NHS Marketisation

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2006 National Delegate Conference
28 February 2006
Carried as Amended

Conference notes with dismay the growing negative effects that the marketisation of the National Health Service (NHS) in England is having on staff and patient services. According to a recent survey by the Health Service Journal, 63% of hospital trusts have been forced to close wards as a result of financial shortages, a quarter have made staff redundant and 75% have been forced to freeze recruitment. Primary care trusts (PCTs) are diverting money away from areas such as sexual health in order to balance their books, and in areas such as Birmingham money has been raided from staff training budgets in order to bring down deficits.

These developments are the direct result of the financial instability caused by the introduction of policies such as payment by results, and the forced transferral of work previously carried out by NHS trusts over to Independent Sector Treatment Centres (ISTCs). In addition, we are now seeing Conference’s warnings about PFI being fulfilled in practice, with spiralling scheme costs, and hospitals pushed into deficit by the high cost of private finance initiative (PFI) charges.

Conference is therefore concerned that, rather than reining its marketisation policies back, the government’s July document “Commissioning a Patient Led NHS” appeared to extend them into the area of primary care. While Conference welcomes the announcement by Patricia Hewitt that PCTs will not be forced to outsource community services, we remain concerned that PCTs may be subjected to indirect pressure to do so, for instance through the imposition of cost cutting targets. Conference also opposes the top-down process of boundary reconfiguration imposed on both PCTs and Strategic Health Authorities, and agrees with the Health Select Committee that this will increase costs and jeopardise the quality of commissioning and patient care.

Conference notes that many NHS trusts are now providing services at less than their full capacity due to lack of funds. Conference notes the 2005 Labour Party Conference’s decision to call on the government to “suspend any further expansion of the role of the private sector into the NHS”. Conference believes that the government should suspend further investment in private sector providers, and instead conduct a thorough public review of the available capacity growth within the public sector, with a view to investing first in the public sector wherever possible.

Conference also notes with concern the decreasing democratic accountability of the NHS, with NHS hospitals being given autonomy from government through foundation status, and increasing reliance on unaccountable private sector providers. In addition, there is a need to ensure that structures for patient and public involvement work effectively and that the public have a genuine say over commissioning and configuration decisions.

Conference welcomes the different approach to NHS reform in Scotland with its emphasis on co-operation rather than competition. The abolition of NHS Trusts and the internal market is giving greater weight to genuine user involvement rather than relying on market mechanisms. Nevertheless, there is still pressure to increase investment in private sector provision and PFI at the expense of NHS in Scotland (NHSiS).

Conference reaffirms its support for a publicly funded, owned and controlled NHS providing a comprehensive health service from “the cradle to the grave”.

Conference calls on the National Executive Council, working in co-ordination with the health and other service groups, the General Political Fund and the Labour Link, regions and branches to:

1)campaign against service cuts and closures in the NHS, and for an approach to reforming services that is based on collaboration and standards rather than competition and private sector involvement;

2)work with patient groups and with voluntary organisations to develop a positive vision for the future of primary care and to campaign against the marketisation of primary and community care services;

3)research the experience of the first wave of the ISTCs, including on the quality of care provided and their impact on the financial viability of other neighbouring services;

4)work with other relevant groups to develop an agenda for ensuring more effective patient and public accountability, particularly in the area of primary care;

5)work with the union in Scotland, Wales, and Northern Ireland to resist the application of market-based reforms similar to those being introduced in the English health service;

6)Conference welcomes the establishment of the Keep Our NHS Public campaign and calls on branches, regions and the National Executive Council to affiliate to and work with this campaign.