Using the cover of ‘saving’ money by reducing ‘bureaucracy’, the Conservative/Liberal Democrats (‘Con-Dem’) coalition government is effectively proposing the wholesale privatisation of the National Health Service (NHS). In doing so, Tory Prime Minister David Cameron and Liberal Deputy Prime Minister Nick Clegg aim to finish what Margaret Thatcher started in the 1980s and Labour enthusiastically continued.
Andrew Lansley, the new Tory health minister, has set out his government’s plans to reduce the NHS to dust. Far from the stated aim of cutting bureaucracy and saving money, these plans are predicted to cost £1.7 billion to implement. Seumas Milne, writing in the Guardian, summed up the proposals: “From a major public service with a million employees, [the NHS] will have become a central fund with a minimal workforce, commissioning services from a string of private companies in a fully-fledged health care market.”
The NHS is due to be turned completely on its head and there is no doubt that chaos will follow. If Andrew Lansley succeeds in getting his legislation passed the NHS logo will be all that remains to be misused by a multitude of new health care providers.
Private companies that specialise in ‘out-sourcing’ of public services, such as Capita, Serco and many others, are lining up to take advantage of the huge profits they can make by the ‘denationalisation’ of the NHS. Richard Marchant, one of the heads at Capita, openly stated that the ‘problems’ in the public sector represent a ‘significant opportunity’ for his company.
The White Paper
Can it be managed by the ‘third sector’? Can it be cut? Can it be privatised? These are the three questions the new Con-Dem government is asking about the NHS.
The White Paper calls for more and more NHS services (including those which directly provide patient care) to be tendered out to ‘any willing provider’. Private companies will be lining up for their golden opportunity to take their pick of the most lucrative NHS services.
Profit maximisation in the NHS will have a profoundly damaging impact on a service, which was designed to have the needs of the patient at the heart of its core philosophy. Lansley is explicit about his desire to “create the largest social enterprise sector in the world”.
The idea of the ‘internal market’ was first introduced into the NHS by Thatcher in the 1980s and it was carried on with zeal by Tony Blair’s New Labour administration. One aspect of the market policy is that various NHS services get ‘split off’ into separate components and they are then tendered out to companies like Serco.
This process has happened wholesale in all NHS cleaning and catering services and it is happening increasingly with phlebotomy (blood taking) services. We have all borne witness to the damage inflicted on the NHS via PFI (private finance initiatives) which basically gave construction companies carte blanche to lock NHS trusts into long term, hugely expensive contracts for building new hospitals. NHS trusts ended up in massive amounts of debt as public funds were effectively diverted into the pockets of company shareholders.
The GMB union has identified around 640 current PFIs and more than 100 new projects in the pipeline (across all public services, although many may now be cut). The total cost was estimated at £250 billion over 25-30 years, four times the value of the assets built (£64 billion). This is equivalent to £8,400 per taxpayer.
Duplication of existing services will also be encouraged under the pretext of ‘offering choice’ and this production of excess capacity will lead to unnecessary waste.
Extended role of the GP
Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs) are to be completely abolished by 2013. This will fundamentally change the structure of the NHS and radically alter the existing funding and commissioning of health care. These changes will be costly and complicated to implement.
Groups of GP surgeries (consortia) will be handed responsibility for up to 80% of the £100 billion health budget. GPs will increasingly have their eyes on budgets rather than on providing and accessing care for their patient population.
When money is a factor in a GP’s decision-making this will make purchasing the cheapest, possibly less effective health care option more attractive, regardless of a patient’s clinical need. GPs will end up avoiding referring patients on for specialist investigations and services that are deemed to be ‘too expensive’ or are not deemed to provide ‘value for money’.
35,000 doctors could form up to 500 consortia, which will then ‘buy care’ from local hospitals or other providers, including private organisations. They will hire staff to manage these processes. While some have welcomed this proposal, Unison reports that around half of GPs are opposed.
GPs are not trained for their new commissioning responsibilities and will need to employ existing commissioners to help them. Capita, for example, is already offering to ‘help’ GPs with billing and human resources etc. It is acknowledged in the White Paper that GPs will not fully understand all of the complex areas of the specialist services, eg mental health services, that they will be commissioning.
According to Rethink, a mental health charity, two-thirds of GPs say they lack the expertise to commission mental health services. Ignorance of the value of a particular service will rapidly lead to ‘disinvestment’ which is the current NHS buzz term for cutting a service.
There are some GPs who wisely realise that they are going to be handed a ‘poisoned chalice’ and will end up implementing the government’s hidden agenda of carrying out cuts to patient services.
‘Efficiency savings’, i.e. cuts of £20 billion, are expected over the next few years and if GP consortia are deemed to ‘fail’, i.e. overspend on their allocated budgets, the government is being explicit about the fact that there will be no ‘bailouts’. Any failure will pave the way for other groups with vested interests to take away the health care commissioning role from a GP consortium.
