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Wider context

The wider picture regarding services related to A&E in Gloucestershire

The Patient Transport Services for Gloucestershire have already been taken away from the Ambulance Service which continues to run the emergency ambulances, reducing their fleet of vehicles considerably. These services are now to be run for those who need help getting to hospital appointments by the bus company Arriva (owned by Deutsche Bahn of Germany).

Another set of transport providers is to be commissioned which can only be called on by such as GPs if the patient’s needs are urgent but it is not an emergency.

The 1947 Act of parliament which established the NHS promised a ‘no-gaps’ service but we now have to very aware of this risk. For this reason REACH is closely watching these services that impinge on accident and emergency situations.

The CCG have announced that they will put out for tender October 2014 the Out-Of-Hours GP service presently provided by a consortium of local GPs and the Ambulance Service.

The wider picture – why are these changes happening?

The reduction in A&E services in Cheltenham must be seen in the context of what is happening to the NHS that may influence this development.

Firstly, the NHS is expected to be reducing its costs by 20% in 2013.

In April 2012 the Health and Social Care Act was passed by Parliament and came into force in April 2013. As a result of this Act major changes are now happening:

  • The Secretary of State for Health (Jeremy Hunt in autumn 2013) no longer takes responsibility for the provision of healthcare free to every member of the population at the point of need
  • This responsibility is now delegated to a quango: National Health England
  • Locally, the Gloucestershire Clinical Commissioning Group (CCG) manages the purchasing of all services including medical treatment providers
  • All clinical services have to be offered to private contractors to provide by a tendering process (Section 75 Regulations)
  • The process of selling the opportunity to supply medical services will be managed for the CCG by a private company – the clinical support group
  • Contracts for taxpayers expenditure on NHS services will be kept secret: ‘commercial in confidence’
  • It is very difficult to find out who ultimately owns many of these private providers as many are owned by offshore groups, venture capitalists etc.
  • The cost of the various tendering processes across England is estimated to be around one fifth of the total health budget (previously spent on clinical services)
  • Being certain how capable a company is to provide the services they bid for will be difficult – as seen over the Olympics security contracted to G4S
  • Exemptions to the Freedom of Information Act make it difficult for the public to find out for instance how much a company is being paid or how much profit they are making out of providing health services to the NHS
  • Private companies providing medical services can refuse to treat patients who are ‘complex cases’
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