NHS: More fragmentation, privatisation and rationing

During the election campaign the Conservatives made great play of their commitment to put an extra £8bn into the NHS. This was their response to the Stevens Report from 2014 which identified a £30bn gap in NHS funding by 2020, and which argued that £22bn of this could be met with ‘efficiency savings’. Meeting such a target was always fanciful, and now senior NHS managers are stating openly that it is impossible, and that achieving even £15bn of savings is unlikely. Health Secretary Jeremy Hunt has seized the opportunity to express his doubts about the long-term viability of funding the service through taxation. Further fragmentation, privatisation and rationing are inevitable as part of undermining a universal service free at the point of use.

According to a study by the Centre for Health and Public Interest, one fifth of the NHS budget is contracted out and this includes GPs, pharmacies, opticians and dentists. Local commissioning bodies and NHS trusts have increased their spending in the private sector by almost 50% in the last four years. It costs £1.5bn per year and 25,000 people employed to oversee the contracts, of which there are about 53,000 between the NHS and the private sector.

Rationing of services

One widespread example of rationing is in hearing aid provision. Currently 22 Clinical Commissioning Groups (CCG) are discussing decommissioning some audiology services. In Devon, the CCG discussed only providing one hearing aid to those with hearing loss in both ears, while in North Staffordshire and Kernow (Cornwall), those with mild to moderate hearing loss will not be eligible for hearing aids at all. This comes at a time when the London Assembly has issued a report pointing out the disadvantages hearing-impaired and deaf people face when trying to access health services. Other rationed services include weight management, exercise referral programmes, NHS health checks, child and adolescent mental health services, sexual health services and services for those with alcohol and drug problems and for smokers.

Medication costs and Hunt’s sleight of hand

In his next discriminatory move, Jeremy Hunt has suggested printing the price of prescription drugs which cost over £20 on the packet. The implication is that anyone who is ill and needs drug treatment is a burden on society. It is claimed that between £150m and £300m worth of drugs are wasted. However, a billion prescriptions are issued a year, two-thirds more than ten years ago but their extra cost has increased at a much lower rate. There is something far more insidious behind Hunt’s suggestion. NHS spending on drugs is far higher in poorer areas of the country where there is greater ill health: in Cumbria, Northumbria and Tyne & Wear, total estimated prescribing costs were the highest in the country, £320 per person across primary and secondary care. Merseyside was second with £315.55, followed by Greater Manchester with £303.88. The lowest spend was at Thames Valley, with £200.50 per person, followed by Hertfordshire and South Midlands with £206.24 and Arden, Hereford and Worcester with £237.83 per person. The next step will be to cap spending per head of population in a direct attack on working class people.

Immigration rules and staff loss

Racist Home Secretary Theresa May has a plan to ‘ensure that only the brightest and best [migrants] remain permanently’, and under new rules due to come in in April 2016, non-EU workers who are earning below £35,000 after six years’ work in Britain will have to leave the country. Apart from the human trauma, this will exacerbate the shortage of nurses in the NHS and is exposing the international recruitment cost that goes on within the NHS. The Royal College of Nursing has suggested that this could affect up to 3,365 nurses who cost £20m to recruit.

The NHS has spent millions hiring nurses from overseas. There is little mention of the ongoing brain-drain from the original countries to which the NHS is contributing and the lack of forward planning of staffing needs and training at home. There is an estimated shortfall of 190,000 nurses by 2016, with 13% fewer nurses being trained than in 2011 and a third of nurses near retirement age. At the same time, Jeremy Hunt announced a maximum hourly rate for agency doctors and nurses and a cap on the amount any trust in financial trouble can spend on them. The combination of the immigration law changes and the cap will mean that safe staffing levels will be impossible to achieve.

In the meantime St George’s Hospital in south London has requested and received immigration staff posted at its administration department to help identify possibly migrant or overseas patients to enable them to be charged for any service they receive, or to check that they have paid the NHS surcharge. This will of course deter many, especially asylum seekers who are entitled to free health care, from seeking medical assistance when they need it.

Losing GP surgeries

Between January 2010 and the end of August 2014, 117 GP surgeries closed in London and 40 opened. Between August 2014 and the end of May 2015, 18 GP surgeries closed and one opened. Since 2011, closures, including mergers and takeovers, have eclipsed the number of new premises. This did not stop David Cameron in his post-election speeches making the ludicrous claim that he was planning to increase the number of GPs by 5,000 over the next five years. This is obviously impossible: one third are planning to retire by 2020, 400 GP training posts were not filled last year and it takes ten years to train a GP. His plan for GPs to be available between 8am-8pm seven days a week by 2020 is nonsense. The reality is that in the next three years London could lose up to 140 out of 1,400 practices, adding to the pressure created by 656 surgeries that have merged or have been taken over since 2010. In a recent survey, almost three quarters of surgeries have a doctor due to retire by 2018, and over half are trying currently to recruit a GP or practice nurse. These staff shortages and closures will mean that millions of people will struggle to see a doctor and many will be denied appointments.

The NHS can only be saved if we fight for it.

Hannah Caller & Robert Clough

FRFI 246 August/September2015


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