THE National Health Service is under attack on every side by the government. It is being crippled by funding cuts and privatisation reforms.
The latest onslaught is the Darzi Plan for London, which aims to replace NHS GPs and District General Hospitals (DGHs), with privately-owned and run Polyclinics. It is the blue print for privatisation of the NHS in England.
Under orders from central government, many Primary Care Trusts (PCTs) are ‘reconfiguring’ DGHs out of existence.
The method employed is to remove Accident and Emergency (A&E), Paediatrics and Maternity and then run down the rest.
Chase Farm Hospital, in north London, is a typical example, where the consultation only gave local citizens the options for either a Polyclinic and an Urgent Care Centre, or these plus an Elective Surgery Centre. There was no option to keep open a fully functioning DGH, with acute inpatient beds.
The National Audit Office (NAO) found a third of PCTs and hospital trusts were in deficits in 2006/7.
PCTs are also strapped for cash as they have been instructed to build new hospitals as Private Finance Initiative (PFI) schemes and are running up debts trying to finance them.
In order to reduce the use of NHS hospitals, PCTs have been instructed to interfere with GP referrals to consultants, by demand management techniques. They are listing procedures which will not be provided by hospitals in their areas.
They are diverting patients away from hospitals and back into primary care to see GP specialists. In the North West, GP referrals are being diverted into Independent Clinical Assessment and Treatment Centres (ICATs), where private companies organise staff, to see new patients, who may not be medically qualified. They use protocols to send them for investigations provided by private companies.
Only if the patients are more complicated than the company can deal with, do the patients get referred to NHS hospitals.
At a time when hospitals only get paid for the work that they do, through Payments by Results (PbR) tariffs, this takes work away from NHS hospitals and financially destabilises them.
But this is the government’s aim. Everything becomes clear with the Darzi Plan for London. ICATS are now given a new name – Polyclinics.
Not only are they to take away 50 per cent of patients, that would normally be seen in hospital outpatients, but they are also to take away from hospitals 100 per cent of routine diagnostics, such as X rays and other tests, AND minor surgery and endoscopies.
In addition, it is proposed that they take 40 per cent of urgent cases away from hospital A&E and put them into Urgent Care Centres.
Thus the plan is, to shift the majority of care of walking hospital patients into Polyclinics. These would be staffed by GPs, nurse-practitioner specialists, staff nurses, a few consultants and no junior doctors.
But polyclinics are also intended to provide ALL the General Practice of the future. Initially, each would contain 25 or more GPs, but in the course of time all GPs would be pressurised to move into them. So the local NHS GP would be phased out!
Polyclinics would thus be a hybrid of Primary Care and Secondary Care. Darzi does not say so, but they would be owned and run by private healthcare corporations, who would see NHS patients for profit.
The details of the services, staffing and funding of Polyclinics are to be found in the ‘Technical Paper’ of the Darzi Plan, which reads like a prospectus for private investors.
Their design is based on American Health Maintenance Organisations (HMOs). The report speaks favourably of Kaiser Permanente, one of the biggest and most notorious of American HMO providers.
With the advent of Practice-Based Commissioning and the ownership of Polyclinics, private companies would then control the entire flow of patients into Secondary Care.
This process will accelerate the present instructions for PCTs to hand over their own commissioning role to the private sector.
Hampshire’s new head of commissioning has just been seconded from the private commissioning company Humana, and this PCT has been named as one piloting the use of private companies to support commissioning.
Darzi makes clear his A Framework of Action will take the form of ‘new pathways of care’, which will be determined by the commissioners.
Instead of seeing a Consultant at the hospital, the commissioners ‘best practice pathway’ could insist the NHS patient sees a Non-Medically-Qualified Practitioner at the private Polyclinic.
So it will not be a patient or medical staff that will be deciding on patients’ care, but the commissioners, and the government are making sure that they will be private companies.
To pay for the 150 new Polyclinics in London, each with catchment areas of 50,000 population, not only will NHS land and infrastructure be sold off on a massive scale, but eight to 24 of London’s 32 DGHs will be closed down.
With them will go high-quality, acute Consultant-led departments in Obstetrics, Paediatrics, Intensive Care (ITU), Emergency Surgery and A&E.
The Darzi Plan means the end of our tried and tested NHS institutions; General Practice, which provided 24-hour personalised care, and access to the specialist care of a Consultant at a DGH.
These would become things of the past. For-profit care of private Polyclinic/HMOs would replace it.
Then it would be ‘core services’ only and charges for all the rest. An insurance-based system would follow.
The Health Service Journal informs us that the government has accepted all Darzi’s recommendations. (HSJ 11.10.07. p6)
However, there are some campaigners close to the trade union bureaucracy, who seek to mislead people that the Darzi Plan ‘deserves to be taken seriously in proposing some radical changes and seeking genuine modernisation to deliver improved health and social care provision across Greater London’.
London Health Emergency’s account of the Darzi Plan says: ‘We believe that there might be some merit in the proposal for polyclinics . . .’ It calls for the piloting of Polyclinics.
It actually suggests that ‘. . . the focus of the report is on the development of the NHS as a public service’, ending with the statement: ‘Professor Darzi may have identified some better ways forward.’
Nothing could be more dangerous than to spread the illusion that the Darzi Plan is about improving a publicly-provided NHS. It is the complete opposite. It spells out the total destruction of the NHS as a publicly-owned and publicly-provided service.
Such deceptive responses, provide a figleaf for some public sector trade union leaders to hide behind.
The celebration of the 60th Anniversary of the NHS today, must be accompanied by urgent plans to defend it.
It is not enough to make speeches and applaud. It is not enough to talk about a campaign against a pay cut, next year.
These attacks are speeding ahead now.
The NHS has never been under greater threat from the privateers, who are being sponsored by Brown’s government.
The conspiracy of silence must cease. The trade union leaders must stop going along with the closures and privatisations, and stop funding the Labour Party.
A new leadership must be rapidly built in the trade unions to take forward this fight nationally, building on the tremendous local campaigns, which have been taking place all over the country.
Every local campaign must continue to challenge the spurious consultations and broaden to take in all the local residents and staff, and workers from other industries, to build Councils of Action.
These should organise to defend our hospitals by all means necessary, including occupations to maintain fully functioning hospitals.
Hospital land and buildings are public property and must remain in the hands of the public. They belong to us, we need them and we must protect them.
All the public services are being privatised by this government. United action by all public sector unions has been called for by the Civil Servants trade union, the PCS.
The Health Service unions must coordinate their actions with civil servants, postal workers, firefighters teachers and council workers, and all public sector workers, in strike action to stop redundancies and defend our public services.
This government has no mandate for privatisation of public services and it must go. The unions must organise a general strike to kick it out.
It must be replaced by a workers’ government that will expand a publicly-owned and publicly-provided NHS, as part of a socialist programme.
