NHS maternity services up for sale

NHS for sale

‘We are all trapped in a marvellously pure ideology, the ideal socialist dream.’ So said Tory peer Baroness Cumberlege in 2000 of the NHS, as she advocated for an injection of private companies, competition and profit-making to improve ‘freedom of choice’. Cumberlege is the ‘independent’ chair of the 2016 NHS Maternity Review ‘Better Births’, and it seems her interests remain the same. The review recognises some maternity service problems, but offers a solution which would pave the way to further undermining of free, accessible, universal care.


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Unite in struggle to save the NHS

The NHS grinds steadily towards a government-engineered financial collapse. After five years of flat-line funding, spending on health has dropped from 11% of GDP in 2007 towards 6.6%.  Chancellor George Osborne may have announced £10bn investment in NHS England last November, but only £8bn of that represents new funding, and most of this is to paper over the fact that NHS spending must expand at 4% per annum to keep pace with demand.

In February 2016, the NHS provider sector recorded a deficit of £2.26bn, £622m worse than planned. A report to the joint meeting of Monitor and the National Trust Development Authority boards showed that as of 31 December 2015, 179 (75%) out of 240 NHS providers reported a deficit, of which 131 were acute hospitals; providers had made £1.94bn of savings, £257m less than planned. Hospitals as a whole missed the A&E waiting time target of seeing 95% patients within four hours between October and December 2015, and the size of the waiting list for routine operations reached 3.14 million as they failed the referral to treatment 18-week health care standard for the first time.


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Starving the NHS of staff and money

An adequate system of health care needs people to deliver it and the funding to sustain and develop it. In Britain, both are severely threatened, despite this being the fifth richest nation in the world. Services are being closed or handed to the private sector, poorer working conditions are being imposed on the remaining staff, and increased zero-hour contracts and job losses introduced for the already lowest-paid, tendered-out hospital staff, such as domestics, porters and caterers, vital members of any health care team.

The NHS employs more than one in 20 of the working population in Britain and nearly 80% of its workforce are women. Across the country there are tens of thousands of unfilled doctor and nurses’ posts, while training places are cut and student nurses, midwives and others are about to have their bursaries axed. Thousands of pounds are spent recruiting abroad for short-term gain in the NHS.

In 2013, Britain spent 8.5% of its total GDP on health care, ranking it 13th out of the 15 original EU members. For NHS spending to match the average European country’s level of expenditure by 2020 would require a 30% increase, equivalent to £43bn a year. The government has promised a mere £8.4bn extra, little more than 1% more a year. In the past five years, the average increase in NHS spending has been 0.8% per year. Yet annual spending on the NHS has to increase by 4% just to keep up with the annual increase in costs of treatments and running services. The future is one of yet more cuts, with the NHS facing continuing financial crises.


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Crisis in mental health services

On 25 January 2016 The Guardian exposed the collapse of NHS mental health services, citing figures from the NHS’s Health and Social Care Information centre showing that the number of registered mental health nurses (RMNs) working in psychiatry has decreased by 10.8% since 2010 as funding for the service has been slashed. The following day the paper revealed that the number of unexpected mental health patient deaths had risen by 21% over the last three years. This was inevitable given that mental health service budgets fell 8% in real terms under the last government. Claire Wilkinson reports on the crisis engulfing NHS mental health services.

Working on an acute psychiatric ward for the last four years, my experiences certainly correspond with this data. The North West mental health trust I work for is increasing its training and employment of Assistant Practitioners (APs), a relatively new role where a healthcare assistant is trained to take on many of the duties of a nurse while remaining unregistered in a professional capacity. APs are employed on a Band 4 in the NHS pay scale, whereas an entry-level RMN is employed on the more highly-paid Band 5. There is an obvious financial incentive for trusts to employ fewer RMNs and replace them with the cheaper APs, who are unable to progress past Band 4 or register with a professional body.


