THE White Paper produced by the Tory-Lib Dem coalition government says that all NHS Trusts must become Foundation Trusts (FTs) within three years.
There are still quite a few of the eligible 225 NHS Trusts that are not FTs yet. The White Paper says: ‘Our ambition is to create the largest and most vibrant social enterprise sector in the world . . . . staff will have the opportunity to transform their organisations into employee-led social enterprises . . .’
FTs were set up with rules in the 2003 legislation and, whether employee-led or not, they have to make a surplus. The White Paper makes clear that they cannot get in debt as ‘There will be no bail outs’. They must therefore go to the wall, or be merged, or taken over.
Whereas it used to be the duty of NHS hospitals to care for the clinical needs of patients in their catchment areas, this is no longer required of them. In fact, when hospitals do provide the care to patients coming in through A&E and via outpatients that they need, they are accused of ‘overspending’ their budget. They are maligned as running up debt and being financially ‘unviable’, and then labelled as a ‘failing’ trust.
Monitor, the body which oversees FT Hospitals, has been given the task of deciding what happens to such recalcitrant Trusts, and has been given the power to ‘trigger the special administration and regime’, i.e. the ‘regime for unsustainable NHS providers’, legislated by the Labour government.
The Tory-Lib Dem coalition is changing the law to prevent FTs from reverting back to being NHS trusts again. This route is being ‘de-authorised’. Such is the hatred of anything approaching the original aim of the NHS hospitals to fulfil all the clinical needs of patients in a catchment area. Instead they must be competing autonomous businesses.
The White Paper is consulting on –
• Abolishing the FT private patient cap, so that they can make more money from private patients.
• Making FT mergers easier.
• Making it simpler for FTs to keep any surpluses they raise, so that they more and more resemble a private profit-making business.
FTs already have the autonomy to partner with private companies, borrow from banks, and sell off their assets which no longer belong to the NHS, with the approval of Monitor.
FTs have to select ‘service lines’ which run at a surplus, according to William Moyes, the erstwhile Monitor Chairman. He advised they should stop offering services on which they cannot make a surplus. So this is about reducing services not providing them.
FTs are being gradually forced to ‘cherry pick’ the easier cases, like private Independent Sector Treatment Centres (ISTCs).
Intensive care units, for example, are now under great pressure to limit their intakes. Staff are threatened with loss of national terms and conditions and told that ‘NHS pensions may act as a barrier to greater plurality of provision’.
The White Paper claims that FTs will not be privatised. But FTs are being packaged up for this very privatisation. The rules are already being considered for change, so that the surplus can be extracted away from the NHS as a whole and accumulated within one ‘autonomous’ organisation. The only thing missing is the giving of the surplus to shareholders. A small alteration in the law could change that!
Monitor’s role is to be further extended.
• It has to become the economic regulator of a competitive market and, moreover, it has to promote competition. ‘Like other sectoral regulators such as OFCOM and OFGEM, Monitor will have concurrent powers with the Office of Fair Trading to apply competition law to prevent anti-competitive behaviour’. (p38)
It must ‘help open the NHS Social Market up to competition’. It must ‘require monopoly providers to grant access to their facilities to third parties. The focus on competition regulation is on preventing anti-competitive behaviour of powerful suppliers’.
These are acts which seek to actively undermine NHS providers.
Healthcare in the NHS was, for 55 years, largely provided by a publicly-provided monopoly which covered primary, secondary and community care.
A large monopoly and the unity of funding and provision, enabled risk pooling and comprehensive care.
Sharing assets and transfer of patients from one part of the system to another without transactions costs, minimised expense and maximised patient convenience and professional cooperation. Without these, universal and equitable access is impossible.
The proposed anti-NHS-monopoly measures, signal the end of this. What now becomes paramount is financial survival of ‘autonomous’ providers in a competitive market.
The White Paper states: ‘Existing providers will be set free, and will be in charge of their own destiny, without central or regional management or support.’ (p46) ‘Set free’ to make money, or sink. Patients will lose their access to much needed NHS District General Hospitals (DGHs) and other NHS services.
There will no longer be equality of access, or comprehensive care. For-profit production for the market does not allow this.
Massive withdrawal of services is on the way, which is why the new ‘Autonomous NHS Commissioning Board’ has been given powers ‘to restrict the scope of service provided by the NHS’.
In order to stimulate this ‘competition’, the payment tool of PbR is being modified and rolled out to mental health and community services.
The White Paper says: ‘Monitor’s role will be to set efficient prices, or maximum prices, for NHS services, in order to promote competition and drive productivity.’ (p38) ‘We will rapidly accelerate the development of best practice tariffs, introducing an increasing number each year . . .’
Best Practice tariffs are essentially about driving down the tariff for a procedure, over a period of time.
They will advantage those units with least overheads and minimal staffing. They open the door to a race to the bottom on price. Already the 30 per cent tariff for emergency hospital admissions, if they exceed last year’s number, has been put into effect. PbR is being used to prevent provision and downgrade services, not enhance and improve them.
As for patients, their interests come last. The White Paper wants to push ahead with patient budgets so that the responsibility for the risks of care or lack of it, would be borne by the patient.
Patients must be encouraged to stay out of hospital and die at home, and not be seen in a clinic, but email instead, in order to save money. Their right to comprehensive services is already being decimated with the withdrawal of lists of operations and treatments by PCTs and removal of accessible hospital care.
This White Paper should be opposed by all the trade unions, by every means necessary, as it spells the end of a national publicly-provided NHS and putting the corporate private sector in charge of both commissioning and provision.
Once in the hands of big business, charges for diagnostic tests and treatments, that are not funded by
GP consortia, will be instigated to boost profits. Already thousands of frontline nursing posts have gone and this will soon involve doctors as the privateers move in and fragment care, making it harder and harder to defend national terms and conditions, and pensions.
It is clear that decrepit British capitalism, battered by the world crisis, is driven to destroy the NHS. That is the significance of the Tory-Lib Dem White Paper.
Urgent action is necessary immediately to stop the total privatisation of the NHS and its destruction as a publicly-owned and state-run system, providing universal and equitable healthcare, free at the point of use.
In every locality the NHS trade unions and patient groups must organise Councils of Action to defend all NHS services against privatisation and destruction, by all means necessary – pickets, marches, rallies, occupations and strikes.
All the NHS trade unions, which set up NHSTogether through the Trades Union Congress three years ago, must organise action now. They must call on everyone to stop work and take part in a national demonstration and lobby of Parliament on the day the Health Bill is presented to the House of Commons.
There must be a clear message delivered: Hands off the NHS! The Health Bill must go!
When the Tory-Lib Dem government proceeds with this Health Bill, then the whole trade union movement must organise an extended general strike to bring it down.
Today, the only way the NHS can be restored and expanded is through a workers’ government carrying out socialist policies, nationalising the banks and major industries to provide funds for essential services, like the NHS and education.