Stop the NHS sell-off / FRFI 223 Oct / Nov 2011

FRFI 223 October/November 2011

‘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 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.

The Labour Party could of course stop the Bill in its tracks. All that Ed Miliband would have to say is that it would renationalise any privatised hospitals or services when it came back to office. He could also point out that the Coalition has no electoral mandate for selling off the NHS. This would frighten away private health care companies from bidding for bits of the NHS. But Labour won’t. It too is a ruling class party, and it laid all the groundwork for the Coalition Bill, as FRFI has reported over the years and as Colin Leys and Stewart Player show comprehensively in their recent book The plot against the NHS (see our review

Everyone says they are against the Bill – the Royal Colleges including the Royal College of Nursing (RCN), the British Medical Association, the Labour Party (for the little it is worth), the trade unions, uncle Tom Cobley and all. They wring their hands, complain – and do nothing. Unison, the largest trade union within the NHS after the RCN, is prepared to ballot on strike action to defend pensions, but not to prevent the privatisation of the NHS. Yet the assault on pensions will be as nothing compared to the attacks on pay and working conditions in the free-for-all that will accompany the sale of NHS hospitals and services.

The Bill has now gone to the House of Lords having passed through the Commons. There, ConDem Coalition Health Minister Lord Howe has said in one breath that it doesn’t matter who provides the care as long as it is free at the point of delivery, and in another that the Bill ‘presents huge opportunities for the private sector’. As was to be expected, the ‘listening exercise’ over the summer proved to be a complete fraud. The outcome was not to change the fundamentals of the Bill, but to tinker with small parts of it. Crucially, the Secretary of State loses all responsibility for the delivery of health services. Replacing the current structure is a jumble of organisations – more than 500 – which will be ripe for privatisation.

Even before the Bill becomes law early in 2012, the pace of privatisation is being stepped up. Circle Health is earmarked to take over the management of Hitchinbroke Hospital in Cambridgeshire, a Trust contemptuously seen as a financial ‘basketcase’ because of the historic financial problems it shares with other hospitals in outer London and the south east. Circle Health is also poised to take over the running of Epsom Hospital, which is being split off from the Epsom and St Helier Trust to help resolve a £38m deficit. It does not matter that Circle Health itself is a ‘basketcase’: it lost £35m last year, and its sole experience in running a hospital is a boutique 28-bed unit in Bath. If it fails, then it will get taken over by another health care company. The market in the NHS is not just about the buying or selling of services or hospitals, it is also about the buying and selling of health care companies and the creation of new monopolies to control the emerging market.

The Department of Health (DoH) is encouraging the process. Trafford Healthcare NHS Trust, the Royal National Orthopaedic Hospital and Whiston Hospital in St Helens have publicly voiced their interest in having their management privatised. Helios, a German company, has been negotiating since December 2010 to take over up to 20 NHS hospitals. Management consultancy McKinsey, central to the whole process of privatising the NHS, brokered a meeting between Helios, Ian Dalton (head of provider development at the DoH) and Ruth Carnall (chief executive of NHS London) just one month before the ConDem Bill was published. Just after it came out, the DoH invited McKinsey to discuss the Helios proposal. Ramsay Healthcare has signed contracts with 34 hospitals and treatment centres to treat patients who might otherwise wait longer than the 18-week NHS target. Given the onus on the NHS to find £20bn ‘efficiency savings’ while saddled with huge PFI debts, the numbers of patients that Ramsay will be treating is likely to grow. Suffolk’s community health services are up for grabs: 27 services are being sold off in four lots. The five short-listed private companies have no experience of running these services.

Standing tall in the midst of the mish-mash of organisations running, commissioning or supervising services in the ConDem’s privatised health service is Monitor, the independent regulator of Foundation Trusts. Its already considerable powers will increase considerably as all hospitals are now being pushed to achieve Foundation status. On top of this, however, the Bill makes Monitor responsible for extending competition within the NHS and giving it powers to enforce EU competition law. In practice, Monitor will take over the government’s responsibility for ensuring the delivery of health services – but only those services which conform to the diktats of the market. Monitor’s current chair, ex-McKinsey consultant David Bennett who is on £300,000 a year, has declared that buying health care services is like buying gas or electricity and that:

‘choice and competition will work in the NHS as it did in those other sectors…we’ve done it in rail, in water, so there’s actually 20 years’ experience on taking monopolistic, monolithic markets and providers and exposing them to economic regulation.’