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NHS under-funded and under pressure

The Autumn Statement’s proposal to increase NHS funding by £3.8bn in 2016/17 is the minimum required to avoid financial disaster over the next 18 months, but may be too late to avoid a crisis this winter. The NHS needs £30bn by the next general election just to stay still; however, the government has only promised £8bn. The health service will have to find the balance of £22bn through ‘efficiency savings’ – about 20% of its current budget. This is an impossible target: but the government pretends not only that it can be achieved, but also it will be sufficient to meet what it defines as a 24-hour, seven-day-a-week service. The savings require productivity improvements at twice the rate of the past five years, during which time the increase in health spending has averaged 0.8% per year, the smallest five-year rise since the NHS was introduced in 1948. In reality, annual spending has to increase by 4% to keep up with increasing need and escalating costs of new drugs and treatments.


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No solution but to fight for health care

The financial crisis of the NHS is now so deep that Tory Health Secretary Jeremy Hunt has been forced to concede its existence. Typically, however, he has blamed it on factors beyond the government’s control: ‘There’s a triple whammy of the ageing population which means there will be a million more over 70s by the end of the parliament than there are today – that’s a massive impact; the financial pressure which means that the government is not able to increase spending in real terms on the NHS by the amounts it has done historically – that’s something we’ve had to get used to over the last five years; and raised expectations from people who use the NHS about accessing it more easily but also raised expectations post Mid Staffs in terms of the quality and standard of care.’ The underlying message is that capitalism will not provide a decent health service for the mass of the people. There was an £822m deficit in the NHS last year and the NHS is facing a £2bn deficit this year. Had the Department of Health and NHS England not put in £350m, the deficit would have been bigger.


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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.


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The NHS: facing a financial nightmare

As the financial crisis engulfing the NHS deepens, Conservative promises to create a ‘seven-days-a-week’ NHS by 2020 already ring hollow. Its election commitment to invest an extra £8bn a year by 2020 will at best keep the NHS standing still: more likely, it will involve further cuts to an increasingly threadbare service.

Desperate pleas for an immediate cash injection of £1bn into the NHS demonstrate how close it is to a financial abyss. Hospital, mental health and community services collectively ended 2014/15 £821m in deficit, nearly eight times the 2013/14 figure of £107m. The total deficit for acute hospitals was just over £1bn, with Barts £80m overspent and foundation trust Kings College £47m overspent. On current trends, the projected NHS deficit for 2015/16 is in excess of £2bn.


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Who will defend the NHS?

The Labour Party has long presented itself as the principal defender of the NHS. Yet in one fell swoop, the Conservative Party outflanked it with an apparently unconditional guarantee that in government they would meet the 2019/20 £8bn funding gap identified in the December 2014 Stevens review: The NHS Five Year Forward View. Labour was left looking flat-footed: it has pointedly refused to meet the gap, pledging instead an extra £2.5bn to fund training and employment for an extra 8,000 GPs, 20,000 nurses, 5,000 care workers and 3,000 midwives. Even this, however, is conditional on receiving matching income, in particular from the so-called Mansion Tax to be imposed on homes worth more than £2m, and a levy on tobacco companies to guarantee a week’s turnaround time for cancer tests and results. The reality is that the NHS is not safe in Labour’s hands: its pledges during the election campaign to end privatisations are just lies.


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Health Matters - Capitalism is bad for your health

At the end of March the NHS deficit stood at £1bn; on current projections by the end of March 2016 it will be £2.5bn. The NHS is in financial meltdown, and despite a poll showing that 46% of the electorate regards the NHS as the issue that will decide which way they vote at the general election, all we get from the major bourgeois parties is smoke and mirrors.


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Health matters - Fight to save the NHS

As we approach a General Election, the depth and extent of the crisis in the NHS is evident. In an unprecedented step, hospitals responsible for 75% of care across the country have rejected a proposal to cut the tariff (a standard amount for each type of treatment) by 1.9%. They have stated that they cannot manage a fifth round of cuts without either endangering patient safety or reducing the number of operations they perform. The majority of foundation trust hospitals are in financial deficit; 80% of all hospitals will be by the end of March. They will also face a transfer of £1.9bn to social care from April and further cuts of £290m in specialist care and £220m for some A&E services. There are insufficient numbers of nurses, GPs and A&E doctors. General practice as whole is almost broken with few trainee doctors wanting to become GPs; waiting times for appointments are running into days and sometimes weeks. Mental health service provision is a disaster area. Hospitals around the country are declaring major incidents because they are unable to cope with the number of people coming into their A&E departments and then requiring admission. Meanwhile the proportion of GDP being spent on health services is falling as a result of austerity. HANNAH CALLER and ROBERT CLOUGH report.


