS market, admitted: “It is becoming clear that NHS laboratories are not well equipped to respond to this competitive onslaught, lacking the commercial skills necessary to develop and market their services.”

MSF has publicly warned its laboratory membership around the country that, where joint ventures with NHS laboratories are proposed: “The private companies may well be more concerned with obtaining inside information on local NHS laboratories, equipment and staff in order to prepare their bids for taking over these services when competitive tendering becomes more widespread.”

More and more questions are being raised about the health and safety, quality control, research and staff training implications of becoming involved in such projects.

The non-medical health professions are beginning, at last to move together in defence of clinical support services and the NHS patients who benefit from them. It is this development that, more than any other, could stem the “second wave” of privatisation once and for all.