NHS ‘RECONFIGURATION’ IS CLOSING HOSPITALS! – GP role being changed from patient advocate to care denier

Message from a TUC march against Tory government austerity

THE NHS was a key issue in the general election.

US-HMO-style (Health Maintenance Organisations) integrated care systems are being set up all over England.

Provided largely free at the point of use since 1948, and funded by taxation as a publicly provided service with nationalised hospitals, – the NHS provided healthcare for all according to need. Up to 2012, life expectation increased every year.

In the frantic battle to win the election, Tory PM Boris Johnson constantly reiterated that his ‘one nation government’ of four months duration, is putting record amounts of money into the NHS.

This is not true. The so-called ‘extra £35bn per anum’ to be reached by 2023/4 is in fact around only £20.5bn (which Theresa May announced in September 2018) when inflation is taken into account. This does not remotely make up for the billions taken out of the National Health Service England (NHSE) budget by the Tory Lib Dem coalition between 2010 and 2015 and then from 2015 to date. We have suffered nine years of ‘flat line funding’ of 0.1% pa.

The NHS needs 4% per anum increases just to stand still and keep up with population needs, let alone address the backlog of capital spending needed to address crumbling infrastructure. Labour’s proposals for funding would increase funding per anum by around 4%.

Neither the Tories nor Labour like to mention the millstone of the private finance initiative (PFI) used to build new hospitals.

Around £11bn of new hospitals are costing the treasury £88bn of long term debt. John Major’s government initiated this scheme and New Labour’s Blair and Brown implemented it.

The Labour manifesto said it would eliminate PFIs over time. The Tory manifesto did not mention it.

The PFI new hospital building scheme has resulted in the biggest hospital closure programme in history, started by the Tories and accelerated in the Blair years with the Darzi-Nicholson plan to close 60 District General Hospitals (DGHs). All over the country scores of hospitals have been closed in this ‘reconfiguration’ through the device of closing the maternity, paediatrics and A&E departments. This is still in full swing with acute hospitals going in Dorset, Lincoln, Essex, London etc.

Johnson had the cheek to propose the Tory manifesto in the West Midlands town of Telford, in the full knowledge of the green light to close Telford’s A&E at night, so that sick emergency patients will have to be shipped up to Wolverhampton and even Stoke to get emergency care, putting their lives at risk.

Every time a DGH is closed, the neighbouring hospitals become full to capacity, resulting in sick hospital patients languishing in corridors.

It is outrageous that the excuse of ‘purdah’ during the election, meant that the hospital statistics on A&E care, black alerts, etc were postponed till Friday 13th December, the day after the election, so the full scale of the acute hospital crisis was hidden from the public during the election.

Meanwhile, a new study has shown that over 5,000 patients have died prematurely over the last three years because of lying on hospital trolleys for extended periods. These patients could have been saved, had a timely hospital bed and full care been available.

Corbyn’s Labour Party has rightly made a big issue of NHS privatisation which started mainly under Margaret Thatcher, but then proceeded apace under Blair’s Concordat with the private sector in 2000, and the diversion of NHS patients into the private sector, on ‘patient choice’.

Blair’s health advisor from 1997 to 2004 was Simon Stevens, the same Stevens who currently controls the NHS Commissioning Board (NHS England-NHSE) as Chief Executive.

This process accelerated after the Tory-Lib Dem coalition brought in the Health and Social Care Act 2012, which made it mandatory for NHSE and CCGs (Clinical Commissioning Groups) to put every NHS contract over £615,000 out to tender on the market. At the same time, a decision was made to cut training for all NHS professionals which has resulted in the current shortage of over 100,000 NHS staff.

Meanwhile, the 40 year-long bed closure programme has left the NHS the most under-bedded health service in Europe.

Labour’s manifesto stoodfor reversing this Act, and making ‘in-house provision the default option’ rather than outsourcing, and for ‘ending privatisation’.

Corbyn rightly made a key issue of the secret trade talks of government officials with the US government, regarding the purchases of drugs from the US giant pharmaceutical companies at grossly inflated prices.

But it is not just pharmaceuticals which have been discussed. As the retired US trade negotiator David Hennig explained: ‘Everything is potentially up for grabs in a trade negotiation.’ And these have been going on for two years at least.

What was missed out of the election debate is that NHS clinical care is already being packaged up into business structures ready for American corporate investment as we speak.

Simon Stevens was brought back from the US, where he was Head of Global Health and Vice President of UnitedHealth – the biggest American Health insurance company – from 2004 to 2014. There he became the big guru for spreading American Accountable Care methods all over the world. The then Tory PM David Cameron installed him as Chief Executive of NHS England (NHSE) in April 2014.

With the full powers of the Health and Social Care Act behind him, Stevens inaugurated the ‘Five Year Forward View’ (FYFV ) of October 2014, to end District General Hospitals and independent contractor GP surgeries, and replace them with the US model of Accountable Care Organisations (ACOs).

He called the latter ‘new models of care’, amid a spin campaign promoting them as ‘care in the community’, and ‘joined up care around the patient’, and ‘integrated care’.

