John Lister, Director, London Health Emergency argues that with Lansley’s Bill on the statute book we need to step up campaigning in defence of the NHS:
None of us wanted to start from here. Despite massive and growing opposition from doctors, nurses, health professionals, health unions, and the wider public, Andrew Lansley’s Health and Social Care Bill is now on the statute book.
Of course the Tories and their LibDem bag carriers had to tell a lot of lies, mislead a lot of people, and suppress a lot of information to get the bill through in the teeth of this level of opposition. That’s why Lansley was so determined not to release the Risk Register compiled by Department of Health civil servants back at the end of 2010 which warned of the dangers of implementing the White Paper proposals, or the wider ranging Strategic Risk Register which was produced in February 2011, despite rulings by the information Commissioner that he should do so.
Now, after the bill has become law, a panel of judges on the Information Rights Tribunal has declared that the government breached democratic procedures by forcing through a Bill for which they had no mandate, and again instructed Lansley to release the earlier version of the Risk Register. Clause 85 of their judgement makes interesting reading:
“From the evidence it is clear that the NHS reforms were introduced in an exceptional way. There was no indication prior to the White Paper that such wide-ranging reforms were being considered. The White Paper was published without prior consultation. It was published within a very short period after the Coalition Government came into power. It was unexpected. […] Even more significantly the Government decided to press ahead with some of the policies even before laying a Bill before Parliament.”
This is just what critics said from the beginning. But of course to have it echoed in this way is little consolation now that the Bill is law.
Not only were the warnings in the risk registers concealed from MPs and Lords voting on the Bill, they appear also to have been ignored by ministers, who forged ahead regardless of deep and unresolved concerns that the Bill would result in a loss of financial control, lack sufficient
Gleeful Tories are now rushing to implement the carve up of the NHS, with local health budgets soon to be taken over by untested Clinical Commissioning Groups (CCGs) – led in many cases by a handful of grasping and self interested GPs, but in others by GPs who lack the time, skills and motivation to take charge of multi-million pound budgets and take responsibility for planning healthcare for whole local populations. So private companies will do much of the work.
Planning is not the right word: the new Act opens up a progressively larger share of the NHS for competition. NHS hospitals and other NHS providers are likely to lose contracts to deliver an increasing number of services – and vital income that enables them to provide services that the private sector will never willingly provide, such as emergency care, complex, costly, and risky treatments, and community mental health services.
Lansley’s Bill offered up a growing share of the NHS for private sector companies, whether home-grown or multinationals, to pick and choose those services they think might yield the best profit.
Privatisation is gathering pace fastest in community health services. In Devon, children’s services are among those to be parcelled out, with Virgin and multinational all-purpose privatising company Serco both in the running for the contract. In Suffolk Serco has just been awarded a £140 million three-year contract to provide community health services.
In North Yorkshire Virgin has won a competition panel ruling that York Hospital could be in breach of competition rules if it York Hospital retains more than 40% of referrals for musculoskeletal treatment: the panel calls for further measures to ensure the maximum number of patients are referred out of the NHS for treatment.
The Act would open up even more services, allowing patients to choose “any qualified provider” outside the NHS. These problems come on top of the £20 billion of so-called “efficiency savings which are forcing NHS Trusts to slash jobs and axe services.
Now the Bill is passed, the big cuts are coming. Already in London (where a McKinsey report found that only two of the capital’s 18 non-foundation NHS trusts are financially viable) and many other parts of the country sweeping plans are being drawn up to close down accident and emergency units, merge trusts – sometimes many miles apart – and “centralise” services, meaning much longer journeys for many patients to access the treatment they need.
In Peterborough, the ruinous costs of a £300m PFI hospital and primary care centre have driven the Foundation Trust into deficit to the tune of 25% of its turnover – with the prospect of draconian cuts to balance the books.
Hit squads are being formed by the regulator Monitor to intervene in other foundation trusts faced by growing financial problems.
The key question for the left is what we are willing to do about all this, and how far we can unite the scattered campaigns and resources into a powerful fightback to resist and obstruct implementation of the Act.
We don’t need pointless and divisive recriminations about the past: what we need is closer links between the different strands of opposition to the Bill – campaigners, trade unions and the political opposition, and ways to work together on what should be common aims.
These include monitoring the implementation of the Act in every locality – itemising which services are put out to tender, or opened to “Any Qualified Provider”, and compiling online dossiers on every company and social enterprise on Monitor’s list of “qualified” providers.
We also need to build broad support for the “pledge” through which the many thousands of GPs opposed to the Bill can commit themselves to press in their local CCGs for each of them to adopt policies which will preserve the NHS and frustrate the drive to the market and competition. This encourages GPs to argue that their local CCG should take its role seriously, exploit the bogus assurances given by Andrew Lansley,and refuse to accept the imposition by central government of “Any Qualified Provider”.
CCGs can also commit to maximum transparency, refusing to accept contracts which have to be kept secret, discussing all significant decisions on local services with the local communities affected, and taking decisions on services in public session.
And they can reject the logic of the £20 billion cuts programme by declaring their commitment to maintain local access for their patients to the existing services that they need, trust and rely on.
Unions, campaigners, councillors and communities can rally behind any CCGs that take a stand, defying the NHS Commissioning Board to intervene. Joint efforts by campaigners and health unions can also help to compile a database listing:
· Examples where grasping GPs running CCGs plan to pay themselves bonuses,
· Hospital consultants and others who aim to profit from expanding private patient income,
· Instances where competition law is being invoked by the private sector to help carve up the NHS
· The fragmentation of community health services and other services as they are carved up between
· CCG support services and commissioning work contracted out to private management consultants,
which firms are involved, and how much their services are costing.
his level of scrutiny and resistance, coupled with all-out opposition to cutbacks in local health services and closures of hospitals can build an even bigger tide of public anger against the Cameron government, and open up discussion on alternative policies to reverse the LibDem Lansley Act, restore and improve our NHS.