Commenting on the government’s NHS ‘reforms’, Professor Ham, a former Director of Strategy at the Department of Health said: ‘The foundations have been laid for a complete transformation of health care delivery.
‘We are shifting from an integrated system, in which the National Health Service provided virtually all the care, to a much more mixed one, in which the private sector will play an increasingly major part.
‘The government has started down the road which will see the NHS increasingly become a health insurer.’
A crippling £1.2bn funding squeeze, over 18 months, has led to a huge reduction in capacity in NHS hospitals, forcing the closure of thousands of beds, the loss of 20,000 nursing staff posts, and those of many others such as secretaries, pathologists and administrative staff, and the closure of scores of essential community hospitals.
In June 2006, the new NHS Chief Executive David Nicholson said he wanted to drive the reforms faster, and was keen to see plenty of new entrants to the market ‘right through to the private sector running district general hospitals’ (DGH).
A month later, the Department of Health (DoH) put out an advert for the out-sourcing of the whole of Primary Care Trust (PCT) commissioning money, i.e. £60bn, to the corporate sector.
This would enable them to use all this public funding to commission from themselves and essentially allow the privatisation of all healthcare in England.
In September 2006, Health Secretary Patricia Hewitt announced there would be no limit on the private provision of clinical services.
Health Service Journal (HSJ) published a study, in which they revealed that 60 per cent of Independent sector Treatment Centres (ISTC) capacity was unused and that PCTs were being ‘left with massive bills.
‘Where ISTC operators don’t carry out enough procedures to reach a guaranteed value, they still get paid – potentially costing the NHS millions of pounds in unused capacity.’
On September 13, David Nicholson, told the Guardian that he planned to ‘reconfigure’ 60 hospitals, a quarter of English hospitals.
He said that the £512m deficit would ‘squeeze over-capacity’ out of the hospitals.
He announced that A&Es, paediatrics and consultant-led maternity units were no longer efficient.
Injured patients should either go to hi-tech tertiary centres, or to walk-in urgent care centres.
Rupert Murdoch stated that Chancellor Gordon Brown would be judged on whether he privatised Education and Health.
The removal of A&Es, maternity and paediatrics from 60 NHS DGHs in England will put an end to them as acute comprehensive hospitals.
They will then become ‘cold sites’, which can be turned into a ISTCs, new community hospitals, primary care centres, or the land sold off to developers.
This mass hospital closure programme, plus the new commissioning powers of PCTs to reduce the work done by remaining hospitals, means a huge reduction in NHS hospital capacity.
The DoH is investing £1bn in primary care and a further £750m in a new generation of community hospitals.
Patient access to consultant-led clinical services, both acute and elective, will be drastically reduced.
Privately provided, new community hospitals (polyclinics) will be most unlikely to employ consultants.
Remaining acute hospitals will be PFI builds and Foundation Trusts, run along business lines.
It is proposed that many patients, with acute medical emergencies, be treated at home, or at a walk-in centre, according to a draft Directory of Ambulatory Emergency Care, produced by the Institute for Innovation and Improvement.
They will not receive consultant-led hospital care. There will be deaths as a result.
Hewitt stated on November 25 that there are far too many hospital doctors, indicating that many hospital staff face unemployment.
She was preparing the way for the leaked draft of the NHS pay and workforce strategy for 2008-11, on January 4, 2007.
This says there will be ‘an excess supply of 3,200 whole-time equivalent consultants which we cannot afford to employ’.
It encourages Foundation Trusts to create ‘more cost-effective’, sub-consultant roles and more fixed-term appointments.
It suggests a ‘sharp reduction’ in staff numbers this year and reducing the NHS workforce by 2.75 per cent, or 37,000, and more use of temporary staff, a ‘market model’ for employment.
DGHs employ consultants and train junior doctors. The run-down and closure of 60 DGHs will mean thousands of consultant redundancies and early retirements, and a large reduction in long-term training posts for juniors.
There will also be the loss of thousands more nursing, paramedical and health scientist posts, and ancillary posts.
What is being forced through is a huge withdrawal of medical care, with the withdrawal of the right of patients to see a consultant.
The right of a General Practitioner (GP) to refer to consultant colleagues is being removed.
Clinical Assessment and Triage (CATs) are being introduced by the PCTs all over England, on the orders of the DoH, to prevent GPs’ letters reaching hospital consultants.
‘Demand Management’ techniques are being used to pressurise GPs not to refer patients to hospital.
Already many patients, with skin, musculo skeletal and diabetic conditions, are being removed from consultant outpatient clinics and are being diverted back to their GPs, or non medical practitioners.
This process is accelerating as the PCTs force trusts to close departments by withdrawing funds.
The result will be that poor patients will not see a consultant. The better off will pay.
At the heart of the foundation of the NHS in 1948, was the nationalisation of the hospitals and the opening of the door, for the first time, through the GP, to consultant care for every citizen who needed it, free at the point of use.
All over the country, huge campaigns are taking place. Patients and staff are battling to save their local DGHs.
These have served us well for 40 years and provided high standards of consultant-led care.
The health service unions and Trades Union Congress (TUC) which should be leading this fight, gave a muted start with a lobby of Parliament on November 1, 2006.
The downgrading and closure of our District General Hospitals is a necessary part of the government’s plan to privatise clinical services.
The funds are being taken from them and transferred into ISTCs, PFI hospitals, Local Infrastructure Finance Trust (LIFTS), Specialist Community Hospitals and corporate primary care.
It will result in the biggest reduction in healthcare services since 1948.
Universal access to consultant care is being abolished.
Every single DGH must stay open with full funding and all services.
The trade unions and local campaigns must organise councils of action in every area, to organise demonstrations, pickets, occupations and strike action, to put a stop to cuts and closures and defend every single NHS hospital.
The national unions must be forced to take general strike action to defend the NHS hospitals and defeat this government, to replace it with a workers’ government that will adopt socialist policies and expand the NHS.
This requires the building of a new leadership in the unions to replace those leaders who collaborate with the government’s plans and refuse to organise action.
