Health Minister Patricia
Hewitt has denied that the government is privatising the NHS. She says that
the ‘competition' she is introducing only affects 10% of elective surgery and
is supposedly 1% of the overall budget. She is a cynic. She knows full well
what she is doing. Sir Nigel Crisp NHS Chief Executive has instructed Primary
Care Trusts that they should not ordinarily carry out work in house. By 2008
they are supposed to have rid them selves of all of it. But we have already
seen the consequences of this move to privatise PCT work. All non-emergency
work done by the ambulance service in Surrey is to be handed over to a private
company, GSL, which specialises in prison management, immigration detention
centres and court escort duties. It is a breakaway from that bastion of high
quality work Group 4 (the one which kept on losing prisoners). GSL will look
after high dependency patients who need oxygen and supervision during journeys
between hospitals. Try not to fall ill in Surrey.
Meanwhile Thames Valley Health
Authority took a step towards contracting out NHS healthcare management in
Oxfordshire. On October 12 Thames Valley Strategic Health Authority voted
through proposals that would remove the PCTs' senior staff from April 2006 and
replace them - most likely by managers from a big corporation. The new,
outsourced, PCT commissioners will buy in services from the private sector,
Foundation Trusts and the NHS, for the people of Oxfordshire at the same time
as preparing to shed those services currently provided by the PCT.
The SHA has made no attempt to
seek or consider the public's view of these latest 'reforms'. The announcement
was buried in Board Paper 62-05 on page 9: "The SHA proposes to procure the
provision of management services to the Oxfordshire PCT(s)".
Staff of the existing PCTs
heard about this plan just two days before the proposals came into the public
arena. Having rubber stamped what is laughingly called the "procurement"
process, TVSHA has indicated that there will be no further consultation with
staff or public on this issue. This process is as transparent as all those
contracts handed over to Haliburton by the Bush government.
And it has been made clear
that while the size and configuration of other Thames Valley PCTs is up for
consultation, Oxfordshire's privatised PCT isn't. It’s believed that the
Primary Care Trust inc (as it has been called by staff) might be put out to
tender in the Official Journal of the European Commission (OJEC) in late
November, and by April 06 may be up and running with new staff.
The Department of Health, it
is said, views Oxfordshire as a pilot site, and if successful would like to
put all PCTs out to tender.
Rigged ‘health market’
Elsewhere news is emerging
that the so-called 'health market' is rigged in favour of private companies.
In fact there is no competition. NHS organisations are being instructed to
hand over work to the private sector. In Yorkshire for instance, the
Department of Health has instructed the Trusts in that area to increase the
value of work given to the private sector from £3.2 million to £18 million.
Brighton hospital has learned that 85% of its orthopaedic work will be simply
handed over to a private hospital down the road. Oxford's Nuffield hospital is
faced with closing up to half of its beds because it is losing work to a
private hospital which has just been opened up nearby. There are many other
examples. Between 10-15% of elective work will initially be given over to
private companies, not as a result of competition but by instruction of the
Department of Health.
The work being given away to
private health companies is the more simple and profitable work. Such
businesses will not be interested in Accident & Emergency work, nor in chronic
diseases which require long term treatment. This will tend to mean that
general hospitals will have to carry out more expensive work. As private
companies take more work off of the NHS then types of activity currently
carried out will be abandoned by NHS Trusts, thus meaning that the 'choice'
that patients have been told they will have will disappear.
And the government is paying
private companies 9% more for operations than it does NHS bodies. Is this
'greater efficiency'? What else is this but encouraging the growth of private
companies, at the expense of the NHS?
The watch word of this
'market' is 'patient choice'. Sick people do not want such a choice. They want
to be treated to a good standard in the locality where they live. They are not
shopping for DVDs, they are ill. Such ‘choice’ will destroy the basis for
planning and introduce the chaos of the market. 'Patient choice' will produce
the same result as 'parent choice'; 'sink hospitals' instead of 'sink
A report published in June by
consumer watchdog Which? (formerly the Consumers' Association) discovered that
nine out of ten respondents to their survey supported the key argument of
those opposed to 'choice': essentially patients want good local services which
'obviate the need for choices'.