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Nothing is irreversible – act now to save the NHS

The NHS faces meltdown. The third week in November revealed the extent of the crisis: a 5% rise in attendances at A&E departments across the country compared to the same period in 2013 led to units as far apart as Cambridgeshire, Scunthorpe, Middlesbrough, Wigan, the Wirral and King’s Lynn urging patients to stay away. The situation has been made worse by cuts in social services which have meant patients cannot be discharged safely, reducing the number of available beds. The reason is quite simple: there is not enough money. Five years of flat-line funding has left it facing a £30bn budgetary shortfall by 2020. With their commitment to austerity, none of the parliamentary parties have the slightest intention of plugging the gap. In the meantime, stories of bad care and deteriorating quality are cynically used by the media to claim that a nationalised service cannot work.


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NHS - End privatisation and save our surgeries

The NHS budget has a £2bn shortfall for 2015-2016 and still there is the target of £30bn efficiency savings by 2020. In England between 2012-13 and 2013-14 the number of trusts in deficit rose from 45 to 66 and a £383m surplus in 2012-13 became a £100m deficit in 2013-14, despite emergency funding. This included £500m in summer 2013 to help prepare for the winter pressures, followed by another £150m in November. In June this year, a further £400m was provided to reduce the pressure on A&E and allow 100,000 extra operations in July and August when it emerged that waiting times for many operations, such as hernia repairs, cataract removal, tonsil and adenoid surgery, hip and knee replacements, are rising sharply. It is estimated that following three years of standstill funding, the NHS needs £15bn for the five years from April 2015 to avoid collapse.


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Fighting to save Whittington NHS Hospital

Whittington Hospital is a local general hospital with a maternity wing and an A&E department that serves 40,000 patients a year; it has the reputation of being the safest hospital in the country. Its situation on Highgate Hill, which is a prime site two miles from the City of London, has long tempted private interests to grab the land for development. Unfortunately for them, the land is granted by ancient charter for the purposes of hospital welfare only.


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Mental health: services ground down

In May, a woman was admitted to the acute mental health ward on Merseyside where I work as a full time nursing assistant. She had tried to kill herself using an overdose of prescription medication and a bottle of vodka. We found out that she had been financially supporting her daughter, who has two disabled children and had got into thousands of pounds worth of debt – because the disability benefits had been stopped. Now, without any prospect of getting the money to pay off her debts, the woman had attempted suicide in an effort to get away from the relentless tyranny of telephone calls and letters demanding repayments. She was on our ward as a direct result of poverty and welfare benefit cuts.

Her case shames me, both as a mental-health worker and as a citizen in our so-called society. In a true and functioning society no one is left behind. Not our patient, not her daughter, and not her grandchildren. The disabled grandchildren have been failed due to the cut in the benefits which were there to sustain and support them. Their mother is failed because her needs as the carer of these children have been ignored. Our patient was failed because it fell to her to pick up the bill for the needs of her disabled grandchildren, while her basic needs as a human being had been ignored.


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Health Service: remorselessly deepening crisis

Every politician knows that the NHS faces financial collapse in 2015. As a proportion of GDP, health spending reached a peak of just under 9% in 2009; it is now predicted to fall to under 8%. The scale of service cuts required to meet a £20bn funding gap for 2011-14 is already huge, with soaring waiting lists and extended A&E waiting times. With flat-level funding expected for the three years from 2015/16, the overall gap will reach a massive 23%. General practice services are facing disintegration with some practices unable to offer a consultation for two weeks. NHS Monitor is requiring foundation trusts to rework two-year financial plans submitted in April because their assumptions are unrealistically optimistic. These are the consequences of slashing state welfare: the ruling class may be sitting on ever-growing and obscene levels of wealth, but it will always ensure less and less is spent on the working class. Hannah Caller and Robert Clough report.


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Big Pharma rip-off

The independent NHS watchdog, the National Institute for Clinical Excellence (NICE), decided that a new breast cancer drug, Kadcyla, developed by Roche is too expensive. It costs more than £90,000 per patient per year to extend life by 5.8 months. The decision was criticised by Roche and some breast cancer charities, but the episode is the latest in a series of revelations showing how the pharmaceutical industry (Big Pharma – multinational monopolies including Roche, Bayer, Novartis, Astra Zeneca, GlaxoSmithKline, Pfizer, and Merck) is ripping us all off. The Tamiflu saga, where the UK government paid Roche close to £500m for a drug no more effective than paracetamol, shows the level of robbery. With the NHS facing budget shortfalls as it is privatised by stealth, and with cancer rates set to double between 2002 and 2020, Big Pharma profiteering is unsustainable and things are coming to a head.


