Free NHS for Sale: Myths, Lies & Deception by Jacky Davis, John Lister, David Wrigley Page A

eye-watering fines paid is outside the scope of this book but the interested reader will find plenty of material. Of course monitoring fraud and pursuing it through the courts costs money which is lost to frontline care. In the US healthcare fraud is well recognised and dealt with by the FBI among other government agencies. 27 Here in the UK we are babes in the wood and it is unclear how the NHS, in thrall to commercial confidentiality and struggling financially, will even know when it is the subject of serious fraud.

Destabilising the NHS
    In this chapter we have already had examples of contracts awarded to the private sector leading to destabilisation of local NHS services and there are a number of reasons why this may happen. It might be because the NHS is left to discover and then deal with poor outcomes for NHS patients who have been treated by a private company, as with the patients who had problems after joint surgery in the private ISTC. It may be because a private firm has abandoned a contract and left patients without cover, as happened after companies walked away from unprofitable contracts to run GP surgeries. It may be because the outsourcing of profitable services may leave an NHS unit unable to deliver the rump unprofitable service, as is threatened when MSK services are cherry picked leaving the local trusts with only the acute and emergency orthopaedic work.
    The latest and perhaps most worrying example is unfolding in Nottingham where last year the local CCG awarded community dermatology services to Circle. The dermatologists at the local hospital, which had bid unsuccessfully for the contract, were reportedly concerned about job stability under a private employer, and also feared that Circle would not offer opportunities for training and academic research. The CCG ignored their concerns and six out of eight consultant dermatologists have since left, five citing their unwillingness to work for Circle. This means Nottingham University Hospitals Trust, until recently a national centre of excellence for dermatology, is now unableto offer acute and emergency adult dermatology services, an extraordinary and potentially dangerous situation by any standards. 75
    The British Association of Dermatologists (BAD) warned that the privatisation and fragmentation of specialist services was ‘decimating’ some areas of the NHS. Dr David Eedy, president of BAD, said an increasing number of private providers were taking on dermatology services around the UK, including in Cumbria and Colchester. He added that the exodus of staff should have been predicted:
    Nobody has thought through the implications for teaching, training and research – the whole future of British dermatology. Nottingham is just one example of the many fires we are fighting across the UK to try to keep dermatology services open in the face of poorly thought out commissioning decisions, and the Government’s lack of understanding of the implications of pushing NHS services into unsustainable models provided by commercially driven private providers or enterprises. 76
    NHS hospitals are complex organisations whose many departments are interdependent to a high degree, which is often not appreciated by non-clinicians. They resemble children’s Jenga towers in as much as removal of one block may lead to instability while the removal of too many blocks will inevitably lead to the collapse of the structure. Not only are different specialities dependent on the clinical expertise of many others (for example obstetricians and paediatricians must work closely together) but within departments expensive work has traditionally been cross-subsidised by simple and easier work. Thus NHS services will be destabilisedif specific expertise is removed or easy work is outsourced. In Nottingham this has happened with fatal results for acute adult dermatology. Consultant dermatologists are in short supply, with 200 posts unfilled across the country, and it will be no easy