THE government has launched a blitzkrieg of around £900m cuts to NHS hospitals resulting in the closure of thousands of hospital beds and compulsory redundancies. Over 4000 jobs were lost in the last 3 weeks and predictions for future losses reach 25,000 plus. These include nurses midwives and consultants.
The Blair-Brown government portrays these cuts as ‘deficits’ and blames local hospitals of mismanagement.
The government gave the money to hospitals before the May 2005 election to meet the waiting time targets.
Since the election, the government has moved the goal posts and demanded the money back.
Trusts have to make savings for this year and pay back historic ‘debts’ from last year and the year before.
These are not deficits. These are cuts. Turn around teams of city accountants, costing millions, have been drafted in to make sure they happen.
This financial crisis in the NHS is not the fault of management. It is government created. It is part of a conscious plan to close down NHS hospitals.
As the government forces through £900 million of cuts in NHS hospitals they have announced a further £6.6 billion of contracts to the big healthcare corporations. (BMJ Vol330, 21.5.05 p1170)
NHS hospitals are at the heart of the government’s attack.
The nationalisation of the hospitals was the greatest gain of the NHS.
The jumble of poor law, fever and voluntary hospitals which existed before 1948, could not meet the needs of the second world war, and the government commandeered them to create a national network, making available secondary and tertiary care for the injured soldiers.
The working class was not prepared to go back to the hungry thirties and Labour won a landslide election in 1945.
The NHS for the first time enabled access for the whole population to specialist care; to consultants.
In the 1960s district general hospitals (DGHs) and teaching hospitals grew up in which all specialties were present, so that patients from the catchment area could receive comprehensive care for their different conditions at one time and place.
This integration of elective and emergency care, medicine surgery and anaesthetics, obstetrics and gynaecology paediatrics and geriatrics, diagnostics and ITU, in-patients and out-patients, was highly efficient in clinical and economic terms, with units run to capacity.
The system of block funding meant no money was wasted on buying, selling and billing. The treatment of the fit subsidised that of the complex and chronic sick. There were large risk pools.
NHS hospitals are huge schools, that teach and train healthcare professionals.
If NHS hospitals are broken up and closed down then the training of junior doctors will be decimated.
The reason why NHS Hospitals are at the heart of the Blair government’s attack is because the nationalised hospital system gives such high quality consultant-led care, and is so economically efficient, that it acts as a barrier to privatisation.
The government wants to privatise the provision of clinical services, in the same way as Thatcher privatised ancillary services in the 1980s.
They aim for a public /private partnership, in which the NHS will purchase from corporate private healthcare companies in much the same way as the rail network is run.
The private contractors will make large profits, services will be axed and will no longer be universal and in 2008 when the funding is reduced, the patients will pay.
This is the only way to understand where all the money has gone.
The government itself said in the NHS plan 2000 that the new money would be largely spent on restructuring rather than revenue funds. And that is what they have done.
The lion’s share of the money has been spent on privatisation reforms.
Funding has gone up from £37bn in 1997 to £80 bn now and will increase up to 2008.
It has been invested in market reforms which undermine NHS hospitals on every side.
We have already seen:
– a new hospital building plan using the PFI (private finance initiative) causing the biggest hospital closure programme ever, resulting in crippling longterm payments and cuts in services to pay for them;
– 303 expensive primary care trusts (PCTs), creating the purchaser provider split which opened the door for the private sector to come in through the ‘choice’ diktat;
– practise based commissioning (GP fundholding) designed to ration referrals to hospital;
– £40 bn to be spent over 10 years for the central computerised patient records and IT, to facilitate payments by results (PBR) and a ‘choice’ diversion to the private sector;
– the billing accounting and pricing bureaucracy needed for PBR giving transaction costs approaching 15% of funding compared to 4% administration costs of public provision;
– 34 new private treatment centres to compete with and dismember elective surgery in NHS hospitals and – contracts to the private scanning companies to do the same for hospital diagnostic departments;
– the transformation of NHS hospitals into foundation trusts businesses;
– a colossal increase in NHS management and management consultants.
The new consultant and GP contracts facilitated these changes, particularly the loss of the GP monopoly of primary care.
With payments by results due to rollout for all procedures this month, a further massive destabilisation of NHS hospital funding will take place, with only the ‘fittest’ in business terms surviving.
The blitzkrieg cuts on the hospitals are the start of the healthcare outside hospital ‘care in the community’ fraud. (‘Our health, our care, our say’: Jan 06)
At the same time as cutting 5% of funding from hospitals, (£4 billion a year for 10 years) this money is to be shifted into the ‘community’ and used to boost private corporate healthcare investment.
