THE government is cutting more than £1bn from NHS hospitals.
All over the country, trusts are cutting staff, beds, operating theatres and services.
The result is that capacity in NHS hospitals is being drastically reduced.
At the same time the government is increasing capacity in the corporate private sector. £6.6bn of contracts were signed last year with private treatment and diagnostic companies etc.
The government has pledged in the healthcare outside hospitals white paper (Your health, Your care, Your say, Jan 06) to shift £4bn a year for the next 10 years, from NHS hospitals to ‘community care‘ in order to commission new health centres and polyclinics from multinational companies.
It has continued to spend billions on private finance initiative (PFI) hospital schemes e.g. Barts and London PFI hospital £1.1 bn.
The inescapable conclusion is that the government is now transferring funds out of NHS hospitals and other NHS community services and into the private corporate sector.
‘Crunch point’
On the 18th April, Tony Blair, prime minister, said ‘We have reached crunch point where the process of transition from one system to another is taking place.’ It is.
Up till now, the huge extra funding in the health service which has risen from £37bn in 1997 to more than £80bn this year, has largely been spent on ‘restructuring’ for the market.
There have been increases in staff and waiting times have come down, but the lion’s share of the money has been spent on the following privatisation reforms –
• Privatisation of the bricks and mortar of NHS buildings using PFI and LIFTs. (an equivalent for GP surgeries)
Establishing the Primary care Trusts – a purchasing bureaucracy given the power to ‘commission’ 80 per cent of healthcare.
• The government used the PCTs to open the door for private tendering and uses them to make centrally directed rationing decisions.
PCTs are also used to organise the scam of ‘patient choice’ whereby 15 per cent of NHS patients are directed into the private sector, to provide so called plurality of providers.
• Organising the IT for payments for results (fee for item of service) and the setting up the electronic patient record. The DoH estimated the costs at £40bn over 10 years.
• The organisation of an administrative bureaucracy to account and bill and code for the new method of financing payments by results.
The new transaction costs are estimated to be 15 to 20 per cent of all NHS funding.
• Private sector treatment centres.
• other market reforms such as –
Changing NHS hospitals into Foundation trust businesses owned by their boards and run for profit.
Changing the GPs contract enabling the penetration of large multinationals into the provision of primary care.
Re-introducing GP fund-holding (practice based commissioning) to incentivise GPs not to refer patients to hospital.
It is doing the deed and actually shifting the provision of care out of NHS hospitals and into the corporate private sector in secondary and primary care.
Blair has chosen to make the push using direct cuts by central diktat.
This is why he told managers to ‘grasp the nettle’ (HSJ 23.2.06).
This is why Sir Ian Carruthers the new chief Executive of the NHS told Human Resources Directors to ‘roll up their sleeves’ and get on with the job of making difficult decisions because they have unprecedented backing ‘from the prime minister down.’ (HSJ 4.5.06)
This is why Blair is said to have ‘phoned Patricia Hewitt after her defeat at the RCN conference and supported her, and pointedly kept her on as Health Secretary.
Blair told his press conference on the 8th May, that he wanted to stay on to see through ‘the second stage of NHS reforms’.
The central diktats
Increase staff productivity through performance managed targets.
You must –
• Get your work done in the allotted time as you will not be paid for extra time.
• Do x operations in a theatre list.
• See y new patients in a clinic and reduce follow ups.
• Reduce patients length of stay, you will be benchmarked against a national average.
• Perform 80 per cent of operations as day cases.
• Accept workforce redesign in hospitals at night with more non medical staff doing doctors work.
• Accept skill-mix on the wards with less trained nursing staff.
• Expect that vacancies will not be filled and locums not appointed for sickness and leave.
• Accept that services which do not make a surplus at tarrif will close and that you may be made redundant.
• Reduce sickness.
• Accept that the trust will charge patients for drugs in A/E, day care surgery and charge you more for car parking, canteens prices, etc.
• Accept service ‘reconfigurations’ by strategic health authorities which will involve the closure of whole hospitals.
In essence NHS hospitals are being turned from institutions to provide healthcare for their populations into businesses to cut services which do not make a surplus at tarrif.
Instead of clinical need being the priority, financial profitability is the driver.
When the staff say, ‘but this means cutting services, how can this be justified?’ management say ‘don’t blame us, it is not down to the trust, the SHA has instructed us to get in balance and the PCT will only pay so much.
‘If they won’t pay we can’t do the work’.
The PCTs are the clever instrument, through which the government cuts are transmitted and they have had their own funds cut and they have been instructed to divert 15 per cent or more of their funding into the private sector.
This is a fight against the Blair government
Blair has repeatedly stated that he is staying on to carry through the reforms.
The unions must recognise that Blair has to go now and take action on this issue.
The time has long gone for negotiations. This government is destroying NHS jobs at the rate of 500 a week.
Student nurses and midwives, and physios have no jobs to go to.
Unions must call action
All the health service unions must call for a day of action to stop the NHS cuts and oppose the privatisation reforms.
They must call on the TUC for supporting strike action.
We should coordinate with other public sector workers like the civil servants fighting redundancies and privatisation and the RMT and firemen and local government workers fighting to maintain their pensions.
The unions should also coordinate with patient campaigns to keep their local hospitals open.
What is needed is a new leadership in the unions which is not afraid to call national action to defend the NHS and stop the redundancies, and which calls for public ownership and public provision of services under a workers government and socialism.