Health Minister Patricia Hewitt has denied that the government is privatising the NHS. She says that the ‘competition’ she is introducing only affects 10% of elective surgery and is supposedly 1% of the overall budget. She is a cynic. She knows full well what she is doing. Sir Nigel Crisp NHS Chief Executive has instructed Primary Care Trusts that they should not ordinarily carry out work in house. By 2008 they are supposed to have rid them selves of all of it. But we have already seen the consequences of this move to privatise PCT work. All non-emergency work done by the ambulance service in Surrey is to be handed over to a private company, GSL, which specialises in prison management, immigration detention centres and court escort duties. It is a breakaway from that bastion of high quality work Group 4 (the one which kept on losing prisoners). GSL will look after high dependency patients who need oxygen and supervision during journeys between hospitals. Try not to fall ill in Surrey.Meanwhile Thames Valley Health Authority took a step towards contracting out NHS healthcare management in Oxfordshire. On October 12 Thames Valley Strategic Health Authority voted through proposals that would remove the PCTs’ senior staff from April 2006 and replace them – most likely by managers from a big corporation. The new, outsourced, PCT commissioners will buy in services from the private sector, Foundation Trusts and the NHS, for the people of Oxfordshire at the same time as preparing to shed those services currently provided by the PCT.
The SHA has made no attempt to seek or consider the public’s view of these latest ‘reforms’. The announcement was buried in Board Paper 62-05 on page 9: “The SHA proposes to procure the provision of management services to the Oxfordshire PCT(s)”.
Staff of the existing PCTs heard about this plan just two days before the proposals came into the public arena. Having rubber stamped what is laughingly called the “procurement” process, TVSHA has indicated that there will be no further consultation with staff or public on this issue. This process is as transparent as all those contracts handed over to Haliburton by the Bush government.
And it has been made clear that while the size and configuration of other Thames Valley PCTs is up for consultation, Oxfordshire’s privatised PCT isn’t. It’s believed that the Primary Care Trust inc (as it has been called by staff) might be put out to tender in the Official Journal of the European Commission (OJEC) in late November, and by April 06 may be up and running with new staff.
The Department of Health, it is said, views Oxfordshire as a pilot site, and if successful would like to put all PCTs out to tender.
Rigged ‘health market’
Elsewhere news is emerging that the so-called ‘health market’ is rigged in favour of private companies. In fact there is no competition. NHS organisations are being instructed to hand over work to the private sector. In Yorkshire for instance, the Department of Health has instructed the Trusts in that area to increase the value of work given to the private sector from £3.2 million to £18 million. Brighton hospital has learned that 85% of its orthopaedic work will be simply handed over to a private hospital down the road. Oxford’s Nuffield hospital is faced with closing up to half of its beds because it is losing work to a private hospital which has just been opened up nearby. There are many other examples. Between 10-15% of elective work will initially be given over to private companies, not as a result of competition but by instruction of the Department of Health.
The work being given away to private health companies is the more simple and profitable work. Such businesses will not be interested in Accident & Emergency work, nor in chronic diseases which require long term treatment. This will tend to mean that general hospitals will have to carry out more expensive work. As private companies take more work off of the NHS then types of activity currently carried out will be abandoned by NHS Trusts, thus meaning that the ‘choice’ that patients have been told they will have will disappear.
And the government is paying private companies 9% more for operations than it does NHS bodies. Is this ‘greater efficiency’? What else is this but encouraging the growth of private companies, at the expense of the NHS?
The watch word of this ‘market’ is ‘patient choice’. Sick people do not want such a choice. They want to be treated to a good standard in the locality where they live. They are not shopping for DVDs, they are ill. Such ‘choice’ will destroy the basis for planning and introduce the chaos of the market. ‘Patient choice’ will produce the same result as ‘parent choice’; ‘sink hospitals’ instead of ‘sink schools’.