Effects on existing NHS staff
The abolition of the PCTs and SHAs will lead to masses of job losses as all of the existing staff cannot be absorbed into the new structure. Admin workers and other ancillary staff will be hit the hardest. In the meantime Andrew Lansley is already busying himself finding cushy, lucrative roles for the old bosses of the quangos.
Dame Barbara Hakin, chief executive of NHS East Midlands, has already secured a role for herself as one of the directors of the new NHS commissioning board. She will be paid £200,000 a year in the midst of ‘the very challenging financial position’ to which Lansley alludes.
In the meantime, the accelerated privatisation of the remainder of the NHS will mean that the contracts of NHS staff will change and our pay and conditions will most likely be driven down in the process. Staff will find that who they work for, what they work for and the way in which they work will change fundamentally.
Lansley is signing the death warrant for national pay bargaining and agreements: “Pay decisions should be led by health care employers rather than imposed by the government. In future, all individual employers will have the right, as foundation trusts have now, to determine pay for their own staff.” NHS workers’ pensions are also under threat.
The White Paper also proposes changes in the provision of staff training which will be outsourced to the cheapest bidder. There is a real risk that the content and the quality of training will evolve over time to incorporate more of a ‘business ethos’ with reduced emphasis on the needs of the patient being at the heart of operational philosophy.
Staff who entered the service because they care about patients will end up feeling completely demoralised as they are pressurised to ensure that ‘the company is successful’.
The cost of caring
The drive towards ‘payment by results’ and introducing ‘currencies’ for units of care will be pushed forward and standardised. This is to ensure that service providers can be compared with each other and to increase competition between an ever-growing number of health care providers.
Prices for service provision will inevitably rise as new technologies, medicines and treatments are refined and developed. An organisation called ‘Monitor’ will be involved in price regulation, but only for publicly provided NHS services.
Competition rather than cooperation will become the order of the day. Disputes between providers could become a reality and the resolution of these disputes via the courts could put further strain on the public purse.
Health and social services will be integrated further and their budgets will be pooled. This integration has already been started and staff are finding that they have to take on additional roles and responsibilities for which they are not trained. This has a negative impact on the quality of care a patient receives.
Integration of services also leads to services being centralised in one building and patients then have to travel miles out of their local area to access the service they need.
Funding arrangements for social care are being scrutinised by the government and they are openly admitting that they are considering voluntary health insurance as one of the payment options. Of course this option will not be open to everyone, particularly the unemployed and could directly lead to those most in need of services being excluded.
The White Paper proposes radical changes to the way in which patients communicate with health care professionals. Patients and professionals will be encouraged to communicate about a patient’s health status online. This is a time-saving exercise and there is no evidence that patients have requested this style of communication or will value this ‘arm’s length’, and essentially dehumanising, approach.
There will be implications for patients as their confidential health information will be shared with a multitude of newer, profit-driven, health and social care providers and the government has yet to clarify the legal situation around this.
In reality it will be very difficult for GP consortia and the new NHS commissioning board to ensure that these many and varied health care providers are held accountable to the public.
A patient’s confidential information could end up being misused in a variety of ways and there will be more opportunities for confidentiality to be breached and privacy eroded.
These plans must be stopped
These proposed changes will make a mockery of the founding principles of the NHS constitution. Legislation still needs to get through parliament in order to effect the changes so urgent, nationwide action is needed right now to send a clear message to Andrew Lansley and the big business vultures that we, the NHS staff and service users will not tolerate the massacre of our NHS.
During the general election campaign Labour candidates liked to dress in the cloak of saviours of the NHS. This was and is pure hypocrisy. Labour’s 13-year reign saw the massive expansion of the internal market in the NHS while Private Finance Initiatives sucked up enormous amounts of public money, depositing them in the pockets of private, profiteering contractors. Lansley’s plan is but the next logical step.
While all three main parties agree wholeheartedly on the ‘need’ for private companies in the NHS the majority of public opinion wants the NHS to remain a publicly owned and run service. An overwhelming 89% of the public agree that “public services should be run by the government or local authorities, rather than by private companies”, according to a 2005 YouGov poll. A mass workers’ party that represents that majority view is desperately needed as part of the struggle to save the NHS.
We cannot sit back and allow this government to sell off the NHS. The Socialist Party calls for the formation of a broad coalition of NHS staff (nurses, ancillary and medical staff), trade unions, patients, carers, community and health campaigners to coordinate a nationwide campaign to save what remains of the NHS and rebuild it before it’s too late.
We urgently need a national trade union-led demonstration against all cuts in jobs and services. The slogans for this demonstration must include opposition to the destruction of the NHS and for kicking out the profiteers, as well as defence of health jobs and services.