From 1 April, the NHS will be catapulted into chaos as the Health and Social Care Act comes into force. Health Secretary Jeremy Hunt expressed his contempt for those labouring in the face of massive cuts when he declared: ‘Too many hospitals are coasting along, settling for meeting minimum standards.’ No longer will he be responsible for the delivery of health services, and nor will anyone else under the new and immensely convoluted arrangements. 211 Clinical Commissioning Groups (CCGs) will be responsible only for buying health care, spending £64.7bn of the NHS budget of £95.6bn for 2013/14. Foundation Trusts and other organisations, many of them privately run, will be responsible only for what they are contracted to do. The Clinical Commissioning Board exists only to support commissioning and to buy specialist services. Monitor exists only to enforce competition. The Care Quality Commission has no teeth and is grossly understaffed: it is a myth that it can do anything about quality. No one is in charge. There is no nationalised health service anymore. Instead there will be chaos.
In the run-up to April there was a sudden furore as the government laid Section 75 regulations of the Act before parliament. Those whose support for the Act had been bought on an assurance that privatisation would not be its aim were outraged. These regulations require CCGs to purchase all health services through open tendering procedures – opening the gates for full privatisation.
Subsequent government amendments made just one apparent concession: that CCGs can avoid tendering if services are ‘capable’ of being delivered by only one provider – eg, the nearest NHS hospital. However, this means nothing. The CCG must hold a competition if the contract is capable of being delivered by more than one provider (say, another nearby hospital) or if the ‘capable’ provider is a legally distinct entity – an NHS Foundation Trust, for instance. In reality it is virtually impossible for CCGs to avoid a tendering process without ending up in court.
While the Act is costing billions to implement, the NHS is under pressure to save over £20bn by 2015. The NHS is short of nearly 10,000 nurses. One in ten A&E departments has either gone or is under threat in England, including nine in London. 20 hospital trusts are on the brink of bankruptcy – if they go over, there is no longer any way to manage the consequences for patients. As it is, up to 30,000 managers are losing their jobs while many more than that will be needed in the new structures. And while hospital services are being pared down with the message that care can be delivered in ‘the community’, there are only five nurses in London currently undergoing training to be district nurses.
Competition and costs
There is no evidence of any benefits of competition in health care. The greater the involvement of private companies, the more expensive services are to run and the more expensive to sort out when they fail. Monitor has announced it will need a further 50 staff just to do pricing, IT support and administrative services for it to function. With individual staff costs of £100,000 pa, this will amount to over £5m on tasks unrelated to health care delivery. 14% of the NHS budget is now spent on administrative costs; this has been rising year on year since the 1980s when it was about 7-8%.
Clinical Commissioning Groups and GPs
A recent survey has revealed that one in three GPs in CCGs are running, or have shares in, private health care for-profit firms, including Harmoni, Circle Health and Virgin Care. For example six of eight GPs of the Blackpool CCG have an interest in Fylde Coast Medical Services, the local out-of-hours provider and five have an interest in Virgin Care. 4% of GPs on CCG boards advise private health firms or pharmaceutical companies and 5% work for a private health firm in addition to their work as a GP. Some conflict of interest! They are not only commissioning services, but also rationing access to treatment and at the same time benefiting personally financially. The British Medical Association’s response has been to pass the buck back to the government – which will do nothing now that it has no responsibility for the NHS.
The new NHS will be a disaster for patients. Saddled with huge PFI debts, many hospitals will go bankrupt. CCGs will be spending all their time trying to arrange complex tenders and even more complex contracts for the delivery of health care services. Stafford Hospital disasters will multiply as hospital managers try to contain costs. Private companies will circle round like vultures trying to seize lucrative opportunities, running to the courts when they miss out. The fight now is not just to keep our NHS public, but for its restoration as a free, universal and nationalised service.
Hannah Caller and Robert Clough
Save Lewisham Hospital
On 31 January Secretary of State for Health Jeremy Hunt announced that the government was going ahead with its decision to remove Lewisham Hospital’s Accident and Emergency Service, maternity wards, paediatric and other services. This was just days after 25,000 people had marched through Lewisham demanding that the services be maintained. The Save Lewisham Hospital campaign and Lewisham council have launched separate but co-ordinated legal proceedings against the government’s decision. The campaign is keeping up the fight with rallies and stalls. FRFI has been active with sales, petitions and megaphone in Lewisham – the people are angry and remain ready to mobilise to save their hospital.
Defend Whittington Hospital! Give us back our NHS!
On 16 March, FRFI supporters joined up to 5,000 people marching through Holloway, north London against the proposed sell-off at Whittington Hospital. The hospital board has announced plans to sell hospital land and cut beds by up to 50%. This is on top of 570 planned redundancies. The board has launched a bid to become a Foundation Trust, the first step towards privatisation. The sell-off plans are a part of this.
The march showed the strength of the opposition but the choice of slogans and line-up of speakers were deliberately designed to lend credence to the Labour Party in its bid to present itself as an anti-cuts party. No one mentioned that Labour will not get rid of Foundation Trusts or PFI; nor Labour councils’ swingeing cuts to services and benefits. We must expose the role of Labour in paving the way for NHS?privatisation.
North London FRFI is attending Defend Whittington Hospital Coalition’s organising meetings and has stalls in Holloway every Saturday exposing the sell-off.
To get involved contact [email protected]
Fight Racism! Fight Imperialism! 232 April/May 2013
