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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Health care secondary to profits

Health and Social Care Bill passes through the Lords

The Health and Social Care Bill has been in the House of Lords where a hundred peers queued to speak and were given eight minutes each. The outcome was a comfortable defeat of attempts to delay or throw out the Bill in the biggest turnout in the Lords for over ten years. Attempts to defeat the second reading and to set up a special committee to study the impact of the reforms were both defeated.

The Health and Social Care Bill removes from ministers the responsibility to provide or commission health care services directly, passing the duties on to ‘frontline organisations, free from political micromanagement’. The Bill removes the cap associated with earnings from private patients, opening up huge opportunities for the private sector.


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Stop the NHS sell-off

‘I think breaking up the NHS is exactly what you do need to do to make it a more responsive service.’

That was what Nick Clegg said in 2005, refusing to rule out an insurance-based model for health services (cited nhsmanager.net). Yet there were those who imagined that he and his colleagues would get a good kicking at the LibDem annual conference in mid-September for failing to stop the Coalition’s Health and Social Services Bill. They were wrong. Privatising the NHS is ruling class policy. The LibDems are a ruling class party, so those in charge of LibDem conference arrangements made sure the issue was not debated.


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The Plot Against the NHS - Review - Sep 2011


The Plot Against the NHS by Colin Leys and Stewart Player – book review

Read this book and get very angry. It shows very clearly how private capital in the form of health care multinationals, giant international consultancies and private equity companies have used their highly-paid agents, bureaucratic stooges, hireling politicians and other placemen to plan and implement the destruction of the NHS as a universal service, free at the point of use. Leys and Player demonstrate from today’s perspective that a sometimes apparently random set of policies, decisions and actions from 1999 were no such thing, but part of a long-term plan to privatise the NHS, and that the ConDem Coalition’s Health and Social Security Bill is the inevitable consummation of this process.


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The end of free universal health care?

Despite almost universal opposition, the government is pressing ahead with NHS reforms which will spell the end of the NHS as a free, universal service. After a short pause to allow for a farcical ‘listening exercise’, the Bill has gone back to the House of Commons. In fact only 64 of its 299 clauses returned to the Commons Public Bill Committee on 28 June, meaning that there would be no chance of scrutinising the document as a whole.


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Profiteering and Abuse in Care – Demand Decent Services as a Right! - 10 Jun 2011

southern_crossOn 10 June Southern Cross Healthcare, the largest provider of residential care in Britain, announced that it will ‘surrender control’ of 132 of its 754 care homes, handing over the homes and their residents to landlords to deal with as they see fit. The company’s financial crisis threaten the security of the company’s 31,000 vulnerable residents. It is the consequence of a trend which has seen care providers bought up by private equity companies seeking a quick profit. In it we can see what will happen if the ConDem Coalition succeed in breaking up the NHS.

Southern Cross’ business model has involved buying packages of existing care homes, selling the buildings on to landlords and then leasing them back on contracts which promise an automatic rent increase each year. This led to a rapid expansion of the company, netting a £1 billion profit for private equity firm Blackstone when it sold Southern Cross in 2007. With the onset of the economic crisis, and with growing reports of substandard care, the strategy began to fail and has now been brought to crisis by the cuts in local authority funding. This has meant that payments for residents have reduced while rents continue to rise.


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NHS – open for business, closed for treatment

The ruling class is determined to break up the NHS and privatise its services. The last Labour government prepared the ground, the health care multinationals have their shock troops in place to make it happen, and the ConDem coalition’s Health and Social Care Bill is to give it the green light. However, the bill faces widespread opposition, and Deputy Prime Minister Nick Clegg has now backtracked on his earlier support to save the LibDems and his political career. The government is trying to defuse this with a bogus consultation process. Hannah Caller reports.


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Kill the Bill – not the NHS!

The ConDem coalition is intent on destroying the NHS. The Health and Social Care Bill as it stands will allow private companies to decide what health services are to be provided and who will be entitled to them. It will allow these private companies to use competition laws to challenge public policies that impair their profitability and freedom to operate. These private companies will also be able to select their patients, determine staff terms and conditions, and generate and distribute surpluses to shareholders, investors and employees by underspending the patient care budget. Private interests nakedly determine public policy; profit will replace universal health care, and the working class will pay.


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ConDems propose privatisation of the health service

Stop the destruction of the NHS

The ConDem Coalition’s Health and Social Care Bill is now before parliament. Building on Labour’s privatisation programme, its implementation will destroy the NHS. It will replace health care free at the point of delivery with a chaotic market system in which privatised health care delivery will become the norm, and where the working class will be forced to accept second class treatment if any at all. It is vital that newly-mobilised forces against the cuts take up the defence of the NHS. Hannah Caller reports.