Even before the emergence of
this new 'market', the funding crisis of the NHS has reached unprecedented
proportions. London Health Emergency has examined the accounts of 22 of the 28
Strategic Health Authorities and discovered a £1.6 billion funding gap (See
the full report at
The Health Emergency Press
“Despite record levels of
funding at national level, the National Health Service is facing a drastic
autumn round of local cutbacks and economies throughout England as Trusts,
Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs) attempt to
deliver a balanced budget for the current financial year. 16 SHAs have
projected deficits in 2005-6, while four have projected end of year deficits
in excess of £70m for local NHS organisations. A snapshot estimate of the
available figures suggests a total shortfall of more than £1.6 billion across
22 SHAs: the 51 most financially challenged NHS Trusts face deficits and
savings targets totalling almost £650 million.
A survey of SHA, Trust and PCT
papers and local press websites has revealed that tens of millions in deficits
carried over from the last financial year are now worsening the plight of
hard-pressed Trusts and PCTs as they attempt to stay within spending limits
this year, while meeting stiff government performance targets.
Many Trusts and PCTs are
counting on substantial brokerage and one-off support payments organised by 6
SHAs as a means to prop up their floundering finances and remain within
borrowing limits. One Trust, Mid Yorkshire Hospitals, is seeking brokerage
this year of £100m, while others are so deep in the red they are having to
defer payments on accumulated debts, and hope to clear their deficits over the
next three years.
No fewer than 29 hospital and
Mental Health Trusts have been identified as facing deficits or savings
targets of £10m or more in 2005-6, leaving them just six months to push
through far-reaching cuts and changes. At least another 22 Trusts face savings
targets or deficits of £5m or more. And well over a dozen PCTs face massive
deficits across the country, several of them in excess of £10m. While
previously published official figures have set last year's deficits against
under-spends elsewhere within each SHA, resulting in an apparently marginal
deficit across the NHS as a whole, it is clear from this recent survey that
the sheer scale of the cutbacks required in the overspending Trusts and PCTs
must have an impact on patient care.
Beds, wards and some
well-loved smaller hospitals and units are closing, jobs are being axed, and
PCTs, which foot the bill for each episode of hospital treatment, are seeking
to cut back the use of hospital services and divert patients to primary care
or to nursing homes and social services to balance their books at the expense
of yawning deficits for their local provider Trusts.”
It is no exaggeration to say
that the government policy of 'payment by results' and introduction of a
'health market' is destroying the foundations of the health service as 'social
medicine'. The government says that it does not matter who provides the
service whilst it remains free at the point of delivery. However, instead of
NHS organisations collaborating they will all be competing to attract patients
and struggling to survive. And just as in the past New Labour abandoned its
promise that all clinical work would remain in the NHS it cannot be long, as
the financial crisis deepens until they decide that “those who can afford it”
should pay. Or else, the road will be open to introduce charges should the
Tories get back into office.
So what can be done to
challenge the government? A national campaign has been launched, Keep Our NHS
by health workers organisations and campaigning groups, with the support of
UNISON. It is hoped that other unions will come on board. It has been launched
with the statement shown below. (See the list of signatories thus far at:
It has to be said that it is
rather late in the day. Much damage has been done to the NHS. The health
service unions have downplayed their differences with the government. The 'end
of the two tier pay system' was trumpeted as some great achievement. Dave
Prentis said he would judge the union’s relationship with the government on
whether or not it ended the two tier pay system. Whilst it is a step forward
for the workforce, the government has continued with its privatisation agenda.
Surely it is whether or not it presses ahead with privatisation, on which the
government should be judged? The attempt of the unions to reason with Blair’s
neo-liberal gang of careerists and self-seekers has been futile.
