NHS news review: Cameron confirms that the intention is to privatise the NHS

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Best wishes for the new year.

Seven former presidents of the Faculty of Public Health accuse the Prime Minister of ploughing ahead with an “unprecedented marketisation” of services, which poses a “major threat” to the integrity of the NHS.

David Cameron confirms that the intention is to “… drive the NHS to be a fantastic business“. How is that anything other that the privatisation of the NHS?

Watch the video here VIDEO BLOG: Cameron wants the NHS “to be a fantastic business” « sturdyblog

Drop perilous NHS reforms, say leading health professionals – Health News – Health & Families – The Independent

David Cameron faces fresh calls to abandon his NHS reforms, as a group of leading public-health experts predicts that the changes will “exacerbate inequalities” in the health of the nation.

Seven former presidents of the Faculty of Public Health accuse the Prime Minister of ploughing ahead with an “unprecedented marketisation” of services, which poses a “major threat” to the integrity of the NHS.

In a letter to Mr Cameron, the group warns: “The Bill is likely to produce a ‘patchwork quilt’ health system that will vary hugely across the country, failing to meet the diverse needs of the population and undermining the health of vulnerable, minority groups.”

27/11/13 Having received a takedown notice from the Independent newspaper for a different posting, I have reviewed this article which links to an article at the Independent’s website in order to attempt to ensure conformance with copyright laws.

I consider this posting to comply with copyright laws since
a. Only a small portion of the original article has been quoted satisfying the fair use criteria, and / or
b. This posting satisfies the requirements of a derivative work.

Please be assured that this blog is a non-commercial blog (weblog) which does not feature advertising and has not ever produced any income.

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Continue ReadingNHS news review: Cameron confirms that the intention is to privatise the NHS

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Colin Leys – co-author of ‘The Plot Against the NHS’ – has an article at Opendemocracy.

The NHS will be privatised – it doesn’t matter what the British people want | openDemocracy

In voting for the third reading of Andrew Lansley’s Health and Social Care Bill last week MPs voted to replace the NHS as a public service with a system of competing businesses – foundation trusts, social enterprises and for-profit corporations.

The government’s claim that the Bill does not mean privatisation is plainly specious: the truth of the matter is to be found in what Lansley’s health minister, Lord Howe, told a meeting of private health businessmen on the day the Bill was approved. He said it presented ‘huge opportunities’ for the private sector, and noted that commissioners of health care would be barred from favouring NHS providers. The truth is also to be found in the government’s leaked plans to hand over the management of NHS hospitals to private companies, and in the current and promised large-scale opening up of NHS work to ‘any qualified provider’.

Conservative election poster 2010

Lord Howe reiterated Tony Blair’s dictum that it doesn’t matter who provides care, so long as it is free to the patient. What this does is to treat as irrelevant everything that follows from introducing market dynamics. The basic fact about health care is that high quality care depends on a sufficient ratio of skilled staff to patients, whereas in the long run profits can only be made by reducing the skill-mix (to lower the wage bill) and cutting staff ratios. The resulting decline in care quality is already evident in privatised long term care and home care, and is now beginning to be seen in community health services and GP services. Once NHS trusts have to compete with for-profit companies they will be forced to follow suit.

The erosion of quality will be reinforced by two other powerful factors: a) the cuts being imposed in the NHS budget, leading to the withdrawal of some services and the scaling back of others; and b) rising costs due to marketisation.

The costs of market-based health care – from making and monitoring multiple and complex contracts, to advertising, billing, auditing, legal disputes, multi-million pound executive salaries, dividends, fraud, and numerous layers of regulation – will eventually consume 20 per cent or more of the health budget, as they do in the US. Neither the Care Quality Commission nor NHS Protect (the former NHS Counter-Fraud Unit) is remotely resourced enough, or empowered enough, to prevent the decline of care quality or the scale of financial fraud that the Bill will introduce.

The effect will be that people with limited means will be offered a narrowing range of free services of declining quality, and will once again face lengthening waits for elective care. To get high quality and more comprehensive care people will have to pay for private insurance and private care, if they can afford to. More and more NHS hospital beds will be occupied by private patients, further reducing the resources available for free care. Fixed personal budgets, like those already given to people for social care, are to be introduced for a growing range of chronic conditions, allowing those with resources to top up their allocations while leaving the rest to make do with ‘basic’ NHS provision.

None of this is wild speculation. It is either already happening or announced or readily foreseeable on the basis of current policy. To deny that the Bill means privatisation and the end of the NHS as a comprehensive service equally available to all is like denying that the earth is round.

The fact that MPs have nonetheless endorsed the Bill reveals something more serious than an ideological blind spot. It shows that they don’t really care that they are flouting the wishes of the electorate. Cameron promised categorically that there would be no further top-down reorganisation of the NHS, but is pushing through a reorganisation that amounts to a destruction of it, against the known wishes of a large majority of voters. Governments, we are told, must often take unpopular decisions. But this is not some incidental measure. We are talking about something fundamental to what, for more than half a century, has played a key part in making Britons equal citizens, and Britain a civilised and humane country. If democracy doesn’t mean that governments have to respect public opinion on something as important as this, what does it mean?

It is no less depressing that the Department of Health has been reduced to peddling more and more brazen lies, such as its ‘Department of Health Myth Buster’ document, published to coincide with the Third Reading debate. The principle seems to be that that if an official lie – such as that the Health Bill does not mean privatisation – is repeated often enough, most people will feel it must be true. Democracy depends on voters having trustworthy information. If we cannot trust departments of state, run by public servants, to tell the truth, who can we trust?

Selected excerpts from ‘The Plot Against the NHS’ by Colin Leys and Stewart Player. Chapter One is available here. I highly recommend this book available from Merlin Press for £10.

