Introduction

Recent decades, shaped by powerful neoliberal forces, have witnessed a significant encroachment on the UK state sector with privatisation advancing over many social and economic sectors. Despite the political sensitivities, the role of the commercial sector in the National Health Service (NHS) has progressively expanded since the 1980s when compulsory competitive contracting in cleaning, catering, portering and laundry services was introduced. Now, but not exhaustively, commercial operators are involved in the provision and management of assets (for example through the private finance initiative); in the provision of clinical services (through the structuring of the health service as a contract-based market) and semi-clinical services (such as pathology); in the provision of support services for the market's commissioning function; as well as in policy making, for example through secondment to the Department of Health (DH) or Treasury. The extension of private sector involvement has implications for the effective public accountability of our ‘public’ services. While the secondary legislation concerning local authority Health Overview and Scrutiny Committees stipulates that private providers are regarded as ‘responsible persons’ with the same duties to provide information as other ‘responsible persons’ such as NHS hospitals, elsewhere the use of markets and private providers in the NHS has resulted in reduced transparency. This chapter examines, through case studies drawn from the past 10–15 years, selected aspects of this diminished accountability. The three case studies concern the availability or non-availability of data in different dimensions of NHS policy under privatisation: performance data in the provision of care when NHS-funded care is provided by private companies; financial and ownership details in infrastructure procurement; and technical data and organisational powers allowing an assessment of the character and implications of proposals in the policy process.

Patient safety and the limited obligations upon the private sector to report performance data

Although the private health sector in the UK had always treated a very small number of NHS patients (for relatively minor procedures such as vasectomies), Labour's creation of a market structure in the NHS during its second term of office (2001–05) established a mechanism for increasing the role of private providers in providing clinical services for NHS patients. This new structure permitted commissioning bodies to contract with non NHS bodies to provide NHS-funded clinical care, justified on the grounds of patient choice and service personalisation.