This discussion paper was presented to the the Socialist Health Association Central Council November 2013 but not considered. It is not agreed policy. This is a revised version.
This set of principles is founded on the presumption that the SoS has ultimate powers of direction over providers of NHS services and that Part 3 of the H&SC Act is repealed.
There should be no support or any form of incentive for privately provided care, through tax allowances or any form of subsidy. There must be strong professional guidance about the circumstances when non NHS provided health care options should be offered and proper independent expert advice available to all care users on their rights and options (including, where appropriate, advocacy).
Private Medical Practice
The NHS should continue to be a provider of privately funded health care where this can bring benefits to the NHS. There must however be proper guidance over separation of accounting to ensure transparency.
All Trusts must report in their accounts the level of income and expenditure from private patient activity in a prescribed manner which would cover income through Joint Ventures and similar organisational devises. The calculation of expenditure on private patients must include a contribution for the NHS costs in training the staff involved and the finance costs of the equipment used. In addition, the “profit” derived from treating private patients must be greater than the “surplus” which would have arisen from treating NHS patients with similar conditions.
Any plans by an NHS provider to significantly change the level of private patient activity must be consulted upon and supported by appropriate HWBs and (if there is one) the Governing Body.
Private Provision of NHS Funded Healthcare
Healthcare must remain a predominantly publicly delivered service, and the public provision of social care should be strongly supported. All providers of care must comply with minimum standards around workforce terms and conditions, training, development and supervision as well as quality standards.
Commissioners/planners should review all care services on a regular basis and include in that consideration proper engagement with service users. Reviews should be published. Where they are satisfied that the service provided is appropriate they should support it (preferred provider). Any proposed change to care services should be examined also for its wider impact on other services – a whole system test.
Where a service from the current provider cannot be improved to the required quality standard or where a new service is required which is currently not provided then competitive procurement including private providers may be used. Organising a new service through supporting development of current NHS providers would also have to be considered.
Commissioners and the HWB must ensure that all providers of NHS care have public and patient involvement embedded in their governance.
It is unlikely that any service will be procured using a contracting arrangement unless:-
- the service is largely independent of other services
- the quality requirement can be properly specified in a legal contract
- there are already a number of recognised providers of such a service.
The national procurement regime (as permitted under EU Public Procurement Directive) for care services should ensure that there is no compulsory competitive tendering (old EU Part B services).
There should be a test of suitability applied to prospective private care providers applied through continuing registration conditions or through contracting. Major changes in capitation (for example) could enable contracts to be terminated.
The relationship between commissioners/planners and public providers should be through “NHS Contracts” which are not legally enforceable but rather subject to arbitration.
Where a public body has a legal contract with a private provider that contract must ensure full openness and transparency – with no “commercial confidentiality” outside the actual procurement process. FoI would apply to such providers. Contracts and procurement requirements should specify ability to ensure continuity of care (which might include some financial bond being required) and knowledge of local conditions and services and populations would be an essential condition.
The price paid for services to any non public providers should be the same or consistent with the price that would have been paid to a public provider for the same service.