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Introduction

11.1 The NHS is a huge organisation. Using extra capacity and extra investment from voluntary and private sector providers can benefit NHS patients. The Private Finance Initiative is already delivering new hospitals, on time, to budget as part of the biggest hospital building programme in the history of the NHS. The NHS already spends over £1 billion each year on buying care and specialist services from hospitals, nursing homes and hospices run by private companies and charities. The time has now come for the NHS to engage more constructively with the private sector, and at the same time make more of its own expertise available to employers throughout the country.

The basis for a new relationship

11.2 For decades there has been a stand-off between the NHS and the private sector providers of healthcare. This has to end. Ideological boundaries or institutional barriers should not stand in the way of better care for NHS patients. Public funding for the NHS will increase substantially over the next four years. The private and voluntary sectors have a role to play in ensuring that NHS patients get the full benefit from this extra investment. By constructing the right partnerships the NHS can harness the capacity of private and voluntary providers to treat more NHS patients.

11.3 Developing these new forms of partnership will not compromise the fundamental principles underpinning this Plan: that healthcare should be available on the basis of need, not ability to pay. There is a world of difference between the NHS paying to have patients treated, as NHS patients, in a private hospital for free, and what some propose - forcing patients out of the NHS to pay for their own care. Under our proposals a patient would remain an NHS patient even if they were being treated in the private sector. NHS care will remain free at the point of delivery, whether care is provided by an NHS hospital, a local GP, a private sector hospital or by a voluntary organisation.

11.4 High standards of care for patients and good value for money for taxpayers will have to underpin any arrangements between the two sectors.

A new concordat

11.5 In many areas NHS services are already delivered in close partnership with the private sector. The problem is that most of the arrangements are ad hoc and short term. This way of working provides a poor basis for partnership and value for money.

11.6 As part of the NHS Plan for the first time there will be a national framework for partnership between the private and voluntary sector and the NHS. It will include a set of national guidelines to help primary care groups and trusts when they commission services.

11.7 These new arrangements will be set out in a concordat between the NHS and the private sector covering private and voluntary providers. The concordat will highlight three particular areas for co-operative working:

11.8 Clear cost arrangements, particularly when patients are transferred as emergency cases, will need to be established before the concordat takes effect locally.

11.9 Having these facilities available will help the NHS with winter planning and the drive to reduce waiting times. The concordat will also cover:

11.10 The concordat is intended to be the start not the end of a more constructive relationship. The NHS will explore with the private sector the potential for investment in services - such as pathology and imaging and dialysis. The Government is investing in improvements in these services and wants to help the NHS make the fastest progress possible. Already a number of NHS trusts share or lease facilities. We will encourage more arrangements of this kind by negotiating national call-off contracts with a number of major suppliers. We also propose to develop some partnership arrangements at a regional level for modernising pathology services.

The pharmaceutical and bio-pharmaceutical industries

11.11 The pharmaceutical industry is a UK success story, employing over 60,000 skilled workers and maintaining an annual trade surplus of over £2 billion. The industry is also the UK's leading investor in research and development. The NHS has a major role to play in ensuring that the UK remains an attractive base for the industry. Earlier this year the Pharmaceutical Industry Competitiveness Task Force was established to help develop a deeper partnership between industry, the NHS and Government. Already the task force has agreed that pharmaceutical industry involvement in the development and implementation of national service frameworks would benefit both the NHS and industry.

11.12 Research and development is the key to the future flow of new medicines for the benefit of patients and is the cornerstone of a successful pharmaceutical industry. We must ensure that there are no unnecessary delays in conducting research whilst still protecting the interests of patients. A new policy on research governance in the NHS will be published by the end of the year. By April 2001 we will have developed ways of streamlining the work of research ethics committees whilst preserving all the necessary safeguards. This will allow faster and more effective recruitment of patients into clinical trials, enabling new medicines to be brought on stream more quickly. In addition the new NHS cancer research network will be evaluated as a model for enhancing recruitment into and management of trials of new treatments.

Research and development

11.13 Advances in science and technology have revolutionised modern medicine, providing the antibiotics, vaccines, modern anaesthetics and pharmaceuticals that have helped transform our lives. The NHS has a responsibility to contribute to, facilitate and embrace these advances in partnership with the private and charitable sectors and academia. We will lead this by further developing a strong set of national research and development programmes. However, we recognise that this top-level commitment needs all staff and their organisations to be involved in developing innovative ways of improving patient care.

11.14 We now have the first provisional map of the human genome and innovation will occur at an ever faster rate. It is vital that the NHS plays an active and collaborative role in realising the benefits in genetics. We will contribute with other government departments and medical charities to a long-term study of the interactions of genetics and the environment in common diseases of adults such as cancer, heart disease and diabetes. These powerful techniques for understanding and treating disease also raise important issues for society in general. The Government has already set up the Human Genetics Commission to advise on the social, ethical and legal implications of developments in genetics and to engage the public in considering these questions.

11.15 Working with the private sector and other partners we will commission NHS research and development in new centres of excellence. These medical knowledge parks will evaluate all aspects of the emerging developments in genetics, from the laboratory testing to the requirement for counselling of patients. They will bring together NHS research, the private and charitable sectors alongside front-line NHS staff and patients.

NHSplus

11.16 Working with the private sector is not just a one-way arrangement. The NHS also has a lot to offer industry and employers; ill health has a big effect on the economy. It has a cost in terms of lost productivity and - where the illness is severe or debilitating - can result in unemployment which in turn is a principal cause of poverty.

11.17 A total of almost a quarter of a million working years are lost through disease each year. The Confederation of British Industry estimates that temporary sickness costs business over £10 billion annually. The burden is born by employers and by the NHS too. Backpain accounts for 119 million days of certified incapacity. It also consumes 12 million GP consultations and 800,000 in-patient days of hospital care.

11.18 Individuals, business and government all have an interest then, in breaking the vicious cycle of illness, unemployment and poverty. Across the country, the NHS is already working in partnership with private sector employers to improve the health of their employees. There are managers receiving NHS pre-employment checks, other staff benefiting from NHS health checks, and a range of advice being given by the NHS on health and safety, health information, risk assessment, environmental health advice and stress management. Services of this sort are of particular benefit for small and medium-sized enterprises which lack the size to organise in-house services but where ill health amongst employees can have serious consequences. The NHS gets the benefit too, by intervening to prevent and avoid injuries and sickness before they occur.

11.19 These partnerships will be extended. A new set of services, NHSplus, will be developed as part of this NHS Plan. A portfolio of NHS occupational health services will be identified which can then be bought, in whole or in part, by employers to improve the health of their employees.

11.20 NHSplus will be established as a national agency. The business plan for NHSplus will ensure these new services are provided at no cost to the taxpayer and will build upon local services provided by hospitals and Primary Care Trusts. Surpluses will be reinvested in the expansion and improvement of NHS services. NHSplus will be launched in 2001 and its coverage will develop as the capacity of the NHS expands.

Conclusion

11.21 A closer working relationship between the NHS and the private and voluntary sector will be mutually beneficial. By putting the relationship on a new footing NHS patients will benefit. It will, in particular, contribute to winning the war on waiting for treatment in the NHS.