Sexual health services are in danger because they are being fought over in a contractual free-for-all between the NHS and private companies, senior doctors are warning.
In an unusual move, representatives of the UK's hospital doctors and sexual health specialists have written to every local council in England strongly advising them not to put services that provide contraception and diagnose sexually transmitted infections (STIs) out to competitive tender. Tendering poses several "key threats", including reduced access to clinics and treatment, a fall in the quality of patient care and the undermining of existing services, according to the British Association for Sexual Health and HIV (Bashh) and the Royal College of Physicians (RCP).
The president of Bashh, Dr Janet Wilson, and her RCP counterpart, Sir Richard Thompson, admit in their letter that tendering can offer greater patient choice, lead to innovation and cut costs. But they warn: "It does cause considerable disruption and is not without risks. Tendering has negatively impacted on the provision of sexual health services, destabilising, disintegrating and fragmenting services, causing significant uncertainty amongst patients and staff, and reducing overall levels of patient care."
They express "grave concerns" that improvements over the last decade in tackling STIs, which have been rising steadily, "could be reversed with the current trends in tendering and the prospect of wholesale tendering of sexual health by local authorities in the future. This could have serious implications for patients and the public's health."
Local councils took over responsibility from the NHS for commissioning most sexual health services in the coalition's controversial overhaul of the NHS in England in April. While they are not obliged to use competitive tendering, some have already done so, and it is expected that most will follow suit by 2016 in the face of deep cuts by Whitehall to many councils' budgets.
The medical leaders have also sent councils a paper detailing the "problems that have occurred with tendering of sexual health services, and with outsourcing of services from the NHS to private and third-sector providers".
They cite the anonymous example of a new healthcare operator winning a bid to run a sexual health service but then having to hand back the contract to the original provider after it could not find premises in which to see patients. That procurement process proved "a waste of time and money", say Bashh and the RCP, which represents hospital doctors.
In another case, the arrival of a new provider in the area led to "a significant reduction of sexual health services for several months" until portable buildings could be erected to house the new service, "meaning the service fell well below that which is mandated".
In other places, non-NHS providers have tried to reduce the number of senior doctors delivering the service and have excluded them from key meetings, and another non-NHS operator proved unable to deliver the services it had secured because it could not retain staff, while the transfer of contracts has also led to problems with the management of medical records, the paper says.
Andy Burnham, the shadow health secretary, said the letter and paper were "a serious warning from senior clinicians of the damage now being done to the NHS by an obsession with market ideology". He added: "It is breaking up before our eyes. Their analysis explodes the myth that markets save money. The NHS is now wasting millions on competition lawyers as a direct result of David Cameron's Health Act – money taken from patient care."
The doctors' intervention would increase the growing pressure across the NHS for a relaxation of rules designed to entrench competition, Burnham predicted.
The Department of Health declined to respond directly to the doctors' concerns or the examples they cited. "As this paper points out, there is no requirement for local authorities to make sexual health services subject to competitive tendering. But the NHS and local authorities must work together to make sure that sexual health services are convenient and work for patients," said a DoH spokeswoman.
Its sexual health improvement framework, published earlier in the year, "puts patients and the public at the heart of commissioning HIV services – and this includes focusing on prevention and early diagnosis", she added.