A report published in June by consumer watchdog Which? (formerly the Consumers’ Association) discovered that nine out of ten respondents to their survey supported the key argument of those opposed to ‘choice’: essentially patients want good local services which ‘obviate the need for choices’.
Even before the emergence of this new ‘market’, the funding crisis of the NHS has reached unprecedented proportions. London Health Emergency has examined the accounts of 22 of the 28 Strategic Health Authorities and discovered a £1.6 billion funding gap (See the full report at http://www.keepournhspublic.com/pdf/SHAlist.pdf ).
The Health Emergency Press Release explained:
“Despite record levels of funding at national level, the National Health Service is facing a drastic autumn round of local cutbacks and economies throughout England as Trusts, Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs) attempt to deliver a balanced budget for the current financial year. 16 SHAs have projected deficits in 2005-6, while four have projected end of year deficits in excess of £70m for local NHS organisations. A snapshot estimate of the available figures suggests a total shortfall of more than £1.6 billion across 22 SHAs: the 51 most financially challenged NHS Trusts face deficits and savings targets totalling almost £650 million.
A survey of SHA, Trust and PCT papers and local press websites has revealed that tens of millions in deficits carried over from the last financial year are now worsening the plight of hard-pressed Trusts and PCTs as they attempt to stay within spending limits this year, while meeting stiff government performance targets.
Many Trusts and PCTs are counting on substantial brokerage and one-off support payments organised by 6 SHAs as a means to prop up their floundering finances and remain within borrowing limits. One Trust, Mid Yorkshire Hospitals, is seeking brokerage this year of £100m, while others are so deep in the red they are having to defer payments on accumulated debts, and hope to clear their deficits over the next three years.
No fewer than 29 hospital and Mental Health Trusts have been identified as facing deficits or savings targets of £10m or more in 2005-6, leaving them just six months to push through far-reaching cuts and changes. At least another 22 Trusts face savings targets or deficits of £5m or more. And well over a dozen PCTs face massive deficits across the country, several of them in excess of £10m. While previously published official figures have set last year’s deficits against under-spends elsewhere within each SHA, resulting in an apparently marginal deficit across the NHS as a whole, it is clear from this recent survey that the sheer scale of the cutbacks required in the overspending Trusts and PCTs must have an impact on patient care.
Beds, wards and some well-loved smaller hospitals and units are closing, jobs are being axed, and PCTs, which foot the bill for each episode of hospital treatment, are seeking to cut back the use of hospital services and divert patients to primary care or to nursing homes and social services to balance their books at the expense of yawning deficits for their local provider Trusts.”
It is no exaggeration to say that the government policy of ‘payment by results’ and introduction of a ‘health market’ is destroying the foundations of the health service as ‘social medicine’. The government says that it does not matter who provides the service whilst it remains free at the point of delivery. However, instead of NHS organisations collaborating they will all be competing to attract patients and struggling to survive. And just as in the past New Labour abandoned its promise that all clinical work would remain in the NHS it cannot be long, as the financial crisis deepens until they decide that “those who can afford it” should pay. Or else, the road will be open to introduce charges should the Tories get back into office.
So what can be done to challenge the government? A national campaign has been launched, Keep Our NHS Public (http://www.keepournhspublic.com), by health workers organisations and campaigning groups, with the support of UNISON. It is hoped that other unions will come on board. It has been launched with the statement shown below. (See the list of signatories thus far at: http://www.keepournhspublic.com/supportlist.php )
It has to be said that it is rather late in the day. Much damage has been done to the NHS. The health service unions have downplayed their differences with the government. The ‘end of the two tier pay system’ was trumpeted as some great achievement. Dave Prentis said he would judge the union’s relationship with the government on whether or not it ended the two tier pay system. Whilst it is a step forward for the workforce, the government has continued with its privatisation agenda. Surely it is whether or not it presses ahead with privatisation, on which the government should be judged? The attempt of the unions to reason with Blair’s neo-liberal gang of careerists and self-seekers has been futile.