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Conservative election poster 2010

A few recent news articles about the UK’s Conservative and Liberal-Democrat coalition government – the ConDem’s – brutal attack on the National Health Service.

BMA Exposes Government’s Unjustifiable Changes in Healthy Pension Scheme | News Tonight

In a shocking revelation, it has come to light that the controversial Government plans to reform NHS pensions could put an extra £230,000 burden on GPs over their career. It has been reported that BMA forecasts have revealed that the NHS pension reforms made by the Government earlier this year are already raiding GPs up to £125,000 each over the course of their lifetimes.

Further, GPs will lose £124,500 by the time they reach 85, if the proposal produced in April, involving shift from use of the retail price index to the lower consumer price index to uplift NHS pensions, is passed.

Reacting to the unjustifiable changes to the financially healthy pension scheme, Dr. Hamish Meldrum, chair of the BMA council, said: “his isn’t about affordability; it’s about the Treasury looking for yet another quick hit from public sector workers. Doctors pursuing a career as a consultant or GP will have to pay significantly higher contributions in return for a much reduced pension at retirement”.

Anger as ‘ludicrious’ referral gateway rejects up to a quarter of GP requests – newsarticle-content – Pulse

Exclusive GPs have been forced to formally complain to PCTs over a series of technical and administrative problems with referral management centres, with one practice claiming a quarter of its referrals have been rejected.

In NHS West Essex, GPs have been left frustrated by rejections and the insistence of administrators that referrals are resubmitted, sometimes several times, without having been triaged by its Central Referral Service.

Examples of rejections include a referral to a surgeon for diagnosis and removal of a lump refused because a minor surgery proforma was not attached, and a gynaecology referral refused ‘in error’.

A GP in Uttlesford, Essex, who wished not to be named, said: ‘I am vehemently opposed to referral management systems. It is intensely frustrating and is not working for administrative reasons and ludicrous technical problems.’

A practice manager at a practice in Essex claimed a quarter of its referrals had been rejected by the referral triage system: ‘I feel our patients are suffering. So many receive letters stating their appointments have been cancelled.’

NHS spends nearly £16 million a year on headhunters – Telegraph

The NHS is spending nearly £16million a year paying recruitment firms to headhunt senior executives … it was revealed yesterday.

In one example, a primary care trust paid an agency more than £111,000 to fill the post of its chief executive, only to later promote its own deputy into the role.

The vast expenditure comes despite Government promises to cut back on “wasteful bureaucracy” among health trusts.

Health Secretary Andrew Lansley has pledged to reduce money spent on managers and pen-pushers by 45 per cent over the next four years. Hospitals are also being forced to axe thousands of front-line staff in an effort to save the NHS billions of pounds.

Yesterday, Freedom of Information figures revealed primary care trusts and strategic health authorities spent an estimated £15.9million paying recruitment firms to hire new managers.

Darzi centres heralded as “massive waste of money” – News – Practice Business

PCTs struggle to justify Darzi centres after revelations of low patient numbers

Statistics from over 95 PCTs have revealed that 26% of Darzi centres have fewer than 500 registered patients, and that 35% had fewer than 1,000 patents.

The new information was gained through the Freedom of information Act and revealed via investigation by GP online that also found that over 12% of all Darzi centres had no registered patients whatsoever (though some stated that they did not offer this option). One of the centres had just a single registered patient.

Each PCT was forced to set up a Darzi centre under the previous government as part of a plan to provide primary patient care seven days a week between the hours of 8am and 8pm each day.

The centres cost around £1.1m each year and the General Practitioners Committee’s (GPC) negotiator, Dr Peter Holden, has stated that the on reflection the centres were “a massive waste of money”, saying that it was “outrageous” that centres had failed to register fewer than 500 patents.

Adelaide Surgery in Southampton has just 1,220 patients registered, GP Online reveals, despite receiving £907,000 in 2011/12, which means the centre receives around £743 per patient per year – or seven times as most GP practices.

[I need to check, but I think that the real issue about Darzi centres (Polyclinics) is that PCTs were forced to provide them by government ~ Darzi clinics being the latest policy fad. ‘The Plot Against the NHS’ by Colin Leys and Stewart Player discusses Darzi clinics.]

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Healthy alternatives | Red Pepper

Colin Leys looks at how Scotland and Wales have rejected marketising the NHS

As expert commentators have amply shown, the coalition’s plan to privatise the NHS lacks any basis in evidence – no surprise there. What is less well recognised, and so far amazingly unmentioned in the debate, is that powerful evidence against privatisation exists on our own doorstep – namely, the fact that in Scotland and Wales the NHS is working well as a publicly provided and managed system, based on planning and democratic accountability.

Marketisation was tried, especially in Scotland, and rejected. The purchaser-provider split, which is at the root of the marketisation project, was introduced but then abandoned in both nations, and neither foundation trusts nor payment by results were introduced in either of them. PFI was used in Scotland under the first Labour government in Holyrood, and one private treatment centre for NHS patients was opened, but the SNP has since scrapped the use of PFI and taken the treatment centre into public ownership. Wales has used neither PFI nor private treatment centres. The NHS in both countries is once again planned and managed through a mix of democratically accountable central and local structures, as it was in England before the 1990s.

We have an excerpt of The Plot Against the NHS reviewing Scotland and Wales’ approaches.

Selected excerpts from ‘The Plot Against the NHS’ by Colin Leys and Stewart Player. Chapter One is available here. I highly recommend this book available from Merlin Press for £10.

