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.
The Bill proposes the abolition of Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs) by 2013 with the loss of 24,000 jobs. PCTs have been responsible for buying health care from hospital trusts. That responsibility will pass to many consortia of GPs who will then manage about 80% of the total NHS budget – £80bn. Plans to force hospitals and mental health services to become semi-independent Foundation Trusts will be accelerated: there will be further encouragement for them to become ‘social enterprises’ outside the NHS, with staff losing NHS terms and conditions, pay scales and pension rights. Limits on the numbers of private patients they can treat will be abolished, while NHS care can be delivered by ‘any willing provider’ – that is, any private company. The opening market will enable patients to choose their GP based on the services the practice provides – an opportunity for the wealthy to take advantage of the postcode lottery for treatment.
The GP consortia, whose number is as yet unknown, but which will each probably be made up of 80-100 GPs, will have to set up organisations to manage the commissioning process. This will be provided in the main by private management consultancies. UnitedHealth, KPMG and Bupa, for instance, have already offered to run the commissioning and office functions for GP consortia. As an example of what is to come, in west London US private health company UnitedHealth will vet all referrals from GPs for hospital care to reduce spending. Monitor, which scrutinises Foundation Hospitals, will become a market regulator with the remit to promote competition.
The Bill makes no mention of the 140 statutory responsibilities of the current PCTs, for instance, child protection and mental health, or those of the SHAs for elements of medical and nursing education. Current PCT responsibilities in public health are to be taken on by local councils – when they too are facing severe cutbacks – making a mockery of long-term improvements in the health of a community. There are no assurances for the vulnerable elderly population, who make up 15% of patients but whose care accounts for 75% of health care expenditure. There are no assurances for those with mental health problems. There are no assurances for those with chronic conditions.
There are no incentives for consortia to cooperate locally, and this will affect local service provision. The creation of the competitive market between health professionals will obstruct the collaboration that is needed for decent care. GP consortia will be obliged to put out services to tender under European and British competition laws. Hospitals will compete with each other for patients and this will be based on price. Even the private hospitals’ trade body, NHS Partners Network, has said that the competitive policy will be ‘a race to the bottom on price that would certainly threaten quality’.
The dangers of competition in the NHS have been shown in the past in the tendering out of domestic services within the NHS, where the cheapest options were chosen to the detriment of workers and at the cost of decent services. The problems are now being replayed in the agreement between Guy’s and St Thomas’s Hospital (GSTT) and private company Serco for pathology services. What has happened? The new private partnership has spent its first year getting more business from other hospitals rather than delivering a decent service. Consequently a GSTT internal report speaks of ‘concerns over quality and clinical governance issues, and data security risks…poor engagement with clinicians’. There ‘appears to have been an increase’ in numbers of clinical incidents, serious untoward incidents are ‘not always handled appropriately’ and overall the service is more expensive.
The private sector will be able to pick and choose the more profitable areas of health care. Costly services – complex cases and emergencies – will be left for Foundation Trusts. Removing the cap on the number of private patients hospitals treat will inevitably lead to situations where such patients are treated in preference to those who cannot pay.
In the new system we will not know how GP consortia or hospitals arrive at their decisions on treatment – this will all be a ‘commercial’ secret. They only have to hold one public meeting a year: the key decisions will be made behind closed doors. Social enterprises and for-profit organisations are not even obliged to hold any public meetings at all. Decisions will be announced when they have been signed and sealed. With GPs able to acquire undisclosed financial interests in other services, no one will know what is driving their clinical decisions when patients are denied second opinions or treatment.
20,000 NHS jobs to go…
Quite apart from the 24,000 jobs threatened by the ConDem Bill, 20,000 jobs will be lost in the next year as the NHS attempts to save £20bn by 2014. These were cuts planned by the Labour government. Recent announcements of job losses include:
• 444 at Calderdale and Huddersfield Trust;
• 1,000 at United Lincolnshire Trust;
• 705 at the University Hospitals of Morecambe Bay;
• 450 at Coventry and Warwickshire;
• 1,600 at the Heart of England Trust (20% of the trust’s staff);
• 257 at Nuneaton’s George Eliot Hospital by 2014.
• 550 (20% of the staff) over the next four years from Coventry and Warwickshire Partnership Trust.
The hundreds of avoidable deaths at Mid Staffordshire Hospital Trust were a consequence of the management forcing through savings and cuts to try and achieve Foundation Status. It is a frightening example of what lies in store.
… and treatment denied
Labour’s cuts mean that PCTs are refusing to pay for certain treatments or insisting that they be delayed. Examples are:
• In northeast Manchester, 57 surgical procedures have been put on hold until April, including hip and knee replacements, cataract surgery, hysterectomies, tonsil removal and hernia repair;
• At least nine PCTS are refusing IVF treatment, despite national guidance that three courses should be available for infertile women aged 23-39;
• In Warwickshire, all routine hip, knee and shoulder operations will be delayed until April, as will some orthodontics procedures and some cataract operations;
• NHS Eastern and Coastal Kent will extend the average waiting time for ‘non-urgent’ operations including hip, knee and cataract surgery by three weeks;
• Patients in Wiltshire will face an extra five-week wait for routine operations;
c Sheffield PCT may delay non-urgent orthopaedic, dermatological and orthodontic treatment until April;
• GPs in Warrington have been asked to delay all non-urgent referrals to hospital by two months;
• Surrey may refuse operations for patients who smoke until they have undertaken a smoking cessation course;
• In Portsmouth, severely obese patients can only have knee and hip operations if they lose weight first.
Rationing and service cuts will become the norm for working class patients, especially if they are elderly or suffer from a chronic condition. They will not be able to shop around for treatment like the rich. The ConDem Bill represents an appalling attack on the poor, and a naked defence of the interests of the rich and health care multinationals. FRFI urges all its readers to get involved in campaigns to defend the NHS such as Keep Our NHS Public (www.keepournhspublic.com) and any local campaigns that emerge in the coming period.
FRFI 219 February / March 2011
