BY ANNA ATHOW, BMA COUNCIL, IN A PERSONAL CAPACITY
THE Tory-Lib Dem coalition government is determined to push through the Health and Social Care Bill to open up the provision and commissioning of NHS care to private companies.
The NHS, as founded, redistributed public funding according to clinical need, through the nationalisation of the hospitals, a special contract with GPs, direct provision of community care, a special administrative structure and a public service workforce.
Funding, planning and provision were one integrated whole and within the public sector, and because of this extremely efficient, with no transaction costs, as pertains in Scotland, and as is restored in Wales today.
Standards were maintained because of the national training system of medical and other NHS staff.
All this is to be broken up in England. The NHS would become a huge public-private partnership
Corporate multinationals posing as ‘Any Qualified Provider’ are to be invited into a competitive market to make huge profits out of NHS funding
At a time of world economic crisis, big business needs state funds to survive. The Health Bill provides them with this.
Mark Britnell, global head of health at KPMG, recently told a conference of US Health corporation executives: ‘In future, the NHS will be a state insurance provider not a state deliverer,’ and ‘The NHS will be shown no mercy and that the best time to take advantage of this will be in the next couple of years.’
There has been huge opposition to the Health Bill from the public and the trade unions.
The BMA called a SRM. Unison and Unite called for it to be scrapped and the RCN conference voted 98.7% no confidence in Lansley’s handling of the bill.
The medical profession and health workers have seen privatisation in action in the PFI hospital scam, the Connecting for Health fiasco and with ISTCs.
Private nursing homes run for profit are another outrage. Southern Cross, was asset-stripped by private equity, and left cutting staff and selling homes. Staff have been made redundant and standards lowered to boost profit margins.
The Future Forum (FF) reported on June 13, after eight weeks of ‘listening’, but essentially supported the Bill with tweaks, and delayed some deadlines.
Next day the government accepted the report and claimed that the main principles of the Bill, Cameron’s ‘red lines’, were intact and that the following should be legislated :–
• The ending of PCTs and SHAs and the introduction of GP commissioning groups (GPCGs) to commission hospital and community care, supervised by the NHS Commissioning Board (NCB).
• The NCB would have a duty to promote choice and competition, and a ‘choice mandate’. It would ensure that GPCGs kept to the reduced budgets demanded by the £20bn ‘efficiency’ cuts and give contracts to private companies.
• GPs must join GPCGs and together with the commercial primary care providers would commission and provide primary care, with some token other clinical professionals.
GPCCs could buy in support for commissioning from private companies, which could control finances and run clinical referral vetting services.
Already UnitedHealth and KPMG have been given commissioning contracts with pathfinder consortia. Such multinationals would be in a strong position to influence much of the NHS commissioning budget.
GPCCs would convert GPs into budget-cutter/doctors and present them with the job of rationing care, closing hospitals, redesigning care pathways, and promoting private sector providers, guided by new clinical senates advising the NCB. Commercial contracts would be used.
l Every hospital and other trust must become a Foundation Trust business with new ‘freedoms’ to treat unlimited private patients, borrow from banks and to go bankrupt. They would not be bailed out and must be allowed to fail.
These can hardly be described as NHS providers, but are halfway houses to fully commercial businesses.
• The market. Competition must stay, and will be promoted by the NCB and the Competition and Cooperation Panel with its own identity inside Monitor, the new regulator of the market.
‘INTEGRATED CARE ORGANISATIONS’
The new proposal from the FF was integrated care, which the government has taken up. Monitor and the NCB are to promote this. HealthCare is to be integrated with social care (for which users are charged), public with private care, primary and secondary care, commissioning with provision, etc.
The idea comes from the Kings Fund Chief Executive Prof Chris Ham, who has written extensively on the subject (Where next for the NHS reforms? The case for integrated care 2011) and is a great admirer of the American Health Maintenance Organisation, Kaiser Permanente (KP), an insurance healthcare company.
The Bill abolishes the duty on the Secretary of State for Health to provide, or secure, the provision of a comprehensive NHS in England.
HOSPITAL CUTS
A central part of the government’s plan is the £20bn of ‘efficiency savings’, the ‘Nicholson challenge’, which in plain words are gigantic cuts.
The McKinsey report 2010 proposed that the acute hospital sector bear the brunt of these cuts.
There has been a constant outpouring of reports and a recommendations from the NHS confederation, the so-called ‘independent think tanks’, the Kings Fund and the Nuffield Trust, from Steve Field and Chris Ham, and David Nicholson, CE of the NHS, and Dr Carter of the RCN, calling for rapid hospital closures.
All over the country cuts are proceeding apace and District General Hospitals are losing their A&Es, maternity and paediatric departments.
Big business must get NHS hospitals closed. So long as patients can find good consultant-led District General Hospital care close to home, the private sector can never take off in the way that it wants.
Massive funding cuts, de-commissioning of care, and waiting lists all lead to a reduced state-funded rump service. Inadequate individual patient budgets shift risk onto the patient, and favour the development of co-payments and private health insurance.
Competition and insurance rely on ‘cherry picking’ to limit costs and avoid clinical risk.
The Bill leads in the direction of American-style health care – profit making, expense, waste, fraud and minimal regulation. This is the end of universal healthcare on the basis of clinical need.
The BMA has a duty to expose the real aim of this government and dispel all the lies about improving outcomes, clinicians in control and about ‘not privatising the NHS’.
At stake are the jobs, terms and conditions and pensions of thousands of medical staff, the training of juniors, the reputation of GPs as patient advocates, and the health of millions of people, as the NHS as a public service is smashed up and handed to private corporations.
THE WAY FORWARD
We call on all BMA members to campaign for the BMA to change course and completely oppose the entire Bill.
The way forward is to unite with other public sector workers in struggle over pensions and organise national industrial action in defence of our NHS and occupations to keep our hospitals and other units open.
To defeat the Health Bill it is clear that the coalition government will have to go and a workers government brought in to defend and develop the NHS and bring in socialism.
Come to our fringe meeting:
Tuesday at 6pm
The Royal Hotel,
88, St Mary’s St,
Cardiff