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Continue ReadingNHS news review – Colin Leys

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It appears that all is not well following the recomendations of the future forum and the acceptance of its recommendations by the ConDem coalition government. Many NHS news articles highlight the fact that despite the many changes to the Destroy the NHS bill the privatising elements remain intact. The bill is still on course as the first stage of transforming the NHS into a restricted, privatised, insurance-based model of care.

It is clear that the revised Abolition of the NHS Bill does not satisfy the demands of the Liberal-Democrat Spring Conference due to the reliance on private providers. It is recognised that the Liberal-Democrats are facilitating the destruction of the NHS.

Conservative election poster 2010

A few recent news articles concerning the UK’s Conservative and Liberal-Democrat coalition government – the ConDem’s – brutal attack on the National Health Service.

Still a clear and present danger / Features / Home – Morning Star


The NHS Future Forum, while having uncovered many faults throughout the legislation, was never asked to consider the ideological foundations behind the Bill.

This leaves Field between a rock and a hard place, having ensured new safeguards are applied while at the same time adding legitimacy to a significant departure from the founding principles of the NHS.

The Health and Social Bill remains a real threat to the NHS as a comprehensive service free at the point of use.

All this means that the threat to NHS services and staff remains a clear and present danger. The Future Forum did little to assuage the fears of NHS staff who still face losing nationally determined pay, terms and conditions and will have little confidence in their job security which has been a hallmark of our National Health Service, established over 60 years ago by a Labour government.

The Health and Social Care Bill will now return to a public Bill committee of MPs of which I will be one.

How the coalition implements the NHS Future Forum recommendations in legislation and to what extent these recommendations change the direction of travel charted by the Bill will be known shortly.

One thing is certain – the Bill does far more than the coalition’s stated aims. Otherwise we would not need a Bill at all.

As I said in the Commons earlier this week, the changes set out by government this week are largely cosmetic. “You could put lipstick on a pig, but at the end of the day it was still a pig.”

Grahame Morris is Labour MP for Easington.

NHS: still on the road to privatisation | openDemocracy

On Monday, the Future Forum unveiled its long-awaited report on the Coalition’s NHS bill. Having now agreed to implement the majority of its recommendations, the Conservatives are keen to portray the episode as an example of a government willing to “listen” and improve “where it hasn’t got things right”. The reality is that their initial bill was a transparent attempt to privatise the NHS. Only the prospect of the Lib Dems voting it down forced any change. This was not a “listening exercise”, it was a last ditch attempt  to push the bill through with the minimum concessions necessary. The primary function of the bill remains in place: to introduce private sector provision throughout our health service.

The argument for Andrew Lansley’s NHS bill has been tenuous from the outset, encountering continual and vocal opposition. Recognising that the bill’s defeat would be catastrophic for his premiership, Cameron has desperately tried to repackage it whilst keeping the fundamentals in place. It has been a master class in the rhetoric and evasions of privatisation. But with minor tweaks there lies a danger that the bill will be accepted, both in the legislature and by the public, on the basis that it is less destructive than Lansley’s original proposals. This mentality of concessions and minor victories must be avoided. Instead, what must be continually asked is whether the bill is acceptable and legitimate in its current form – does it leave the NHS as a nationalised, coherent health service, and did the public vote for it?

Lansley will tell his backbenchers that the fundamentals of the bill remain in place: GP Consortia commissioning services, and the private sector brought in through competition requirements. The involvement of private health firms has always been at the centre of these proposals and nothing in today’s report will worry them overly. In years to come, any niggling public safeguards can be slowly eroded.

The bill still represents a fundamental change to our NHS; it is a programme for widespread privatisation. Private services will expand, the truly national part of our health service will shrink, and incidents like Southern Cross could become more and more common. John Redwood’s claim on Question Time that providers must put “patients first” was typically disingenuous; corporations have a legal obligation to maximise shareholder value. They will be obliged to seek the maximum revenues and prices possible, and incur the minimal costs possible. They are profit maximisers, not charities, and a patient’s worth is measured in pound sterling.

GMB On NHS Changes

GMB today set out its position on the recently published NHS Future Forum Recommendations.

Rehana Azam, GMB National Officer Public Services Section said “ The report and recommendations on the face of it appears that significant progress has been made. In reality there is much to be concerned about and until the details emerge as to what the amended Bill will look like the GMB remains of the view that Bill should be scrapped. The Bill in its current format will lead to the break up of the NHS and this break up continues to be the most significant threat to the NHS.

HR Magazine – NHS reform will increase usage of PMI schemes, says Mercer


Earlier this week, the Government announced it would be changing many of the initiatives that were to be implemented, following recommendations from the NHS Future Forum. According to Mercer, despite the proposed changes, companies should continue to prepare for further increases in corporate healthcare costs. GP consortia will work with healthcare professionals to ensure the most effective multi-professional involvement in the design and commissioning of services.

Consortia will also not take on the full range of responsibilities by April 2013, but when they have the right skills, capacity and capability to do so. Despite these changes, Mercer believes that giving these consortia control over budgets may still affect the quality of care and the length of waiting lists.

According to Naomi Saragoussi, principal in Mercer’s health and benefits business: “The devil is in the detail. While the Government has accepted the criticism of its policies and the plans to make the NHS more competitive appear to have been watered down, some areas lack clarity. It may be difficult for the consortia not to take a more commercial approach and prioritise more cost-effective treatments, despite their good intentions. We will have to wait and see.

Half-steam ahead on NHS reform but still on course » Hospital Dr

According to all accounts Captain Cameron and second mate Lansley have listened to the weather warnings of the Future Forum, have duly altered course and are now steering the SS Health Service into a bright new future.

Or are they? Closer examination of the small print suggests that we are in reality still heading into stormy waters and are the victims of a massive PR trick by the government who have managed to stay on course while persuading us that they have significantly altered the Health and Social Care Bill.