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NHS: fragmented, privatised and on the brink

March against the partial sell-off of Whittington Hospital in north London - March 2013

The NHS faces a real possibility of collapse before the 2015 general election. Two factors will have led to this situation: real cuts in NHS funding and the fragmentation of services that has been the consequence of the 2012 Health and Social Care Act. A programme of impossible savings is pushing many foundation hospital trusts towards bankruptcy. Clinical commissioning groups, responsible for buying health care services for their local population, are signing contracts left right and centre with private companies. At least £6bn worth of work is out to tender in the NHS in England. Financial pressure to make savings of £30bn by 2021 will mean that trusts that don’t make money can expect to be closed, aided by the new powers that the Health Secretary has now enshrined in law with Clause 119 of the 2014 Care Act. A market in health care inevitably leads to priorities that are not in the interest of people’s health care.


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Mental health problems equal discrimination and poverty

In October, the government once again delayed the implementation of so-called Personal Independence Payments (PIPs), the replacement for Disability Living Allowance (DLA), saying it had not been able to carry out enough assessments. PIP is part of the latest attempt by successive governments to cut benefits – already at almost subsistence levels – to people with disabilities and introduce draconian checks on whether claimants are ‘really’ disabled.

Such discrimination and contempt is particularly severe for people whose disabilities are caused by a mental health problem. Mental health problems can be as debilitating as any physical illness and are equally exacerbated by difficult economic or social circumstances such as poverty, isolation, poor housing or inappropriate work. Mental health problems are more common among poorer people in general and already oppressed groups such as black people, migrants and the LGBT community.


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Lewisham Hospital victory for campaigners

On 31 July, the High Court found that the Secretary of State for Health, Jeremy Hunt, had acted unlawfully when he decided to cut two-thirds of services and close departments at Lewisham Hospital in southeast London. He had exceeded his powers when he parachuted in a Trust Special Administrator to make cuts in Lewisham to save the neighbouring South London Healthcare Trust and rescue two bankrupt Private Finance Initiative (PFI) hospital contracts in the region. On 21 August, the government confirmed it will appeal against the judgment and implied it may investigate changes to the law to prevent similar challenges to its plans in the future. The High Court ruling is a victory for all those who campaigned in Lewisham and for all those who continue to fight for services that are being taken away or pared down around the country. Had it not been for the campaign, the government would have got away with unlawfully destroying health services. This case also makes it clear that providing excellent services and meeting local needs are no safeguard against government-imposed cuts.


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Health matters / FRFI 234 Aug/Sep 2013

As the NHS descends into chaos, the government knows who to blame: uncaring nurses, greedy doctors, poor management, negligent hospitals, patients who do not look after themselves, old people, inaccessible GP services – anything but the tightening squeeze on the NHS budget and the burden of the Health and Social Care Act. In an orchestrated campaign to denigrate the NHS as a public service, the Department of Health leaked a report into the quality of care and treatment provided by 14 hospital trusts in England to the press in advance of its publication. The result was hysterical and lying headlines claiming that ‘13,000 died needlessly at 14 worst NHS trusts’ (Sunday Telegraph).


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We want our NHS back

This video is produced by north London Fight Racism! Fight Imperialism! as a record of our unremitting and principled campaign on the streets and in the communities against the plan for a sell-off at Whittington Hospital. The proposal, launched in January of this year, to sell-off £17 million worth of buildings, halve in-patient beds to 177 and cut jobs by 570 and put a cap on maternity services of 4,000 a year, has now been cancelled. In July the hospital board was forced to tell the local press that this original plan was ‘just and idea’. There can be no doubt that the mobilisation of local protest against the sell-off plans must have influenced this retreat which is to be seen as a victory for the people.


