Dismantling a central coordinating body like NHS England creates an environment where further fragmentation and, potentially, increased privatization become more feasible.
Centralized Control vs. Decentralization:
NHS England provides a degree of centralized control over the NHS in England, with standardized practices, budget allocation, and overall strategic direction. Getting rid of it will lead to greater decentralization, giving individual regions more autonomy. It also creates the potential for
– Varied service provision across different areas.
– Increased competition among local providers, opening the door to greater private sector involvement.
– A more complex and potentially less transparent system, making it harder to maintain national standards and equity.
And since NHS England plays a major role in commissioning services and managing contracts with providers, including those in the private sector. Breaking up this function will lead to a greater number of individual contracts, making it easier for private companies to bid for and secure them, plus less oversight and control over the terms and conditions of those contracts.
NHS England was responsible for national standards consistency of care, making sure that no matter where you lived, you could expect the same standard and quality of care.
Without NHS England oversight there’s a risk of a “postcode lottery,” where the quality and availability of services will significantly depending on where you live and what service deals local health authority and private sector providers have negotiated.
Look at what happened with the Utilities – water, gas, electricity, the railway system.
The British Medical Association in a report on NHS Outsourcing refers to “the four-year ‘National Increasing Capacity Framework’. … an agreement that could see ICSs and NHS trusts spend up to £2.5 billion a year procuring elective activity from a pre-approved list of ISPs. These funds represent almost double the amount spent on contracts with independent sector hospitals in 2018 and 2019.”
A 2022 Lancet report: Outsourcing health-care services to the private sector and treatable mortality rates in England, 2013–20: an observational study of NHS privatisation states “The privatisation of the NHS in England, through the outsourcing of services to for-profit companies, consistently increased in 2013–20. Private sector outsourcing corresponded with significantly increased rates of treatable mortality, potentially as a result of a decline in the quality of health-care services.
And of course there’s the personal ‘off-the-books’ incentives’, and ‘donations/gifts of medical technology to sweeten deals.