Lansley has reassured backbenchers that no red lines have been crossed and that the core principles of the Bill are untouched. On the same day that the papers were reporting Cameron’s “explicit rejection of further private sector involvement in the NHS” Lansley himself was addressing a conference of private companies eager to get involved in commissioning and providing NHS care.

One of the core principles of the Bill is to facilitate private involvement in commissioning and delivering NHS care (and anyone who still doesn’t believe that this is advised to read Colin Leys and Stewart Player’s compelling book The Plot against the NHS). All the policy levers for this – in particular GP commissioning and any willing provider, – remain in place. The emphasis of the role of Monitor has been altered but can easily be redirected once the well orchestrated political dust has settled.

 

Selected excerpts from ‘The Plot Against the NHS’ by Colin Leys and Stewart Player. Chapter One is available here. I highly recommend this book available from Merlin Press for £10.

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NHS news review: Interview with Colin Leys ‘The Plot Against the NHS’

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There are three articles on ‘The Plot Against the NHS’ today:

The Plot Against The NHS / Non-Fiction / Books / Culture / Home – Morning Star

‘The Plot Against NHS’: Essential reading for battles ahead|28May11|Socialist Worker

Resisting plot against NHS|28May11|Socialist Worker

The NHS is under serious attack from the Tories and faces rampant privatisation. Colin Leys, co-author of a new book on the NHS, spoke to Yuri Prasad about what the cuts mean—and how this is the logical conclusion of policies pursued by New Labour

Many say that if the government’s health and social care bill were passed in its present form it would mean the end of the NHS as we know it. Does that overstate the threat?

Colin Leys I don’t think it overstates the threat at all. The bill removes the secretary of state’s responsibility to provide a national health service and doesn’t assign it to anyone else. She or he would only be charged with “promoting” it.

 

Selected excerpts from ‘The Plot Against the NHS’ by Colin Leys and Stewart Player. Chapter One is available here. I highly recommend this book available from Merlin Press for £10.

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The Plot Against the NHS by Colin Leys and Stewart Player – review | Society | The Guardian

A year ago Peter Martin, the chief executive of Tribal Group plc, which describes itself as a “leading provider of commissioning services to the NHS“, presented his view of the future for the health sector in England. He was bullish. Although he described market conditions as “challenging”, he saw an “improved flow of service delivery opportunities” that would significantly support Tribal’s revenue growth. Andrew Lansley’s 2010 white paper would bring “major changes in structure of UK health markets”. Martin’s goal was to focus Tribal’s health business on the profit-making opportunities these reforms would create. He set out five growth priorities: commissioning for GP consortia, clinical support services, patient management services, informatics outsourcing and hospital management services.

This is the future for the NHS that David Cameron and Nick Clegg have planned for us since the launch of the coalition. Despite their claims to the contrary, they have been laying the ground for wholesale privatisation of the NHS, the destruction (without any democratic mandate) of one of Britain’s most cherished and effective postwar institutions, and the transfer of its stewardship and operations to organisations concerned only with maximising revenues and reducing costs. The word “quality” appears nowhere in Tribal’s vision as communicated to investors.

How has the NHS arrived at this moment of crisis? Colin Leys and Stewart Player provide an indispensable guide to understanding the origins of what they call a plot against the NHS. Surely this is an exaggeration? Not so. Cameron, Clegg and Lansley are merely continuing two decades of policies – begun by Tony Blair, endorsed by Gordon Brown, and supported by successive Labour governments – aimed at introducing markets into the health service. Where Labour tried to hide its intentions, the only difference with the Conservative-Liberal alliance is their shameless transparency.

Looking back at Labour health policy now, I have to ask myself how so many of us were unable to see through the mists of what Leys and Player call the “misrepresentation, obfuscation, and deception” perpetrated by Blair, Brown, and a host of health ministers all too willing to genuflect to the market zeitgeist. Too many of us – whether doctors, nurses, or just members of the public – were willing to be bewitched by Labour’s mellow language of reform. The words are all too familiar now: modernisation, choice, empowerment, diversity, plurality, improvement, contestability, and, most beguiling of all, patient-led.

The Department of Health created a commercial directorate to oversee the plan to privatise the NHS. A group of passionate market advocates were hired to transform a public sector institution into a target for private sector takeover. People such as Mark Britnell, who was the Department of Health’s director general for commissioning when Labour was in office and who later joined KPMG – able to sell his experience in government to the world of management consulting – have now been outed as agents for the merciless dismemberment of the NHS. There was a revolving door between civil servants in the department and McKinsey, KPMG and Deloitte. Ex-ministers, such as Patricia Hewitt and Lord Warner, traded their knowledge of NHS privatisation with those who could benefit in the commercial sector.

Doctors’ leaders were little better. The British Medical Association’s John Chisholm and Simon Fradd, who led negotiations with government to revise the GP contract in 2002, won a huge victory by making out-of-hours care for patients optional. Nine out of 10 GPs stopped offering services to patients from 6.30pm to 8am. This withdrawal of NHS care allowed private providers to step in and take over. After Chisholm and Fradd had succeeded in putting out-of-hours care out for private tender, they set up Concordia Health, a private company, that offered to run those very same services, only now at a profit to themselves.

The networks of health institutions that propped up the case for marketisation and privatisation of the NHS were intricate. They include private providers, such as UnitedHealth (whose president of global health, Simon Stevens, was once a key Labour adviser); thinktanks, such as the King’s Fund (whose trustees have included Stevens and Julian Le Grand, his successor in Number 10); and lobbyists, including several NHS outsourcing and private equity businesses.

