Local evidence shows transparency is giving way to secrecy in the restructured NHS

Written by Tony Millett.

Marlborough News Online has been alerted to hard evidence that the re-designed NHS will become less transparent as more services are put out to tender and contracted to commercial companies, charities and not-for-profit organisations. This has already been happening in Wiltshire under the government’s policy for the out-sourcing of specific services to ‘Any Qualified Provider’.

With less than one month to go before the 212 new NHS clinical commissioning groups (CCGs) take over £60 billion of England’s healthcare budget, the government was forced yesterday (March 5) to withdraw and rewrite regulations already before Parliament which implement parts of the coalition government’s Health and Social Care Act.

These regulations were said (as MNO reported) by many doctors, health care professionals, lawyers to require that unless there are exceptional circumstances, all services would have had to be put out to tender. This, it was said, would lead to the privatisation of much of the NHS and put unacceptable tendering costs and work onto the GP-led CCGs.

It remains to be seen whether the government’s rewrite will change the regulations significantly – leaving the CCG’s to take the heat when they decide move parts of the NHS from the public sector to private companies and charities.  Alternatively the government may simply order a speed up of moves to privatisation under the Any Qualified Provider programme.

What is certain is that the government’s new NHS is becoming less transparent. This was shown clearly when Marlborough area GP practices were approached – using the Freedom of Information Act – for figures to show how local surgeries’ finances work and how much they benefit from dispensing drugs.

In papers now in the public domain, the Information Commissioner has ruled that the surgeries do not have to provide information that may help anyone wanting to set-up a rival surgery or start a chemist shop which could dispense drugs and so impact on their financial sustainability. However, the rules say that a new dispensing chemist can only be authorised if there is a proven un-met need for one.

The Commissioner did require the Marlborough practice to release a little more data than it had wanted to – about the numbers of staff it employed. But said the total salary bill need not be revealed because that would indicate the profitability of the practice.  At the time of the request the practice had seven partners paid out of profits and two salaried GPs.

In the ‘Decision Notice’, after considering the public interest value of disclosure, the Commissioner finally came down on the side of the practice: “…the Commissioner finds the public interest in avoiding unnecessary and unwarranted prejudice to the commercial interests of the Practice particularly weighty.”  Here, ‘public interest’ seems to be taken as supporting the continuing health care service by the existing provider.

However, the real interest in the Information Commissioner’s decision is in the wider picture he draws of the current state of the NHS.  He is “aware that primary care health service contracts are currently being granted to private companies...” and argues this means the “...the Practice is operating in a competitive commercial environment”.  

Or again and more bluntly: “Given the increasingly competitive market that the Practice is operating in, the Commissioner is satisfied that the disclosure of information that would allow competitors insight into the profitability of the Practice, and its dispensary, would be likely to prejudice its commercial interests and may result in the closure of the Practice.”

This means commercial interests will generally trump the public interest in greater transparency where a service is seen as part of a ‘competitive market’.  Even charities which win these contracts will be able to claim ‘commercial interest’ in avoiding the Freedom of Information Act and choosing to limit the information they provide about their operations and finances.

There seems to be a distinct miss-match developing between the government’s policy and its consequences.  The coalition government’s White Paper published in July 2010 which was the basis for the Health and Social care Act, promised an NHS that “Is more transparent, with clearer accountabilities for quality and results.”

It is now clear that the more services are contracted out to the private sector, the more commercial interest will rule and transparency will be curtailed.