Privatisation in all but name

‘Are we privatising the NHS? Never. Are we changing the NHS? Absolutely.’ These are the words of the Health Secretary Patricia Hewitt as she pledged to press on with the current NHS reforms despite protests from health workers and patients, calls for an end to private sector involvement and outcry over hospital closures, cuts in salary, job losses and service reduction.

In a speech to health workers at the Institute for Public Policy and Research, Hewitt insisted that core NHS values were ‘non-negotiable’ but that services had to change to meet modern needs and admitted that it was difficult times for staff and ‘there is a sense that many in the service no longer know where it is going’. In reply to a question on how far the government would go with the new reforms, Hewitt replied ‘I don’t think we should set artificial limits’. She has stated that introducing more competition is vital to securing better services and has ruled out limits on the involvement of private companies in the NHS. Hewitt’s pledge amounts to little more than a semantic con-trick than fools no-one. The government’s plans for the NHS will amount to privatisation in all but name.

Reducing the deficit or improving care
Only a month into the job and the new NHS chief executive David Nicholson has announced up to 60 ‘reconfigurations’ of NHS services affecting all areas of Britain with the aim of improving patient care. This will particularly focus on A&E services, maternity departments and children’s services. Nicholson angered the Royal College of Midwives by referring to the ‘wicked issue’ of maternity. Nicholson admitted that some changes were aimed at reducing the NHS deficit, £512 million last year, but said the overall aim is to improve the NHS by concentrating services in fewer hospitals. The plans include closing hospitals in towns of fewer than 250,000, closing midwife-led maternity units, replacing A&E departments with minor injury units and moving some services out of hospitals and into community clinics and GP surgeries.

This comes at the same time as research is published showing that A&E attendances have risen since the GP contract changed and out-of-hours care was handed over to the Primary Care Trusts. Since October 2004 for instance, Heartlands and Solihull Hospitals have seen attendances for less severe conditions rise by 51% while major illness and trauma figures have remained stable. Earlier in the year, A&E attendances across the country were reported to have risen by 13%.

Privatisation’s ugly trail

Despite Hewitt’s protestations, privatisation is being stepped up and money is being poured into the private sector, with significant redundancies and closures widespread. The Independent Sector Treatment Centre programme (now in phase two with 14 different independent sector providers being brought in to deliver 150,000 elective operations per year) will take work from the NHS and contribute to situations such as that at Ravenscourt Park Hospital in west London. Ravenscourt Park Hospital was leased from the private sector by the NHS in 2002. After four years of not attracting sufficient patients it is closing. If the building is not used taxpayers will be paying £40 million for an empty building for the remaining lease.

Outsourcing supplies

NHS Logistics, set up in 2000 as a non-profit organisation and responsible for £4.2 billion a year of purchasing and distribution, provides the health service in England with a huge range of products from food, mattresses and syringes to magnetic resonance imagers, electricity and fuel. NHS Logistics employs 1,400 staff in five distribution centres, services 10,000 destinations and makes an average of 1,200 deliveries a day.

Now NHS Logistics and the Purchasing and Supplies Agency are being outsourced to DHL/Novation. Novation, based in Texas and currently under investigation by the Senate for alleged anti-competitive behaviour, is negotiating a contract that will make it and its German partner, DHL, responsible for buying everything for the health service. From 1 October, Novation will be responsible for negotiating the purchase of 500,000 products. DHL/ Novation will be paid on the basis of the money it saves the NHS. There is no incentive for quality. The Department of Health has refused to disclose the full list of what it will supply, stating that it is a confidential part of the negotiations.

There is great concern about whether a private company will be able to deliver on time. This concern follows the deaths of elderly people when the privatised company responsible for delivering oxygen to their homes failed to do so.

Unison says that the ten year contract is worth £3.7 billion. Workers at NHS logistics are planning two 24-hour walk-outs, the second to coincide with the Labour Party conference. This is part of the biggest outbreak of industrial unrest in the NHS for almost 20 years.

A government pledged to our well-being?
How ironic this all is in the light of a document brought out recently by the Labour government: A strategy for health and well being of working age people. It states that: ‘The health and well being of people of working age is therefore of fundamental importance to our future and we are committed to bringing about a real and sustained improvement in this area.’

In London alone in 2005, £259 million was cut from health spending with £70 million further cuts announced. 300 jobs are to go at the Hammersmith Hospital, 480 at the Royal Free, 300 have gone from St George’s with a further 150 to go, and the Queen Elizabeth Hospital in Woolwich has gone bankrupt through the process of Private Finance Initiative. Surrey and Sussex are losing 400 jobs, United Lincolnshire hospitals over 500 jobs, the National Blood Service has lost over 150 jobs and NHS Direct over 1,000 jobs. These are just a few examples. Overall up to 20,000 NHS staff are set to lose their jobs.

Always electioneering
It is increasingly clear to all that these changes are motivated by financial and political considerations, not a desire to improve patient care. With an eye to the next general election, the government is attempting to engage in some damage limitation, mapping out closures to avoid making cuts in marginal Labour seats.

Meanwhile, Prime Minister-in-Waiting Gordon Brown has his own plans, to devolve the running of the NHS to an unaccountable board which will enable the government to distance itself from any controversial decisions about services.

Despite Hewitt’s words, the government plans are clear – there is no limit to their plans, market forces are driving the changes and this is the next step in the dismantling of the National Health Service.
Hannah Caller

FRFI 193 October / November 2006