- New guidance on NHS imaging services: New Move to Create Significant Operation Businesses in Their Own Right Out of NHS Imaging Services
Workers' Weekly On-Line
Volume 51 Number 15, May 1, 2021 ARCHIVE HOME JBCENTRE SUBSCRIBE

New guidance on NHS imaging services

New Move to Create "Significant Operation Businesses in Their Own Right" Out of NHS Imaging Services

On April 22, NHS England released new guidance on government plans for NHS imaging services [1] in England. This is part of the long-term plan confirmed by Matt Hancock in the government's White Paper on "the future of health and care" entitled "Integration and Innovation: Working together to improve health and social care for all". The guidance was issued in three documents [2], the "Diagnostic imaging network implementation guide", the "Diagnostic imaging network capital equipment planning guide" and the "Diagnostic imaging network commercial structure and operational governance guide". The guidance gives trusts "until 2023" to set up diagnostic networks which will have their "own distinct leadership [and] governance arrangements" and will be responsible for asset management, financing, quality, staffing and location of all elective and non-elective imaging across England.

In one of the few reports commenting on the release of this guidance, an article for subscribers in the Health Service Journal (HSJ) [3] pointed out that the stated aim was new diagnostic imaging networks that "will be of such scale that they will be 'significant operation businesses in their own right' and will 'need a distinct identity and arm's length separation from the trusts'." In the guidance, NHS England has outlined seven models that the new imaging networks can take, but clearly promotes the preferred model of "outsourcing the service in its entirety, including ownership of the capital assets required for delivery of the service, to a commercial partner". The other options are "collaboration or alliance contracting", both of which the guidance says offer "poor autonomy" because decisions must be approved by all trusts! The use of a "host trust" involves using delegated authority from other network members to make decisions, two joint venture models, or a community interest company. All three would need HMRC approval for VAT exemption and are only suitable for foundation trusts. Whilst the guidance does admit that there are "disadvantages" to outsourcing, which it admits include "the loss of direct control of operations", its main thrust is to detach all imaging services from NHS Trusts and organisations and set up yet another separate organisation with its own management and governance arrangements.

The proposal is that instead of providing imaging services at local hospitals the new imaging "hubs" will now be further separated from most local hospitals, increasing the difficulty of patients accessing these diagnostic services both routinely and in an emergency. This continues the present pattern of the direction of the "long-term plan" of claiming to make care "more accessible to the communities" whilst actually making it harder for communities to access services and increasing the inequality of access by poorer communities that have low car ownership and cost and mobility difficulties.

In other words, far from being "integration and innovation" and "working together to improve health and social care for all" as the government's White Paper claims, this guidance is one of the latest examples of how the government and NHS England intend to break up the NHS. In particular, this example demonstrates how the government is intent on making the most profitable sectors available to the private health corporations without the inconvenience of having to provide the services to each and every hospital and community. It further reveals the capital-centred direction at the heart of NHS England's government-led "long-term plan", of which the White Paper is a part [4].

This plan is a continuation of the capital-centred direction of previous plans that, for example, passed direct control for NHS elderly care and social services from from the public sector to the private owners of social wealth in the 1990s. It is this capital-centred direction that intensifies the crisis in the NHS as services are privatised, because the new value to society that is created by health and social care workers, those that build hospitals and produce the medical equipment and medicines, and so on, is claimed by the private owners of social wealth. As a result, the social wealth available that the government needs to meet the needs of all for health care and the general interests of society is increasingly diminished by this direction for the economy. This is why in the United States where the health service is almost completely privatised, on the one hand the US government and US states spend almost twice as much per GDP than any other developed country on health care, yet on the other hand some tens of millions people have no access to health care at all, and the rest of the population has to pay punitive sums to private insurance corporations [5].

What is needed is a new direction for health and social care where health staff and people in the communities they serve are empowered to directly speak about their needs and participate in making the decisions. Health care is a claim the people must make on society. Placing the imaging service under the control of private interests must be opposed. It must be publicly provided as part of a human-centred health and social care system operating at the highest level accessible to all in their hospitals and communities.


Notes
1.Imaging services for medical purposes involves a team which includes the service of radiologists, radiographers (X-ray technologists), sonographers (ultrasound technologists), medical physicists, nurses, biomedical engineers, and other support staff working together to optimise the wellbeing of patients, one at a time. Appropriate use of medical imaging requires a multidisciplinary approach. (Source WHO)
2. The "Diagnostic imaging network implementation guide", the "Diagnostic imaging network capital equipment planning guide" and the "Diagnostic imaging network commercial structure and operational governance guide". April 22, 2021
https://www.england.nhs.uk/publication/
3. "Commercial partners" could take over "entirety" of planned imaging networks - Sharon Bremen, April 23, 2021
https://www.hsj.co.uk/commissioning/commercial-partners-could-take-over-entirety-of-planned-imaging-networks/7029943.article#commentsJump
4. "Continuing the Wrong Direction for a System of Health and Social Care" - Workers' Weekly, February 27, 2021
http://www.rcpbml.org.uk/wwie-21/ww21-07/ww21-07-03.htm
5. US Health Care from a Global Perspective, 2019: Higher Spending, Worse Outcomes?
https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019


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