The health secretary, Patricia Hewitt, intends to confront her union critics at the Labour conference next week with an unapologetic defence of the government's drive to make the NHS compete with private healthcare providers. In an interview with the Guardian yesterday, she rejected claims that her policy amounts to the partial privatisation of the health service.
The government's decision to bring in the private sector to operate on patients from the NHS waiting list was "a success story" that was set to provide quicker treatment for about 500,000 people a year. "Contestability and innovation works and the idea that this is privatisation is complete nonsense," she said.
Ms Hewitt's defence of the virtues of "contestability" - a Labour code word for competition - was a signal that the party hierarchy is in no mood for compromise on the issue. At a cabinet meeting on Tuesday, ministers discussed how to react to a move by the big four unions to push through critical motions at the Brighton conference.
They include a resolution from Unison, the public service union, calling for an urgent review of the private sector's role in the NHS. The union wants to stop the government signing contracts worth £3bn for a second round of independent sector treatment centres, including plans to transfer NHS hospitals, staff and patients to private companies, as disclosed by the Guardian yesterday.
The cabinet is understood to have decided a course of confrontation with what it heard one minister describe as "a backward-looking union agenda". Ms Hewitt said the first wave of independent sector treatment centres will soon be carrying out 200,000 operations a year. "It is a success story. I have lost count of the number of hospital chief executives who have told me that the presence of a specialist treatment centre down the road has been the key to unlocking change in their consultants' performance. I remember one chief executive who had been struggling to get the orthopaedic waiting list [for patients needing joint replacements] below six months. As soon as he told his surgeons that an orthopaedic treatment centre was opening nearby, the waiting list at his hospital melted away."
Contracts for a second wave of private centres would provide capacity for a further 300,000 operations a year. In some cases NHS buildings and facilities might be used during the five-year life of the contract, but ownership would remain with the NHS. "No NHS staff will be lost to the NHS. Unions will be consulted on the detailed arrangements, as they were in the first wave," she said.
The Unison motion is also intended to trigger debate about plans to introduce greater competition among GPs. Ms Hewitt said: "I very much hope entrepreneurial GPs from neighbouring areas may want to expand." Instead of running one health centre, they might run a small chain of doctors' surgeries.
Private companies might decide to enter the market, although none yet existed with the appropriate range of skills. Nurse practitioners might also decide to set up community clinics, employing salaried doctors to provide services that only doctors are qualified to offer. There could be new forms of social enterprise run by midwives or therapists. Ms Hewitt has discussed with the Royal College of Midwives the possibility of setting up community cooperatives, offering a home birth service to mothers. "GPs don't have to do everything and they don't have to be in the lead," she said. "They are trusted and have a complex and sophisticated set of skills ... But there is now an extraordinary opportunity for health and social care professionals to work together in new and different ways that will meet the needs of different patients and different communities." Service would remain free at the point of need.
Ms Hewitt quoted Nye Bevan, the Labour minister who founded the NHS. He said GPs should not become salaried employees of the state. They were independent contractors, often owning their premises and operating as small businesses. "To say they are sacrosanct - and other independent providers are a betrayal of the NHS - misunderstands the health service," she said.
Karen Jennings, Unison's head of health, did not accept the assurance that the NHS would not be privatised. "Whatever she is saying now, there is huge speculation, anxiety and concern building about the future of the NHS. Changes are being parachuted in with no real attempt to take staff, patients or unions along with them. Against this background it is hard to believe that the government doesn't have a hidden agenda and more privatisation isn't round the corner."
Sir Digby Jones, the director general of the CBI, said: "We welcome the government's determination to press ahead with increased competition within the NHS. Competitive pressure could advantage patients because it encourages efficiency and effectiveness which will help tackle health inequalities."
