A six-page “contract notice” placed by the Department of Health in the supplement to the Official Journal of European Union, and seen by The Times, encourages the private sector to apply for a wide range of roles in the control and running of primary care trusts (PCTs).
The trusts are responsible for about 80 per cent of the annual £80 billion NHS budget. They not only fund GP surgeries but also commission hospital operations and have a large say over which drugs patients in their area can receive.
Critics said that the move was like “putting the NHS up for sale”, while some also said it signalled the end of PCTs’ role as providers of clinical services.
Last night, after being contacted by The Times, the department suddenly withdrew the advertisement. It said that drafting errors in the document had given the “false impression “ that clinical services provided by PCTs would be phased out in favour of the private sector. However, it insisted that plans to broaden use of “expert help “ from the private sector for ailing PCTs remained accurate.
Health economists said that while the Government had tentatively suggested expanding the use of private firms as purchasers of care for NHS patients — one of the key roles of a primary care trust — the document went much farther.
It invited tenders for a multitude of services, including “general management”, “financial management”, healthcare administration and human resources.
Additional information, provided on request to potential applicants, revealed that candidates should have experience of managing £300 million-plus health budgets. The stipulation meant that only the largest insurers and providers, such as the American firms United Healthcare and Kaiser Permanente, were likely to be suit- able. The advertisement asked for tenders, or “requests to participate”, by July 17, with selected candidates due to have been notified by the beginning of August.
Policy experts and health campaigners questioned last night how an initiative with such major repercussions for the future of British healthcare could be introduced without public debate. Mark Hellowell, research Fellow at the Centre for International Public Health Policy, said that the document implied that the Government felt a lot of services run by PCTs were inadequate and would be more efficiently provided by the private sector.
He added that it was not possible to know exactly what the Government’s intentions were, because there had been no public announcement or debate and the initiative did not appear in any manifesto.
“The scope appears to go beyond commissioning care. It is the full gamut of PCT activities, “ he said. “When a government comes out with a policy, it normally wants to shout about it. But it seems with this that they want to do it on the quiet. “
Private providers already supply a small but growing proportion of NHS operations, diagnostics and mental health facilities.
The Department of Health is understood to be particularly keen to get independent firms involved in the purchasing of care, which would reassure commercial health providers that they will not fall victim to any NHS bias.
Alex Nunns, spokesman of the campaign group Keep Our NHS Public, said that the move flew in the face of government insistence that it was not privatising the NHS by stealth.
“What happened to the idea of putting the health service under the control of patients and communities? This puts it under the control of share- holders, “ he said. “This is a giant leap towards privatisation. We are seeing the Government inviting the private sector to take over all the functions of a public body, with control over astronomical sums of public money. “
“It is a policy that has come out of nowhere with no debate in Parliament, nothing in the manifesto, and no attempt to consult NHS staff. There is no mandate to fundamentally change the NHS in this way. “
John Lister, director of London Health Emergency, said the document appeared to have the potential to whittle down PCTs to “a rump organisation”.
“It is utterly remarkable that we have got to this stage, considering [that PCT’s] are key bodies that the Government set up and has only just restructured again. “
Lord Warner, the Health Minister, said that the tendering initiative had been designed to create a list of potential private providers of different services, which PCTs could call upon as and when they were needed. He added that it was not designed to divest the trusts of their role providing clinical services.
“The Government has no plans to privatise the National Health Service. We are determined to create stronger and more effective primary care trusts, which can secure the best possible healthcare for patients in local areas by commissioning services from a range of providers. “
“We want those PCTs who require it to have access to expert help in developing that commissioning role, including from the private and voluntary sectors if necessary. “
He added that it was up to PCTs to decide if they wished to use those services in the future and that they would be free to make their own local arrangements.