Healthcare: private feast, public famine

The impact of the Health & Social Care Act on the NHS is neatly summed up by the event on November 29 organised by Healthinvestor magazine, at which you can book seats at £330 per head to take part in a celebration of the “Power 50” private sector movers and shakers in health writes John Lister.

Among the usual suspects nominated are top bosses from Virgin and Serco, the corporations that have hoovered up a growing number of community health service contracts and are poised for an even larger slice of this £11 billion “market” opened up where previously the NHS was solely responsible.

Other prominent companies include the management consultancies, McKinsey (all over the NHS like a rash), PriceWaterhouseCooper, Deloitte, and KPMG – all of them moving in on the lucrative business of advising “GP-led” Clinical Commissioning Groups how to spend their multi-million budgets, while also advising hospital Trusts how to cope with the decisions the CCGs take.

Also strutting around will be the private hospital chains, the South African-owned GHG, Australian owned Ramsay Health, the former BUPA hospitals now known as Spire, and Nuffield Health. All of these have been profitably filling their otherwise empty beds with patients funded by the NHS.

There are also a mix of private health insurers, biding their time until the logic of the new Act works through to the allocation to a personalised health budget to each patient, leaving the need to finance “top-up” payments for the extra costs of some treatments, and care home providers, who will no doubt be trying to take their minds off their massive £4.5 billion overhang of debt, and concentrate on the short-term profits that can be made as the last remnants of public sector provision are withdrawn.

Lansley’s Act means that health care is being transformed before our very eyes into a big business. The grinning Branson is scooping up profits from services ranging from mental health for children through to sexual health, while Serco shamelessly submits bids for services it has no intention of delivering for more than a month or two before slashing back the numbers of staff to boost their profits. The ghastly Cherie Blair has been raising £75m from her city speculator friends and a right wing crony of Sarah Palin to set up a chain of private clinics in supermarkets.

NHS hospital Trusts are being transformed into a channel through which taxpayers’ money is funnelled into the coffers of private investors in PFI consortia, with services to patients and the jobs of health professionals sacrificed to ensure that the sacred stream of funds is undisrupted. In the bankrupt South London Healthcare Trust, services are being broken up and hived off, but a £20m a year subsidy will ensure the PFI bills can still be paid, and the debts built up from unaffordable PFI hospitals are to be written off. PFI is being rescued at all costs – like saving a hot air balloon by throwing all the passengers out of the basket.

None of this can happen without serious damage to the NHS, which is being reduced from a proud and popular public service to a fund to pay a range of private providers: it was no accident that Lansley’s Act is being introduced hand-in-hand with a massive £20 billion squeeze on the NHS, requiring unprecedented “efficiency savings” to 2014, and the threat of even more brutal cash cuts in the five years to 2020. Foundation Trusts expect to cut their workforce by at least 6% by 2014: NHS hospital beds are to be culled faster than badgers – only private providers will be expanding.

The Tories are happy to see the public sector provision of health undermined and discredited, local provision closed down and queues and delays that were reduced from 2000 growing again: this helps whip up custom for an otherwise desperately unpopular private sector which can only flourish in a regime in which “patient choice” is a simple one of “go private, or go without”.

The Act does not take full effect until April: but in advance of this, doomed Primary Care Trusts have been driving through decisions to close A&E and other services, and putting a growing number of services out to bids from “any qualified provider”, the ultimate Tory dream of privatisation that is central to the Act.

‘Any qualified provider’ excludes GPs from any real control over quality or planning role in the provision of health services, and reduces CCGs to signing cheques. It’s the main aim of the Lansley reforms, and it’s vital to build pressure on CCGs to use the little remaining power GPs will have to reject it and hang on to the option of preserving local NHS services.

The Act was designed to go far further than the Blairite market experiments, usher out the NHS and open up a brutal new dawn of private provision: the scandal is that it’s got so far with so little organised opposition.

That’s why it’s so important to build big and noisy campaigns to challenge each and every cutback, very move to privatise, every extension of any qualified provider – to fight for the scrapping of PFI before it bleeds the NHS dry of resources.

Defeatism only aids the Tories. Let’s build big, angry, united campaigns that stand up for public health services, and exposes the naked profiteering and cheapskate services on offer from Virgin, Serco and the rest of the “Power 50”.

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1 Comment

  1. We don’t have to have other providers. It is not the law. We can have the NHS but we all have to write to our GPs and tell them this and write to our Clinical Commissioning Groups now and to the Primary Care Trusts before April next year when they are abolished.

    John Lister is an NHS doctor in London. He has this website:

    At the foot of his article this month he says:

    “GPs and CCGs are NOT compelled to put services out to tender, or to open them up to Any Qualified Provider. This is made very clear in the NHS Commissioning Board’s own ‘Briefing on Procurement of healthcare (clinical) services’ published last month.

    [14 September 2012] on this website:

    [In “Briefing 2: What are the procurement options?” it states on page 3 that] there are three options for procuring services:

    any qualified provider (AQP), which gives GPs no control whatever, and no guarantees of quality, as “patients will decide which providers to be referred to”;
    competitive tendering, which does allow GPs to assess rival bids from NHS and other providers and to choose the most suitable; and
    “appoint a specific provider or group of providers without competition (Single Tender Action)”.

    “Of the three, the worst in every respect is AQP: so why are GPs and CCGs allowing themselves to be led into it? It is more urgent than ever for campaigners, health unions the BMA and the Royal College of GPs to remind CCGs that they have been told they have a choice, and they should clearly choose now, in advance, to reject AQP. If enough CCGs take a stand, it will encourage others, and restrict the areas where AQP can be implemented. If this triggers a clash with the Commissioning Board, it will be a useful and educational test of strength that will also expose to all GPs and the wider public the extent to which the NHS is being hijacked by the private sector. The fight is one that must be waged on all fronts: we have to resist cuts and closures, challenge and fight privatisation, demand PFIs are brought back into public ownership, repel attacks on the national pay and conditions of health workers, and do everything possible to blunt the impact of the Health & Social Care Act.”

    What John Lister says is also discussed in the online version of the publication GP:

    “PCTs ready to expand any qualified provider policy this month” Marina Soteriou, 08 October 2012

    The Department of Health is quoted as saying that:

    “Providers will only be able to refused by commissioners if they reject the price offered, refuse to agree to local standards or to comply with pathways and referral thresholds, or if they fail quality standards.”

    But the article then says:

    “National Association of Primary Care chairman and Surrey GP Dr Charles Alessi said there were a lot of misconceptions about AQP. ‘It is not a bidding process,’ he said. ‘Nobody is forcing anybody to use AQP.
    “’From April, it will be up to the clinical commissioning groups (CCGs) whether they wish to use AQP or not.”

    Please write to your CCG.

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