ANYONE who has made a careful reading of Department of Health documents (see footnote) and considered the implication of the legislation can only come to the conclusion that the provision of clinical services is being privatised.
Acts were passed introducing Primary and Social Care Trusts in 2002 and Foundation Trusts in 2003.
In all three sectors – hospitals, GPs and Community Care, private sector providers are being invited in to battle it out for the contracts on the payments by results (PBR) market.
Those that produce the largest volume per quarter, will win the contracts and put the rest out of business.
There will be a massive reduction in healthcare services, especially hospital care.
1. Hospitals
NHS hospitals all have to become foundation trusts by 2008, that is, those NHS hospitals that are left after the further roll-out of (PBR) in April 2006.
Foundation trusts are commercial entities, run like private businesses.
They are not-for-profit mutuals, directed by unelected boards and have a remit to make a surplus.
The buildings and land of foundation trusts no longer belong to the state.
They can subcontract to profit making companies and charge.
They do not have to adhere to national terms and conditions for staff. They are overseen by Monitor, chaired by Moyes and if financially ‘failing’ can be handed over to private management, as happened at Leeds.
Moyes said (Health Service Journal [HSJ] 17.11.05) that a third of trusts would need to shut hospitals or services to become credible candidates for foundation status.
‘The issues (with these trusts) are about the healthcare system, either it’s wrong specialties, too many hospitals, too many specialties in different sites, there is a need for rationalisation.
‘If you’ve got two or three Accident and Emergency (A&E) departments (in a health economy) then you might conclude that there is only one that is truly viable.’
These rationalisations and closures are taking place right now as a result of the government’s present round of funding cuts.
Projected deficits for the end of the year have reached nearly £1bn. One thousand beds and 8,000 jobs have been lost since June. (HSJ)
For example, Surrey and Sussex Strategic Health Authority (SHA), is heading for an annual deficit of £80m.
‘The SHA is now pressing all organisations to hit their control targets in March through cutting pay bills.
‘A number of hospitals in the area are already implementing a virtual freeze on the use of agency staff and some are closing wards.’ (HSJ 24.11.05)
‘The trust is planning to sell off some unused land and buildings but is looking at more dramatic options such as “sell and lease back arrangements” on its properties.
‘These could include its two hospitals in Crawley and Redhill.’
One option being considered for East Surrey Hospital ‘would be stripping out elective care, leaving the centre as a critical care centre.’
The Chief Executive admitted that ‘little is known about how such a model of care . . . would work.
‘Crawley hospital would be retained primarily as a “nurse or therapist led” unit.’
The same thing is happening all over the country.
Thirty two Private Treatment Centres are due to come on stream shortly and together with G Supp are skimming out the straightforward elective procedures.
Large NHS treatment centres such as in Birmingham and Ravenscourt in London are being handed over to the private sector.
The market being introduced has a logic of its own. Once the big healthcare corporation are in, their share of NHS patients for elective surgery will not be limited to 15 per cent. Once good NHS, or foundation trust units have closed, they will take off, like Tesco, and there will be no stopping them.
When Lord Warner was pressed on this issue at the Central Consultants and Specialists Committee (CCSC) of the British Medical Association (BMA), on October 8, he would not be drawn, because there will be no limit.
Alan Maynard wrote: ‘In most markets, capitalists seek to destroy contestability as it threatens their profits.’ (HSJ 24.11.05).
2. General
Practice
With the closure of large numbers of hospitals and A&Es, there is to be a strategic shift of patients into primary care.
GP fund-holding, now called practice-based commissioning, is to be instituted by December 2006, and will incentivise GPs not to refer patients to hospital.
GP specialists will be seeing patients instead of medical and surgical consultants in hospital out-patient clinics.
Fifteen million out-patients appointments are to be transferred into primary care. (Creating a patient led NHS)
Given that there is no expansion of GPs numbers, and they will be doing all this specialist work, nurse practitioners are envisaged as taking over aspects of general practice, especially in deprived areas.
The most complicated, chronically-sick patients are to be ‘case managed’ by 3,000 community matrons, district nurses, who are to take histories, investigate, diagnose, prescribe, admit and discharge from hospitals and hold budgets incentivising them not to refer patients to hospital.
‘Skill mix’ will enable them to hand over parts of their work to untrained healthcare assistants (HCAs).
‘Supporting people with Long Term Conditions; liberating the talents of nurses who care for people with long term conditions.’ (DoH Feb 2005)
Corporate private providers, are to provide ‘contestability’ with traditional GPs and once in, will buy up retiring GPs practices.
3. Community
Care
The whole of Community Care is to be out-sourced to private providers by December 2008. (Commissioning a patient-led NHS 2005)
Every district nurse, health visitor, school nurse, prison services, many mental health services, community paediatrics, speech therapy, chiropody, etc, are to be provided by private companies.
So the ‘community matrons’, doing the GP work, will also be out-sourced as well.
Millions of patients will find themselves cared for in the community by HCAs, or voluntary agencies, or no one at all.
Primary Care Trusts (PCTs) are themselves to be merged and wound down, with their commissioning role, to be out-sourced to private companies to do the purchasing. (Commissioning a patient led NHS)
So private companies will spend government money on private companies!
The goal is that by 2008:
A. Provision of all clinical services will be privatised.
B. Access to secondary healthcare services will be hugely reduced and primary care restricted and downgraded.
This will fulfil the government’s twin aims –
Diverting public money to the giant corporations through public private partnerships;
Cutting money on public spending.
The Government’s aim is an Americanised healthcare system with the difference that the government will pay for some core services for the population for an interim period.
Once the big corporations are in the saddle and comprehensive NHS hospitals are no more, the market will let rip and charges will be introduced.
A market system cannot provide universal health care. Whole sections of the population will be left without.
Dentistry shows the way. Two million patients have no dental care and patients are charged 80 per cent of costs.
(Footnote; The NHS plan 2000, Delivering the NHS Plan 2002, Growing Capacity. A new role for external care providers in England 2002, Reforming NHS Financial Flows Introducing payments by results 2002, Payments by Results Consultation 2003, Treatment Centres: Delivering Faster; Quality Care and Choice for NHS patients 2005. The NHS Improvement Plan June 2004. Creating a Patient-led NHS 2005, Commissioning a patient led NHS 2005)