Lord Howe openly acknowledges that independent organisations like BPAS and MSI provide abortion services at a cost below standard NHS tariffs.

Which would appear to be a pretty cogent argument for private providers carrying out more NHS work wouldn’t it?

but it wouldn’t be an argument for abolishing PCTs and replacing them with GP consortia, a giant quango, and 3 times as many bureacrats would it?

As ever, Unity is using a sledgehammer to crack a nut here.

But the OP does raise some important questions.

Why, in this age of transparency, does the NHS NOT collect and publish detailed information on the costs of procedures that run into tens of millions of pounds?

Indeed, why does it not publish (or make it a condition of contracts with BPAS and MSI that they publish) even more detailed data on this complex subject.

Talk of the ‘average cost’ of a procedure is pretty useless, given that there are many types of abortion. In its ‘private provider’ mode, BPAS charges private patients anything from around £650 for a medical abortion in the first nine weeks to >£1600 for a surgical abortion at 20 weeks.

It would be helpful to policy makers in a number of areas to know how many of the 93% of BPAS abortions the taxpayer pays for are in which cost category of the half dozen or so in the tariff list.

There are, after all, limits to what taxpayers would freely assent to paying for. I’d guess that most would accept the burden of not begrudging the odd £700 for a teenager who’s got into trouble.

But £1600 for a 30 year-old who just can’t be arsed to use contraceptives or get round to dealing with her pregnancy in its early stages? Probably not. That is – if such people exist. They may only exist in the imaginations of Mail leader-writers. But we can’t know for sure if no-one is publishing the data.

I have to say that my first reaction to this was the same as Tim J’s above: shock, not that there might be any dishonesty in the abortion debate, but to find LC contibutors tacitly accepting the government’s argument for the use of private contractors to provide NHS medical services. Who would have thought it?

1 TimJ

Costs and tarriffs are different things.

@3

“Why, in this age of transparency, does the NHS NOT collect and publish detailed information on the costs of procedures that run into tens of millions of pounds?”

The NHS doesn’t collect or publish data on a whole load of things – things like postnatal depression, use of anti-depressents, access to diabetic clinics and much more. Perhaps there’s an argument that the NHS should, but if you’re going to make it, then you’d better give an idea of where the funding will come from for them to do so, in these austere times.

“But £1600 for a 30 year-old who just can’t be arsed to use contraceptives or get round to dealing with her pregnancy in its early stages? Probably not. That is – if such people exist. They may only exist in the imaginations of Mail leader-writers. But we can’t know for sure if no-one is publishing the data.”

No data published by the NHS would ever reveal whether this was the case – I doubt it would even reveal the average age of the person who had a late term abortion. Certainly, the idea that it would reveal the *motivations* of somebody having a late term abortion is farcical.

@4

That isn’t what is being said – the article says the average cost of an unspecified procedure is more than the cost of an abortion specifically. There is no indication at all that the chairities invovled offer the service at a reduced price.

Let’s clear up a few technicalities.

1. NHS tariffs set the baseline for the unit cost pricing of contracted services, whether internally or externally, with the expectation being that contracts should only be entered into at price at or below tariff.

In practice, the tariff is national average figure which each individual trust has to modify using its own specific market forces factor (MMF) to the actual tariff is hsould be working to – so, an NHS Trust in London will have a positive MMF which reflects the higher costs of operating in the capital, which a Trust in the North of England may have a negative MMF to reflect the fact that its overheads are lower than the national average.

2. As to why the NHS does not publish the full data on the costs of these services, in practice they can’t because these are tendered contracts and therefore subject to competition law. Exact contract prices are, I’m afraid, commercially sensitive data and cannot, therefore, be readily disclosed to all and sundry as this may give potential rivals an unfair advantage when contracts go out to tender.

3. What BPAS charges private patients bears little relation to what it charges the NHS. The simple fact of the matter is that, for 2009/10, if BPAS’s entire annual income (£25m) had been derived solely from NHS contracts then its average cost per procedure would have been £481, which is lower, even, than the cheapest NHS tariff at the time, for medical abortions, which was £502.

As for the use of private contractors, there are a number of very sound reasons for outsourcing abortion services that don’t rely solely on cost grounds, not least the fact that many, if not most, modern hospitals operate all their ob/gyn and maternity services out of dedicated units/centres and it is nothing if not fucking insensitive to ask women who’re having an abortion to use the same building in which the maternity ward is located.

For that reason, I don’t think you can reasonably generalise from outsourcing abortion services to private providers generally taking on more NHS work, it depends on the type of service you’re talking about and the impact that this may have on other services. There is a need for NHS hospitals to maintain a critical mass of services if they are to become simply a repository for just the risky and unprofitable services that the private sector don’t want to touch, so there’s more to it than just a simple cost argument.

Which would appear to be a pretty cogent argument for private providers carrying out more NHS work wouldn’t it?

Erm, except they don’t carry out the work for profit. I’m happy for that sort of work to be outsourced.

BPAS is a not-for-profit organisation, unlike the medical-sector companies straining at the leash to get their teeth into the NHS. So that’s a pretty major factor to note, right there.

@3: No-one *wants* to get a late-term abortion. There are almost always exceptionally compelling reasons why someone has to opt for a late-term abortion: intimate partner violence, late diagnosis of fatal foetal abnormality, onset of life-threatening cancer and need for abortifacent chemo, young girls who either don’t know they are pregnant or are too scared to tell anyone in the early stages… etc. This anti-abortion trope (not saying you are anti-choice, but that the language you use is – intentionally or not – reminiscent of the pro-forced-birth crowd’s slogans) of the “irresponsible woman who couldn’t be arsed to sort out contraception” is immensely damaging; it’s a stereotype that can’t apply to more than a tiny handful of people, among the near-200,000 who have abortions every year.

And of course David Alton has more previous than Nad the Mad in his reactionary campaigning in this area.

Unity 8

Your point 2 seems weak.
We’re just wondering why the NHS doesn’t publish the total, aggregated figures, across all suppliers – silly of you to suggest they’d be publishing details per contract or per supplier.

> 2. As to why the NHS does not publish the full data on the costs of these services, in practice they can’t because these are tendered contracts and therefore subject to competition law. Exact contract prices are, I’m afraid, commercially sensitive data and cannot, therefore, be readily disclosed to all and sundry as this may give potential rivals an unfair advantage when contracts go out to tender.