Class War In The NHS

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Wednesday lunchtime pickets determined to stop the closure of Lewisham Hospital
Wednesday lunchtime pickets determined to stop the closure of Lewisham Hospital

2013 OPENS with Michael Farrar, the NHS confederation chairman, appealing for fewer hospitals and beds, and more care for elderly people in their own homes and the ‘community’, to make the health service financially ‘sustainable’.

While hundreds of beds have been closed, thousands of nurses’ posts lost, and the hospitals are full to bursting as a result of the £20bn McKinsey QIPP cuts, he tells us that more savings must be made.

This, despite the fact that nearly £3bn of the £5b.8bn cuts so far, have gone back to the Treasury, whilst the rest have been diverted into large private sector contracts and restructuring.

The crisis of hospital care, with reports in the press of neglected patients, is laid at the door of an NHS which ‘lacks compassion’ says Prince Charles, and staff that don’t care, says new Health Secretary Jeremy Hunt, the pro-Murdoch press stalwart.

Yet the real cause of the crisis, the massive cuts and the rip-offs of private sector contracts, is hidden from view.

The public presentation of the Francis report on Mid-Staffordshire Hospital, where hundreds of patients died due to staff cuts caused by making £10m savings to achieve foundation trust (FT) status, has been postponed over and over again.

The imposition of unaffordable PFI schemes, the commissioning of fewer services, cuts to tariffs, and penalties for missed targets, the forced march to FT ‘sustainability’, mean that it is government policy itself which is forcing hospitals to the wall.

The so-called bankruptcy of hospitals is nothing less than a horrendous and conscious under-funding by government as part of a definite plan to destabilise and close what were perfectly good NHS hospitals, in order to run down their acute services and hand their elective care to the private sector.

Yet the latest twist from the NHS Commissioning Board (NCB) – the new master of the health service in England – is that staff are to blame. The NCB’s medical director, Sir Bruce Keogh, says that the answer to poor care and staff shortages on weekends is to make the NHS more commercial like Tesco.

24/7 working schedules must be imposed on staff, concentrated in fewer larger specialist hospitals miles from where patients live.

A special NCB committee is looking at breaking up staff contracts, such as those for hospital consultants and junior doctors, to provide a constant source of medical labour without paying overtime.

Not only has the three years of pay freeze provided most of the QIPP cuts, but earlier this year, a cartel of trust in the SW was set up to pioneer imposing local pay, strongly backed by the Chancellor, George Osborne.

Meanwhile, the DoH is pushing to alter ‘Agenda for Change’, affecting up to a million NHS staff, which would bring in performance related pay, cut sick pay and reduce newly qualified nurses’ wages.

In short, government is smashing all the publicly provided NHS structures with cuts, and privatising what is left. The £20bn cuts and the Health Act are the means.

The public is to be left with a vastly reduced service or none at all. The remainder is to be provided by the private sector on rotten terms and conditions for staff.

Dominating the health service landscape are the plans to ‘reconfigure’ acute care out of District General Hospitals (DGHs). This is being done by stripping out their acute services – A&E, emergency surgery, maternity, intensive care – leaving the profitable elective care for the euphemistically called ‘community care’ (private providers such as urgent care centres, independent treatment centres, pathology centres, etc) and increasingly commercialised primary care.

It is estimated that up to 32 DGHs have either already lost or are planned to lose their A&E departments.

McKinseys and other management consultants call the tune, with the assistance of the new commissioners; the NCB local area teams (LATS), the Clinical Commissioning group chairmen and the outgoing PCT clusters as they morph into Commissioning Support Units. (CSUs). The NCB itself is to play the key role in centralising hospital care, as it now controls spending on specialist hospital services which have been packaged for outsourcing.

A huge reconfiguration in NW London proposes the closure of four out of eight A&Es with the ending of Ealing, Charing Cross, Central Middlesex and Hammersmith as acute hospitals and the loss of 391 hospital beds and 5,600 jobs by 2015.

In South West London the ‘Better Services, Better Value’ plan threatens the A&E maternity and paediatric departments of St Heliers, and Epsom.

In North East London, King George and Newham are at risk, and in North Central, Chase Farm and the Whittington.

The Greater Manchester reconfiguration imperils the future of up to seven more A&Es and their parent DGHs in a similar way. These reconfigurations are being imposed everywhere, even Wales and Northern Ireland.

