26 January 2011
by John Lister
The publication of Andrew Lansley’s enormous 367-page Health and Social Care Bill last week brought no significant surprises or changes from last summer’s white paper.
As expected, the Health Secretary has completely ignored all of the 6,000 responses which in any way criticised or challenged his plans to privatise virtually all the provision of health services in England, leaving the taxpayer footing the bill for care from a range of services delivered by for-profit or non-profit companies.
The growing body of professional opinion, including criticism or opposition from around three-quarters of GPs and almost every body of health-care professionals and every health trade union, the employers’ body the NHS Confederation, the British Medical Journal, the Health Service Journal, almost every think tank with any independent thought, the Commons Health Committee – and many MPs in Lansley’s own party – have all been ignored.
Why would he let evidence get in the way of rolling out an ideological policy, which rests on eternal Thatcherite hope that a free-market model and privatisation will eventually deliver, ignoring the bitter experience of costly failure of such schemes to work, especially in health care?
Lansley’s swivel-eyed obsession with driving through changes that almost nobody but the private medical companies that have donated to his campaign and Tory funds appears to support has even triggered a more vigorous response from Labour’s shadow health secretary John Healey.
He has correctly – if rather belatedly, given that these plans have been out in the open since last July – pointed out that “the purpose lies in opening up all parts of the NHS to private health companies, and taking what remains of NHS out of the public sector.
“It lies in removing the ‘N’ in NHS, so there are no consistent service guarantees for patients wherever they live and no consistent national contracts for staff. It lies in overriding service co-ordination and planning with competition.”
Spot on – but Healey stops at the point of labelling the Tory plan and showing how it represents a series of broken Tory promises. He makes no call for the kind of campaign that can build maximum popular opposition and try to stop these changes going through Parliament.
And even now that Labour has partially responded, there is no sign of the health unions – all of which, on paper, reject all of the key components of the Bill – getting together the kind of concerted campaign that could pile pressure on this wretched coalition government and possibly stop Lansley in his tracks.
The big unions have been going through the motions of opposition rather than mobilising their powerful communications and publicity teams to get the real scary facts out to their members on the ground and the wider public whose services are at risk – few of whom have the slightest idea from media reports of the scale of the threat facing the NHS.
Union leaders may argue that their members have not been pressing them for action, and this may well be true – because people who don’t know there’s a problem can’t get angry about it and therefore appear passive.
But why do they know nothing? Whose job is it to tell them? If the unions do nothing and our NHS is smashed up and its services privatised by Lansley, no excuses for today’s inaction will be good enough.
Why is there so little commitment to act? All of the unions are opposed to the privatisation and marketisation of health services – and these are the very core of Lansley’s Bill, despite the fact that a few GPs have been gulled into believing that ministers really want to give them more power over budgets.
The GPs are simply being used as a handy lever to force through changes. In fact, the extensive powers in the hands of the NHS Commissioning Board – itself to be largely driven by directives from the Health Secretary – and the massive constraints on spending and resources over the next few years mean GPs will have little real discretion to do anything but cut and ration services.
Even at local level, few GPs will have the time, training or inclination to engage in the complex work of commissioning services and tracking the spending of their share of the £80 billion NHS commissioning budget.
They will hand over most of this work, and with it most of the actual power, to management teams, in many cases private-sector management consultancies, which are even now licking their lips at the prospect of lucrative contracts.
Already in Hounslow in west London a consortium of all the borough’s GPs have handed control over GP referrals to hospital treatment to UnitedHealth, the US-based profit-seeking company.
It will have a brief to cut spending and will do that by effectively overriding GP decisions and contradicting “patient choice.”
Increasingly the options for rationing care, and proposals on which services to exclude from NHS treatment in the quest for the £20bn “efficiency savings,” will be drawn up by private-sector managers working for GPs.
Only the final rubber-stamping of cutbacks will ensure that GPs are left to carry the can for any bad publicity.
The GPs will also be working under other constraints. Brutal European competition laws will oblige them to open up any service for competitive tender and Lansley’s Bill insists that this must mean that “any willing provider” – for-profit or non-profit – must be allowed to bid.
Worse, for the first time clinical care will be opened up to competition based on price. Soon the lowest-priced bids will win, driving a new race to the bottom on quality of clinical care, just as surely as it did with hospital cleaning when Thatcher’s government loaded the dice in favour of cowboy cleaning firms in the mid-1980s, triggering two decades of MRSA and other infections.
And just to make sure that the private sector gets to move in across the board on health care, all limits on the income foundation trusts are allowed to make from private medicine are to be lifted, as a new European directive opens up a new era of health tourism, and NHS budgets are frozen, with the “tariff” of payments hospitals are paid for NHS treatment reducing year by year.
With more private patients and less public funding, foundations will be obliged to prioritise the paying customers, leaving NHS patients as less attractive prospects.
But we now know that all this will take place behind a wall of silence.
Lansley’s Bill makes clear that unlike primary care trusts and strategic health authorities, which all meet in public and publish their board papers, the GP consortiums and the NHS Commissioning Board that will replace them will be secretive bodies meeting behind closed doors with no press or public allowed access.
Secretive foundation trusts will replace the last NHS trusts.
And the so-called scrutiny proposals are also a sick joke. Stooge “health and well-being” committees will replace councils’ “oversight and scrutiny committees” and “local healthwatch” will be the latest even more toothless replacement for the lost powers of community health councils.
Neither of these bodies will involve more than a token garnish of patients or public or hold anyone to account for anything.
That’s the way Lansley and the Thatcherite coalition want your NHS – the best part of £100bn of taxpayers’ money controlled by closed bodies subject to no serious local scrutiny, steered by private management consultants and under pressure to award a growing share of spending in contracts to private providers.
All the closures and economies will be in the public sector, all the growth and profits will go to private providers.
Rampant and growing inequalities and a postcode lottery will predominate as various consortiums come to varying decisions on what services should be provided and what should be axed.
The public and most union members have been left in the dark by feeble and lazy media reporting and even more feeble political and trade union opposition.
This has to change. One bright light on the horizon is the TUC demonstration against cuts and privatisation on March 26.
Our challenge is to ensure that is not the culmination or the end of a campaign but a trigger for an even stronger fight to kill Lansley’s Bill.
John Lister is director of Health Emergency.
From the Morning Star