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.
61,000 nursing posts across Britain have either gone or will go since April 2010, according to the Royal College of Nursing (RCN). There are warning notices that staffing levels are not safe in several hospitals including Dewsbury, Leeds, Lancaster, Mid-Staffordshire, Pembury and Queen’s, Essex. Andrew Lansley, secretary of state for health, was greeted with scorn at the May RCN conference and heckled from the floor when he denied the reductions. Meanwhile the government is massaging the data on waiting times and cancelled operations in order to appear to keep its promises. Its techniques include all the old favourites like resetting waiting time clocks when patients cancel dates; prioritising those about to breach the government targets, not those who have already done so and giving last-minute slots that are impossible to meet.
Despite Lansley’s declaration that talk of privatisation is scaremongering, services are being tendered out all over England with increasing lack of accountability or transparency in the resultant deals. Moreover, CCGs can now decide what services they will and won’t provide at local level – their priority is to balance the books. The chief executive of the NHS, David Nicholson, has said that this is acceptable since patients can choose to go elsewhere.
Private health care companies such as Virgin, Spire, Ramsay and others report doing very well in 2011 and attribute this to long waiting lists, with those who can afford it going private. 23 companies made combined profits of over £1.3bn in their last published accounts (2010 or 2011). The top six – Fresenius, BUPA, BMI Health, Ramsay, Spire and Cygnet – each made annual profits over £100 million.
This list excludes other major private companies such as Serco, as not all their profits are made in health care, and Virgin, as they are new in the health market. All these companies are involved in tax avoidance. Evidence of privatisation’s impact on patient care is already abundant.
Camden Road surgery
The Camden Road Practice, a GP surgery in north London, closed in April because The Practice Plc, which has managed the surgery since 2008, failed to find new premises, leaving 3,000 of the surgery’s 4,700 people without a GP. United Health UK (subsidiary of the huge US health insurers) originally won the contract but then subcontracted The Practice Plc to complete the term. An investigation is now underway over the legality of this arrangement, but the reality is that it is normal business practice.
Central Middlesex Hospital
Care UK is a major £200m health care company which has run an urgent care centre at the Central Middlesex Hospital in London since last year and has dealt with 50,000 patients. In March, it appeared that of a sample of 300 x-rays, 120 required further action which was not taken: Care UK could not confirm that the second-stage specialist review had taken place and has now been asked to check 6,000 x-rays. Urgent care centres are like minor injury centres open 24 hours a day within A&E departments and in part designed as a cheaper option to A&E, five out of eight of which in North West London are mooted for closure.
Virgin
Richard Branson’s Virgin Care has so far secured about £1bn of NHS business and is present in 18 separate parts of the country. This includes £650 million for the entire provider arm of NHS Surrey, a five-year contract to run seven community hospitals, community nursing services, community dentistry, health visiting, prison health services and specialist services for physiotherapy, diabetes and renal care. The 30 March NHS Surrey risk register shows there is a struggle to retain staff due to the deal, and that there are extra costs of software licences and the renegotiation of leases due to private company involvement. The Surrey situation has also revealed that Virgin Care is not obliged to comply with the Freedom of Information Act, that NHS whistle-blower protection legislation does not apply to NHS staff transferred to Virgin Care, and that unlike NHS trust boards, Virgin Care Surrey is not required to hold meetings in public.
Virgin, which took over Assura Medical, now has a partnership with 350 GP practices or medical centres throughout Britain, allowing it to bid for contracts everywhere. It has hundreds of doctors on CCG boards that decide who gets NHS contracts. Recently Virgin took NHS York to court for beating them in a bid to run NHS services. Virgin accused NHS York of predatory pricing for charging too little, and of foregoing profit – their case was thrown out this time, but it shows the lengths to which they will go to secure business.
It has been revealed that the NHS constitution which lists the rights of patients and the responsibilities of the health service towards patients and staff will be reviewed, and Virgin Care’s commercial director will be involved in the process.
Politicians lie about transparency and accountability: commercial confidentiality is now used in England as a cover for the absence of public consultation regarding the thousands of commercial contracts for the provision of health care, the merging and closing of services, and the loss of jobs. Now Lansley is planning to switch funding from poorer to richer parts of the country by changing the way health funding is allocated, arguing that where people live longer they need more money. This will further compromise equity of health provision as poorer working class areas where life expectancy is already 15 years less, face £3,000 cuts in health spending per person over five years, and already wealthier areas will get £1,750 more. A two-tier service is inevitable with privatisation.
Hannah Caller
Fight Racism! Fight Imperialism! 227 June/July 2012