In July, a new more powerful weapon was unleashed, the Unsustainable Provider Regime. This is being tested out in South East London. The Trust Special Administrator has agreed his report, drawn up by McKinseys, to wipe out Lewisham hospital as an acute DGH, and decimate acute care in the remaining South East London hospitals, with huge staff cuts, bed losses, land sales and shift of elective care into private facilities. All to be rubber stamped by Jeremy Hunt on 2nd February with no appeal.

General practice is under attack by the threatened imposition of a new 2013/4 contract, with new QOF targets and the phased loss of the Minimum Practice Income Guarantee.

Many smaller practices will lose out, hastening their amalgamation into large federated practices ripe for commercial takeover.

Even the compliant BMA GP’s committee (GPC) is planning road shows to garner members’ views in January, though they insist that all they can do is ‘ensure that the imposition is as minimal as it can be.’

Meanwhile, GPs are being forced into clinical commissioning groups about to take nominal charge of £65bn of commissioning money on April 1st 2013. Far from being run by GPs, CCGs are totally dominated by the requirements of the NCB and the Health Act to ration care and contracts with the private sector.

Frequent demands from the ranks for an official boycott of CCGs by the BMA, which would stop the government’s plans in their tracks, has been constantly opposed by the GPC leaders and a majority on BMA Council.

What we are seeing is the culmination of the massive sell-out by the trade union leaderships, which allowed the Health and Social Care Bill to become an Act in March 2012, and have avoided any national fight against the £20bn cuts. Moreover, they failed miserably to coordinate action to defend NHS pensions.

The health unions, TUC and the Labour Party ensured that no united industrial action of any sort was organised to stop the Bill.

The coalition government is moving with breakneck speed to continue to implement the Health Act’s measures.

The NCB takes formal control of running the health services and the new commissioning bodies in April 2013, and oversees the handover of the CSUs to the multinationals in a huge flotation.

Together with Monitor, the new competition regulator, it has the powers to enforce the open market and to transform all trusts into FT businesses.

There has been a rush of competitive tendering with large contracts going out to big business – Surrey Community Care to Virgin on a £500m deal; Suffolk Community Care to Serco for £140m; £300m contract to Interserve in Leicester; Hinchingbrooke hospital management to Circle in a £1bn 10-year deal; Harmoni (now owned by Care UK) gets a large NHS 111 contract.

They are also pressing ahead with centralising and privatising pathology.

In October 2012, thousands of types of elective work, formerly provided by PCTs and NHS hospitals such as outpatient clinics, day surgery, physiotherapy, ultrasound scans, podiatry etc were put out to Any Qualified Provider ( AQP). Big private companies, such as Care UK, BMI Healthcare, Inhealth, Specsavers and Virgin Care have been authorised on AQP for some of these areas and started to receive contracts.

But 2012, saw constant opposition by the public and staff to these closures and privatisations. There have been strikes at Mid Yorkshire and Brighton against compulsory redundancies. There have been petitions and rallies at Redditch Worcestershire, Eastbourne, St Heliers, Bolton. Flint North Wales, Northern Ireland and Manchester, to name only a few.

Two large demonstrations in NW London opposed the closure of Ealing and Charing Cross A&Es, 15,000 marched in Lewisham on 24th November to keep that hospital open. Over 200 Lewisham doctors and clinical staff produced open letters exposing the devastation that closing Lewisham as an acute hospital would cause.

The NE London Council of Action have maintained the pressure at Chase Farm Hospital to stop the removal of A&E, paediatrics and maternity, with a daily picket for the whole of 2012, calling for occupation as necessary to keep all acute services on site.

What must be done

Such Councils of Action, drawing together staff, residents, trade unions and campaign groups, must be set up to organise occupations wherever NHS services are threatened, to keep them open.

This must be the year to turn the tide on these treacherous trade union leaders and get a change of leadership, which will not be afraid to use their industrial muscle to stop the cuts and redundancies and defend national contracts.

It must be the year when the entire trade union movement comes out on a general strike and brings down the coalition, to bring in a workers government that will defend and expand the NHS under socialism.

We must build up the revolutionary leadership to mobilise the working class to take revolutionary action to expropriate the banks and major industries, to set up a workers government, and plan the economy and public services for people’s needs. This is the task of the Workers Revolutionary Party. We must build it now.