Having anatomised the diseased political corpus that has begun to infect the NHS with a commercial ethos that will increase costs, cut services and reduce quality, Leys and Stewart try to look to the future. They mount a strong defence, claiming there is no evidence the NHS is in urgent need of fundamental reform. Given the statement by Steve Field, who is leading Cameron and Clegg’s pause to review the Lansley reforms, that the current Bill could “destroy key services” and destabilise the NHS, it seems that the gathering momentum for markets as the solution to whatever ills the NHS might have could be about to stall.

Selected excerpts from ‘The Plot Against the NHS’ by Colin Leys and Stewart Player. Chapter One is available here. I highly recommend this book available from Merlin Press for £10.

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NHS news is dominated by a speech given by David Cameron yesteday. He claims that the NHS must change but that does not justify the privatisation and withdrawal of services that he proposes.

He mentions a crisis of funding. 38 Degrees and UK Uncut are clearly showing how to resolve that issue – by combating tax avoidance by rich tax avoiding Capitalists.

17.05.11: Steve Bell on David Cameron's NHS reforms speech
17.05.11: Steve Bell on David Cameron's NHS reforms speech

He engages in “It’s because I love the NHS so much that I want to change it.” emotionality which attracts many comments. I wonder if Craig Oliver was drunk when he came up with that one.

Cameron repeatedly claims that the NHS is safe in his hands BUT the Health and Social Care Bill does away with the government providing a comprehensive health service

and

it has received near total opposition from healthcare professionals. Cameron claims to be willing to listen to doctors and nurses BUT they are calling for the bill to be abandoned.

Many groups and individuals respond to Cameron’s speech.

Conservative election poster 2010

A few recent news articles concerning the UK’s Conservative and Liberal-Democrat coalition government – the ConDem’s – brutal attack on the National Health Service.

My love for the NHS is why I want change… » Hospital Dr

(Text of Cameron’s speech)

PM has still not made case for NHS reforms | News

David Cameron’s speech today on NHS reform has one familiar element: the extent of his personal attachment to the health service.

“It is because I love the NHS so much that I want to change it,” he says. That is an argument familiar from the election campaign, when Mr Cameron emphasised that the NHS was safe in his hands precisely because he had personal experience of its excellence during the tragic illness of his late son, Ivan. Indeed, it underlay the Tories’ commitment not only to exempt health from spending cuts, but to increase its funding.

Few doubt the NHS needs reform and that spending at present levels is unsustainable given the demands of an ageing population and the expansion in expensive new treatments. But accepting the need for reform is not the same thing as welcoming the Government’s health bill. This is a complicated set of proposals in one piece of legislation, which gives GPs more control over spending and commissioning services and at the same time seeks to take out layers of bureaucracy and increase competition. Many people, including health professionals, who would happily give GPs a greater say in the service, baulk at the extension of commercial competition. And Mr Cameron’s decision to “pause” the reforms – but not, as he says today, to stop them – is a measure of the public disquiet about the Bill and its implications.

UNISON Press | Press Releases Front Page

Commenting on David Cameron’s speech on the Health and Social Care Bill, at Ealing Hospital, in London, today (16 May), Christina McAnea, Head of Health at UNISON, which represents more than 450,000 health workers, said:

“David Cameron is taking the ‘national’ out of the health service and turning it into a fragmented, money-spinning operation.

“The Prime Minister is using extreme examples to paint an untrue picture. He admits the NHS is providing the best service it has ever done, with reports saying it is the most efficient and equitable health system.

“Cameron’s call to crack down on waste in the NHS is a smokescreen for a move to a wholesale market, which opens the NHS up to privatisation. The real waste is the time spent on the fatally flawed reforms, which will force NHS patients to the back of a very long queue.

“He talks about having more choice and protecting budgets, but health workers are seeing their jobs axed and wards, services and even entire hospitals lost without any arrangements to protect continuity of patient care.

Unite questions how Cameron’s ‘substantive’ changes to NHS bill are going to happen

David Cameron’s pledge to ensure ‘substantive’ changes to the NHS ‘reform’ bill should be probed to discover what he actually means, Unite, the largest union in the country, said today (Monday 16 May).

Unite said that the deeply flawed Health and Social Care bill should be scrapped and a rtoyal commission set-up to investigate the future of the NHS.

Unite pointed out the discrepancy between the prime minister’s ‘vision’ and the fact that tens of thousands of NHS jobs had been or were going to be lost in the near future. Wards are already closing, waiting lists growing and services being axed or reduced.

Unite national officer for health, Rachael Maskell, said: ”David Cameron in his speech today was long on rhetoric, but short of specifics. This was a PR exercise in verbal gymnastics due to the political pressures he is under, especially from his Liberal Democrat allies.

”David Cameron wants it both ways with the Health and Social Care bill. He said today there will be no privatisation, no ‘cherry picking’ of services by private companies and no up-front costs for care, but we question how the prime minister’s ‘substantive’ changes are going to be incorporated into the legislation.

”The bill is so flawed that it should be scrapped. The whole bill is designed on the premise of Monitor’s role as an economic regulator and the concept of ‘any willing provider’ i.e. private companies. If the prime minister is serious about these changes, it will mean a new bill.

Macmillan Responds To The Prime Minister’s Speech On NHS Reform, UK

Responding to David Cameron’s speech on NHS reform today, Mike Hobday, Head of Policy of Macmillan Cancer Support, said:

“We welcome the Prime Minister’s reassurance that the relevant healthcare professionals will be involved in key decision-making about the commissioning of NHS care and the commitment that patients will receive high-quality and coordinated care, rather than the NHS being subject to an unbridled free market. This is a key safeguard to ensure that care for cancer patients does not suffer under the proposed NHS reforms.

