A report from a left leaning think-tank, which calls for an extension of the private finance initiative to cover clinical services, was attacked this week for being sponsored by backers with major vested interests.
In its report the Institute for Public Policy Research called for the private finance initiative (PFI) to be extended to clinical services and for primary care trusts to operate local government-style best value regimes—where value for money, along with quality of care, dictates who should provide a service.
The 285 page report was highly critical of some of the existing private finance initiative schemes. It argued that the initiative offers value for money in roads and prisons but not in hospitals and schools, and it questioned whether such schemes offer better value for money at all. “All PFI projects are publicly funded and incur future liabilities for the exchequer,” it said.
But despite this the report called for:
The PFI to be extended to clinical and clinical support services and to some of the new diagnostic and treatment centres
Pilot sites to establish long term partnership arrangements with the public, private, and voluntary sectors to develop intermediate care
Primary care trusts to use the private and voluntary sectors to help with strategic management functions and establish contracts with a range of providers for the delivery of new and refurbished premises—likely to cost £1bn ($1.4bn) overall.
Allyson Pollock, professor of health policy at University College London, was extremely sceptical about the institute's research.
“It's a very slippery report,” she said. “Basically what they are advocating is easier privatisation.
“But you have got to look at the sponsorship of this [report], which includes Norwich Union, KPMG, and General Healthcare. They all have a major vested interest in trading in public health care. They want to get more NHS funds, but they also want to get access to more patients to offer them more healthcare insurance.
She said that the recent Health and Social Care Act gave Alan Milburn, the health secretary, the power to go out to the private sector.
“It's double speak,” said Professor Pollock. “If the government was really serious, it would change the regulations in the act. Tony Blair and Alan Milburn might be saying one thing, but in reality it is very different.”
The BMA is already opposed to the private finance initiative, arguing that it does not offer value for money.
In the week before the institute's report was published, the public service union Unison expressed grave doubts about the government's plan to make greater use of the private sector.
The disquiet from Unison and other unions forced Prime Minister Tony Blair to defend publicly provided health services, and Mr Milburn declared the NHS was “not up for sale.” A Downing Street spokesperson emphasised that closer links with the private sector was only one part of the government reforms.
“The idea in no way undermines the central principle that the health service should be available to all on the basis of need and irrespective of the ability to pay,” he said.
Mr Milburn has denied that private sector managers might be brought in to shake up ailing trusts. Instead, he told the Times newspaper that he planned to hand over the 12 worst hospitals to the NHS's best management teams and clinicians for them to run.
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