NHS Together recognises that considerable progress has been made in improving and modernising the NHS in recent years. We welcome the focus on quality and innovation in the Darzi Review and its vision for NHS services over the next decade, particularly the commitment to ensuring a high quality workforce. Also, the pledges in the NHS Constitution emphasise the importance of staff, patient and community engagement. In this regard, there has been a marked improvement in staff consultation and the principle of union involvement in policy development.
However, the TUC and health unions are alarmed at certain policy initiatives which threaten to derail these largely positive developments. We have identified certain market-based reforms, such as the Transforming Community Services initiative, which will not only lead to damaging fragmentation of the NHS, but will be hugely wasteful. The economic recession and its attendant pressures on public spending also threaten to undermine the progress made in recent years, with job security, training and staff engagement all potential casualties where NHS organisations take cost-cutting measures.
The recent massive show of public solidarity to defend the NHS against misinformed attacks from America demonstrates how important it is that the NHS remains public.
Transforming Community Services
The government's Transforming Community Services (TCS) policy places an explicit emphasis on competition and contestability, and a clear signal that Primary Care Trusts must look beyond the direct provision of health care services in favour of external / private providers. We believe that this fragmented approach to delivering services will be to the detriment of patient care, as the continued dismantling of a joined-up health service undermines the public's faith in the NHS.
The TUC, health unions and many academics and commentators believe that in-house services are best placed to provide integrated care, backed up by the necessary training and development required for high quality services. In particular, public health and preventative health strategies can be delivered more efficiently and effectively within the NHS, rather than through a multiplicity of providers - the current flu pandemic being a prime example of the need for a coherent approach to safeguarding public health.
Commercial Operating Model
The government's market reforms seek to impose commercial values on the NHS so that competition is prioritised over co-operation and the need for sustainability and integrated pathways of care. Private sector involvement in the NHS is being presented as both inevitable and of unquestionable benefit. There is no evidence that competition leads to better public services. The best way to improve services lies with service reviews, partnership working and greater collaboration between commissioners and providers. There are currently too few incentives to promote joint working in the planning and delivery of healthcare. We need to ensure that in-house NHS bids to provide services are able to compete on an equal footing with private providers.
Public spending and efficiency savings
We understand that with the current economic crisis, public spending is under acute pressure. The health unions are committed to working with the Department of Health to find ways of boosting productivity and performance, while providing value for money. Service redesign, rather than change of provider may often be the best approach and it is vital that staff and unions are fully involved and consulted on any new health care programmes. Short-term pressures to cut costs must not be allowed to affect the long-term viability of the NHS. Trade unions have a great deal of experience of employers that prefer to cut services, jobs and training budgets rather than work in partnership with staff and unions to find constructive solutions. This was particularly the case during 2006 when the NHS was in deficit.
Substantial savings could be made from the abolition of market reforms. Billions of pounds a year are allocated to the transaction costs of the market, through duplicated management structures, tendering, billing, invoicing and contract management. The creation of the new commercial support units as part of the commercial operating model itself will cost taxpayers an extra £20 million. No less than £350 million was spent in the last financial year on management consultants. With no evidence of whether this delivers value for money, or helps improve patient care, it is impossible to defend.
An alternative direction
The TUC and the NHS Together trade unions believe that a change of direction is necessary to secure the future of the NHS and to guard against it being undermined by the increasing involvement of the private sector. We have identified a number of measures that are necessary. These include limiting independent sector involvement in the NHS and an explicit statement from the Department of Health of its preference that services should stay within the NHS. We want sufficient time and support given to service reviews and service improvement as an alternative to market testing, and for the NHS to be given the first opportunity to develop new services. PCTs and Trusts must demonstrate partnership working on implementing measures to achieve quality, innovation and productivity, and to fulfil the rights and pledges contained within the NHS Constitution. We want an assurance that staff training budgets will be protected; and we want a full evaluation of external management consultants on whether they provide value for money. We are calling on the Government to work with us in partnership to put the necessary changes in place.
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