It will be used to fund a large expansion in primary care in the form of new corporate provider health centres which will compete with traditional GPs.
These new private entrants will pick up NHS capitation fees with which to commission services from their own companies.
There is to be a large expansion in so-called ‘specialist community care’ to take profitable work away from NHS hospitals.
50 polyclinics staffed by ‘practitioners’ will provide day case surgery, outpatients, step down care and diagnostics. This will be done by unbundling consultant-led hospital care pathways and removing 15 million outpatients from hospitals.
The so called ‘third sector’; the voluntary sector or cooperatives, which could also own the new facilities are defined by the fact that, as for the corporate private sector, their staff will not be on NHS terms and conditions and pensions and will be cheap and expendable.
The chronic sick are to be kept out of hospital and to be case-managed by glorified district nurses called community matrons, who may delegate to healthcare assistants.
The elderly must be encouraged to die at home as it is said to be cheaper. This is possible, given that the carers are to be dual purpose social and healthcare, untrained, unregistered, agency carers.
Social care and healthcare is to be amalgamated, with PCTs and Local authorities having boundaries in common, and social and healthcare records fused, so that the separation between health and social care become so blurred that healthcare can be means tested and charged for.
As Blair’s forward says: ‘We will cut back on bureaucracy so local government and the NHS work effectively in tandem and give customers a bigger voice over the care they receive.’
The other huge blow to NHS hospital care is the onslaught on A/E departments. (‘Taking healthcare to the patient’ June 2005) This foresees millions of patients kept out of A/E so that patients with conditions such as acute asthma attacks and cardiac exacerbations will be managed by emergency care practitioners who ‘see and treat’ them in their homes.
National emergency services director Prof Alberti, is proposing the closure of scores of A/E departments.
‘He believes that the public need to be educated that the fully equipped A/E department of the past is not now required for every hospital.’ (HSJ 30.3.06)
According to the report commissioned by the National Leadership Network on DGHs, (HSJ 30.3.06) ‘Round the clock access to acute medicine and diagnostic radiology must be provided . . . on site.
‘But other services, such as emergency surgery and trauma, could be located at another hospital in the local network.’
The report suggests that even if the ambulance took the patient to the wrong hospital, ‘that every A/E department should have access to advice from consultant surgeons within one hour.’
This is the opposite of the ATLS guidelines for immediate availability of hands-on care within the ‘golden hour’ and the start of disbanding of training of junior doctors in trauma teams.
The reason for their urgent desire to close A/Es and remove surgical cover, is their drive to concentrate elective surgery on reconfigured single sites.
There is no profit to be made from the treatment of emergencies but elective surgery concentrated on single sites would be ripe for selling off to the private sector.
These attacks are government policy. ‘The prime minister has made it clear to his inner circle that he wants to tackle the financial crisis in the health service and push through NHS reforms before he stands aside.’ (Guardian 24.3.06).
Simon Stevens was Blair’s health adviser before he became president of UnitedHealth Europe and is the architect of these reforms.
Simon Stevens (BMA News 1.4.06) tells us that ‘not every reform is a betrayal’ and that the NHS must be ‘depoliticised.’
The privatisation of NHS clinical services by the forced introduction of global capitalist enterprises to compete with and break up our nationalised hospital network, drive out traditional general practice and the outsourcing of community services is overtly political and aims to destroy the NHS.
New Labour is doing it against the wishes of its own party. There was a large majority at the Labour party conference last Autumn for a Unison motion calling for halting the reforms.
The reason why the government has to dress up the privatisation of NHS provision as ‘modernisation’, ‘choice’ and ‘innovation’, is that the NHS as a public service providing high quality healthcare to the whole population free at the point of use is massively popular. The patients’ campaigns all over the country to save local hospitals proves this.
It is outrageous that the BMA has invited this spokesman of corporate america to head its morning platform of pro-government speakers at this conference. This was not what the members requested.
Blair has laid down the guantlet. The unions must take it up.
NHS hospitals must be defended. The hospital closures and forced redundancies must stop.
Blair’s blitzkrieg must be resisted with action. The BMA must call on all health unions to unite in a Day of Action to demand that funding is restored to NHS hospitals and the privatisation is halted.
The health unions should call on the TUC to call out all affiliated unions in strike action as every worker and their family is affected.
This should be the start of a campaign for unlimited national strike action to defend the NHS and remove this privatising government.