THEY are smashing up the NHS as founded in 1948. The health service in England Wales and Northern Ireland is in huge crisis.
Cuts and ‘reconfiguration’ are being used to pulverise, general practice, hospital care, mental health services and all community services, midwifery, to the ambulance service and care of the elderly.
Patients are finding it hard to access their GP in a timely manner, because funding for the service has been eroded, such that there is an estimated shortage of 10,000 GPs.
Consequently, those that are left are overworked and stressed. This is leading to early retirement and lack of recruitment.
Unprecedented numbers of patients are attending A&Es. It is estimated that many may attending there because they could not reach their GP. A&E attendances in England have climbed by 11% in four years to 5.77m in 2012/13.
Last week A&Es received an unprecedented 299,301 attendances, the highest on record, mimicking a Winter crisis. Hospital in-patient beds have been cut by 23,000 in the last four years.
Hospitals are full to capacity. Ambulances queue outside to offload patients, imparing the care of emergency patients. Patients are also waiting longer for diagnostic tests such as scans, many now exceeding the six week guaranteed wait.
Elective waiting lists at 3m, are the highest for six years. A recent study by the Royal College of Surgeons shows that many elderly people are being denied the surgery that they need, such as hernia repairs and hip surgery.
Huge cuts in funding for mental health have led to a loss of 31% of beds in the last ten years, with 1,700 beds going in the last two years and decimation of community care.
Mental health patients are having to be ‘sectioned’ so as to get a bed and then often have to travel hundreds of miles away from home to get admission, many in private hospitals.
A fifth of all spending on community health services now goes to private providers, reflecting a jump of a third to private providers in the last year.
An unprecedented £700m contract has been put out to tender in Staffordshire for cancer care, which is the first time that specialist care has been outsourced on this scale.
NHS staff are at breaking point in hospitals because of year on year 4% ‘efficiency savings’, when the only thing the Trusts can cut is staff numbers.
Staff have also had to put up with a four-year pay freeze and cut in pensions. It would be wrong to think that this is some kind of accident. Far from it. It has been organised.
In 2009, the McKinsey (US management consultants) report outlined the plan to cut £20bn from the NHS over five years And that is what is being done.
The long-term strategy, pursued by successive governments, Labour and Tory, has been to privatise the NHS, and bring in an American-style health system, based on health insurance with co-payments.
The Tory coalition legislated the final straw, the Health and Social Care Act 2012, which sets up the market structures and administration to drive the privatisation of the whole of commissioning and clinical provision.
A huge public private partnership. This is what we are seeing unfold under our eyes. To implement the strategy they have installed three things: massive cuts to smash the current NHS structures, the open market to allow in the private companies, and the leadership to see it through.
The latter, they have in the form of Simon Stevens, the new CE of NHS England who has returned fresh from running the global health division for the American UnitedHealth, health corporation.
He was also the architect of Blair’s NHS 2000 plan which brought in the concordat with the private sector. In his June 4th speech, Simon Stevens, made clear that he would accelerate the strategy.
He is strengthening and shaping the new commissioning organisations, the CCGs, NHS England and the Local Area teams of the latter, so as to use funding and pricing mechanisms to attract in private healthcare companies.
He has dedicated himself to accelerating ‘the reconfiguration’, which has been ongoing since the Darzi plan 2006, to run down 60 District General hospitals (DGHs), and ‘consolidate’ complex and acute care in just 40 to 70 major hospitals with proper A&Es.
Other DGHs would be reduced to lesser local hospitals without a full complement of services. Simon Stevens proposes that junior doctors are no longer required in such hospitals.
As we speak, this programme is continuing by stripping DGHs of their A&Es and/or paediatrics and maternity, all over England, Wales and Northern Ireland e.g. Ealing, Hammersmith, Charing Cross, and more in London and Greater Manchester, and Yorkshire.
He endorses the complete redesign of primary care into ‘out of hospital’ extended primary care organisations containing GPs, social workers, some hospital specialists and commercial managers, which on close examination, and as described by Prof Chris Ham of the Kings Fund are modelled on American Health Maintenance Organisations such as Kaiser Permanente.
These networks covering up to one million registered patients could eventually merge with the CCGs, which under the Health Act have the power to select patients, limit the services they provide, sell insurance and charge co payments.
These plans are cleverly dressed up confusing language. All the talk from the government, NHS England and think tanks is of ‘integration’.
But in fact this is ‘integration’ within the private sector, not the public sector, and is completely spurious.
When they talk of integrated care they are often refer to a prime provider model which outsources all the steps in the care pathway to a series of subcontractors each making a profit, as is the plan for the £700m contract for Staffordshire cancer services.
All the main political parties talk of ‘integration’ of healthcare with social care and fusion of the budgets. But this would be extremely dangerous as social care is means tested with charges, and healthcare is free at the point of use.
The fusion of the budgets means, at one swoop, that healthcare would be charged.
GP surgeries are being bankrupted through funding cuts and GPs are being coerced into federations as the only way to survive. Clare Gerada, the new head of primary care for London, (GP magazine 6.6.14) makes clear that GP practices would become extinct.
So GPs would end up as salaried employees working for commercial outfits.
The fact is that the government is pulling the funding from general practice, generally and by cutting MPIG, in order to break up the traditional NHS GP practices. 98 are now at risk and 60 imminently, which is why hundreds marched through Tower Hamlets on June 5th.
Prof Chris Ham (CE of the Kings Fund) the proxy voice of government is quite clear. ‘The status quo is not an option’. He says there must be ‘investment for reform’ and the money cut, must be siphoned off into a transformation fund.
This is ‘the Better Care Fund’ whereby up to £5bn of health services funding is being transferred into social care to fuel the fusion of the two services, to be run jointly with local authorities.
The crisis in funding helps the privatisers to come in and demand patient charges. The Lord Warner (Reform report) and the Barker (Kings Fund report) are designed to soften up the public for the the co-payments required by the insurance model they hope to impose.
A kite was flown for patient charges at the GP and RCN conferences, but the doctors and nurses overwhelmingly voted against.
The third thrust of the attack is aimed at NHS staff themselves. All the contracts of NHS staff are under attack.
The defence of the NHS, can only be carried out through mass industrial action by the trade unions, supported by the public.
All the public services are under similar attack and the need of the hour is for a general strike to bring down this Tory coalition.
We need a workers government committed to annulling the PFIs, and the Health Act, and restoring the NHS as a publicly provided service.
The Young Socialists march goes from London on August 19th to the TUC conference in Liverpool on September 7th to lobby for an end to tuition fees and zero-hours contracts and a general strike now.
We urgently need to build a leadership in the unions which stops marking time and instead goes forward to fight for a workers government and socialism.
