Private healthcare could yet go the way of nuclear power
If private healthcare wants to be taken seriously, it needs to embrace information transparency. Failure to get that right will leave the industry in the same position as the nuclear power industry – deeply distrusted.
As the reformed NHS commissioning system gets off the ground in England, a fascinating BBC Radio 4 programme highlights the need for information transparency. It examines cases where operators lied to commissioners – as Serco did, when it misreported performance figures for its out-of-hours contract in Cornwall – and also in which the NHS bodies awarding contracts refused to discuss them on the grounds of “commercial sensitivity”.
None of this will help open up the £20bn-a-year market for medicalised homecare to private operators. Anonymous sources claim that, in Suffolk, where Serco has won a large homecare contract for community nursing, it has reduced staffing levels, forcing some nurses to drive up to 100 miles to provide care. Serco denies this, but, having proved that it had lied in Cornwall, why would anyone believe it in Suffolk?
The situation is further muddied by the way the Brits tend to apply mad EU procurement laws in a way that precludes bidders from having a proper dialogue with payors, leading to unnecessary muddle and secrecy.
What, then, is the way forward?
We like the approach adopted by Stockholm county in Sweden, where the amount operators, private and public, receive is dependent upon patient feedback a year after an episode of care. For instance: if the patient has no pain from their hip replacement, then the operator gets a fat bonus. If the patient is in pain, then a similar amount is deducted from the original DRG payment for the procedure.
We really fail to see why such a system can’t be rolled out in almost every sector. Take homecare. An anonymous online survey could be sent to recipients or their family, asking them to complete a customer satisfaction questionnaire. Such a system could be rolled out nationwide and answered by all consumers, whoever their provider is: private, public, or not-for-profit.
The alternative is to put in place a series of complicated metrics measuring operators’ performance. But top0down measuring is much harder, and can lead to distortions as operators seek to hit targets by skimping elsewhere.
We would welcome your thoughts on this story. Email your views to Max Hotopf or call 0207 183 3779.
