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

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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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Foundation hospitals: a step towards privatising the NHS

The outcome of the recent debate in the House of Commons on foundation hospitals was a foregone conclusion: a smaller than expected number of Labour MPs salved their consciences by voting against it, whilst the Labour government took a further step towards opening up the NHS to private healthcare providers.

Previous issues of FRFI (eg FRFI 161, ‘Privatisation accelerates’) have argued that Labour’s commitment to continued privatisation is to enable the creation of British multinational service providers which are of sufficient size to compete on the world market. Its enthusiasm for privatisation has made it a keen supporter for the General Agreement on Trade in Services. This will open up any government-provided service, including health, to privatisation. British private healthcare providers such as BUPA are minnows compared to US counterparts: they have to grow substantially if they are to become a force in the world market. The creation of foundation hospitals will enable this to happen.

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Fight Labour plans to privatise the NHS

In September, the Labour government awarded contracts for the next phase of its plans to privatise the National Health Service. Over 30 Diagnostic and Treatment Centres (DTCs) are to be built and run by private firms. The centres are meant to provide fast-track diagnostic tests and routine surgical treatments such as hip replacements and cataract surgery and are expected to be treating more than 250,000 patients by 2005. The contracts were awarded to companies from Britain, United States, Canada and South Africa, though British firms have a stake in most of the successful consortia.

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Abortion: defend women’s right to choose

Front pages showing a 12-week old foetus sucking its thumb, appearing to smile and all but dancing a jig in the womb; a legal challenge to doctors who aborted a 20-week-old foetus with a cleft palate; another ‘miracle’ baby thriving at 22 weeks’ gestation – this is the emotional and meretricious climate in which the government is to review the 1967 Abortion Act, with a view to revising the time limit from the current 24 weeks to 22. Cat Wiener reports.

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Hospital acquired infections: Labour ignores warnings

In the 19th century, hospitals were dangerous places – little was understood about the transmission of infectious diseases and hygiene was poor. Vast improvements were made once the link between hygiene and infection was established and antiseptic use began in operating theatres. In the 21st century, hospital acquired infections (HAI) are a growing problem in Britain’s health service, under pressure to increase throughput and activity, cut staffing and meet targets.

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NHS in chaos

Foundation trusts ‘should adopt the same marketing techniques as Tesco in their bids to win customers in the new choice-based NHS market’.
Sir Nigel Crisp, NHS Chief Executive

In FRFI 182 (December 2004/January 2005) we argued that the massive increase in NHS funding since 2003/04 had two purposes: first, to ensure there was an adequate level of service to meet the needs of the middle class and the better-off section of the working class, and second, to pay the costs of a necessarily more expensive privatised system. We also predicted that such a system would ride rough-shod over the needs of the working class. With widespread ward and hospital closures now on the cards, that prediction is about to be borne out. Robert Clough and Hannah Caller explain why the NHS is descending into financial chaos.

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Health matters / FRFI 191 Jun / Jul 2006

It is increasingly evident that the only way that NHS hospitals can balance their books is by cuts, closures and more privatisation. It is a vicious circle where hospitals will inevitably have to drop unprofitable services in order to survive while simultaneously people will be pushed further every day to pay for basic services. Against a backdrop of thousands of job losses, angry nurses heckled Health Secretary Patricia Hewitt as she spoke at the Royal College of Nursing conference in Bournemouth at the end of April.

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Health advertisement speaks for itself

On 29 June the Department of Health placed an advertisement in the Official Journal of the European Union inviting private companies to give their views on how they would run Primary Care Trusts (PCT). This was an open invitation to multinationals to manage services worth up to £64 billion.

Faced with outrage from health professionals and union reps, ministers initially defended the policy, then backtracked and withdrew the advertisement to correct a ‘drafting error’. It finally emerged that the only real error was that the advertisement should not have appeared before ministers had announced the policy.

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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.

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Healthcare: capitalism's perverse incentives

‘That any sane nation, having observed that you could provide for the supply of bread by giving bakers a pecuniary interest in baking for you, should go on to give a surgeon a pecuniary interest in cutting off your leg, is enough to make one despair.’ George Bernard Shaw, Preface on Doctors: The doctor’s dilemma – a tragedy

Payment by Results
In 2004, the first wave of foundation trusts took on Payment by Results (PbR). The intention is that over 80% will be under the system by 2008. PbR is trumpeted as a system that will provide a fair and transparent way of funding local services, and one that makes a predictable, single and nationally predetermined payment to the provider of health care for every patient treated in hospital.

It seems simple: admit, treat, code and be paid with a standard tariff... However, first the services delivered must cover their costs and, second, the payment is calculated using a complicated formula which takes into account the complexity and cost of interventions recorded during a patient’s treatment. Each intervention has a code and therefore recording every activity becomes critical for ensuring income recovery.

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