In the last issue of FRFI we showed how the privatisation of the NHS is occurring on a number of different fronts (FRFI 202: Privatising the NHS – Labour steps up the pace). Since then:
- The Department of Health has announced a programme to produce a system of tariffs for community services – those delivered by district nurses and health visitors for instance working for Primary Care Trusts (PCTs) – which are worth £15bn per annum. This will open them up to private providers. The chief executive of Clinovia, a branch of BUPA that provides home treatments, said: ‘Any form of tariff will be an enormous benefit to delivering care closer to home because the independent and third sector can look at the tariff and see where they can provide services for better value for money.’
- GPs in rural areas may lose their right to dispense drugs. This they can now do if their patient lives more than a mile from a pharmacy; in future GPs may only dispense if their practice is more than a mile from a pharmacy. Very few of the 1,100 dispensing practices will meet this criterion. Its purpose will be to hand over £400m business per annum to the big pharmacy chains.
- In April the government started a review of the NHS’s property portfolio – estimated to be worth over £20bn – with a view to selling hospital sites to the private sector and leasing them back.
- A consortium of mainly US firms, which includes McKinsey, Kaiser Permanente and Humana, has been appointed to develop and implement an assurance system for ‘World Class Commissioning’. This will have profound influence on the way PCTs and their GP practices purchase health care from hospital trusts.
A recent letter by Health Minister Ben Bradshaw to The Guardian (14 May 2008) had the effrontery to deny that Labour’s proposals are for the privatisation of the NHS. He was responding to an article by George Monbiot, (29 April 2008) who rightly identified the development of polyclinics as a key element in the drive to hand over swathes of the NHS to multinationals. Bradshaw’s letter is disingenuous. He claims that first, the main priority for the public is better access to their GP -which means being able ‘to see a doctor in the evening or at weekends if they wish’. This was the outcome of a CBI report on a poll it had commissioned that sampled just over 1,000 people. An earlier Department of Health survey covering 2.6 million people revealed that 84% were happy with GP opening hours – but that was the wrong result! Bradshaw then says that polyclinics have nothing to do with closing down practices or imposing polyclinics. However, simple arithmetic proves the contrary. The Darzi report for London proposes a network of 150 such polyclinics. Each will have between 35 and 50 GPs providing services from the site – a minimum of 5,250 GPs. Currently there are about 1,600 practices in London with just under 4,900 GPs. It is inconceivable that GP practices will not close down as a consequence, particularly as any privately-run polyclinic will insist on having its own salaried GPs. Furthermore these polyclinics will be more inaccessible for those who need GP service most – the elderly, disabled and those with young children.
Bradshaw criticises Monbiot because he allegedly ‘conflates what is being proposed for London with what might happen in other parts of the country’. Yet the polyclinic model is being imposed elsewhere in the country with the demand that every PCT procures one new health-centre in 2008/09 through a process whose detailed rules are not yet clear but where there is a clear bias towards the private sector. It is not for nothing that companies like Virgin Healthcare have been touring the country looking for openings. As with the Independent Sector Treatment Centres, which took work and money from NHS hospitals, the new health-centres will undermine existing facilities, in this case GP practices. The outcome of current proposals for primary care is inevitable: the transformation of GPs from independent contractors into salaried workers who can be hired and fired by the multinational providers which will own the health-centres or polyclinics of the future.
Yet polyclinics are only part of the privatisation picture. The development of what is now described as ‘world class commissioning’ is equally important and little understood. The aim is to transform PCTs from being providers of services into commissioners of health care services – including those they currently provide. As Bromley PCT chief executive Simon Robbins puts it,
‘We are not going to be in the provider business in due course…if we don’t shed our provider arms, and I have two provider services, then we’re never going to get the proper focus on commissioning’.
This view emphasises the importance of developing tariffs for PCT services since it provides the basis on which they can be privatised and purchased through the Payment by Results mechanism. Commissioning is already a PCT responsibility; all are supposed to have organised themselves so that GP practices lead the process through local groups or consortia. In the words of Mark Britnall, Department of Health Director of Commissioning, ‘Practice-based commissioning is here to stay; my job is to ensure that it flourishes and thrives. World class commissioning is a very public process and practice-based commissioning is its engine room’. Further, he argues:
‘I believe that those [commissioning] techniques that have been developed by health insurance companies from different parts of the world are very well suited to the best that we can provide for the English NHS – so that’s just one example of where we will look at an idea from elsewhere in the world – in this case the USA and bring it into the English context for the NHS.’
This is the system that denies 20% of the US population access to proper health care and which Michael Moore exposed in Sicko. With US and other health care multinationals advising on ‘world class commissioning’ and, in the future, leading it on the ground through the GPs they employ in their polyclinics, both demand and supply in the NHS will be increasingly dominated by private enterprise. Ben Bradshaw will be proved a complete liar.