Some choice! All that we have had is 20 years of rip-off from the gas, water and electricity monopolies, and railway tickets that are the most expensive in Europe.

There is limited time before the appalling attack on working class people that the Bill represents becomes law. Rationing of essential operations like hip and knee replacement, varicose veins and cataracts has already started. FRFI urges its readers to get active in local Keep our NHS Public campaigns or start one yourselves.

Hannah Caller and Robert Clough

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? / FRFI 222 Aug/Sep 2011

Fight Racism! Fight Imperialism! 222 August/September 2011

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.

The idea that there has been fundamental change as a result of the ‘listening exercise’ is just nonsense. The original Bill stripped the government of any responsibility for the provision of health services; the only concession on this is an empty declaration that the Secretary of State for Health will be responsible for ‘promoting’ the health service. Other proposals in the original Bill are retained, for instance that:

• all hospitals will have to become Foundation Trusts, and effectively become commercial bodies, although the timetable will be extended;

• services can be closed without public consultation;

• caps on income from private patients in NHS hospitals will be removed, tempting many to increase their income at the expense of NHS patients;

• commercial insolvency laws should apply to hospitals going bust;

• commissioning consortia will still be allowed to enter into joint enterprises with private companies;

• any ‘qualified’ provider will be able to deliver NHS services.

The remit of Monitor, which regulates Foundation Trusts in the NHS, has been extended. The original Bill gave it specific powers to extend competition in the NHS and act as an economic regulator for health and adult social care in England. Its brief will now include promoting collaboration. However, Richard Lewis, a partner in the Ernst and Young accountancy group, is quite clear that this means hardly anything, saying that ‘the Principles and Rules of Co-operation and Competition will not only remain, but will gain a statutory footing’. Monitor will retain the power to enforce competition law and can for instance fine hospitals 10% of their income if their transactions are deemed anti-competitive. As if to underline the drive to privatisation, Health Secretary Andrew Lansley announced on 19 July that £1bn worth of community and mental health services will be opened up to competition from ‘any qualified provider’ from April 2012.

In its initial guise, the Bill promised a reduction of 45% in NHS bureaucracy. However, according to the Royal College of GPs, the number of statutory NHS bodies will rise from 163 to 521 given that the Bill now requires five different types of organisation to take over the role of Primary Care Trusts (PCTs) including 300 Clinical Commissioning groups, 150 Health and Wellbeing Boards and 50 PCT clusters.

The original Bill proposed the creation of GP commissioning consortia. Now they have been re-branded as Clinical Commissioning Groups and may include other clinicians. They will do most of the purchasing of hospital care. The revised Bill leaves in place what are called PCT clusters, part of a new NHS Commissioning Board, which will now commission primary care and dentistry. As a sop to the demand for independent clinical evaluation of commissioning decisions, there will be new bodies called ‘clinical senates’, whose powers over clinical commissioning will not include a veto. Local authorities will take over public health responsibilities as originally proposed, while new Health and Wellbeing Boards are supposed to bring health and local government together in a nod to improving collaboration.

The British Medical Association (BMA) has twice voted for the Bill to be withdrawn and in July a British Medical Journal poll showed 93% of its readers calling for the same. The BMA has now launched a campaign to get the Bill withdrawn. Nearly half of all GPs disagree with the reforms and 60% do not want to be involved with commissioning groups.

Almost £2bn will be taken from patient care to cover the costs of the reorganisation, while hospitals have to save an additional £1.1 billion, on top of 4% ‘savings’ over the next four years. This represents a deliberate attempt to destabilise the NHS in order to justify the changes. Already, of the 2.47 million people currently on hospital waiting lists, 236,000 have now been waiting over 18 weeks – an increase of 8.5% over last year. Half of these patients have been waiting over six months, many for orthopaedic operations such a hip and knee replacements. Over the last year, 200,000 patients waited more than four hours in A&E. It is a harbinger of worse to come if the Bill is passed when it goes back to the House of Commons in September.

Hannah Caller

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 / FRFI 221 June/July 2011

Fight Racism! Fight Imperialism! 221 June/July 2011

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.

The eight-week NHS Listening Exercise started in April under the direction of the NHS Future Forum, made up of 43 people chosen because they support the bill. The chair is Professor Steven Field, a past president of the Royal College of GPs (although he has now changed his mind and opposes the legislation). Others on the panel are Charles Alessi, member of the National Association of Primary Care which enthusiastically supports privatisation, and Sir Stephen Bubb, head of the Association of Chief Executives of Voluntary Organisations, who is virulently pro-competition.

