Don't swallow Lansley's pre-election pause

Sunday 24 April 2011

John Lister from the Morning Star

Don’t believe the headlines about a pause or a so-called “listening exercise.” Cameron and Lansley are forging ahead with their plans to break up the NHS into a competitive market, and to slice off a growing share of the NHS budget for private providers.

The pause in the process is designed to give Lib Dems long enough to see their party massacred in the local elections and scare them into agreeing to support Lansley’s Health Bill for fear that they trigger the collapse of the coalition.

To front up the so-called “listening” exercise, an NHS Future Forum has been set up. It is stuffed with high-profile supporters of Lansley’s plans. All five of the GPs on the panel are among the minority of GPs who signed up for Lansley’s suggested commissioning consortiums. The whole forum is under the chairmanship of Professor Steve Field, who controversially supported Lansley’s white paper back in July and has since been replaced as president of the Royal College of GPs by Dr Clare Gerada, who has criticised much of the Lansley plan.

The forum on “choice and competition” will be led by Sir Stephen Bubb, a one-time Labour councillor and now at the head the Association of Chief Executives of Voluntary Organisations.

Bubb is a vigorous advocate of competition and greater private-sector involvement in delivering healthcare. He led a challenge to Labour’s attempts to designate the NHS as preferred provider of community health services.

Other doctors, trust bosses, primary care trust and strategic health authority bosses and senior council officers among the 40 hand-picked appointees on the forum are likely to be influenced by their career aspirations. They are unlikely to listen to any articulate critics of the Lansley plan.

The whole process has been set up to waste a month, to give the impression of responding to public opinion – and then to press through the key elements of the plan with little if any actual change.

There is no indication that the principal objections raised at the Lib Dem conference a few weeks ago have been taken on board by the Tories, not least because the suggestion that the private sector can somehow be prevented from “cherry-picking” the most profitable services from the NHS is pure fantasy.

Cherry-picking is central to the private provision of healthcare. Even the so-called “non-profit” social enterprises will have to focus on delivering a surplus from their work and will be compelled in a competitive market to withdraw from services which cannot guarantee to deliver them a surplus.

The only guarantee against the private sector cherry-picking services and destabilising existing NHS provision in many parts of the country is to drop Lansley’s plans altogether and to focus resources on investing in NHS care related to local need.

That’s why it’s vital that Labour and the unions crank up the pressure to force the Con-Dems to ditch the Bill.

The price of cuts

The new financial year is already starting to reveal an even bigger round of damaging cuts in services across the NHS, with thousands more jobs facing the axe, many of them front-line staff, while remaining staff will also be hit by cuts in admin and management that will dump more tasks upon them.

Among the really massive cuts are a proposed 20 per cent cut in the workforce of the London Ambulance Service, most of them front-line staff without whom emergency services will be put at risk.

Another cut which the media has strangely failed to report is the plan to halve staff numbers in community mental health in east London, putting vital services at risk. Despite being dressed up as efficiency savings, virtually all of the job cuts are nurses and other front-line clinical staff.

The government now admits that at least 22 trusts with major PFI commitments are threatened with major financial problems as the tariff paid for delivering NHS treatment is reduced, new restrictions are placed on the numbers of patients that PCTs will pay for. Overhead costs of PFI projects keep rising year by year even while trust budgets decline.

And more attention is being paid to the number of treatments that are being excluded from NHS provision by desperate PCTs in the name of so-called “efficiency savings.” Waiting times have already sharply increased. The private sector is licking its lips in the wings, just waiting for more frustrated patients to go private.

All this keeps the NHS in the public eye. It’s up to the unions, local campaigners and the Labour opposition to turn this concern into action that builds pressure for a change of course.

Cuts of £20 billion can only be achieved at the price of devastating our health service. Who out there thinks that this is a price worth paying?


Choice costs an arm and a leg

I have just had a very interesting insight into the assumptions of the private sector at a conference of health journalists in Philadelphia.

It is clear that in the US the entire system revolves around the interests of the insurance companies and the private sector. Obama’s plan to create new affordable insurance provision for the poor relies on state subsidies to enable the poor to buy policies, which even then will only reimburse them for part of the cost of their treatment.

Interestingly a succession of speakers referred in discussions on the reforms to “medical loss.” This turns out to be the share of insurance income than is spent on patient care, cash which is therefore regarded by insurance companies as lost profit.

From the patient’s point of view the loss is the other way round, but even Obama’s reforms only seek to limit the amount pocketed by the insurance companies from premiums to 15 per cent of large company schemes and 20 per cent of the contributions paid by individual and small-scale insurance policies. Some companies are apparently up in arms at this constraint on their profits and are threatening to pull out.

In addition, under the Obama plans, insurance companies would be free to raise premiums by up to 10 per cent per year without having to face any inquiry at all, regardless of whether or not these increases are affordable by those who are to be compelled to buy health insurance.

The margin retained by insurance companies to cover their extensive bureaucratic costs, advertising, other overheads and generous salaries to their chief executives – in addition to a profit margin for shareholders – is only part of the total wasted by the arcane US healthcare system.

Out of the 80 to 85 per cent that will have to be spent on patient care, a substantial amount will be squandered on inflated hospital and medical bills to cover the overheads of private hospitals and their bureaucratic administration.

At every level the patient, as an individual consumer of healthcare in the US, comes at best a poor second place to the commercial and financial concerns of a system supposed to be concerned with their health. Overall the US spends between 25 and 30 per cent of every health dollar on administration.

But it gets worse. The new insurance schemes to be offered under the Obama plan will offer varying levels of cover to compensate patients for the often huge costs of their care.

The minimum schemes – most attractive to younger, healthy adults – will cover just 60 per cent of costs. The most generous and most expensive schemes will cover around 90 per cent of costs. This means that millions of patients will have to pay money out of pocket to access healthcare even after the reforms. This is what the free marketers wanted.

As one speaker stressed “health care will still not be free: some people will be shocked at the scale of out-of-pocket spending.”

But while patient care may not be the priority, maintaining patient choice is seen as an important principle in the US health system – resulting in a baffling array of complex choices to be made by ill-informed patients struggling to understand the difference between literally hundreds of rival policies that look very similar.

One speaker, whose job is to help explain the insurance market to baffled consumers, actually said: “Health insurance is always going to be complicated – it’s never going to be like choosing one apple from another.”

In other words patient choice is by no means always a good thing. And in the US it can cost an arm and a leg.

John Lister is information director of Health Emergency.


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