Privatising NHS cancer and palliative care at patients’ expense

By Savi Hensman

March 25, 2015

Controversy over the biggest NHS privatisation deal so far has intensified after details were leaked. £1.2 billion worth of cancer and end-of-life services in Staffordshire may be handed to a private firm to manage.

A single organisation is to be put in charge of spending £700 million on cancer and another “prime provider” handed £500 million for end-of-life care, work usually done by NHS commissioners. The successful bidder can sub-contract some or all of the work and take a cut.

If the transfer goes ahead, other such deals may follow. Indeed, those in charge of healthcare may have no choice. New regulations tabled in Parliament indicate that from April 2016, NHS contracts worth over £625,000 will have to be put out to tender.

However, the publication of a secret memorandum of information in Open Democracy, setting out what is required of the successful bidder for cancer services, has caused alarm. This provides “no more than a blank cheque for whichever private firm is most ruthlessly willing to cut costs to shore up their own profits”, according to John Lister of Health Emergency.

While two NHS organisations are among the shortlisted bidders, private contractors are in the running to take over key services for a 10 year period. They include a subsidiary of United Health (former employer of NHS England chief executive Simon Stevens), Virgin Care and Interserve Investments (chaired by Conservative peer Lord Blackwell, a former Downing Street policy advisor).

The memorandum was leaked to Kate Godfrey, Labour candidate for Stafford. Ordinarily, tender documents state exactly what is expected of bidders. However in this case, details are to be negotiated during a two-year handover. This will allow the winning firm considerable scope to set its own quality standards and targets.

The leaked document, setting out alarmingly vague expectations, can be read here

(In contrast, the 2015–16 National Health Visiting Core Service Specification is an example of how commissioners usually try to make sure that local patients get the care they need.)

Not surprisingly, some local people are vigorously opposing the plans. For example, Gail Gregory’s terminally ill mother was cared for in Staffordshire Hospital’s specialist cancer unit, which later saved her husband’s life. “This sell-off was agreed by stealth, with a sham consultation. If it goes through, we’ll be locked in for 10 years – with no way out, even if the standards of care fall,” she wrote in a blog for 38 Degrees. “We can’t let Staffordshire blaze a trail for privatisation.”

There are perhaps three main ways in which the successful bidder could increase their profit from the deal. The first would be to reduce either the number of hours or quality of care to patients, for instance through less skilled staff being employed. This might involve paying less money per patient to current providers such as hospitals and hospices and/or bringing in cheap if inexpert firms for some tasks.

For example, less qualified staff might carry out scans, or patients and their families or be expected to take on tasks now done by nurses or healthcare assistants. The memorandum states that “where clinically appropriate”, cancer patients should “be able to self-manage or to receive supported management of their condition at home.”

The second way would be to bar some patients from treatment by setting a higher threshold, though this would be controversial. For example chemotherapy or surgery could be refused to some people who would previously have received this.

The third way, which might get less media coverage and be harder to challenge legally, would be to persuade more people with cancer to agree not to undergo expensive treatment. Patients already have a right to turn down treatments which they do not want because, to them, the drawbacks (such as fatigue) outweigh the advantages. However it would be gravely wrong if, for commercial rather than clinical motives, patients were put under pressure to agree not to carry on being treated.

The Staffordshire and other such deals involve a heavy human – and sometimes financial – cost for patients and carers. Some households may end up paying privately for care which would previously have been free, quickly swallowing up modest pay rises and savings.

It has been widely pointed out that many private health firms have close links to politicians. However there are also strong ideological motives behind the drive to privatise.

Some supporters of privatisation are genuinely convinced that large corporations are almost always better and more efficient than the NHS, despite all evidence to the contrary. They ignore disastrous failures in care quality by firms such as Circle, which is withdrawing from running Hinchingbrooke Hospital, and international research by the Commonwealth Fund and others which show that the NHS far outperforms the expensive, and largely private, US health system.

Others seem to have a skewed moral belief that those with great wealth are thus deserving of receiving yet more, even if this is at the expense of others. If a retired former clerk or cleaner is left in agony so that a multi-millionaire can afford an extra yacht, some people may not realise that this is problematic.

Ultimately, NHS privatisation, though benefiting a few, comes at a heavy cost to many, and raises serious concerns about society’s values.

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© Savitri Hensman is a widely published Christian commentator on politics, welfare, religion and more. An Ekklesia associate, she works in the equalities and care sector.