The Health and Social care bill brings in the legislation to privatise the delivery and commissioning of healthcare in England.
Coupled with the massive cuts, the NHS would end up providing a minimal core service, leaving patients having to pay, get insurance or go without.
The bill reverses the gains of 1948, the publicly owned infrastructure, and the public service workforce, and the national training system.
It brings in an open competitive market of private providers like the American system.
The NHS would be reduced to a funder (a kitemark). It would be public money and privately delivered care. NHS care would put out to tender.
They plan to do to the NHS clinical and clerical workforce what they did to the ancillary workers in the 1980s when almost half lost their jobs and national terms and conditions were destroyed.
In this economic crisis, big business needs the lifeline of public private partnerships. Pricewatershousecoopers estimates there is £1.8 trillion of business for public private partnerships in the next decade, given the any ‘willing provider policy’ and the cuts.
The £20bn cuts are a key part of this. They are proceeding with the McKinseys 2010 plan of a 10% reduction in of NHS staff. Already 50,000 jobs are going.
The mass hospital closure programme is at the centre. Without the wholescale closure of NHS hospitals, the private sector will never get a foothold in the NHS.
The privatisation bill and the cuts go hand in hand.
It is no accident that David Nicholson, the NHS chief executive, who is driving through the £20bn QIPP cuts of 25% of the NHS budget, the biggest in its history, was recently appointed by Lansley as the new chairman of the NHS commissioning board (NCB) to drive through the privatisation reforms.
The bill introduces key legislation – to create an open competitive market, to privatise commissioning, to corporatise general practice and to run foundation trusts like commercial companies, to commercialise medical training.
The open market
The new commissioning bodies, the NCB and GP commissioning consortia, must enforce the market. Any company that gets a license from the changed Monitor will be able to compete for NHS contracts. Monitor will enforce competition for the other utilities, gas and electricity.
The NCB would be appointed with a remit to enforce the open market and make the £20bn cuts. The responsibility of the Secretary of State for health is to ensure the provision of a comprehensive service for the whole population is abolished.
GP commissioning consortia (GPCCs) would commission hospital services and community care. They are instructed by the board to ration services within budget and ‘reconfigure’ care out of hospitals ‘into the community’ for ‘any willing provider’. GPCCs are performance-managed by the board and if they do not do as instructed, can be closed down or taken over by private management.
GPs will not end up doing commissioning
The government calls this ‘GP commissioning’ but the majority of GPs do not have the time for population planning and contracting. A small clique would be on the management and the bill empowers outsourcing of commissioning functions to the private sector.
Already the big management consultants KPMG, United Health and McKinseys are getting contracts to do commissioning functions.
‘GP commissioning’ is already becoming big business before the bill is passed.
‘GP commissioning’ will therefore not be ‘clinically led commissioning’. GPs are being double crossed.
GPs will be held responsible for the consortia decisions to withdraw care and close hospitals. Their names will be used to effect the consortia policies of giving contracts to private providers and rationing the budget.
Corporatisation of General Practice
Every GP would be forced to join a consortium. The GP contract would be changed. The independent practitioner status of GPs would be abolished.
Instead of putting the clinical interest of their patient first, they would have to obey the diktats of the consortium; to reduce referrals to hospitals, cut prescribing budgets, and deny care.
GP practice boundaries would be abolished. Consortia have no duty to provide comprehensive care for patients in a defined area. Already many GP surgeries have been taken over large commercial companies Assura, First Health, United health, and these would dominate the consortia.
Hospitals are to be
and closed on
a massive scale
They must all become Foundation Trust businesses and then convert to ‘social enterprises’. These do not have to adhere to national terms and conditions or NHS pensions to their staff and are a transition to fully-fledged private hospitals.
Circle Health, which took over Hinchingbrooke Hospital, claims to be a social enterprise but is 50.1% owned by the banks and is out to make a healthy profit out of the NHS.
Foundation Trusts would be run like commercial companies under the bill. They could treat unlimited private patients, sell assets and borrow from the banks making it easier for lenders to recoup loans in the event of ‘failure’.
Hospitals must make money on tariff or go bankrupt and ‘fail’ and must not be ‘bailed out.’
Already, the PCTs are withdrawing funding from hospitals and not renewing contracts for vital operations, such as cataracts and hip and knee surgery. Over 50 hospitals are ‘in deficit’ and hospital managements are axing jobs beds and services.
25 hospitals are due to lose their A&E and maternity units. Top of the list are London’s Chase Farm, King George and Queen Mary’s Sidcup.
Plans are being prepared for mergers, closures, franchising out, and bankruptcy and take over by private companies, on a massive scale.
This will take us back to the 1930s. All that would be left is a tattered patchwork of private voluntary and co-op hospitals, such that many patients would not be able to get to a hospital and would be denied the right to see a specialist.
It is clear that this entire health bill has to go. ‘Clinician-led commissioning’ is a sham, to cover up the forced march to an American style open competitive market, erected on the bones of the public provided GP surgeries, community care and the nationalised hospital network, won in 1948.
The BMA, as the doctors’ union, must stop the policy of critical engagement with the bill and stop kidding its members that there are good bits and bad bits. The BMA should stop endorsing GP commissioning as ‘clinically-led commissioning’.
They should explain that it is a blue-print for the privatisation of provision and commissioning laying the basis of an American style health market.
It should advise its members to withdraw from and stop cooperating with GPCCs immediately. It should decide on a strategy to get rid of this bill. This must mean action.
The BMA must link up with the other health service unions and the wider trade union movement and take part in the March 26th demonstration against the £81bn public spending cuts.
What is needed is industrial action to prevent the dismantling and closure of NHS infrastructure and mass redundancy of the public NHS workforce.
The Special Representative Meeting (SRM) today should oppose the bill in its entirety and give Council the power to call industrial action as necessary to defend the NHS as a publicly provided service and keep big business out of provision and commissioning.
Every NHS hospital and unit and every job must be defended, as must national terms and conditions and pensions.
Hospitals faced with closure must be occupied.
The NHS must be preserved as a public service, caring for the clinical needs of the whole population, free at the point of use.
The whole strength of the trade union movement must be mobilised to defeat this bill and if the government falls, so be it. It should be replaced with a workers government and socialism.