Care and profit just don't mix

Monitor, the organisation which is becoming the supervisor of the trusts, felt it appropriate, in an astonishingly condescending manner, to pat the government on the head for being clever enough to give it the role.

And where it didn't patronise, it simply parroted Tory policy, presumably to reassure ministers that there wouldn't be any nasty surprises when it took over the role completely.

It burbled on about "a growing body of evidence to show that competition under fixed prices can drive improvements in health-sector quality and productivity" and continued that "choice and the implied competition that goes with it should be key components of creating a patient-centred, patient-led NHS."

With such a slavish restatement of the accepted Tory wisdom, Prime Minister David Cameron and his mates clearly have nothing to worry about there - at least in terms of the regulator sticking like glue to government policies.

But there are other worries that they are either unaware of, or discount in their usual inimitably dogmatic and ideologically driven way.

Because the evidence, where it exists at all, indicates that privatisation and marketisation in health and social care is a poisoned chalice.

And to prove that, it's only necessary to look at the situation in the care homes industry.

In that industry, the private sector has now put tens of thousands of care places at risk by the speculation and unhealthy financial gambles which typify private capital let loose in big social enterprises.

Unrealistic and chancy sale and leaseback arrangements have led to profits warnings, soaring and uncontrolled costs and chains of speculative takeovers which have very nearly made Britain's biggest care home provider a basket case, one which is now appealing to government for what amounts to a bank-style bail-out.

Which has led commentators to ask worriedly if this is the shape of the NHS of the future.

Monitor claimed that the Health and Social Care Bill defines its primary role as protecting the interests of service users. It's not making much of a start.

Following the disastrous annual 4 per cent cut called for by the Department of Health as part of efforts to slash £20 billion from NHS running costs, Monitor seems to have been driven to go one better and jack the figure up to 6 or 7 per cent a year.

Now, it may well be that Monitor's figures are far more realistic in terms of real costs of these so-called efficiency savings. Indeed it warns that its "assumptions are a reflection of the risks in the external environment," and that's probably true.

But posing even bigger cuts than the government has demanded doesn't bode well for "protecting and promoting the interests of service users."

And the external environment is largely hostile. Again, the care home sector is instructive. Once, it was largely local authority and then was privatised.

But, being based on what was assumed to be a secure local authority income stream, the process was soon financially manipulated, heavily leveraged, sold and leased back and, now that the income stream is being hacked back, is in deep trouble.

It will need more than a Tory-aspected regulator to keep the NHS out of the same dire situation the private sector has dragged residential care into.

Once and for all, this government and its regulators have to understand very clearly that private profit and social care don't mix.