ConDem health reforms - The end of the NHS in England

ConDem government policy for the NHS has become absolutely clear with the appointment of Jeremy Hunt as Health Secretary: it is to reduce state-run health care services to a basic minimum. Hardest hit will be the working class, the elderly, disabled people, the chronically ill and those suffering from diabetes or cancer. Quality and level of care will come at a cost to be met through a widening system of top-up payments – a two-tier system. Meanwhile state-run hospitals and primary care or GP services will be step by step taken over by private monopolies and run for profit. The end of the NHS as a universal system funded by taxation will be a savage blow for the working class. Hannah Caller and Robert Clough report.

Fit for purpose

Come the time, come the person. Former Health Secretary Andrew Lansley had done the spade work with his Health and Social Care Act. Jeremy Hunt, however, has impeccable credentials. He is Teflon-like. He was investigated for fiddling expenses and got away with being told the ‘error was caused by his misinterpretation of the rules’. He later repaid over £11,500. In 2011, although only the Culture Secretary, he was given the power to approve the News Corporation takeover bid for BSkyB. Despite a mountain of evidence showing active collusion with the Murdochs, he got away with it all when he appeared at the Leveson Inquiry.

His promotion to Health Secretary comes as a reward. In 2005 he was one of the co-authors of a book written by a group of Tories which says: ‘Our ambition should be to break down the barriers between private and public provision, in effect denationalising the provision of health care in Britain.’ He is an enthusiastic champion of monopolies taking over NHS services, lobbying in support of Virgin Health’s take-over of primary and community services in his constituency this year.

Charging for health care

The 2012 Health and Social Care Act means that England will no longer have a national health service from April 2013. It does not apply to Scotland or Wales which will still have a publicly accountable national health service. Under the Act, the 60-year duty on the government to provide the universal right to health care has gone. Taxpayers’ money will increasingly come under the direct control of global health care corporations.

Within England, the Act allows charges for services to be introduced and allows any service to be taken over by a private provider. Staff will have to transfer out and will inevitably face poorer conditions of work and pay. State-run hospitals will have to act more and more like private corporations: all of them are being forced to become Foundation Trusts, 49% of whose income can come from private work. Getting such private work will become their primary aim. The so-called ‘transaction costs’ of a privatised system – setting tariffs for surgical operations, negotiating and managing contracts, sending out bills, reconciling and disputing them, paying, chasing missing payments – have more than doubled administrative and management costs from 6% of the NHS budget to 14%.

Commercial confidentiality will mean that there will be no accounting for quality of care let alone for cost. An example of this is Hospital Corporation of America (HCA), the largest for-profit hospital chain in the US. While recession bites, HCA profits have soared. The reason is massive fraud. Currently in the US, some of HCA’s 163 hospitals are under investigation for both refusing care and for performing unnecessary procedures. In 2002 HCA settled fraud charges with a payment of $1.7bn. HCA entered its first joint venture with the NHS in London in 2006 in the PFI-built University College London Hospital where HCA-UCLH provides private cancer treatment.

Cuts, cuts and more cuts

A combination of £20bn cuts and the re-organisation demanded by the ConDem reforms has already created a desperate situation for the NHS. The number of emergency admissions in England rose by almost 12% between 2004/05 and 2008/09. This meant an extra 1.35 million admissions to hospital. Over the last ten years there has been an increase of 37%. This was manageable while funding rose above the level of NHS inflation. But with fewer hospital beds, especially in PFI-built hospitals, a recent report by the Royal College of Physicians says that hospitals are ‘on the brink of collapse’. Now we are hearing more and more about ‘unlimited demand’ for health care, and about people, especially the poor, living too long. The over-65s constitute two-thirds of hospital admissions. But a decent system could not only treat them all, but do so safely and with dignity. This is of course not what the ruling class wants – they want a system that generates profits for the big corporations. It is not surprising that the Francis report into the disaster that was Stafford Hospital, due to be published in October, will now not appear until January 2013. Anywhere between 400 and 1,200 people died because of management pressures to maintain the Mid-Staffordshire Hospital trust as a Foundation Trust.

Where have the unions and the Labour Party been?

There is no doubt that with determined action by the trade unions, Royal Colleges and professional associations Lansley’s Act could have been stopped in its tracks. The vast majority of the NHS opposed it as did most of the public. But their opposition was timid and in the end completely ineffective. There were two reasons why the trade unions did nothing: first, they would have had to confront the anti-trade union laws in order to organise serious action, and second, they would have had to oppose the Labour Party. It was the Labour government which re-introduced the internal market. It was Labour which started to hand out service provision to the corporations. It was Labour that opened the door to the market. Labour invented Foundation Trusts and Monitor, the useless Care Quality Commission. The foundations for the Health and Social Care Act were dug by Labour. Where has this led? To a situation where an NHS organisation, Suffolk PCT, can put up the following statement on its website:

‘Do you seriously think you’re dying? If the answer is no, then it’s likely you shouldn’t be at A&E looking for medical treatment.’

What an indictment of government policy and cutbacks. We must fight to maintain universal health care free at the point of delivery.

Fight Racism! Fight Imperialism! 229 October/November 2012