John Lister from London Health Emergency looks at the issues facing us in defending the NHS
The National Health Service has never faced a more serious threat than it does now, with a marginally amended form of Andrew Lansley’s Thatcherite Health & Social Care Bill rolling through the House of Lords, while the biggest-ever spending cuts start to rip the heart out of local services.
After LibDem votes effectively pushed Lansley’s Bill through its second reading vote in the Lords, leading LibDems including Shirley Williams have now thrown in the towel altogether and accepted the Bill, urging Labour to drop its opposition. Ironically this predictable if pathetic collapse has occurred at the very point where Lansley’s isolation from the medical profession and all health professionals was more starkly exposed than ever, and he had begun to hint at accepting more significant amendments.
And Labour’s new Shadow Health Secretary, Andy Burnham, had begun to crank up some form of campaign, neatly exposing the fraud of Lansley’s claim that the Bill is simply a move to put “more power in the hands of GPs”.
Labour peers in the Lords, and Burnham in a fresh debate in the Commons have offered the government a deal in which they would support greater powers for GPs in exchange for Lansley agreeing to drop the rest of his highly controversial Bill.
Of course Lansley, who knows that the Bill is not even partly about giving powers to GPs, rejected the suggestion out of hand. The Bill is about putting more power in the hands of the private sector: it smashes up the existing NHS structure, scrapping all of the existing management structures at local and regional level, to open maximum opportunities for management consultants and multinationals to steer local “Clinical Commissioning Groups” of GPs.
But despite Lansley’s bravado and the LibDem collapse, the Bill is not out of the woods yet: there are still weeks of committee stage discussion in the Lords, with more than 350 amendments tabled, and the BMA pressing for changes on 11 different aspects of the Bill. The early signs are that there is likely to be more stomach among peers for this piecemeal guerrilla resistance to specific clauses than there was to turn the whole Bill over.
Critics of the Bill will be further angered by Lansley’s insistence on appointing as Chair of the newly-created NHS National Commissioning Board (with a £20 billion a year budget and extensive powers over local GP groups) an arrogant university academic with no NHS experience, who told the Commons Health Committee that the Bill was “unintelligible”. Professor Malcolm Grant, boss of University College London, only secured the committee endorsement on the casting vote of Tory Chair Stephen Dorrell after non-Tories all refused to accept him. The Commissioning Board was launched in shadow form on Halloween.
But while he can bully MPs and even peers into backing the Tory party line, Lansley has been almost completely unsuccessful in winning over support from the medical profession – not least among the GPs, who are supposedly the ones to gain from the Bill. An autumn poll of 1900 GPs by the Royal College of GPs found a staggering 78% against the Bill, with just one GP in six (16%) saying they wanted to be involved with the new Commissioning Groups.
On one level this is no surprise, because a majority of GPs have been opposed to Lansley’s White Paper and the Bill from the start, even though a wafer thin majority of BMA GPs initially accepted the principle of GP-led commissioning.
But on another level this solid and growing opposition among the very people to whom Lansley plans (in theory) to devolve a massive £80 billion in commissioning budgets, is remarkable: it bucks the trend of MPs, peers and others who have begun to justify their acquiescence on the grounds that much of the Bill is already a fait accompli.
That’s why Lansley, key NHS managers, and the handful of fanatically pro-market GPs who are heading up the Clinical Commissioning Groups (CCGs) have been forging ahead, implementing more and more of the Bill in advance of it completing the parliamentary process.
CCGs have begun signing up firms of management consultants to advise them (but in reality to do most of the hands-on management and planning work that the GPs won’t and can’t do themselves), giving us a clearer idea of who will really run services if Lansley eventually gets his Bill through.
Interestingly, while the local CCGs talk big and act tough, the vast majority of their leaders are unelected – only 7% of commissioning group board members have been subject to competitive election. Most GPs are ignoring them, and just getting on, caring as best they can for patients.
It’s not just GPs who are unmoved by Lansley’s rhetoric: 84% of psychiatrists, in a poll of 1890 members by the Royal College of Psychiatrists, were also against the Bill, convinced it would do nothing to reduce bureaucracy or improve services for their vulnerable patients. And the Academy of Medical Royal Colleges, representing 20 Royal Colleges has registered “united opposition” of its members to aspects of the health Bill – notably its proposals to promote competition.
Even the normally docile Patients’ Association has spoken out on its members’ fears of the consequences of Lansley’s Bill.