“Cancer is a set of highly complex diseases and GPs tell us that they will need specialist help to commission cancer services. This is why it is vital that cancer networks should continue to be used to inform decision making about the commissioning of cancer services, and why the Government must commit to fund them at least until GP consortia are up and running in 2014.

“We hope the ‘listening exercise’ results in a long-term commitment to clinical networks, and are encouraged by the David Cameron’s comments today that this will be the case.”

BMA Comment On Prime Minister’s Speech On NHS, UK

Commenting on the Prime Minister’s speech on NHS reform in England today (Monday 16 May, 2011), Dr Hamish Meldrum, Chairman of Council at the BMA, said:

“We agree with the Prime Minister that the NHS needs to change. There needs to be greater integration, greater efficiency, and more emphasis on prevention. However, the Health Bill as it is currently written would make these improvements far harder to achieve, leading to a more fragmented health service, with many hospitals at risk of closure. Whilst we welcome his commitment to listening to staff and to taking them with him, most doctors will not feel able to support this Bill unless it is radically amended.”

The Prime Minister also highlighted the fact that alcohol misuse and obesity place significant burdens on the NHS. Dr Meldrum added:

“Unfortunately the government has often ignored the advice of health organisations on how to tackle alcohol misuse and obesity, preferring to listen to and rely on the views of industries which have a vested interest in selling unhealthy products“.

Labour – Cameron’s Reforms Will Leave NHS Fragmented, Taking it Backwards – UK Politics – News on News

John Healey MP, Labour’s Shadow Health Secretary, has hit out at David Cameron’s plans for NHS reform, saying they will leave the service fragmented and take it backwards.

Labour has also released a document on the lack of coherence in the Tory-led Government’s plans and showing the level of concern and opposition to them throughout the NHS.

John Healey said:

“This is the Prime Minister’s third launch of his NHS plans. He’s made his ‘I love the NHS’ speech before but today he said nothing to clear up the confusion and chaos around his ideological, top-down reorganisation. He made the case for change in the NHS, but not for his change.

“David Cameron’s plans will fragment the NHS, with a free market free for all undermining the quality, integration and public accountability of NHS services. As even the Tory-led Health Select Committee has said, the legislation as it stands will make better services and better value for money harder not easier to achieve. It will take the NHS backwards.

“David Cameron talks of his love for the NHS, but he has broken his promise to protect the NHS. If he really wants an NHS with no privatisation, no new charges for patient services and no competition for its own sake, he must make fundamental changes to his NHS plans because his Health Bill allows exactly this.”

Ignore his denials: Cameron, like Blair, wants to turn ‘NHS’ into a kitemark | George Monbiot | Comment is free | The Guardian

The difference between David Cameron and Tony Blair is that Blair was better at disguising his intentions. He would never have announced, for example, the sale of public forests. Instead he might have promised “a world-class forest estate” in which “walker-led beacon-foundation woodlands” would be managed through “partnerships with a plurality of recreational providers”. Ten years later we would discover that our forests had mysteriously fallen into the hands of timber companies, and were being felled in the name of customer choice.

Nor would he have done anything as stupid as this government’s attempt to transform the NHS in one bill. Cameron sought to dig himself out of his hole on Monday, but too late. His claim that “there will be no privatisation … no cherry-picking from private providers” reminds us that privatisation and cherry-picking are the likely outcomes of his bill. Blair would have allowed private interests to keep spreading through the health service as slowly and quietly as dry rot. In their book The Plot Against the NHS, Colin Leys and Stewart Player show that Cameron’s health and social care bill consolidates a plan that has been fermenting for many years.

The Plot Against the NHS #1

The Plot Against the NHS #2

 

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The Plot Against the NHS #2

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Selected excerpts from ‘The Plot Against the NHS’ by Colin Leys and Stewart Player. Chapter One is available here. I highly recommend this book available from Merlin Press for £10.

p.148~154 References in the original.

Within the BMA a strong challenge emerged to the leadership’s position of ‘critical engagement’ with the government’s plans, and a demand for outright opposition. The development of serious opposition from a large part of the medical profession, and especially from GPs , was significant, because Lansley constantly claimed to have their support.

The false case for the Health and Social Care Bill

The government’s claim that the NHS was in urgent need of further fundamental reform was also becoming more and more obviously false. During the previous ten years, while the NHS was being covertly marketized, the Labour government had raised NHS funding rapidly towards the average level of spending of the other major countries of Western Europe. Spending on the NHS still remained significantly below that of the richer EU nations, and a significant portion of the new funding was absorbed by the cost of market creation. But the extra cash also produced some important improvements. Staff levels were improved, waiting times for elective care were sharply reduced, facilities were renovated or replaced.

This was reflected in the high marks given to the NHS in the Commonwealth Fund report cited in chapter 1. And by 2010 the particular charge constantly made by the marketizers, that England lagged behing European countries in the survival rates for major killer illnesses, was ceasing to be true. Lansley repeatedly declared that a wholesale restructuring of the NHS was ‘a necessity, not an option’, and David Cameron asserted that ‘pretending that there is some “easy option” of sticking with the status quo… is a complete fiction’. But in January 2011, coinciding with the publication of the Health and Social Care Bill, a paper by the King’s Fund economist John Appleby, published in the BMJ, showed tha t the marketizers’ charge was unfounded. It turned out to rest partly on the use of European data that were not comparable with the English data (and in some cases highly unreliable), and partly on selecting static data instead of trends over time. For several of the conditions usually cited English survival rates have in fact been improving so fast over the last 30 years that if the trends continue they will overtake
European rates by 2012.

