THE Tory coalition is accelerating its onslaught on the NHS. Every structure that was good in our publicly provided NHS is being destabilised and disintegrated.
On the one hand, the £20bn QIPP ‘savings’ drawn up by McKinseys in 2009 (and projected to cut another £30bn in the next five years), are devastating all our NHS structures with huge funding cuts. On the other hand, the passage of the Health and Social care Act in March 2012, has opened the flood gates for outsourcing clinical care to private companies.
At the heart of the attack are our acute district general hospitals (DGHs) and NHS GP surgeries.
Specialist hospital services are also in their sights. But every service from mental health to pathology, district nursing and midwifery is being ravaged by cuts and privatisation.
GPs, staff and patients marched through Tower Hamlets on 5th June in protest at the imminent bankruptcy of 22 GP surgeries in East London. The Jubilee St. practice recognised that it stood to lose almost £1m of funding over 7 years, due to cuts to Minimum Practice Income Guarantee ( MPIG ).
But 98 practices nationally are at risk!
General practice is suffering a huge crisis, not just from MPIG cuts but also from general long-term underfunding, in the face of a massive increase in workload. Patient contacts with GPs have increased by 40 million per year in 5 years. There is a national shortage of 10,000 GPs, and fewer junior doctors are being recruited.
To think that this has happened by mistake would be wrong. The government has set its compass to end independent contractor status for general practice.
King’s Fund CE, Prof Chris Ham, a proxy voice for central government, says that ‘doing more of the same is not an option’ and that money must be used for ‘transformation of care, not just propping up existing services’. He applauds the view that general practice must cease to be a ‘cottage industry’ and become ‘post industrial’ and proposes ‘investment for reform’.
£5.8bn is being poured into the ‘Better Care Fund’ for this transformation, to ‘join up funding between health and social care’. This is a dangerous development as healthcare is free at the point of use and social care is charged. Once the budgets are merged then healthcare will be charged!
GPs are being forced into federations in order to survive. But the long-term goal, hidden behind coded language such as ‘extended community based services’, leads to competing ‘networks’ covering up to 100,000 registered patients. These networks could cover a million patients (Gerada GP magazine12.6.14. )
The so-called ‘integration’ of primary and secondary care with community care, 24/7 urgent care and social care, with merged funding of health and social care budgets, to provide ‘care closer to home’ is being pushed as the only salvation.
In fact this ‘integration’ is a fraud, as we read that these networks could consist of a prime provider company on a commercial contract, outsourcing to multiple private subcontractors, i.e. in completely disintegrated supply chains.
The King’s Fund’s report ‘Commissioning and funding general practice, making the case for family care networks’ February 2014, explains that the aim of federating GPs is to produce organisations modelled on the US Health Maintenance Organisations (HMOs) of Kaiser Permanente, a giant health insurance company.
HMOs are based on incentivising doctors to cut costs by minimising and denying necessary care for patients, especially by avoiding hospital referrals.
The ‘big conversation’ on patient charges was kicked off again by the Lord Corrigan paper for Reform and the Kate Barker report for the King’s Fund, all part of the preparation for care provided by insurance companies which require co-payments.
GPs reps voted overwhelmingly against patient charges at the LMC conference. Nurses voted 91% against patient charges at the recent RCN conference.
The ‘reconfiguration’ of the DGHs by pulling out their A&Es and maternity and paediatrics continues apace.
Hammersmith and Central Middlesex are due to lose their A&Es on 10th September.
Ealing hospital is planned to follow. Whittington, King George’s, Whipps Cross and Newham are not safe. The Greater Manchester proposals to reduce acute hospitals from 9 to 4 are forwarded. There is a huge reconfiguration in Wales. Campaigners are fighting the removal of acute services from Calderdale Hospital Halifax, and Mid Staffs, to name just a few.
Simon Stevens, the CE of NHS England confirmed in his 4th June speech the plan for two-tier A&E departments outlined in the Keogh review of emergency and acute services.
He said, ‘Which is why – under the fantastic leadership of Bruce Keogh at NHS England we’re working with commissioners and hospitals across the country to designate 40-70 major emergency centres, alongside roughly the current number of existing emergency departments.’
The latest news from NHS England is that there will be ‘Emergency centres’ and ‘Major (or specialist) Emergency Centres’. Cynically, they will all carry the same red and white sign, so that members of the public won’t know the difference. There would also be multiple ‘emergency care centres’.
Keogh’s report said there would be an increased role for stabilisation of seriously unwell patients and their transference in ambulances, from the lesser hospital to the major acute hospital. This is dangerous.
The report also maintained that paramedics would be playing a greater role in assessing and treating emergency patients in their own homes.
But the ambulance service is also being massively cut. Ambulance men and women in Yorkshire are currently balloting for industrial action over staff and patient safety issues. They are concerned that emergency care practitioners (ECAs) with only six weeks training are being instructed to attend ‘red’ emergency calls. Patients are being lined up to die in their own homes.
Stevens’s view on hospital beds is that they are an ‘anachronistic currency’, and has praised the loss of 34,000 beds since 2000.
He also touched on new ways of working. ‘But let me be clear, I am definitely not suggesting a wholesale reorganisation of medical training and staffing across England.’
But that is precisely what is coming. He proposes that DGHs will no longer train juniors and supports the Future Hospital Commission projections for more ‘general physicians’ or ‘hospitalists’ (what are they?) working alongside consultant specialists.
NHSE’s five-year plan focussing on 24/7 working, threatens the current contracts of all medical staff, together with the ‘Agenda for Change’ contracts of other NHS staff.
The TTIP (Transatlantic Trading and Investment Partnership) agreement hangs over us. This would let in US investors to buy up chunks of our NHS. Kaiser Permanente itself could start bidding to run the new ‘integrated’ extended primary care networks.
The dangers ahead must be faced and the conclusion drawn that action has to be taken. The BMA must start to organise physical resistance to these attacks. GP surgeries must not be allowed to go bankrupt, coercing GPs into networks.
The union must organise action to defend GP surgeries and DGHs however late the hour.
Units under threat must be occupied to keep them running. The defence of DGHs and GP surgeries requires industrial action such as strike action and withdrawal of GPs from commissioning.
The BMA must unite with the health unions against the take over of our health service by big business. The entire public sector faces the same fate. There has to be a coming together of all the unions to fend off this destruction of our welfare state.
The NHS and the Welfare State are under a vicious attack from the coalition. Also under very heavy attack are the country’s young people. They now pay £9,000 tuition fees to study at university.
However, there is a government-sponsored campaign under way to lift the £9,000 limit for tuition fees and to have unlimited fees!
Almost a million youth are jobless and face a constant attack at Job Centres where they are continually sanctioned and have their Jobseeker’s Allowance cut or stopped.
Even Labour is now adopting a plan to stop allowing youth access to the Job Seeker’s Allowance. They are to be allowed to starve!
Many youth are being forced onto zero-hours contracts where they are paid very little and are at the disposal of the employer for every hour of the day and night.
They are paid so little and rents are so high that, with savage cuts in housing benefit, they are forced to carry on living with their parents into their late 20s!
On August 19th the Young Socialists will launch a ‘March For Jobs’ from the TUC HQ in London to the TUC Congress in Blackpool to tell the TUC to stop all of the vicious attacks on youth, the working class, the middle class and on services such as the NHS and Welfare State by calling a general strike to bring down the coalition government and bring in a workers’ government.
Tonight, the Young Socialists look forward to welcoming all of the delegates and visitors at the BMA conference to their meeting from 6pm-8pm at the Holiday Inn to discuss the march and the lobby of the TUC Congress on September 7.
