Unions have rounded on government plans to extend patient choice to community and mental health services from next April, amid fears that the plans will green-light widespread privatisation in the NHS.
Department of Health guidance issued yesterday sets out a timetable to ensure that patients will be able to choose from a range of independent, voluntary, or third sector providers who meet NHS quality, prices and contracts (Any Qualified Provider) for certain services initially from April 2012.
These are services for: back and neck pain; adult hearing in the community; continence (adults and children); wheelchair users (children); podiatry; leg ulcer and wound healing; talking therapies (adults); and diagnostic tests closer to home.
By September 2012, PCT clusters across England, supported by pathfinder clinical commissioning groups, will be expected to offer more choice in a minimum of three services either from the recommended list, or for another community, or a mental health service that is a high local priority, says the guidance.
The intention is to expand the number of services further from April 2013, with antenatal education and breastfeeding support; speech and language therapy; long term conditions self-management support; home chemotherapy; and primary care psychological therapies, the next most likely candidates.
Making the announcement, health secretary Andrew Lansley claimed this was “a big day for patients.” He rejected the common assertion that the move was purely to boost the independent sector’s role in the NHS. “Let’s look at what this is really about. It’s about real choices for people over their care, leading to better results,” he said.
The NHS Future Forum report supported the government’s policy to offer patients greater choice of provider, he added.
The Department of Health has also published its official response to the consultation on this issue, set out in Liberating the NHS: Greater choice and control. This specifies that providers will be paid a fixed price determined by a national or local tariff, with competition on quality, not price.
Potential providers will be subject to a national qualification process. They will need to be registered with the health and care services regulator, the Care Quality Commission, where appropriate, and licensed by Monitor (after 2013) and they will need to accept NHS prices.
A national directory of qualified providers will be created to make it easier for commissioners and patients to find out what is available.
Sophie Corlett- Director of External Relations at Mind said that the charity backed the move on the grounds that it would afford greater flexibility for patients.
“Choice can also make talking therapies much more effective. In a survey carried out by Mind in 2010, service users that reported having a choice of therapy were three times more likely to be happy with their therapy than those who wanted a choice but didn't get it,” she said.
But public sector union UNISON is not convinced.
Its Head of Health, Christina McAnea, said: “Patients should not be fooled. There are huge dangers lurking in plans to allow ‘Any Qualified Provider’ into the NHS. It leaves the door wide open for privatisation of our health service.
Patients will be little more than consumers, as the NHS becomes a market-driven service, with profits first, and patients second. And they could be left without the services they need as forward planning in the NHS becomes impossible.”
Staff could also be put at risk, with more unfavourable terms and conditions, he suggested.
Dr Hamish Meldrum, Chairman of Council at the BMA, said the BMA supported the principle of greater choice for patients. But he added: “What we would question is the assumption that increasing competition necessarily means improved choice. When competition results in market failure in the NHS, the ultimate consequence is the closure of services, and the restriction of choice for the patients who would have wished to use them.”