BY ANNA ATHOW BMA COUNCIL MEMBER
ON April 4th, Health Secretary Andrew Lansley announced ‘a pause’, a two month ‘listening exercise’, in implementing the unpopular Health and Social Care bill.
He said he would listen to what people had to say about the bill which he is pushing through parliament, in the natural pause before the bill goes to the House of Lords.
The bill aims to turn the NHS in England from a largely publicly provided monopoly service into an open competitive market, such that any private profit -making company could bid to provide NHS care; the ‘any willing provider’ policy.
It would turn the NHS into a huge public-private partnership, in which big corporations would mint money out of safe government contracts, along the lines of the £70bn PFI hospital building programme.
The bill would hand 80 per cent of NHS money to new commissioners, with which to purchase hospital and community care in England. There would be a new NHS commissioning board and GP commissioning consortiums.
Many soon realised that these consortiums would end up being run by private commercial companies, with GPs only nominally in charge, giving these companies a further opportunity to milk the NHS for profits for shareholders.
Lansley was forced to announce this ‘listening pause’ because of the enormous opposition to the bill, from trade unions, and professional organisations.
Eventually Labour’s Ed Miliband called for junking the bill, and even the Liberal Democratic party, which is part of the coalition government, developed major criticisms.
The British Medical Association (BMA), the main doctors’ union, organised a Special Representative Meeting (SRM) on the March 15 to discuss it and representatives voted for the bill to be withdrawn, although the leadership pushed through motions supporting GP commissioning.
Unison said that the bill should be scrapped. Unite, which contains the Medical Practitioners union, is opposed to the bill in its entirety.
The nurses at the RCN conference in April were so hostile to the cuts and the bill that Lansley did not dare address the conference. They took a 98.7 per cent vote of no confidence in his handling of the health bill.
The Royal College of General Practitioners ( RCGP ) expressed concern that GPs would face an impossible conflict of interest as they would be contracted to provide primary care for patients, at the same time as commissioning hospital and community care while forced to cut the NHS budget.
The Parliamentary Health Select Committee, and the Public Accounts Committee were sceptical that the bill’s ‘reforms’ could be successfully implemented at the same time as making £20bn of ‘efficiency savings,’ which they thought were the main issue.
This is why Lansley set up a special group, the NHS Futures Forum, to appear to take stock and consider criticisms.
The ‘red lines’
However, both he and Prime Minister Cameron made it clear, that there were ‘red lines’ which would not be sacrificed.
Cameron said he would not go back on GP commissioning consortiums, the independent commissioning board to oversee them, every hospital becoming a foundation trust (FT), Payment by Results tariffs and the abolition of primary care trusts (PCTs) by 2013. In other words, there would only be minor tweaks to the bill.
After all, on February 20, Cameron announced that, in future, the government would not bother with separate bills to privatise different services like the Royal Mail and the NHS. He said there should be a presumption that public services must be open to delivery by private companies.
He would bring out a white paper that would give an automatic right for private bodies to bid for public work. The Telegraph commented that these changes could ultimately see many functions of the NHS, from operations to walk-in triage, being run by private firms.
He need not have worried. The NHS Futures Forum set up by Lansley contains ardent supporters of privatisation measures, led by chairman Steven Field. It was Dr Field, former chairman of the RCGP, who publicly urged the BMA not to totally oppose the health bill at their SRM.
The Forum therefore is a cosmetic exercise.
On May 4th, Prime Minister, Cameron announced the setting up of a separate group of health policy experts, to advise him on how to manoeuvre the health bill through parliament.
The group includes leading lights who assisted Tony Blair to implement Labour’s stepwise privatisation of the NHS: former NHS Chief Executives Lord Nigel Crisp and Sir Ian Carruthers, Bill Moyes former chairman of Monitor, Mark Britnell, former Department of Health director of commissioning and now Head of Health for management consultants KPMG, and Nicolaus Henke, head of global health systems at McKinsey.
Number 10’s new health policy advisor, Paul Gape, trained by McKinsey, set up the group.
Meanwhile the real job of axing the NHS and physically smashing it up, is proceeding apace. In fact it is accelerating.
David Nicholson, Chief Executive (CE) of the NHS and chairman of the NHS commissioning board, (even before the bill has been enacted), wrote to Strategic Health authorities (SHAs) and primary care trusts (PCTs), and pathfinder consortia leads on April 13 and told them to implement its provisions.
As the PCTs are being dismantled and making staff redundant, they are simultaneously (i) setting up the GP commissioning consortiums as ‘shadow pathfinders’ (ii) implementing the £20bn ‘efficiency savings’ and cutting the money to the hospitals (iii) increasingly putting NHS services out to tender to private companies. These include services such as ambulance transport, path labs, community hospitals, walk-in centres and more private finance initiative (PFI) newbuild hospitals.
Nicholson has a track record in the NHS as a hatchet man. He won his spurs in the 1980’s closing down the mental hospitals in the Thatcher era.
He was chairman of the West Midlands SHA at the time that Mid Staffordshire hospital was cutting nurses and medical staff to save £10m, to become a foundation trust. Cynthia Bower, chairman of the Care Quality Commission, testified to the public enquiry last month, that the Mid Staffs disaster happened on his watch.
He is an ardent supporter of the Foundation Trust (FT) business model and is pushing through the requirement that every NHS trust becomes a FT by April 2013.
Nicholson told the BBC in February that if hospitals do not reach the bar of financial surplus set by Monitor, then hospitals must merge, be run down or be taken over by private companies.
The employers organisation, the NHS Federation, was more frank in January. It said that hospitals would have to close as a result of the reforms in the health bill.
It said that allowing GPs to commission services from ‘any willing provider’, could mean the closure of some hospitals and units in order to make way for new private providers.
That demolition job, has already begun under Nicholson’s diktats at the Department of Health (DH ). PCTs are being grouped into larger administrative groups called clusters.
These clusters are instructed to implement the £20bn cuts. These are euphemistically called QUIPP efficiency savings (Quality Innovation Productivity and Prevention) or CIPs (Cost Improvement Programmes) but they are straight cuts to staff, beds, departments and whole hospitals.
The PCT clusters, these interim commissioners, are DECOMMISSIONING services on a massive scale.
Throughout the country, they have drawn up lists of operations and procedures that can no longer be performed by their hospitals.
Depending on post code, this can be anything from hip and knee replacements, to inguinal hernia repairs, to operations for carpal tunnel syndrome or trigger finger, hysterectomies for bleeding, IVF treatment etc.
The hospitals depend on the PCTs commissioning money in order to function. Without this funding, they cannot provide the care to patients. Waiting lists are starting to lengthen.
Emergency patients, of course, still keep coming. But the DH has ordained that hospitals will not be fully reimbursed for their care if the number of emergency admissions via A&E exceeds last year’s figure.
Also, patients who are re- admitted within 30 days of discharge will not be paid for, which is expected to deprive NHS hospitals of £790m of funding.
The so called ‘pause’ is designed to hide the fact that the biggest ever destruction of hospital care is taking place in the UK, coupled with the biggest ever outsourcing of clinical care to the private sector in England.
• continued tomorrow