The real choice

The choice is not between change and no change. It is between handing over a public service to be developed by private enterprise in the interests of shareholders, and ensuring that it develops in the interests of the public – and as the public sees those interests, not as politicians declare them to be. To maintain that there is no capacity for improvement within public provision is empty rhetoric. What evidence is there that public servcies are incapable of change and improvement (provided they are not undermined by financial starvation or market-driven disorganization)?

Around the world there are various examples of excellent public and publicly-provided health services, and all of them need to be studied for ways to improve the NHS in England – and beginning with an examination of those that are developing within the UK itself. The national media largely ignore what occurs across our nearest borders, but what is happening there, and especially in Scotland and Wales, raise crucially important questions about the future now being charted for the NHS in England.

Looking at Scotland

Even before devolution health ministers in Westminster had been too aware of Scottish sentiment to risk pushing the internal market very far there, and the Labour-Liberal Democrat coalition governments that held office in Scotland after devolution, from 1999 to 2007, recognised that voters would not support them if they followed England’s path to a healthcare market. Scotland’s Area Health Boards remained in place, foundation trust status was not introduced, nor was payment by results. The PFI was used for three Scottish hospital-building schemes, and one Independent Sector Treatment Centre was opened at Strathco in Angus. But these measures provoked intense controversy and in 2003, responding to pressure from both doctors and the public, the coalition government ended the purchaser-provider split, restoring direct administration to the NHS in Scotland and decisively closing off the market option. Also in response to public opinion, in 2002 the Scottish Labour-Lib Dem coalition made personal care for the elderly free, instead of means-tested as in England.

The 2007 elections, however, led to the formation of a minority SNP government, and yet further departures from the market-driven policy that was being pursued in England. In 2008 hospital car parking charges – a significant deterrant for families – were abolished, except at PFI hospitals, where legal reasons prevented it; and in 2010 plans were announced to abolish prescription charges from 2011. No further PFI schemes have been undertaken. Glasgow’s biggest acute hospital is being built with public funds, the ISTC at Stracathro was taken into public ownership, and plans to outsource the management of a health centre in Lanarkshire to a private company were dropped. Out-of-hours care is publicly provided.

Perhaps most significant of all for the future, in 2009 elections were introduced for the majority of the members of Scotland’s Health Boards, beginning with two pilot schemes to be evaluated after four years. This means that in addition to professional medical judgement democratic representation, rather than individual ‘patient choice’, could become a significant element in determining the direction of future change.

In face of all this the marketizers inevitably portrey Scotland’s NHS as a failure, with the usual misuse of statistics to support their claim. For example they routinely state that Scotland’s waiting times are worse than England’s, because no element of competition has been introduced into Scotland’s. In fact an analysis of newly-consolidated data concludes that since 2005 waiting times have fallen faster in Scotland than in England. In each year since then Scotland has actually had either the second shortest or (more often) the shortest waiting times of the four nations in the UK. And over the ten years from 1999 to 2008 Scotland’s mortality rates for all causes of death declined almost exactly as fast as England’s. As Dr Matthew Dunnigan, the author of the waiting times analysis, says, the objective comparison of English health statistics with those for the three devolved nations is now a very important task.

Looking at Wales

The story in Wales has many similarities to Scotland’s. For the first eight years following devolution a Labour minority government was in office, only giving way to a Labour-Plaid Cymru coalition in 2007. But as in Scotland, even the initial Labour-led Welsh Assembly Government did not dare follow the English path. The purchaser-provider split remained, but Wales did not adopt foundation trusts or payment by results. Development remained based on collaboration and planning, rather than on a market system with legally enforcable contracts and all the tensions and extra administrative costs involved.

And after 2007, under the Labour-Plaid coalition, the purchaser-provider split was dropped. In 2009 a major reform resulted in the formation of just seven integrated Local Health Boards to plan and operate the NHS in Wales. These are very like the Area Health Boards in Scotland, but also have overall responsibility for all aspects of health, including public health, with a strong emphasis on linking health and social care.

The Local Health Boards in Wales are not elected but they must have members representing local primary care, community care, public health, local government and voluntary organizations, as well as lay members. In one Local Health Board (Powys) the purchaser-provider split was abolished earlier and the Board was integrated with primary care and community health service providers. Other Boards are set to follow suit – exactly the opposite direction of change from that taken in England, where even community health services have been forced into the marketplace.

Wales also declined to use the PFI for hospital-building, led the way (in 2007) in abolishing prescription charges, abolished hospital parking charges, and dealt with the vexed issue of means-tested personal care for the elderly by widening the definition of what is considered nursing care (and therefore free), and by setting a flat-rate contribution to the cost of personal care throughout the whole country.

Considerations for England

We need to ask ourselves why Scotland and Wales opted to keep the NHS as a public service, and even extend the principle of free acess. Longstanding Scottish and Welsh cultural traditions are certainly important, especially a deeply-embedded commitment to social democracy in public life, and in the medical profession, which politicians of all parties have to respect. But another key reason is cost. Next to education health is by far the most important and expensive devolved publis service. Even before the financial crisis politicians of all parties in Scotland and Wales realised that if they followed the English route, and allowed the costs of operating a market to start soaking up ten per cent or more of the health budget, health services would be liable to deteriorate, with dire political consequences for themselves.

They know that the public spending cuts imposed by the government in Westminster will hit Scottish and Welsh health services. But they also know that the effects will be smaller that they would have been had they opted for a market, and that whatever they have to do will have a legitimate foundation in public opinion, which remains at the base of decison-making about the NHS in both countries. And when the crisis has passed they will still have a public health service, not a three-tiered healthcare market and a low-risk playground for healthcare corporations and ‘doctorpreneurs’.

