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.