Devolution protects Wales from costly reorganisation

John Osmond warns that the abolition of primary care trusts will lead to the privatisation of the English NHS

I can’t think of a better reason for voting Yes in next week’s referendum than the London Government’s intention to abolish the primary care trusts in England and place the procurement of health services in the hands of GPs.  If  we didn’t have the National Assembly we would be faced with the same disastrous prospect in Wales.

Currently, about 80 per cent of the £100 billion annual NHS budget in England is given to local health managers working for 152 primary care trusts, which in turn commission services for their areas. The London Government are proposing to hand the responsibility for commissioning most of these health services to groups of GP practices that would work together in consortia.

If this new system is to function in the way the Government says it wants, GPs will have to become fully engaged in the commissioning decisions. However, that would inevitably encroach on their patient contact time. The reality is that most GPs will only get lightly engaged and leave the detail to the managerial support staff they will hire to do the job. They will become the main influence on decision-making.

In practice, therefore, the change means exchanging one set of administrators for another, but with one crucial difference. The new system will be opened up to EU procurement rules, requiring contracts to be advertised and contested according to market-based competition regulations. International firms that typically provide health care within the private sector, for instance in the United States, will be free to enter the English health market, and make some loss-leading bids to capture the business.

This will lead to a privatisation of the English health service by the back door. It will result in all manner of cost-savings and centralised forms of provision in the short term that will lead to a poorer and more costly service in the medium to long term. In my view, this is bound to end in tears. Indeed, I think it will prove to be the major reason for the eventual downfall of the Conservative Liberal Democrat coalition in London. Politicians mess with the NHS at their peril.

Mercifully, we are being spared that in Wales by virtue of devolution’s health firewall. There is a firm consensus across the parties in the National Assembly – certainly within Labour, Plaid Cymru, the Liberal Democrats and probably most of the Conservatives – against moving in the English direction. As the One Wales agreement between Labour and Plaid Cymru that underpins the present Welsh administration states, “We firmly reject the privatisation of NHS services or the organisation of such services on market models.”

The immediate result of a No vote next week would be to undermine the National Assembly and its strength in resisting the privatisation instincts of right-wing inclined English governments. A Yes vote will have the opposite effect.

This post originally appeared on the British Medical Association Cymru’s blog, here.

John Osmond is Director of the IWA

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