These work on the same principles as American Health Maintenance Organisations (HMOs) i.e. they are profit making bodies which make their money by denying necessary care. ‘The less care you give, the more money you make’ John Ehrlichman told president Richard Nixon in 1971.

HMOs and ACOs, make their money by using a cheaper skill-mix of staff, forcing doctors to adhere to so called ‘efficient’ managed care plans, and incentivising them to reduce hospital care.

On 7th January this year, the Americanisation programme in the UK, took a giant leap forward with Simon Stevens’ ‘NHS Long Term Plan’ and the agreement by the doctors union the British Medical Association (BMA) to five-year national GP contract reform in England to ‘implement the NHS Long Term Plan’ (31.1.19).

Within six months 7,000 GP practices were herded into 1,259 giant Primary Care Networks (PCNs), taking their NHS registered patients with them, as the clinical delivery arm of 42 Integrated Care Systems in England.

The national NHS in England has effectively been divided into 42 public private partnerships run to make profit from ‘shared savings schemes’. These profits are extracted by incentivising GPs to reduce hospital care (outpatient appointments, elective operations and emergency care) to NHS patients in England.

The role of the GP is being changed from patient advocate to care denier in the financial interests of the Network and the ICS (Integrated Care Systems).

ICSs prepare the ground for ICPs (Integrated Care Providers) which would be able, following changes to the law in Feb 2019, to provide ALL types of medical and social care on ONE NHS long term contract – never seen before in NHS history.

Johnson’s Tory party manifesto was committed to passing all the legislation demanded in the NHS Long Term Plan in the next three months if they won a majority.

Now they have, and pushing ahead with the Plan would make ICPs legal with contracts which could be held by new statutory NHS trusts, with investment opportunities for private partners through joint ventures.

This colossal conspiracy, has been largely kept under wraps by the mainstream media, political parties, and the trade unions.

On 2.12.19 an interesting letter appeared in the Guardian from a Dr Robert Oulton from Godalming, Surrey.

He referred to a Guardian leader article on NHS privatisation on 28.11.19, and then commented: ‘Global capital is certainly desperate to get its hands on £130bn guaranteed annual revenue, but why use cumbersome insurance schemes when you can go straight to the heart of these riches in the public purse and drink deep? …

‘NHS England has been spending the last three years trying to address this in yet another reorganisation, largely unnoticed by the public and press.

‘Its solution to combine CCGs (191) in England into larger “integrated care systems” (ICS, 44 projected) which will be able to commission a single integrated care provider (ICP) to operate all NHS health provision in the ICS area …Whatever emerges from all this, there can be little doubt that the NHS is being reorganised to make possible the acquisition of public contracts at a scale that finally makes sense to global capital … It’s high time NHS England’s plans for the health service were given proper public scrutiny.’

He is saying that NHSE is handing NHS clinical care on a plate to American corporations as profit making investments, under the current secret massive reorganisation plans.

Professor Allyson Pollock and others drew attention to these changes in January 2018 in a seminal paper. She and other prominent health campaigners wrote a letter to the Guardian on 6.12.19 titled ‘Private contracts are at the heart of the NHS crisis’. It starts: ‘The NHS crisis isn’t just about lack of funding.

‘Over the last 30 years the NHS has been structurally dismantled under successive governments, leading to many of the serious failings that we are witnessing. US companies like Kaiser Permanente, McKInsey, Centene and UnitedHealth/Optum have been significantly involved in this, and the delivery of NHS services.

‘US-HMO-style integrated care systems’ are now being installed throughout England …’

The letter suggests that the only way to reverse these processes is by passing the ‘NHS re-instatement bill’. There is silence however, on the forced incorporation of general practices into Networks built into ICSs, as a result of the shocking collaborative role of the BMA with NHSE.

Without NHS registered patients and subordinate GP practices, ICSs could not get off the ground. The union did not even allow GP members a vote.

The only political party to oppose Stevens’ NHSE plans to Americanise the NHS through this massive secret structural change, is the Workers Revolutionary Party.

The News Line daily newspaper has consistently drawn attention to the FYFV and the hospital and GP practice closures. The WRP has campaigned for the reopening of all NHS facilities.

The NHS Long Term Plan and the role of GP contract reform in establishing new primary care networks as the ‘building blocks’ of ICSs was reported in January 2019, March, May, and June 2019. (News Line archives)

The ‘Great NHS Heist’ by Dr Bob Gill, issued in a podcast in April warned that the advent of PCNs as part of the ICS/HMO model would end the traditional GP patient relationship, and hasten the end of British General Practice.

The recent film of this name, highlighted the colossal profits made by US pharmaceutical and insurance companies, whilst millions of Americans die young from lack of healthcare. It showed the critical role of Stevens and NHSE in this process in England.

No amount of parliamentary legislation to restore the NHS, even if it were to get the necessary votes, can return the NHS as a publicly owned and provided system, providing care according to clinical need and not profit, so long as capitalism exists – especially in the current global crisis, where big corporations are scouring the world for easy profit opportunities from the public sector.

It will take a mass revolutionary movement of the working class to get rid of capitalism and build a workers government and a planned socialist economy to restore the NHS on founding principles and all the public services. That is why the WRP stood candidates in the general election. The revolutionary leadership must be rapidly built to lead this struggle.