Could Donald Trump really force us to allow US healthcare companies to take over the NHS? Or is it bullshit?

At school everyone knew someone who told lies. Massive lies. If your dad had a new car their dad had a helicopter. If your dad had new job their dad was James Bond

If you went to Tenerife, they had been to Elevenerife.

If you went to Belmont you didn’t last long with that kind of fibbery, and most people soon grew out of it. Or have it beaten out of them.

But sometimes people grow up in a privileged world where they never have to accept the hard consequences of persistent bullshitting. Boris Johnson. Donald Trump. Trump has elevated this kind of bullshitting into an art form. Possibly the first authentic new art form of the C21st. Trumpshit.

Now that the dust has settled on Trump’s visit to the UK I thought it might be fun to go back and look at his claims that the NHS would be on the table in any future trade deals. Pretty much everyone I know got really angry about this, and plucky memes set sail across the internet powered by the retweets of politicians eager to pose as champions of state healthcare.

Trump increasingly looks like a rather sad figure, flying around the world on State visits to avoid facing up to his failure to achieve very much at home. He’s been on state visits to the UK and Japan back to back.

It’s not unusual for US Presidents to visit the UK, although these visits are mostly working visits to attend meetings of the G7, the G20 or NATO. State visits are rarer and most US Presidents only have 1 in the course of an 8 year term of Office. Some will remember George W Bush going to the pub in Sedgefield with Tony Blair. How Dubya didn’t spot we were taking the piss out of him I’ll never know. There were no state visits at all in the 1960s and 70s. Even Jimmy Carter’s trip to Durham for the Bi-Centenary was tagged onto a working visit.

Trump has been here twice in the last 12 months which looks rather like someone with time on their hands.

While we were members of the EU we were bound by EU procurement rules. EU procurement rules are a massive pain, and have lots of bureaucracy attached to it, but they does allow Governments to protect services like the NHS from commercial competition. The current rules that allow competition by private companies is a result of Government Policy, not EU regulation. As long as we are in the Single Market these rules apply.

But the model of Brexit currently being pushed by most Tory leadrship contenders has us leaving the Single Market in order to do global trade deals.

This means that we will be operating under World Trade Organisation rules not EU. This is where there is some truth in Trumps tweet. The WTO has it’s own rules on opening Government contracts to private sector competition which are much harsher than the EU ones.

If we go WTO we open up the NHS to competition by private sector companies from around the world under the Plurilateral agreement. If we decide not to do this then our companies are excluded from state funded contracts globally. Which makes our global trade deals worth an awful lot less. That’s the nature of free trade deals outside of trading blocs like the EU.

While everyone was getting angry with Trump about the NHS another big healthcare story passed most people by, and didn’t generate any memes on social media.

Circle Healthcare has lost the Nottingham Independent Sector Treatment Centre (ISTC) contract.

I realise that this might not immediately leap out as something of massive importance but it brings to an end an era of NHS outsourcing dating back to the start of the century.

I’ve talked a bit about ISTCs before here, as part of a history of NHS Privatisation

The original ISTCs were introduced by the Blair Government who had inherited big waiting lists and long waiting times from the outgoing Conservative Government. They had big plans to build new hospitals and expand capacity, but needed a quick short term fix to treat the backlog of patients.

The ISTCs were supposed to encourage private healthcare companies, often from abroad, to come to the UK to areas with long waiting lists to provide additional capacity.  This was the first big attempt by the NHS to bring in big healthcare companies from the US and around the world to deliver patient services.

Wave 1 was 25 fixed sites, and 2 mobile units, and wave 2 was another 24.   It was soon apparent that there wasn’t anything like enough interest from the private sector globally to make this work, and the programme was opened up to NHS organisations to run and operate them.  By 2006 nearly all ISTCs were run by the NHS due to lack of private sector interest. 

The last remaining big private sector ISTC contract was the Nottingham one, which was held by Circle Healthcare. They had run the contract for 11 years, and was their last remaining big healthcare deal.

Circle had made the headlines a few years ago when they took over running Hinchinbrooke Hospital – the first private company to run an entire NHS Hospital – only to hand the contract back 3 years later because they couldn’t provide NHS standard healthcare and make a profit.

The events with Circle and the ISTC follows a predictable pattern for private healthcare companies:

  1. lobby Department of Health promising that they can deliver loads of great stuff for NHS patients if they get the right contract
  2. fail to provide anything like the capacity they promise
  3. do good work with routine elective work, but flounder with anything more volatile
  4. get angry with lawyers if they don’t get their own way

The decision to bring it in house is consistent with the stealth nationalisation of the NHS which is going on. While Labour angrily campaign against stealth privatisation the whole edifice of the internal market is being eroded.

This might of course change with a new PM and a crash out No Deal Brexit. But it won’t change the reality of UK healthcare – private sector companies don’t have the capacity or the appetite for whole scale private deliver of NHS services.

I am still pretty supportive of the concept of private healthcare companies providing services to the NHS, as long as they use their own capital and take their own risks. I don’t mind Government Departments outsourcing routine admin tasks either.

But private sector companies across the board have over promised, taken on contracts that were too risky and too ambitious and failed to deliver. In doing so they have damaged their own industries, with the enthusiastic help of daft politicians like Lansley and Grayling.

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