‘I think breaking up the NHS is exactly what you do need to do to make it a more responsive service.’
That was what Nick Clegg said in 2005, refusing to rule out an insurance-based model for health services (cited nhsmanager.net). Yet there were those who imagined that he and his colleagues would get a good kicking at the LibDem annual conference in mid-September for failing to stop the Coalition’s Health and Social Services Bill. They were wrong. Privatising the NHS is ruling class policy. The LibDems are a ruling class party, so those in charge of LibDem conference arrangements made sure the issue was not debated.
The Labour Party could of course stop the Bill in its tracks. All that Ed Miliband would have to say is that it would renationalise any privatised hospitals or services when it came back to office. He could also point out that the Coalition has no electoral mandate for selling off the NHS. This would frighten away private health care companies from bidding for bits of the NHS. But Labour won’t. It too is a ruling class party, and it laid all the groundwork for the Coalition Bill, as FRFI has reported over the years and as Colin Leys and Stewart Player show comprehensively in their recent book The plot against the NHS (see our review http://tinyurl.com/3jc8tnt).
Everyone says they are against the Bill – the Royal Colleges including the Royal College of Nursing (RCN), the British Medical Association, the Labour Party (for the little it is worth), the trade unions, uncle Tom Cobley and all. They wring their hands, complain – and do nothing. Unison, the largest trade union within the NHS after the RCN, is prepared to ballot on strike action to defend pensions, but not to prevent the privatisation of the NHS. Yet the assault on pensions will be as nothing compared to the attacks on pay and working conditions in the free-for-all that will accompany the sale of NHS hospitals and services.
The Bill has now gone to the House of Lords having passed through the Commons. There, ConDem Coalition Health Minister Lord Howe has said in one breath that it doesn’t matter who provides the care as long as it is free at the point of delivery, and in another that the Bill ‘presents huge opportunities for the private sector’. As was to be expected, the ‘listening exercise’ over the summer proved to be a complete fraud. The outcome was not to change the fundamentals of the Bill, but to tinker with small parts of it. Crucially, the Secretary of State loses all responsibility for the delivery of health services. Replacing the current structure is a jumble of organisations – more than 500 – which will be ripe for privatisation.
Even before the Bill becomes law early in 2012, the pace of privatisation is being stepped up. Circle Health is earmarked to take over the management of Hitchinbroke Hospital in Cambridgeshire, a Trust contemptuously seen as a financial ‘basketcase’ because of the historic financial problems it shares with other hospitals in outer London and the south east. Circle Health is also poised to take over the running of Epsom Hospital, which is being split off from the Epsom and St Helier Trust to help resolve a £38m deficit. It does not matter that Circle Health itself is a ‘basketcase’: it lost £35m last year, and its sole experience in running a hospital is a boutique 28-bed unit in Bath. If it fails, then it will get taken over by another health care company. The market in the NHS is not just about the buying or selling of services or hospitals, it is also about the buying and selling of health care companies and the creation of new monopolies to control the emerging market.
The Department of Health (DoH) is encouraging the process. Trafford Healthcare NHS Trust, the Royal National Orthopaedic Hospital and Whiston Hospital in St Helens have publicly voiced their interest in having their management privatised. Helios, a German company, has been negotiating since December 2010 to take over up to 20 NHS hospitals. Management consultancy McKinsey, central to the whole process of privatising the NHS, brokered a meeting between Helios, Ian Dalton (head of provider development at the DoH) and Ruth Carnall (chief executive of NHS London) just one month before the ConDem Bill was published. Just after it came out, the DoH invited McKinsey to discuss the Helios proposal. Ramsay Healthcare has signed contracts with 34 hospitals and treatment centres to treat patients who might otherwise wait longer than the 18-week NHS target. Given the onus on the NHS to find £20bn ‘efficiency savings’ while saddled with huge PFI debts, the numbers of patients that Ramsay will be treating is likely to grow. Suffolk’s community health services are up for grabs: 27 services are being sold off in four lots. The five short-listed private companies have no experience of running these services.
Standing tall in the midst of the mish-mash of organisations running, commissioning or supervising services in the ConDem’s privatised health service is Monitor, the independent regulator of Foundation Trusts. Its already considerable powers will increase considerably as all hospitals are now being pushed to achieve Foundation status. On top of this, however, the Bill makes Monitor responsible for extending competition within the NHS and giving it powers to enforce EU competition law. In practice, Monitor will take over the government’s responsibility for ensuring the delivery of health services – but only those services which conform to the diktats of the market. Monitor’s current chair, ex-McKinsey consultant David Bennett who is on £300,000 a year, has declared that buying health care services is like buying gas or electricity and that:
‘choice and competition will work in the NHS as it did in those other sectors…we’ve done it in rail, in water, so there’s actually 20 years’ experience on taking monopolistic, monolithic markets and providers and exposing them to economic regulation.’
Some choice! All that we have had is 20 years of rip-off from the gas, water and electricity monopolies, and railway tickets that are the most expensive in Europe.
There is limited time before the appalling attack on working class people that the Bill represents becomes law. Rationing of essential operations like hip and knee replacement, varicose veins and cataracts has already started. FRFI urges its readers to get active in local Keep our NHS Public campaigns or start one yourselves.
Hannah Caller and Robert Clough
FRFI 223 October/November 2011
