At a time when ‘efficiency savings’ of £20 billion involving the loss of 100,000 jobs are being imposed on the NHS, it has been estimated that it will cost between £1.7 and £3 billion to implement the changes detailed in the ConDem White Paper; changes that are in the interest of big business, not the health of the population. They continue the policies of past Tory and Labour governments and will hand control of the NHS budget over to big business. Hannah Caller reports.
Soaring costs of the market
Over £15bn, 14-18% of the NHS budget, is now being spent on management, double the proportion spent in 1991 when Thatcher’s Tory government introduced the internal market. Privatisation has increased inequality of access to services, a lack of accountability and conflict of interest. The ConDem White Paper will make this worse. It aims to replace each Primary Care Trust (PCT), of which there are 150 with three or four commissioning consortia by 2013, each with its own managers and layers of bureaucracy. The consortia are to be given control of the £100bn NHS budget to buy health care for their local population. Because the 100 or so GPs in each consortium will be unable to take on the roles of PCTs and Strategic Health Authorities (SHAs), they will have to hire private management consultants and private companies, many of them employing the 60,000 managers made redundant by the abolition of the same PCTs and SHAs.
Private companies are waiting in the wings to reap the financial benefits. 14 US and British companies make up the Framework for Procuring External Support which will be involved in risk assessment, performance management and service redesign.
The companies include AXA-PPP, UnitedHealth Europe, BUPA, Humana, Tribal and McKinsey. United Health’s Vice-President is Simon Stevens, Blair’s former health adviser; former health secretary Patricia Hewitt works for BUPA; Matthew Swindells, former chief information officer at the Department of Health (DoH) and special adviser to Hewitt, works for Tribal; Penny Dash, former DoH head of strategy and planning works for McKinsey.
Foundation trusts and cuts
All hospitals must become Foundation Trusts by 2013. They will be like independent businesses and will compete with private hospitals for NHS funding. A GP consortium which gives its local Foundation hospital preference could be open to legal challenge. Consequently hospitals will have to concentrate on profitable departments and close others in order to remain competitive. If hospitals fail they may close or be taken over by a private company as has recently happened with Hinchingbrooke Hospital in Cambridgeshire.
The 90 Trusts which must become Foundation Trusts have to be financially viable, but one London hospital, already burdened with Private Finance Initiative (PFI) repayments, has suggested that it will need to cut 15% doctors and 30% clerical staff. The government has ring-fenced £267bn for PFI repayments over the next 50 years, of which the NHS owes £50bn for infrastructure worth £11bn. In 1997 the Labour government gave legal guarantees that these PFI repayments would never be cut: they have already cost beds, nurses and doctors, and will continue to take precedence over clinical need.
Already the financial situation looks bleak. University Hospital of North Staffordshire is facing a £22m deficit by March and the PCT has refused to pay for hospital treatment people have received. NHS Lincolnshire aims to cut £54m over three years, Doncaster £51m, Bradford £50m, Sheffield £100m and Plymouth’s Derriford Hospital Trust announced £27m savings this year but is £7m behind target. Specialist children’s hospitals will face cuts of £70m following changes to their tariffs.
Around the country, PCTs are already introducing rationing and therefore a ‘postcode lottery’ for treatment. NHS South West Essex is to save £8.4 million (of its £52 million cuts package) by imposing a four-week pause in non-urgent operations and outpatient appointments, Warwickshire is to stop all elective orthopaedic operations for six months, Hertfordshire is rationing joint replacements, Sutton and Merton are reducing the length of stay for people who are terminally ill and Peterborough is closing nursing homes. Increasing numbers of PCTs are adding to their lists of unfunded procedures and treatments: NHS South West Essex now has 207, including hip and knee replacements and East Kent has added cataract surgery. South West Essex has also cut £1 million from its £6.5 million spending on HIV/AIDS. Meanwhile NHS chief Sir David Nicholson has said PCTs are now in ‘meltdown’ because of loss of staff. Chaos is inevitable.
Opposition growing
There is growing opposition to the White Paper. GPs opposed to the consortia are speaking out about the damage the changes will have on patient care, in particular the most vulnerable, the poor, and those with mental health needs. They are also condemning the wedge that will be driven between services in the community and services in hospital in an increasingly privatised and atomised service and say they cannot maintain a relationship with those they treat while being responsible for rationing health care. The head of the college of GPs predicts groups of angry people will begin to demonstrate outside surgeries about services they are being denied.
FRFI 218 December 2010/January 2011
