The claim
“What they are proposing is…commissioning, not simply being done by an accountable organisation, but potentially being done by the private sector. And I think that is a very, very dangerous situation.”
Ed Miliband MP, Q&A session following a speech on NHS reform, April 4, 2011
The background
Today was a bit of a gift for Ed Miliband. The Government’s shake-up of the NHS stalled amid rumours of a policy rethink – with the launch of a “listening exercise” to iron out NHS reforms for an increasingly unconvinced public.
The Government’s planned reforms would abolish Primary Care Trusts, which currently commission services – and hand 80 per cent of the NHS budget to consortia of GPs.
But the horse has already bolted – the Bill is on its way through parliament – so the prospect of a delay has left patients and doctors “totally confused”.
Mr Miliband wasted no time in zinging into attack mode, slamming the government for a “bad Bill, built on bad assumptions and dangerous ideology” – that has now descended into “utter confusion and chaos”.
The analysis
Most of the hard work had been done for Mr Miliband – with even Downing Street admitting: “There is a job to be done in convincing people of these reforms”.
Feeling generous then, Mr Miliband conceded that “not all Labour reforms worked” – listing some NHS failures such as GP contract changes and the frequent reorganisation of Primary Care Trusts.
But he argued that overall, Labour’s reforms over the last decade worked – particularly with regard to cutting waiting times.
The Government’s reform proposals threaten these achievements, he said, because GPs will find themselves under a mound of paperwork for which they don’t have time for. This will force GPs to farm out the decisions not to accountable organisations but to private companies, Mr Miliband argues (see claim above).
“So actually decisions about what you get in a local area go to the GPs and the GPs who don’t particularly want to be doing it making a private company do it,” he adds.
All of which sounds rather Wild Wild West; that private companies will take over the commissions and that they won’t be held accountable.
Firstly, private companies will not have the power to commission services for the NHS. The only people able to sign contracts will be the GP consortia.
They can hire a private company to consult – to do the number crunching and advise them on a decision. But ultimately, the buck stops with the GP consortia.
As the Kings Fund, an independent healthcare think-tank, told FactCheck: “A private company would be held accountable by the GP consortia. So the consortia aren’t passing responsibility for the quality of care for patients to external providers (private or otherwise) – they would still be held to account.”
Meanwhile the Nuffield Trust pointed out that historically, fears surrounding the involvement of private companies have been “overblown”.
A spokesman told FactCheck: “The barriers on entering the NHS market are very high.”
Indeed, as Mr Miliband himself pointed out today, only three per cent of elective care is currently provided by the private sector.
Michael Fallon, deputy chairman of the Conservative party, told FactCheck: “This kind of scaremongering has sadly become the stock Labour line in the absence of any sense of what they would actually do when it comes to the NHS – other than spend less and keep things the same.
“He is either deliberately misleading the public or he just, plain doesn’t know what he is talking about. Either way, the public deserve more from the Leader of the Opposition.”
The verdict
Looking at the state of the Government’s NHS Reform Bill this morning, Mr Miliband’s prescription was unsurprisingly bleak.
The NHS is the “jewel in Britain’s crown”, said the Labour leader, and it’s about to be ruined by competition – GPs who are too tired to do the job themselves will hire private consultants to carve up the NHS budget for them. And these guys won’t be held accountable.
Well, the competition issue is another FactCheck (read it here) – Mr Miliband should have quit while he was ahead.
What FactCheck found harder to swallow was the rest. While exactly how these GP consortia will operate is still up in the air, what has been made clear is that they are the only ones that can sign commissions.
And if they hire private companies to help with the number crunching, those companies are held accountable by the GP consortia.
Not quite as “dangerous” a situation then as Mr Miliband predicts.
And all this, from the party that opened the hospital door to the private sector.
By Emma Thelwell