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NHS: Opposition grows as chaos looms

At a time when ‘efficiency savings’ of £20 billion involving the loss of 100,000 jobs are being imposed on the NHS, it has been estimated that it will cost between £1.7 and £3 billion to implement the changes detailed in the ConDem White Paper; changes that are in the interest of big business, not the health of the population. They continue the policies of past Tory and Labour governments and will hand control of the NHS budget over to big business. Hannah Caller reports.


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How the Coalition plans to abolish the National Health Service

Under the name of Equity and Excellence: Liberating the NHS, the ConDem coalition plans to destroy the NHS. Health Secretary Andrew Lansley’s White Paper will abolish 150 Primary Care Trusts (PCTs), 10 Strategic Health Authorities (SHAs), and place the management of £80bn annual funding in the hands of 600 consortia run by GPs. These consortia will buy health services from hospitals and community service organisations. All hospitals will have to become Foundation Trusts, and will be able to offer as much private practice as they choose. Hospitals that become bankrupt will not be bailed out.


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Health Coalition wields the knife

The coalition government wasted no time in confirming that Labour’s proposed savings plan for the NHS – £20bn over the next three years – would go ahead. Although it has promised to continue to increase health spending in real terms, there is no indication as to what this means in practice. Meanwhile, NHS organisations are going to have to find levels of ‘efficiency savings’ of 3% per year.


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Spending freeze, cuts and closures – the great NHS cover-up

The NHS faces a cash squeeze estimated to be between £8bn and £20bn by 2017. But while services suffer and patients lose out, consultancy companies are doing very well. One such company, McKinsey, a US-based firm which charges over £2,000 a day, is reaping massive profits. In September 2009 it produced a report for the Department of Health which proposed cutting 137,000 jobs in the NHS to save £2.4bn a year. It also proposes reducing medical school places. It doesn’t mention, however, what Primary Care Trusts (PCTs) – local arms of the Department of Health (DoH) – spend on management consultants to support ‘World Class Commissioning’ and other such privatisation gimmicks – estimated to be an average of over £1.2 million in 2008/09 compared to £360,000 in 2006/07.


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Health matters: The privatisation of health care in Britain

Health care for London

‘The days of the district general hospital seeking to provide all services to a high enough standard are over’, said Sir Ara Darzi, responsible for the ten-year plan for reorganising health provision in London. Commissioned by Gordon Brown in 2007 and promoted to a ministerial post in the Department of Health, he resigned in June this year.

The NHS Next Stage Review Interim Report, published in June 2008, showed there were significant variations in access to and quality of primary medical care services across Britain. The Equitable Access to Primary Medical Care programme was launched to address this. This includes at least one GP-led health care centre in each Primary Care Trust area.


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Why is Labour privatising health?

Labour policy towards the National Health Service has now become quite clear: it is to progressively privatise health care provision whilst funding it through taxation, or, more accurately, national insurance. As the privatised system gets more and more expensive, so eligibility for services will be undermined, and individuals expected to pay their own way. More and more tiers will appear in the system, with the working class and poor losing out along the way. Robert Clough reports.

Labour has promised significant increases in the level of spending on health. Between 1999/2000 and 2007/08, real NHS expenditure will rise from £40.3bn to £90.2bn, with annual increases ranging between 5.3 and 8.9%. NHS spending will rise from 6.6% of GDP in 2002/03 to 8.2% in 2007/08. As we shall see, these rises are essential if Labour is to ensure a viable future for privatised provision of health care, and at the same time meet the needs of the middle class and better-off sections of the working class who cannot afford private health insurance.


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Labour catapults NHS into chaos

On 7 March, Sir Nigel Crisp, NHS Chief Executive, announced that he would take early retirement (to the House of Lords) at the age of 54. He took with him pension entitlements worth £3.2m. Over the following three weeks, the NHS reeled with announcements of cuts and redundancies:


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Old age tax

In May, Health Secretary Alan Johnson announced a consultation paper to prepare for new legislation to fund elderly care. It is suggested that this will require a new form of social care insurance – an old age tax – which is on top of national insurance contributions. He claimed that over the next 20 years there would be a funding gap for social care of £6 billion.  Proposals for private insurance for care and support are also being discussed.


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HIV/AIDS – the fight for life

Across sub-Saharan Africa, 29.4 million people are infected with HIV. In 2002, 2.4 million people died. Four million people are in need of urgent drugs yet fewer than 50,000 are getting them. Tuberculosis infects 70% of those with HIV/AIDS. In South Africa, 4.7 million people are infected, with an estimate that 200,000 people will die this year. Of Malawi’s 11 million people approximately one million are infected; AIDS has reduced life expectancy from 53 to 39 years and made 475,000 children orphans.

AIDS kills mothers, fathers, aunts and uncles and all those who raise the family, who should be working the land, who teach the next generation, who provide health care. AIDS is being passed from mother to child. Orphanages struggle to cope. The HIV/AIDS epidemic in India is thought to be following the African path, only 15 years behind.


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