THE ‘re-configuration’ of 60 District General Hospitals (DGHs) means a huge reduction in National Health Service (NHS) hospital capacity.
This will result in the loss of consultant-led care for large sections of the population and privatisation of the remaining provision.
When the ‘new’ Labour government took office in 1997 it adopted the Conservatives’ health policy and spending plans.
The Tories had prepared the legislative ground for the purchaser-provider split in the NHS and Private Finance Initiative (PFI) schemes for building and extending hospitals.
In 2000, the Labour government used the acute funding crisis to adopt a fundamental change in policy.
In return for increasing the funding of the NHS from 3.5 per cent of Gross Domestic Product (GDP) to seven per cent of GDP, Labour created the NHS Plan 2000.
This contained the seeds of the destruction of the NHS as a publicly-provided and comprehensive service.
• There would be massive new private investment in hospital buildings and General Practitioners’ (GPs) premises using PFI and Local Infrastructure Financial Trust (LIFT) schemes, to be paid for by the local NHS over many years.
• The lion’s share of the new funding would go into ‘re-structuring’, not revenue funds for front-line services.
• There would be a ‘concordat’ with the private sector, which would provide increased capacity.
• There would be an end to the traditional demarcation of roles. Nurses and others would perform doctors’ work.
There then followed an unprecedented wave of reforms, dressed up as ‘modernisation’ and ‘patient choice’ which have, step by step, introduced the infrastructure for a commodity market in healthcare.
The government has increased spending from £37bn in 1997 to £80bn in 2006, with most of it spent on privatisation reforms.
PFI and LIFT consortia built new premises, while hundreds of NHS hospitals and services have been closed to pay for them.
They will continue to be closed to pay for them, as the £8bn down payments involve a £50bn long-term debt.
These hospitals are privately owned and maintained.
In 2002, a purchaser-provider split established 303 primary care organisations, allocated 80 per cent of NHS funds, with commissioning powers.
This opened the door for the Primary Care Trusts (PCTs) to tender out contracts to private companies for NHS work.
The same year, the Department of Health (DoH) launched a plan to welcome external private providers to bid for elective NHS work; the Independent Sector Treatment Centres (ISTCs).
At the same time, the DoH proposed to change the funding system.
Block contracts to NHS hospitals which provided care for all the patients in their catchment area were to end and be replaced by ‘payments by results’ (PBR), whereby each separate procedure has a tariff price and is commissioned as a commodity.
This mechanism facilitates the diversion of funding into a ‘plurality of diverse providers’.
PBR was introduced for elective surgery in 2003, extended in 2006-7 and is due to be applied to two-thirds of procedures by 2007-08.
Legislation went through to turn NHS hospitals into ‘foundation trust’ businesses responsible for making a surplus in May 2003.
On May 13, 2003, Blair told businessmen: ‘We are anxious to ensure that this is the start of opening up the whole of the NHS supply system so that we end up with a situation where the state is the enabler, it is the regulator, but it is not always the provider.’
The years 2004 and 2005 saw central directives applied to the PCTs to out-source up to 15 per cent of their contracts to private providers, such as ISTCs, using the ‘choice’ and ‘choose and book’ mechanisms to divert NHS patients.
GP fund-holding, renamed practice-based commissioning (PBC) has been brought back to incentivise GPs not to refer patients to hospital.
The GPs’ new contract ended their out-of-hours commitment, withdrawing an important part of primary care services, that has opened the door for private agencies and healthcare corporations to move in.
The government dictated that PCTs must tender vacant GP practices to the private sector and the first corporations were allocated contracts in Derbyshire and Barking in 2006.
The NHS Improvement Plan: Putting Patients at the Heart of Public Services, published in June 2004, put private companies at the centre of NHS provision.
Prefaced by John Reid Secretary of State for Health, this described how the old and chronic sick took up expensive hospital beds and proposed a new system, whereby elderly patients would be cared for in their own homes by ‘community matrons’, or have a ‘choice’ of a plurality of providers, including private primary care centres, walk-in centres, pharmacists, etc.
In May 2005, after the general election, the new Health Secretary Patricia Hewitt announced that hospitals all over the country had ‘mismanaged’ their funds and had run up huge ‘deficits’.
In fact, the hospitals had done as instructed and brought down waiting lists by getting work done on waiting list initiatives and in the private sector.
Suddenly the accountancy system was changed and the money spent on these services had to be paid back.
Creating a Patient-led NHS (July 2005) promised 15 million outpatients would no longer be seen in NHS hospitals and would be transferred into private, ‘community’ polyclinics.
Immediately, Community Care, such as district nursing services, etc were no longer to be provided by direct services from PCTs, but out-sourced.
A DoH document on reforming the ambulance service, described how the provision of Accident and Emergency (A&E) services would be drastically reduced and emergency care practitioners, with downloaded electronic patient records, would ‘see and treat’ patients in their own homes.
£40bn, over 10 years, is being spent on providing a national computer database on which to store the medical records of all NHS patients.
Our Health, Our Care, Our Say, in January 2006, proposed cutting five per cent of funding from acute hospitals for 10 years by continuing the ‘turnaround’ cuts and transferring the money into new ‘community care’ facilities:
1. Polyclinics, new specialist community hospitals built by private corporations – to perform day surgery, outpatients, diagnostics and step-down care.
2. New private primary care complexes.
3. Care in your own home, for the old and chronic sick, provided by community matrons, and eventually out-sourced agency carers.
On April 18, 2006, the Prime Minister Tony Blair said: ‘We have reached crunch point where the process of transition from one system to another is taking place.’
He was referring to practice-based commissioning, private providers, and payments by results.
Having put all the building blocks in place, Blair is keen that the NHS as a publicly-funded and provided service should be destroyed and replaced with a publicly-funded, but privately-provided service.
One of the reasons he gave for wanting to stay on as Prime Minister was to see through the ‘NHS reforms’.
• Continued tomorrow
