IT HAS always been the Thatcherite and Blairite dogma when it comes to service provision that the big private companies would provide all the health services, but the commissioning would be done by the independent public sector.

Now even that split, with the public sector confined to a relatively marginal role, is being done away with.

The carving up of the NHS in all its various roles by these private behemoths is now all but complete.

For the first time the NHS under Tory ideological control is asking the private sector to undertake the buying of billions of pounds’ worth of services for hospitals and GPs.

NHS England has just advertised for companies to compete — or share out the booty — for £5 billion or more of work advising the new GP-led clinical commissioning groups (CCGs) which spend more than two-thirds of the NHS budget, around £70bn, buying care for patients.

They will advise on patient care “reforms,” finances, drug purchasing, negotiating hospital contracts, handling NHS patient care data and outsourcing services to private care providers.

Apart from the last, these were of course all functions provided by the Primary Care Trusts up till 2010.

But they were disbanded in order to hand the responsibility to the CCGs, ostensibly on the grounds that “they knew best what was in their patients’ interests.”

As we can now see, this was just a cover.

Partly because many CCGs didn’t want this administrative commissioning role in the first place, but mainly because the Tory intention all along was to close the circle of private-sector control by by giving the big private companies the commissioning role.

This was on the grounds that the CCGs didn’t have the expertise — so why were they given the role in the first place?

Even more remarkably there are already 17 commissioning support units which were set up in 2012 to provide services to CCGs, so why are new bidders like Serco and the US United Health needed at all?

Obviously there has been a concerted lobbying effort by the big behemoth providers to take full control of the whole process without having to negotiate with other parties.

But the costs of this stitch-up will be enormous. There will be huge new transaction costs which, it is well to remember, take up at least 30 per cent of total healthcare costs in the US.

It will obviously fragment the service further, which is clearly the Tories’ intention.

Above all it will produce monstrous conflicts of interest as the big private healthcare providers advise on the commissioning of services of which they are themselves major providers.

There is also the very sensitive issue of handing over the handing of NHS patient care data into private hands.

Much of this, it can be said with assurance, will certainly backfire on the Tory machinators and come back to haunt them.

The NHS, of course, is only one area being parcelled out to the private sector.

Once upon a time we had nationalised industries. Now we have Capita, G4S, Serco, A4E and the rest of a small coterie of private conglomerates who dominate the service world.

Unlike the nationalised industries they have no specialist focus, but merely bid for anything going, much of which they handle poorly or badly as we have seen with G4S over the Olympics, A4E over the work programme and Serco over medical services in Cornwall.

But whereas in the public sector such lamentable shortcomings would be taken as a reason for takeover, closing down or enforced amalgamation, these private-sector oligarchs are treated with kid gloves.

G4S is currently being investigated by the Serious Fraud Office for overbilling the taxpayer by £24 million for electronic tagging and prison escort services.

Has it been closed down for embezzlement? Disqualified from future public contracts for dishonesty? Have its lead executives been prosecuted so they can be jailed if found guilty?

No, it has been given a “minder” from business to oversee its behaviour. How courteous.

His job is to help G4S satisfy ministers that the company is now fit again to take on more public contracts, a charade worthy of the best business world fix.

The problem for ministers is that they have set up a tiny clique of outsized, sprawling behemoths which share out the booty between themselves with assured profits at taxpayers’ expense and virtually no competition.

Lose one contract within the clique and you get given the next.

Of course they will argue that they’re fiercely competitive, just like the banks who copy each other in lockstep, but actually it’s a very cosy little club with everything stitched up — government, taxpayers, consumers, and of course huge profits.

The problem is when things go wrong, as they have done big-time — and repeatedly.

There’s virtually no alternative but to keep them in place, so instead of being prosecuted for stealing public money and directors jailed, or disqualified from the business or broken up, the government merely grimaces, gives them a slap across the wrist and carries on as before.
 
Of course all this is done in true British Establishment style, with high-sounding “crown representatives” appointed — again from big business — to advise the government whether “corporate renewal” has been achieved by the offending firm so that they can be restored to grace. What a farce.

These are public services which have been outsourced, but there is no public accountability.

Everything is commercialised, including the oversight.

Taxpayers are getting a poor deal because they have to pay for the profit premium and the only reason the companies claim to be efficient in cutting costs is either because they pare back the service provision or they take on more low-paid or agency workers on minimum pay and with little training.

This is the marketplace for the poor and socialism for the big rich companies, and it must be comprehensively dismantled by the incoming Labour government.

Michael Meacher is Labour MP for Oldham West and Royton. Read his blog at www.michaelmeacher.info.