Back in the good old days, when British Rail were getting there, British Leyland weren't, and the only Diabetic Eye Screening Programme was the moment the star wore sunglasses on The Mary Tyler Moore Show, the thought of having a National Health Service run by private companies seemed about as likely as Gary Glitter being a paedophile.

Obviously a lot has changed since then. Hospitals no longer give out keys to Radio 1 DJs, and numerous NHS services are now delivered by potentially profit-making businesses. Not all services, of course. The complex, high-risk cases that no capitalist would touch with a bargepole are still happily run by the NHS, but the attractive, low-risk services with a good chance of turning a profit, have been kindly taken over by private companies in a benevolent act that gives the British taxpayer greater value for money, whilst maintaining the high standards of care that Nye Bevan dreamt of.

At least that's the theory. I should state immediately that I work for the NHS. But a lot of retinal screeners don't. The National Diabetic Eye Screening Programme includes the likes of Virgin Care in Surrey, Clinicenta in Hertfordshire, Health Intelligence in Suffolk, 1st Retinal Screen in London and Yorkshire, and Medical Imaging UK in Worcestershire, Essex and beyond. As an NHS employee, it's easy to feel like a T-Rex in the last days before the asteroid hit, but is the spread of privatisation in the world of diabetic eye screening necessarily a bad thing?

Well that depends. At the time of writing, entering the word 'Clinicenta' into Google returns seven results on page 1, four of which are negative news stories, including the headline "Patients 'Lost Sight' at NHS Hospital Private Clinic" . So if they're making a profit, they need to spend some of it on PR. But that doesn't make all privatisation (or indeed all Clinicenta services) bad. Assuming that all NHS programmes are run by hard-working, selfless angels, and all private services by ruthless, money-grubbing profiteers is clearly ridiculous.

My only concern would be whether profits are being put before patients. And that might be a common accusation levelled at a private company by supporters of the NHS. What's more worrying is when those private companies themselves accuse the government of awarding contracts based on price rather than standards of care.

Channel 4 broadcast an edition of 'Dispatches' this week entitled 'Getting Rich on the NHS'. Here's a two-minute clip...


Should we shed any tears when one private company is replaced by another? Well, in this case, maybe. 1st Retinal Screen have been providing diabetic eye screening in Swindon and North Wiltshire since the early days of the national programme. And if Mike Nelson is to be believed, they've only recently made any money. The 'sour grapes' accusation is one that's easy to level at Mr Nelson, and to some degree there's probably an element of truth in it. Is it really so outrageous for a new provider to enquire about buying some cameras? One could argue that if you're taking over an existing service and (presumably) employing a lot of the old staff, then making use of their (now redundant) equipment is a logical and sensible step.

But that doesn't make Mike's arguments invalid. When the PCT began the tendering process in February, there were reportedly fourteen expressions of interest from both NHS hospitals and private sector providers. One would assume that 1st Retinal Screen held all the cards in that bidding war, possessing top trumps in experience, knowledge and quality of care. But they lost out on price, which appears to be the one card that consistently trumps all the others. And that has to be a concern.

Virgin Care might end up providing a first rate service, but the initial impact on patients can only be negative. The handover from one company to another inevitably results in a gap in service, which means delays to patients' screening, and a potential for serious consequences. And in the longer term, how can Virgin Care provide a service of similar quality at a price that's 14% lower than 1st Retinal Screen say they need to charge to break even?

Only time will tell. But as a retinal screener, it's a question which worries me. The biggest overhead for any diabetic eye screening programme is its staff, and those staff will inevitably become the focus for any cost-cutting exercise. If losing screeners is not an option, then getting more out of them is the only alternative.

There seems to be a commonly held misconception amongst some NHS screeners that if their programmes are taken over by the likes of Virgin Care, it will mean the replacement of their chronically underfunded facilities with privately-owned state-of-the-art equipment. Clapped-out laptops will be replaced with cutting-edge iPads, stylish new uniforms will be issued, and Richard Branson will be popping in once a week to hand out £50 notes and free air miles. The perception is that NHS poverty will be replaced by Virgin wealth, and we'll all be riding the gravy train to an easy life.

The reality is likely to be the complete opposite. Any company that wins a contract at a rock-bottom price will be looking to squeeze every last penny of value from each of its assets. And that means making staff do a lot more for a lot less. I have no personal experience of working for a private screening company, but common sense tells me that my professional life can only get worse. By definition, my new employer would have outbid my current one on price, and the programme's budget would therefore be even tighter than it is now.

As I understand it, private companies taking over NHS contracts are not allowed to make current staff redundant, meaning that their only option is to get greater value from them. Which means working them harder, with fewer benefits, and less job satisfaction. That might maintain standards of service at first, but how long before an over-worked and dissatisfied screening team begins to impact on patient care?

As taxpayers, we all want value for money from the NHS, but as patients, we want good care too. And as a screener, I'd like to see fairness for staff in the mix also. Undoubtedly there are private companies who can achieve a balance of all three, but for how long? With prices being driven down all the time, something's got to give, and probably already has. It only takes one company to win a contract by lowering standards, and the rest will inevitably follow suit. In the world of business, how else can they compete?

1st Retinal Screen lost the Swindon contract because they couldn't provide a good quality service for a price that low. So what do they do the next time a contract comes up for tender? Lower their standards, or go out of business? It's a choice no company providing NHS services should be forced to make. And the only way to avoid it, is for the government to place less emphasis on price, and more on the quality of patient care. I don't want shareholders getting rich from my NHS care, but I want that care to be decent. And if it's not, then it's time to renationalise.


***UPDATE 7/12/12***
In the above article, I posed the question "Is it really so outrageous for a new provider to enquire about buying some cameras?". Well, I bumped into a chap from 1st Retinal Screen this week, and it seems the answer's yes. Apparently the equipment you own forms a key part of your bid, so if Virgin Care had the cameras they required, why were they keen to buy more? And if they didn't have the necessary equipment, how did they win the contract? Those are questions I'll be asking when I bump into a chap from Virgin Care.

Looking forward to it, Mr Branson...