The ‘listening’ meetings have excluded the public and are advertised only to small select groups of NHS-related staff. The questions in the exercise direct the answers: one is, ‘How can we best ensure that competition and patient choice drives NHS improvement?’ By 3 May, only 300 people had posted a view on the official ‘listening’ website, practically all against the proposals.

The shock troops of privatisation are active both outside and inside the NHS. Outside there is Mark Britnell, a former NHS director general of commissioning and system management and now head of health care at management consultants KPMG and a staunch advocate of the private sector. At a conference six months ago organised by the private equity firm Apax Partners, he said ‘In future, the NHS will be a state insurance provider not a state deliverer.’ Delegates and representatives of health care companies at the conference on ‘business opportunities post-global health care reform’ heard Britnell say ‘the NHS will be shown no mercy and the best time to take advantage of this will be in the next couple of years’.

Inside the NHS is David Bennett, chair of Monitor, currently the regulator of NHS Foundation Trusts. The Bill gives Monitor the role of financial regulator, with a primary duty to enforce competition between providers. David Bennett (ex-McKinsey management consultants), on £300,000 a year, compares the NHS to a utility company ripe for dismemberment:

‘It is too easy to say “how can you compare buying electricity with buying health care services”, of course they are different. I would say there are important similarities and that is what convinces me that choice and competition will work in the NHS as it did in those other sectors. We in the UK have done this in other sectors before, we did it in gas, in power, in telecom, we’ve done it in rail, in water, so there’s actually 20 years’ experience on taking monopolistic, monolithic markets and providers and exposing them to economic regulation.’

Alongside this the government set up a panel of health care ‘experts’ in early May. Brought together by Paul Bate, former adviser to Tony Blair, it includes past and present NHS dignitaries who have promoted PFI or other forms of privatisation. Amongst them are Lord Crisp, former NHS chief executive, Sir Ian Carruthers, a subsequent NHS chief executive and now NHS South West chief executive and Bill Moyes, former Monitor chairman. There is also University College London Hospitals Foundation Trust chief executive Sir Robert Naylor who, on £262,500, is the second highest paid chief executive in England. Inevitably there are the multinational representatives: Nicolaus Henke, head of global health systems at McKinsey and... Mark Britnell. The panel is to be the executive organisation of health care multinational interests, and its purpose is to ensure that any amendments to the bill do not undermine the underlying drive for privatisation.

Cutting jobs and services

NHS Trusts are having to cut jobs and services to save £20bn, a legacy of the Labour government:

• Bradford Teaching Hospitals NHS Foundation Trust has started a Mutually Agreed Resignation Scheme (MARS) in the second year of a three-year plan to make £50 million savings;

• Queen Alexandra Hospital in Portsmouth has invited its staff to take voluntary redundancy to get rid of 99 jobs as part of their £30 million savings. The chief executive made it clear that if there were insufficient voluntary redundancies, they will make compulsory ones;

• Compulsory redundancies have been announced at Basildon, Castlepoint and Southend;

• NHS South West Essex is merging with NHS South East Essex to save £6.2 million with 100 job losses.

Within the past year, unfilled posts for diabetes specialist nurses (DSN) have doubled. The charity Diabetes UK surveyed 385 hospitals and found 218 DSN posts left vacant. The proportion of DSN posts unfilled due to cost savings is now 43%, up from 34% in 2009. The incidence of diabetes is rising by 150,000 per year and DSNs are popular with patients and their families and have a proven positive clinical record. More broadly, 11% of clinical nurse specialists are at risk of redundancy, while a recent UNISON survey of 2,000 nurses and midwives revealed that 88% have an increased workload, two thirds have considered leaving their job, 61% have lost staff in their department and 78% have suffered budget cuts.

To help meet the savings targets, GPs are facing demands to reduce hospital activity. NHS managers want to cut admissions to hospital by 15% by next April, reduce A&E attendances by 10% and inpatient length of stay by 25%. In Suffolk, a roving GP attends 999 calls and asks GP practices to phone patients who attended A&E to ask why they didn’t go to their GP. In Sefton, Liverpool, they have employed a nurse to sit in A&E to dissuade ‘reattenders’. NHS North Staffordshire have employed private providers including BUPA to implement ‘admission avoidance strategies’. The message is clear: don’t get ill, there’s no place for you in hospital.