Health and Social Care Bill - The taste of things to come

On 20 March, the Health and Social Care Bill cleared its final parliamentary hurdle. Now the road is clear for complete fragmentation of the NHS and the privatisation of many of its services. The result will be an end to universal health provision, charging for more and more services, reduced quality especially for the poor, and widening inequalities. Any possibility of integrating services within the health sector let alone across to social care is at an end. What will now be put in place is a hugely bureaucratic system where private companies will decide what services to cherry-pick and what we will have to pay for them.

Labour has promised to repeal the Act ‘at the first opportunity’. This is as empty as its promise to re-nationalise the railways in 1997. As the Bill wound its way through parliament Health Secretary Andrew Lansley constantly taunted his Labour opponents that he was only continuing along a path set out by previous Labour governments. Labour had no answer: all it could argue was that Lansley was going too far, too fast.

The Act replaces three layers of management with six: DoH, the NHS Commissioning Board, clustered SHAs, Clinical Care Groups (CCGs), Clinical Senates, Health and Wellbeing boards, Healthwatchers. To this can be added a seventh layer not mentioned in the Act, Commissioning Support Groups which the DoH has created because it knows that the GP-led Clinical Care Groups will be unable to do what the Act supposes they should do, buy health care services for local populations.

The ConDem coalition government may have faced opposition from different organisations: professional bodies like the royal colleges, trade unions and the Labour Party. But the opposition was only verbal and often mealy-mouthed. The trade unions professed more practical concern about the future of NHS pensions: striking against the Bill was ruled out because it would fall foul of the anti-trade union laws. In the final days of parliamentary debate, the Royal College of General Practitioners announced that it would cooperate in the Act’s implementation. The hopes of some that the LibDems might oppose it were dashed by the decision of LibDem peer Shirley Williams to support a Bill she once said she opposed so strongly. As for the Labour Party, it was hopelessly compromised by the enthusiastic programme of privatisation it had led between 1997 and 2010.

Increased costs

From April 2013, CCGs will take over the £60bn annual budget for hospital treatment. There have been many reports on the time GPs have to spend preparing for this new system, a chaotic situation that takes them away from seeing patients and replaces them with locum doctors. In some areas, GPs are spending four days a week organising the new CCG system; in others at least one doctor is spending three and a half days a week away from patients. It costs the NHS up to £123,900 a year to replace a GP with a locum. In one CCG alone, where 15 doctors are spending two days a week away from their real work, the cost is almost £1m per year. With 230 CCGs across the country, the final bill just for setting them up will be enormous.

In reality, most of their work will be done by the Commissioning Support Groups. These will absorb PCT staff and will then buy in support from those management consultancies which advised past Labour governments and have helped Lansley formulate his proposals: McKinsey, KPMG and so on. They will be the vehicles through which private companies will drive forward the privatisation of health care services.

Private companies and their priorities

How will the privatised NHS behave? One answer lies in the fate of Camden Road GP practice in north London which will close on 13 April. The practice has been operated by Practice plc, and its decision to close leaves over 4,700 people without a GP. Nearby practices are receiving 150 phone calls a day and have shrunk their boundaries because they can only take on an extra 1,500 patients.  North Central London NHS Trust is struggling to help as it is being dismantled in the current restructuring. At a local meeting, an outraged resident said: ‘We are not chess pieces to be moved around and shoved about…not victims of private companies who are trying to make money out of us.’ Practice plc just decided to pull out. It has a contract to run three practices in Camden until 2013 – but it can walk away from any of these if it so chooses, and if the NHS runs after it, it can declare bankruptcy.

We will never know how contracts with private providers are awarded, nor the terms of the contracts – and there will be thousands of them. Circle Healthcare started its management of Hinchingbrooke Hospital in Hertfordshire on 1 February. Its contract runs for ten years. Both the Treasury and the DoH have refused to release details of the contract claiming commercial confidentiality: the commercial interests of the NHS and/or Circle are more important than transparency and accountability. Under the Act, anyone and any company can claim exemption from Freedom of Information legislation on the ground of commercial confidentiality, making it impossible to discover the truth.

In Devon, two private companies are on the shortlist to provide services for children in the county: Serco and Virgin Care. Neither has any experience of running children’s services, yet they are the favourites for the £130m three-year contract. The winner will be responsible for services for vulnerable children and families: child protection services, mental health services for children and adolescents, respite care for children and young people with disabilities, health visiting services and palliative nursing care for children with terminal illness. The priorities of profit will put the children and young people at risk and leaves them vulnerable to the whims of the market and length of the contract: three years does not allow for any strategic planning.

The writing is on the wall, the stories a taste of things to come – the end of the NHS as a tax-funded system and its replacement by a mixed-funding system with privatisation of provision and commissioning and an increasingly carved-up, inefficient and costly service.

Hannah Caller

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