The opposition is more or less unanimous on all sides: all of the health unions are opposed, even if they have been distracted from doing much about it by the battle over NHS pensions. Thousands of people have marched and tens of thousands have petitioned. But Lansley and Cameron have blocked their ears and closed their eyes, and there was not enough life left in many of the Lords to undo the damage done by MPs.
But as evidence mounts to show how Lansley’s Bill would open up a weakened and fragmented NHS to private sector vultures, the other prong of his attack can be seen in the scale of the cutbacks taking shape up and down the country.
Whipps Cross University Hospital has asked staff if they would be willing to give up paid leave and work their holidays for nothing.
PCTs in South Essex are seeking cuts of £300 million, with Basildon & Thurrock Hospitals Trust looking down the barrel of £34m cutbacks, with the loss of 100 beds and hundreds of jobs, and Southend looking to axe 56 beds and hundreds of jobs.
In Yorkshire the state of the art £66m emergency service at Pontefract Royal Infirmary, expensively rebuilt as part of the £380m PFI scheme for a new hospital in Wakefield, seems set for closure as the cash-strapped Trust searches for £60m of savings while paying its big and growing PFI bill.
In Staffordshire cuts are not only hitting the University Hospital of North Staffordshire (where another expensive PFI is set to trigger a loss of 300 beds and a new cull of jobs) but its notorious neighbour the Mid Staffordshire Hospitals Trust. Even while the public inquiry continues into the virtual collapse of care in its A&E which killed dozens of patients a few years ago, Mid Staffs is contemplating even more desperate cuts to close 165 beds, axe staff by 20%, and flog off more than a quarter of its estate: even then it seems the trust may need a massive £80m bail-out from the government to survive. All this is a grim reminder of the catastrophic situation which led to Mid Staffordshire’s medical and nursing staff being cut below minimum levels – to save just £10m a year.
So bad is the situation for many Trusts that, following dire warning from the National Audit Office on the state of hospital finances, Andrew Lansley is expected to announce loans and subsidies to prop up anything up to 40 of the weakest, some of which may otherwise go bust.
Meanwhile, below the radar of media attention, cutbacks continue unabated in mental health. And the Care Quality Commission survey that recently exposed widespread and gross failures in elderly care also reminds us that neglect and under-funding are the order of the day here too, as Trust bosses focus all their energies on targets for financial cuts and elective (waiting list) care.
With winter coming, more frail older people discharged from hospital face the grisly reality of constant social service cuts, while in the aftermath of the Southern Cross debacle many in cheapskate private care homes face problems easily as bad as those on NHS wards – but forking out from their own savings to pay for the privilege.
All this reminds us we have a brutal, old-style Tory government, dragging us back to the nastiness of the 1980s.
The union leaders who have ignored these issues and focused narrowly on the public sector pensions fight have missed an important opportunity to build a broad and active alliance to link up with the fight against cuts, against privatisation, against the Bill, and in defence of the NHS and its workforce.
In sleepy Stroud in Gloucestershire local campaigners have given a glimpse of what can be done. Refusing to sit by and watch local health unions allow all of the county’s community health services (including nine community hospitals and a workforce of 4,000) to be hived off on October 1 without debate or consultation into a so-called “social enterprise”, they got busy, got organised, and got legal advice. The threat of legal action forced health bosses to hold fire on the transfer of staff out of the NHS, and now a judicial review is being sought.
A protest march of 500 against the forced transfer (possibly the only demonstration of its kind in the country) showed the extent to which the campaigners had managed to explain a potentially complex issue to local people. But this stirring fightback is in stark contrast to the glum, passive acceptance by local unions of the imposition of social enterprises across much of the South West of England.
More could be done to fight this type of privatisation, and to challenge cuts and the new round of closures around the country alongside the fight to defend NHS pensions – and also the start of a belated fight to challenge the vicious 2-year pay freeze which, with inflation at 5.2%, threatens to slash the living standards of every public sector worker.
Another type of campaigning is possible: a combined approach that wins the broadest public support and solidarity in defence not just of working conditions but the very fabric of the NHS. We must fight to stop Lansley and Cameron smashing our NHS to fuel the profits of their city pals.
Campaign postcards and materials from www.keepournhspublic.com
Pressure a peer to challenge Lansley’s Bill with the TUC-backed campaign: http://www.goingtowork.org.uk/peers/