Despite almost universal opposition, the government is pressing ahead with NHS reforms which will spell the end of the NHS as a free, universal service. After a short pause to allow for a farcical ‘listening exercise’, the Bill has gone back to the House of Commons. In fact only 64 of its 299 clauses returned to the Commons Public Bill Committee on 28 June, meaning that there would be no chance of scrutinising the document as a whole.
The idea that there has been fundamental change as a result of the ‘listening exercise’ is just nonsense. The original Bill stripped the government of any responsibility for the provision of health services; the only concession on this is an empty declaration that the Secretary of State for Health will be responsible for ‘promoting’ the health service. Other proposals in the original Bill are retained, for instance that:
• all hospitals will have to become Foundation Trusts, and effectively become commercial bodies, although the timetable will be extended;
• services can be closed without public consultation;
• caps on income from private patients in NHS hospitals will be removed, tempting many to increase their income at the expense of NHS patients;
• commercial insolvency laws should apply to hospitals going bust;
• commissioning consortia will still be allowed to enter into joint enterprises with private companies;
• any ‘qualified’ provider will be able to deliver NHS services.
The remit of Monitor, which regulates Foundation Trusts in the NHS, has been extended. The original Bill gave it specific powers to extend competition in the NHS and act as an economic regulator for health and adult social care in England. Its brief will now include promoting collaboration. However, Richard Lewis, a partner in the Ernst and Young accountancy group, is quite clear that this means hardly anything, saying that ‘the Principles and Rules of Co-operation and Competition will not only remain, but will gain a statutory footing’. Monitor will retain the power to enforce competition law and can for instance fine hospitals 10% of their income if their transactions are deemed anti-competitive. As if to underline the drive to privatisation, Health Secretary Andrew Lansley announced on 19 July that £1bn worth of community and mental health services will be opened up to competition from ‘any qualified provider’ from April 2012.
In its initial guise, the Bill promised a reduction of 45% in NHS bureaucracy. However, according to the Royal College of GPs, the number of statutory NHS bodies will rise from 163 to 521 given that the Bill now requires five different types of organisation to take over the role of Primary Care Trusts (PCTs) including 300 Clinical Commissioning groups, 150 Health and Wellbeing Boards and 50 PCT clusters.
The original Bill proposed the creation of GP commissioning consortia. Now they have been re-branded as Clinical Commissioning Groups and may include other clinicians. They will do most of the purchasing of hospital care. The revised Bill leaves in place what are called PCT clusters, part of a new NHS Commissioning Board, which will now commission primary care and dentistry. As a sop to the demand for independent clinical evaluation of commissioning decisions, there will be new bodies called ‘clinical senates’, whose powers over clinical commissioning will not include a veto. Local authorities will take over public health responsibilities as originally proposed, while new Health and Wellbeing Boards are supposed to bring health and local government together in a nod to improving collaboration.
The British Medical Association (BMA) has twice voted for the Bill to be withdrawn and in July a British Medical Journal poll showed 93% of its readers calling for the same. The BMA has now launched a campaign to get the Bill withdrawn. Nearly half of all GPs disagree with the reforms and 60% do not want to be involved with commissioning groups.
Almost £2bn will be taken from patient care to cover the costs of the reorganisation, while hospitals have to save an additional £1.1 billion, on top of 4% ‘savings’ over the next four years. This represents a deliberate attempt to destabilise the NHS in order to justify the changes. Already, of the 2.47 million people currently on hospital waiting lists, 236,000 have now been waiting over 18 weeks – an increase of 8.5% over last year. Half of these patients have been waiting over six months, many for orthopaedic operations such a hip and knee replacements. Over the last year, 200,000 patients waited more than four hours in A&E. It is a harbinger of worse to come if the Bill is passed when it goes back to the House of Commons in September.
Hannah Caller
Fight Racism! Fight Imperialism! 222 August/September 2011
