Welcome to the two tier NHS

How long will it be before the Conservative’s plans for the NHS turn it into a two tier system?

No time at all seems to be the implication of the news that Care UK has won the contract to provide health care to prisoners in the North East.  Which is fine except that the NHS bid was better on every single metric except one – price.

So, the long and short of it is that prisoners are to get a second class service and price trumps all other considerations.

Will this survive a determined political and/or legal challenge?   I don’t know but even if such a challenge emerges and is successful, I suspect that all that would happen is that such decisions would be driven underground while preserving some fig-leaf of transparency and accountability.   Will savings be due to genuine efficiency gains made while preserving or improving services or only down to surreptitious cost-cutting to provide a lesser service with no efficiency gains?  And how will anyone outside the system ever know which is which?

The Coalition likes to foster the impression that the NHS will be safe in the hands of people like the GPs that we all know and trust.   But will it?   That trust derives in large part from GPs being on the patients’ side, a medical but not a financial gatekeeper – our guide into the labyrinth of the NHS.   Most of us are in no position to exercise knowledgable “choice” so we rely on our GPs for good and unconflicted advice.   But if the Conservatives are following the sort of salami strategy they’ve used before, then it’s only a matter of time before targets for cost savings are added to the mix.  They will presumably be spun as “efficiency targets” or some such, but either way GPs will be forced to choose – good advice or higher pay.

Moreover, it’s unlikely to be your friendly GP that’s calling the shots.   It’s a pretty safe bet that established firms like Care UK will be quicker off the block to elbow themselves into pole position in the Conservative’s new system than the average group of GPs in a busy practice (a process possibly helped along by a few strategic donations).   As their homepage explains they are, “… a leading independent provider of health care and social services. … These services include the operation of NHS walk-in centres, GP surgeries and treatment centres …”.    And the prize is huge, nothing less than substantial influence over the direction of a big slice of government spending; someone is going to get very, very rich on the back of this but it’s hard to see that the quality of care will increase.

Bottom line; market, or more accurately faux-market structures are just don’t have the universal applicability of Conservative fantasy, and are certainly not suitable in health care.

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