The PIP debacle exposes the folly of outsourcing key NHS services

The intransigence of a number of leading cosmetic surgery firms to Government requests for them to provide greater support for women who received breast implants from Poly Implant Prostheses (PIP) has led Andrew Lansley to criticise them on a number of levels, from providing poor data on the number of women that have undergone a procedure and for "not stepping up to their responsibilities at all" by failing in many cases to offer to replace or remove implants.

It is a combination of the clear powerlessness of the Health Secretary and the disregard for any moral duty on the part of a number of the private firms involved that demonstrates a key problem with fragmented and privatised health care.

And yet the government's Health and Social Care Bill, which will increase this fragmentation and privatisation, rolls on. The news that leading management firms are being rewarded for teaching GPs business knowledge that is already available in the soon to be dismantled Primary Care Trusts (a development criticised by the BMA's GPs committee) demonstrates the determination of Cameron and Lansley to force a restructuring through regardless of cost and without evidence that it will improve much beyond the balance sheets of a number of private companies. 

And as if to back up this view, the plans for the privatisation of the NHS compensation - a move that the chair of the consultants committee at the BMA argued would 'mimic the worst aspects of US healthcare' - referenced the Confederation of British Industry as identifying the authority as a "potential opportunity". It seems that for the modern Conservative Party, their key interest in the NHS is how much money its constituent parts can make for private corporations.

It even appears that the Government is reluctant to commit to the recommendations on the pro-reform task force that it set up, the NHS Future Forum. Chris Ham, Chief Executive of the Kings Find has commented that "there were very few, specific credible commitments on the department's part to actually do anything in making a reality of what the Future Forum has said", explicitly citing the need to include in the NHS constitution a commitment that patients who require joined up and integrated care from different parts of the system get the services they need.

It is instructive that one of the latest recommendations from the Future Forum is that the Government should address confusion around 'choice' and 'competition' in Lansley's Bill, stating that "Monitor and the NHS Commissioning Board should urgently support commissioners and providers to understand how competition, choice and integration can work together to improve services for patients and communities". 

It seems that in its haste to plow on with outsourcing as much as the NHS as possible, the government is willing to risk the creation of a fragmented, confused system that may be significantly more bureaucratic than the existing one.