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NHS emergency services face collapse

Gloria Foster, aged 81, died in hospital in early February after being found at home by a district nurse on a chance visit. She had been stranded in bed for nine days with no access to food, fluid or medication. Until that time she had been receiving four visits a day from carers from the private company Carefirst24, contracted to provide care for elderly people by the London borough of Sutton. On 15 January, the UK Border Agency raided Carefirst24 and arrested staff whom they accused of employing undocumented immigrants. Despite warnings to Sutton and Surrey councils, no alternative arrangements were made for Gloria Foster. Surrey police have announced that there will be no criminal charges. Hannah Caller reports on the disintegration of the National Health Service.


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Health matters: Cuts kill people

The NHS is breaking down. A combination of the £20bn cuts programme and the process of privatisation is making hospitals and services more and more dangerous as staffing levels fall – there are already 7,000 fewer nurses in post compared to 2010. With the likelihood of flatline funding from 2016 to 2020, equivalent to a cut of £50bn, the situation will get worse, and the abject failure of the Care Quality Commission (CQC) shows that people must take matters into their own hands if the NHS is to be saved. The campaign to defend Lewisham hospital is an illustration of what is necessary.


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Lewisham Hospital and the PFI parasites – Feb 2013

Lewisham Hospital is being sacrificed to parasites. The government’s plans to remove its Accident and Emergency service, maternity wards, paediatric and other services in order to provide private companies with extraordinary profits, which furnish the pleasures of multi-millionaires.

The South London Health Care Trust (SLHT) has run up a deficit of £15 million over the past 3 years. In 2012 the cost of servicing its debt is estimated to have been £61m – nearly 15% of its income. The SLHT total debt burden exceeds £2bn.


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NHS emergency - Save Lewisham hospital

On 8 November 2012, hundreds of people attended a public meeting to oppose the proposed closure of A&E at University Hospital Lewisham Trust and the reduction of its maternity services. So many people turned up that there had to be an overflow meeting, which itself was packed. There was deep anger at the proposals: for many years there had been pressure to combine Lewisham Hospital with nearby Greenwich Hospital, but these plans stalled when a consultation in 2007 calculated that the Private Finance Initiative (PFI) costs borne by the two hospitals made a merger a financial non-starter. Instead Greenwich was levered into South London Healthcare Trust (SLHT) along with Queen Mary Sidcup and Bromley Hospital. Bromley Hospital also had a huge PFI debt: the upshot was that SLHT was committed to £69m repayments per annum to its PFI creditors, 14% of its income. From the outset it was doomed to fail, and it is now to be dissolved after a bare three years’ existence. It is now proposed to break up SLHT and merge Lewisham with Greenwich, closing Lewisham’s A&E services and reducing its emergency and complex surgery and maternity services.


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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.


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Banks get bailed out, hospitals go to the wall

Disaster looms for the NHS. The combination of privatisation and funding cuts is bringing it to its knees. While the ConDem coalition trumpets its claim that NHS funding is protected and is in fact being increased by 0.1% per annum, in reality this amounts to year-on-year cuts of about 4% because of the scale of rising need. The NHS cannot survive this without irrecoverable damage. The story gets worse from 2015, when projected cuts in government spending rise from 2.3% per annum to 3.8%. Further privatisation, a wholesale attack on working conditions, and health care rationing will be the government’s answer.


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Health privatisation gathers pace

The passage of the Health and Social Care Act in England in April is the most destructive step in 20 years of internal market, fragmentation and privatisation of the National Health Service. Out go NHS Primary Care Trusts and Strategic Health Authorities, in come hundreds of Clinical Commissioning Groups (CCGs), partly run by GPs in England who will be responsible for £60-80bn of funds to commission health care – with more layers of bureaucracy and more private companies.


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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.


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NHS sinks deeper into crisis

The Health and Social Care Bill continues its tortuous way through Parliament. During January, the Royal Colleges of General Practice, Nursing and Midwifery came out in open opposition; other Royal Colleges are following suit. Prime Minister Cameron’s claim that NHS staff support the Bill is proving ridiculous. The House of Commons Select Committee on Health, dominated by Coalition MPs, is against it – but on the grounds that it is distracting attention from the need to save £20bn by 2014. However, the need to turn the provision of health services into a source of profit for private capital remains overriding, and despite all this opposition, there is no evidence that the Coalition is going to either abandon or significantly change the Bill. Hannah Caller and Robert Clough report.


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