NHS Chief executive Sir David Nicholson has been accused of ‘standing next to the carpet bombers’ as the Government opens up more healthcare services to competition from private providers.
In a passionate debate at the RCGP’s annual conference in Glasgow yesterday, Sir David was challenged about his role in facilitating the NHS reforms, which critics warned will fragment care.
Professor John Ashton, joint director of public health for NHS Cumbria and Cumbria County, said competition had negative consequences which must be addressed.
He said: ‘We’re lurching into wholesale privatisation. The carpet bombing approach is what we’ve got. Sir David must be having an interesting time standing next to the carpet bombers of Richmond House.’
‘It should be seen as a last resort. It’s the untoward consequences that one has to address. Increased transaction costs which can be enormous, increased fragmentation. We need to be much more aware of these things.’
He added that patients wanted good, local services and not choice: ‘They don’t want choice. Choice is a middle class concept. Patients want the doctor to tell them what to do.’
But Sir David defended plans for private involvement in the NHS, arguing that competition should be used as a tool for change. He said the current system had ‘conspired’ against some patients.
He said: ‘We have to be straightforward about this. The NHS does not have the monopoly on great ideas.
‘It seems to me that testing the existing services is the right thing to do. There are numerous examples around the country that show that where we have brought outsiders into trying to solve these really intractable problems, a bit of innovation from outside has made a difference for our patients. So we should always use it as a tool to drive change.’
He added: ‘In the NHS sometimes we’ve conspired against our patients when we needed to open it up. The way we are going to open up our services, make ourselves sustainable is by giving people at a local level much more control over what they do and how they do it.’
Professor Rich Roberts, president of the World Organization of National Colleges, Academies (WONCA), agreed there was evidence competition worked. But he said government-run healthcare, vulnerable to political changes, could lead to instability: ‘In the flash of an election you might have another NHS change. You guys are changing the NHS every 15 minutes.’
Lord Victor Adebowale, chief executive of social enterprise Turning Point, said a lack of competition fostered complacency: ‘It’s the repeated provision of services that don’t do any better because they don’t have to,’ he said.
Professor Matt Sutton, health economist at the University of Manchester, said there were forms of competition that were not solely concerned with profit making: ‘You [could] regularly publish and present statistics on quality and encourage the provider to compete that way and not necessarily by tying money to it.’