Tuesday, 2 September 2014

Privatisation of the Scottish NHS.

So, lets knock this on the head.

Currently much is being made of NHS privatisation England, you can read about that here. The Yes Campaign are saying the only way to save the NHS in Scotland is to vote Yes - the reason being, if services are privatised down south, cuts there will in turn mean - via Barnett - cuts to Scottish funding.

Meanwhile, proponents of the union are braying (caution - Daily Express article) on about health being entirely devolved - which it is - meaning funding is up to the Scottish Government - which it is - if you ignore completely the notion that said funding comes from an already shrinking pot 'given' to us by Westminster. Whilst unionists aren't lying, they are engaged in brazen sophistry. In order to assuage cuts as a result of privatisation south of the border, cuts must be made elsewhere north of the border.

This is how Labour front benchers like the oily Jackie Baillie and the intellectually-challenged Jenny Marra get to moan about cuts to college funding (for example) while excoriating the Scottish Government for daring to suggest over-all cuts to the Scottish block grant might possibly have an effect on health spending.

Over and above that, many on 'Team No Thanks' are claiming the SNP have been busy privatising the NHS in Scotland. Since 2007 the bill for what they're calling privatised services has double from £225 million to £500 million.

You know what I'm going to say don't you... It's rubbish.

In terms of health spending there are a number revenue streams going out to the private sector. National Procurement is responsible for central procurement, its usually contract based - I sense unionist ears pricking up - its been that way for years though. National Procurement arrange the supply of goods & services (mostly goods though) on a contractual basis - it means exceedingly keen prices can be assured if the NHS agree in partnership with a supplier to buy selected items from that supplier only.

There is a team in place who assures these companies adhere to some pretty strict criteria ranging from cost & quality, energy efficient processes to how many apprentices they employ and a good bit more besides. What they buy & disseminate from their central warehouse (at Canderside Toll) are mostly consumables - from bog roll to surgeons gloves to medical consumables. They do a lot of tendering too, some of these contracts are for expensive bits of technology so are worth a bit of cash, hence EU competition rules kicking in.

That's at a nation-wide level, the level most folk complain about. All those faceless managers & administrators that cost so much money but 'do nothing' for patients? They work here - its also where I work. A quick anecdote though; the guy who sits opposite me had in the past some responsibility in the procurement of lead aprons and gonad shielding for a large x-ray department. The aprons & shields for what ever reason were found to be faulty - tiny pin hole flaws in the lead inserts as it happens - evidenced by bright white pin points in the apron's test x-rays. If he wasn't doing his job, patient's families - mums and dads - and other health workers on hand to sooth unhappy children would be getting repeatedly irradiated.

We might not have direct contact with patients, but that's not to say we don't have a point.

The second area of expenditure is with health boards - each have their own procurement teams that operate independently of central government or National Procurement. Sometimes processes are duplicated - NP might have a contract for an item but for whatever reason the health board procurement team might source it locally for any number of reasons or none at all - we're getting better at that though.

There's a third fuzzy area of expenditure where social care overlaps with health care. In terms of the £500 million mentioned above and that rather regretful link to the Daily Express article - its where the brunt of the cash goes. 

"... the country's 14 health boards spent £490,622,166 on sub-contractors – 4.8 per cent of the annual budget, and more than the corresponding figure in the north east of England.
Of that total, £63.8million was spent with voluntary organisations and an enormous £343.8million went to councils. The total has more than doubled since the SNP first came to power in 2007, when the annual sub-contract bill stood at £225million."

It might be splitting hairs, but the £343.8 million of the £500 million claimed by various Tory & Labour throbbers is spent by local authorities on social care - otherwise - many of those old folk who receive free personal care at home would be stuck in hospital wards; much more expensive in the long run and positively ruinous in terms of the well-being of the old folk in question. Instead, an army of carers is engaged to keep old folk healthy in their own homes - which I'm sure you will agree is a far better way to treat our elderly - by happy coincidence, its also much cheaper.

(The dig about spending more in Glasgow than is spent in the North of England is typical hard-nosed Tory/libertarian nonsense, they'd rather spend cash on nuclear tipped nobs than on care for the elderly.)  

Of course provision varies and its not perfect, the care workers work for private companies often on zero hour contracts. Its not that the hours aren't there - there are too many and sometimes not enough staff to cover. Realistically though, it is cheaper than councils employing hundreds of people to do the work - so there it is - its not ideal, its a balance.

The kind of privatisation going on down south isn't comparable with commercial involvement in Scotland's NHS - its like comparing athlete's foot with a crinked neck. In England huge swathes of health provision are being offered to tender - contracts worth billions and set to run for years. In Scotland we're talking about care provision - a local authority funding responsibility that overlaps occasionally with NHS responsibilities, the odd prophylactic service like weight control from Weight Watchers in NHS Greater Glasgow & Clyde - a two year contract to keep obese folk (hopefully) out of hospital saving the service money in the longer term and the occasional hiring of imaging equipment to keep waiting lists at an acceptable level.

Its a far cry from dolling out huge contracts of the sort being considered for the provision of cancer care in Staffordshire for example - a £1.2 billion contract to manage cancer care across just one county from diagnosis to treatment to end-of-life care. It takes the entire operation out of state control (which might sound attractive) and puts it in the hands of a private companies (possibly not sounding so attractive now.) Anyone who's ever tried to query a mobile phone bill, arrange car insurance or phone in some meter readings has to know it's not a good idea - that profit might be a consideration any where around your end-of-life care is a travesty waiting to happen.

Having an over-enthusiastic Weight Watchers rep give you a row because your spare tire is becoming too prominent is not the same thing at all. 

That there is as much commercial involvement now in health care provision is a result of a lack of funds across the board. We're already having to involve private companies in new builds across Scotland because so much of the funding is being sooked up by the New South Glasgow University Hospital which is being paid for out of central funding - its not a PFI/PPP hospital build.

This is an example writ large of where if you fund one project - others suffer. Interestingly though, having just finished work on three health centres in NHS Grampian and NHS Highland each with private enterprise involvement - again - the Scottish Government found a balance. Rather than have another gargantuan private finance initiative like Forth Valley Acute Hospital which will rake in private sector profits for decades to come - they kept it to a minimum by using similar funding methods (with rapacious capitalist teeth mostly pulled) for the much smaller projects (about £6 million all in) instead of the huge £842 million project in Glasgow.

There it is, I work for the NHS in Scotland so have a bit of an insight. When some cretin on twitter or the TV accuses the SNP of privatising the Scottish NHS - if you've got this far - you now know roughly how it works and can call bullshit.

No pictures though about which I feel bad - by way of reparations: click here for the most recent Snaps on Sunday from Munguin Towers.


  1. Excellent post.

    Information from someone who knows what he's talking about because he's involved.

    How would we have reached this far in the referendum campaign had we not had citizen journalism.

    Thanks for the Munguin plug.


  2. Great, informative post thank you

  3. Thanks both of you.

    There are those on the unionists side who think they can spout out any old bilge and not have it challenged, as you say Tris - its a totally different playing field than it was in 1979 or even 1999.

    The topic of this post is similar to the government inflating welfare figures by including pensions, pensions shouldn't be lumped into welfare at all - you know why they do it though - it helps them vilify the poor.


Thanks for comment as always and I apologise if you have to jump through any hoops to do so. Its just that, I'm still being spammed by organisations who are certain I can't get it up or when it is up its not big enough or that I don't have anyone to get it up for.

Who knew blogging could be so bad for ones self-confidence?