Having said that, the move to reorganise the PCTs and privatise their work has provided a salutary shock. As John Lister of Health Emergency said at a recent meeting the unions have spoken of ‘creeping privatisation’ but in fact we are facing galloping privatisation.
The key thing now is to build the campaign as widely as possible, involving service users as well as staff. We can learn from the experience of Defend Council Housing where the unions have supported a campaign which has united the workforce with tenants. The advantage there, as compared to the situation in the NHS, of course, is that there has been a ballot process which has enabled local campaigns to overcome the advantage of Councils: publicity machinery, money, and government write off of debt.
There will be no ballots in the health service. The government is ‘letting the market rip’. That is why industrial action needs to play a more central role together with a political campaign. The absence of a national campaign in relation to the NHS has meant that groups of workers have been left isolated. There was no real campaign against PFI. The Dudley Hospital workers, for instance were left to fight alone. However, the new campaign will not only provide a focus, it will enable campaigners to expose in a much more systematic way the disaster which is happening on the ground in countless Trusts and locations.
The weakness of the health service union organisation on the ground remains an objective difficulty that we face. However, it just may be that the launching of a national and political campaign will provide an impetus for rebuilding union organisation in the workplace.
This campaign is important not only for those involved in the NHS and those who use its services. It is politically important because the NHS was one of the most enduring reforms which the post-war Labour government carried out. The generation which grew up in the 1930’s understood life at a time when working class people often could not afford to see a doctor when they were ill. The NHS, despite all its weaknesses, gave a glimpse of a society in which people’s lives were not determined by their status or the size of their bank balance.
The high priests of New Labour, glorifying in the ‘benefits’ of globalisation, believe that everything should be subordinated to ‘the market’. Yes, this is Brown and Blair’s very own version of social Darwinism. We now have the unedifying spectacle of NHS hospitals ‘marketing’ their services, as if the sick were considering what make of TV to buy. We are in fact moving towards a system in which the private sector will pick up the easy, more lucrative work and the NHS will be left with emergency work and treating chronic illnesses which the profit hungry vultures would not want to touch.
Workers organisations are fighting to defend themselves on many fronts against a government which is seeking to destroy the welfare state, cutting our pensions, attacking our democratic rights and so on. Not everybody will be able to become directly involved in Keep Our NHS public. But what every trade union activist can do is to get their branch to affiliate, circulate the material in the workplace and explain to their workmates and their neighbours what is being done to the NHS.
The campaign rightly wants to build local groups. Signatories on the statement, even big names ones, are no substitute for developing active support for the campaign, so that resistance is built. That depends on the full and active involvement of the unions.
Campaigners in South West London have shown what can be done. Opposing the transfer of the £15m NHS-funded South West London Elective Orthopaedic Centre to private hands as part of the government’s £3bn scheme to expand private sector provision of NHS contracts have secured a 2-month delay and a full review of the plans.
They intervened at a meeting of the Epsom-St Helier Trust Board, challenging the directors to explain the reasons for transferring the state of the art, highly successful and popular NHS unit to a US-based company.
Trust directors were unable to offer satisfactory answers, and eventually conceded that a decision on the transfer, due to be taken at that meeting, would be postponed until December.
During these two months a full review of the plan, including a fresh review of the option of retaining the unit and its services within the NHS, would be undertaken. Campaigners now plan to intensify their efforts to ‘Keep SWELEOC in the NHS’: but their example also shows the way for other campaigners faced with the transfer of NHS facilities in the second wave of bidding for Treatment Centre contracts, which are not open to NHS hospitals.
The farther this programme of the government goes, the more we will live to regret it. What could expose the reality of Blair’s neo-liberal programme more clearly than a policy in which profit is to be dumped into the pockets of the private health vultures at the expense of the NHS? No wonder new right wing German chancellor Angel Merkel has been reported to have sought the advice of Blair on how she can introduce a Thatcherite programme into Germany.