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Private sector could control £2bn of community services within five years


Community nurses will increasingly find themselves working for private sector companies outside of national pay contracts during the next five years, market analysts have predicted.

Private sector domiciliary care companies are “well placed” to take over a “significant” part of NHS community nursing in the next five years, according to a report by Laing & Buisson, which provides analysis for private health firms and investors.

It forecasts the private sector could control £2bn of the £8.5bn spent annually on NHS community services by 2016. Domiciliary care companies are “well placed to establish a significant presence” in the community sector, it said, because they can potentially exploit the crossover between home based social care and community nursing.

Until recently, most primary care trusts have been unwilling to outsource core services like district nursing and health visiting to the private sector.

However, the transforming community services programme, which finished in March, has seen these services transferred to acute or mental health trusts, or set up as stand alone NHS organisations or not-for-profit social enterprise schemes. In some places, including Surrey and Suffolk, they have already been tendered out to the private sector.

The report forecasted a “wave of tenders” for NHS services when many current contracts come up for renewal in 2013-14, driven by the NHS’s need to make £20bn savings and the government’s desire to see closer integration of health and social care.

The report said: “There is a clear parallel between where community health services stand today and where social care services stood 20 years ago. In the two decades since, domiciliary social care services have effectively been privatised.”

It added: “Independent sector operators can be expected to take whatever opportunities they have to move away from Agenda for Change onto more flexible and lower cost pay, terms and conditions.”


Readers' comments (4)

  • michael stone

    As I have been haggling with the DH, etc, about EoLC/CPR/VoD policies, protocols and beliefs for the last couple of years, privatisation of DNs troubles me.

    Even at the moment, for patients who are at home, the degree of coherenct behaviour across professionals (GP/DN/paramedic) can be accurately described as pretty poor - if DNs are 'privatised', it is not obvious how it will be improved !

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  • Hi Michael
    I agree with your thoughts re the current behaviour of professionals. However, the goal of the gvt is not to 'improve' this behaviour, it's to change the NHS from a provider of care to a commissioner of care. Despite their rants, there is not a shred of evidence that shows the new system will deliver better, or improved, healthcare.

    Of course, working for private companies rather than the NHS, the first loyalty of all companies (and therefore the staff employed) is for the shareholder, not, as is currently the case, the patient. A fundamental shift which will still have some professionals delivering excellent care in spite, not because of, the new system.

    Clearly, what is needed is the de-politisisation of the NHS, so the focus can be on patients rather than an army of managers running around to satisfy any given political idiology.

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  • michael stone


    I entirely agree with you - especially about your 'not a shred of evidence' point.

    I have got a fair bit of evidence for that 'chaotic non-organisation' across different professionals - such organisation as currently exists, falls within the remit of PCTs usually (sometimes SHAs) and PCTs are for the chop, which presumably will not help.

    The politics does get in the way, but in all honesty much NHS behaviour is not 'evidence-based' to anything like the extent is often claimed. It should be about patient care - and I'm sufficiently left wing to add 'and care for all who want it'.

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  • The track record of local authority commissioning of private sector social care is patchy at best! Reducing care to inflexible, task-orientated, blocks of time and unit costs. Paying unregistered carers peanuts and requiring them to fund their own travel between clients. Could this be the future for community nursing if £2bn of services are tendered out in the next five years?

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