Having said that, the move to
reorganise the PCTs and privatise their work has provided a salutary shock. As
John Lister of Health Emergency said at a recent meeting the unions have
spoken of 'creeping privatisation' but in fact we are facing galloping
The key thing now is to
build the campaign as widely as possible,
involving service users as well as staff. We can learn from the experience of
Defend Council Housing where the unions have supported a campaign which has
united the workforce with tenants. The advantage there, as compared to the
situation in the NHS, of course, is that there has been a ballot process which
has enabled local campaigns to overcome the advantage of Councils: publicity
machinery, money, and government write off of debt.
There will be no ballots in
the health service. The government is ‘letting the market rip’. That is why
industrial action needs to play a more central role together with a political
campaign. The absence of a national campaign in relation to the NHS has meant
that groups of workers have been left isolated. There was no real campaign
against PFI. The Dudley Hospital workers, for instance were left to fight
alone. However, the new campaign will not only provide a focus, it will enable
campaigners to expose in a much more systematic way the disaster which is
happening on the ground in countless Trusts and locations.
The weakness of the health
service union organisation on the ground remains an objective difficulty that
we face. However, it just may be that the launching of a national and
political campaign will provide an impetus for rebuilding union organisation
in the workplace.
This campaign is important not
only for those involved in the NHS and those who use its services. It is
politically important because the NHS was one of the most enduring reforms
which the post-war Labour government carried out. The generation which grew up
in the 1930's understood life at a time when working class people often could
not afford to see a doctor when they were ill. The NHS, despite all its
weaknesses, gave a glimpse of a society in which people's lives were not
determined by their status or the size of their bank balance.
The high priests of New
Labour, glorifying in the 'benefits' of globalisation, believe that everything
should be subordinated to 'the market'. Yes, this is Brown and Blair's very
own version of social Darwinism. We now have the unedifying spectacle of NHS
hospitals 'marketing' their services, as if the sick were considering what
make of TV to buy. We are in fact moving towards a system in which the private
sector will pick up the easy, more lucrative work and the NHS will be left
with emergency work and treating chronic illnesses which the profit hungry
vultures would not want to touch.
Workers organisations are
fighting to defend themselves on many fronts against a government which is
seeking to destroy the welfare state, cutting our pensions, attacking our
democratic rights and so on. Not everybody will be able to become directly
involved in Keep Our NHS public. But what every trade union activist can do is
to get their branch to affiliate, circulate the material in the workplace and
explain to their workmates and their neighbours what is being done to the NHS.
The campaign rightly wants to
build local groups. Signatories on the statement, even big names ones, are no
substitute for developing active support for the campaign, so that resistance
is built. That depends on the full and active involvement of the unions.
Campaigners in South West
London have shown what can be done. Opposing the transfer of the £15m
NHS-funded South West London Elective Orthopaedic Centre to private hands as
part of the government's £3bn scheme to expand private sector provision of NHS
contracts have secured a 2-month delay and a full review of the plans.
They intervened at a meeting
of the Epsom-St Helier Trust Board, challenging the directors to explain the
reasons for transferring the state of the art, highly successful and popular
NHS unit to a US-based company.
Trust directors were unable to
offer satisfactory answers, and eventually conceded that a decision on the
transfer, due to be taken at that meeting, would be postponed until December.
During these two months a full
review of the plan, including a fresh review of the option of retaining the
unit and its services within the NHS, would be undertaken. Campaigners now
plan to intensify their efforts to 'Keep SWELEOC in the NHS': but their
example also shows the way for other campaigners faced with the transfer of
NHS facilities in the second wave of bidding for Treatment Centre contracts,
which are not open to NHS hospitals.
The farther this programme of
the government goes, the more we will live to regret it. What could expose the
reality of Blair’s neo-liberal programme more clearly than a policy in which
profit is to be dumped into the pockets of the private health vultures at the
expense of the NHS? No wonder new right wing German chancellor Angel Merkel
has been reported to seek the advice of Blair on how she can introduce a
Thatcherite programme into Germany.