Scotland and Wales don’t exhaust the alternatives for the future in England. Other good models of publically-provided health services exist and deserve study. But the successful evolution of the NHS in the rest of the UK shows that Cameron’s assertion that ‘we can’t afford not to modernise’ – meaning that we have no alternative but to accept the abolition of the NHS as a public service – is pure bluster. It has no foundation in evidence and serves no interest except that of the private health industry. In the parts of the UK that the plot against the NHS couldn’t reach, people see through it. They know that good health care for all means excluding profit-making, and have shown that with sufficient public backing that principle can prevail. We need to insist that in England too the NHS is not for selling.

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The Plot Against the NHS #1

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Selected excerpts from ‘The Plot Against the NHS’ by Colin Leys and Stewart Player. Chapter One is available here. I highly recommend this book available from Merlin Press for £10.

I got my copy yesterday so I have yet to complete it. The book identifies intense lobbying by commercial interests resulting in the privatisation of ancilliary NHS services under Thatcher, covert privatisation of the NHS under Blair’s New Labour administration and Andrew Lansley’s overt privatisation under the current Conservative and Liberal-Democrat coalition government. It draws a picture of the private sector unable to compete with the NHS in terms of cost or quality and the private sector being given excessive, hugely favourable terms. Patricia Hewitt, Alan Milburn and John Reid are identified as covert privateers ‘marketers’ under the Blair administration.

p51

By late 2008 the crisis was at it’s height. Lehmann Brothers was history, Northern Rock had been nationalized along with Lloyds and the Royal Bank of Scotland, and the government’s debt was on course to reach 70 per cent of national income, up from around 40 per cent for most of the decade. In this situation it was obvious that public spending was going to suffer. How would this affect the NHS?

According to the Department of Health, the management consultants McKinsley (where Dr Dash was by now a partner in the company’s London office) were instructed in February 2009 ‘to provide advice on how commissioners might achieve world class NHS productivity to inform the second year of the world class commissioning assurance system and future commissioner development. The advice from McKinsley … was provided in March 2009.’ But the advice McKinsley gave actually tells a different story.

We don’t know what assumptions they were told to make but it looks as if they were told or at least encouraged to assume that NHS spending would remain constant for the next five years, and asked how productivity could be increased to cope with the rise in demand over that time. Their conclusion was that in order to find enough savings to meet the rising cost of providing health care over those years the NHS might have to shed ten per cent of it’s staff. When the press got  hold of the  report in September 2009 there was a furious reaction from the NHS workforce.

Health ministers then said that the report had been rejected, and even then it had been commissioned without their authority.

p54

In October 2010 the coalition government announced that it would continue to raise NHS spending in real terms (based on the general consumer price index) over the next four years – the figure actually claimed was an annual rise of 0.1 per cent. As a result most people outside the NHS assumed that the cuts would now stop. But the reality was different. For one thing, the NHS was told to transfer £2.1 billion to local authorities over the next five years as part of a drive to move patients out of hospitals and into more ‘cost-effective’ social or community care. So the NHS budget was actually being cut. And the NHS’s costs (for drugs, equipment, electricity, etc) would go on rising faster than the general cost of living, so that even if its budget stayed more or less constant it would soon be too small to cover all the bills.

On top of this, people’s healthcare needs (or ‘patient demand’, as today’s policy-makers call patients’ needs) would also go on rising as  people got older, or more obese, or more depressed – and as more of them became unemployed. The economic crisis was thus also a healthcare crisis, in which drastic measures could be presented as being unavoidable, measures of ‘last-resort’ – even if they implied the end of a high-quality health service equally available to all.

Which was pretty much what the new Secretary of State for Health, Andrew Lansley, decided to do, with proposals for yet another NHS reorganization – a reorganization not only un-mentioned in the election campaign, but one that flatly contradicted David Cameron’s pledge not to undertake any more ‘top-down reorganizations’ in the NHS. Everyone noticed, of course: but the coalition’s argument that the financial crisis meant that all previous bets were off proved effective – even if at first most people couldn’t quite see what Lansley was driving at. All comentators agreed in calling his proposals the most important changes in the NHS since it was set up – but what exactly did the changes mean? And were they really so different from what had been covertly planned for ten years or more under New Labour?

p68

By the time of the 2010 election a fairly clear picture of what the future NHS market would be like had emerged amoung health policy insiders. Influenced by a decade of exposure to US policy advice, and especially by the link with Kaiser Permanente, they envisaged an NHS that was already much closer to being a kitemark attached to a wide variety of provider organizations and systems than people outside the policy-making circle realized.

They imagined a radically reduced NHS hospital sector, with the surviving NHS foundation trusts focused intently on financial success. They envisaged the bulk of outpatient care being transferred out of hospitals into local, cheaper settings, which would be privately built and owned (as so many NHS hospitals already were, through PFI), or jointly owned with ‘entrepreneurial’ clinicians. They envisaged a growing number of the remaining NHS hospitals being run by private companies. They imagined specialist clinicians becoming increasingly self-employed, rather than working on a salary for a single foundation trust, and selling their services to a mix of public and private organizations.

They expected a growing proportion of patients with chronic illnesses to have fixed budgets for their care, and they accepted that top-ups, for which insurance companies would provide insurance plans, would become a normal form of co-payment, as they already were for some life-prolonging cancer drugs. They expected PCTs to be using private healthcare corporations to help them commission services in a more sophisticated way, or doing it for them, and so driving foundation trusts to become more focused on economy and driving more work to private providers. Fundamentally, they anticipated a replication of many of the structures and values of US managed care.

No one who was familiar with this imagined future could have been surprised by the contents of Lansley’s White Paper of July 2010, or the Health and Social Care Bill of January 2011. The only people likely to be surprised were the public, with whom the marketizers had chosen not to share their vision.

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