THE ‘Framework for Action’ plan for London’s healthcare, fronted by Professor Sir Ara Darzi, proposes the destruction of a publicly-provided National Health Service (NHS) in London.
It is a blue print for privatising the NHS nationally.
Lord Darzi, the National Advisor on Surgery, has been working with the Labour government for 10 years on the NHS plan.
He has promoted the separation of elective surgery away from emergency surgery and into Independent Sector Treatment Centres (ISTCs).
Under Gordon Brown he has been elevated to Under Secretary of State for Health, and he is being used to pretend that doctors are in favour of dismantling the NHS.
This lengthy document is designed to deceive the unwary, laced as it is with fine phrases about improving healthcare and ending inequality. Nothing could be further from the truth.
It claims to be about services not institutions. In fact, it proposes to smash the fundamental institutions of the NHS, general practices and District General Hospitals (DGHs), and replace them with brand new institutions: POLYCLINICS.
Though the report does not say so, these would be owned and run by private healthcare corporations and would act like American health maintenance organisations.
The essence of the destruction plan is to be found in the Technical paper.
Accountants have analysed all the health care procedures performed in London in 2005/6.
Using the techniques developed for Payments by Results (PBR) tariffs, every healthcare procedure performed in 2005/6 has been classified by HRG (Health Related Group) and the volume of each of them recorded.
London’s entire healthcare is then viewed from a commercial perspective and is laid out as a prospectus to attract private healthcare investors.
It is the complete antithesis of a medical approach to healthcare, which starts out from clinical needs.
‘Service Lines’ are carved into bits based on prospective profitability.
Elective Surgery, for example, is divided into ‘complex’, ‘high throughput’, ‘minor procedures’ and ‘under 17s’.
‘High throughput’ procedures include cataracts, arthroscopies and inguinal hernia repairs.
These belong to the surgical specialties of ophthalmology, orthopaedics and general surgery, but are all lumped together because they are attractive to ISTCs as short episodes of surgical care.
We are told that the small group behind the technical paper worked to ‘guiding principles’, the first of which was to allocate to polyclinics every aspect of healthcare which could be removed from traditional institutions.
This is what they have done. Essentially, every walking patient having a daytime procedure has been allocated to polyclinic care.
Sixty per cent of London’s healthcare would end up in them. They would contain:
* 70% of all GPs, with the plan that over time all independent GPs will be phased out and go into them
* 50% of community care (district nurses etc)
* 50% of out-patients clinics, shifted out of hospitals
* 50% of A&E patients shifted from hospitals into walk-in urgent care centres
* all ‘routine’ diagnostics, such as X-rays and scans.
They would also take regular attenders, patients with long-term conditions, patients having chemo therapy, and do endoscopies and minor operations etc.
Polyclinics would predominantly employ GPs, and nurse practitioners or other practitioners. There would be a few consultants and staff nurse support. There would be no junior doctors.
For 150 new polyclinics each with catchment areas of 50,000 population to be successfully launched, London’s District General Hospitals are to be largely destroyed.
Obliteration of District General Hospitals – the decimation of acute care
The report says: ‘The days of the DGH seeking to provide all services to high enough standard are over.’
The plan is that the 32 DGHs in London would be reduced to between 8 to 16 major acute hospitals.
The other 16 to 24 DGHs would either be destroyed or turned into rumps called Local Hospitals.
Local Hospitals would have medical in-patients only.
There would be no surgeons or anaesthetists on site. Intensive care units would be closed.
The accident and emergency (A&E) department would remain open, but would be in the dangerous situation of not having surgery on site.
So if a surgical emergency arrived or developed, they propose that either a surgeon would be called in from another hospital, or, if the patient were very ill, he would be intubated and ventilated and shipped across London in an ambulance to one of the few acute major hospitals left. This is a recipe for disaster.
Supposedly, ambulancemen would be trained to decide which patient should go to the urgent care centre, which to a Local Hospital and which to a major acute hospital.
They would learn to ‘by-pass’ hospitals.
Those DGHs closed completely, as is planned at Chase Farm Hospital in Enfield, could become sites for polyclinics with walk-in urgent care centres and elective surgical centres (ISTCs).
Darzi says that six clinical working groups were set up to advise him on the new models for healthcare (mental health left to one side):
1. maternity and new born
2. staying healthy
3. acute care
4. planned care
5. longterm conditions
6. end of life care.
1, 3 and 5 are to be cut to the bone; 2, 4, and 6 are to enjoy new investment for the private sector.
1, 3, 5 all comprise consultant intensive hospital specialties.
1. Consultant-led obstetric units are to be reduced and replaced with midwife-led birthing units and home births (to increase from 2% now to 10% target in the future).
3. Paediatrics, emergency and elective surgery, and intensive care units, are to be stripped out of DGHs as described above.
5. Patients with long-term conditions such as diabetes, who, in their old age make up the majority of acute hospital admissions, are to have their acute care massively cut.
Every effort is to be made to keep them out of hospital. They are to look after themselves, and go to polyclinics.
2, 4 and 6 are to enjoy new investment. Private enterprises are to be employed keeping people healthy. Planned care like out-patients, diagnostics and elective surgery are to expand into polyclinics and ISTCs.
As for the dying, the DoH has suddenly developed huge enthusiasm for helping patients to die out of hospital and in their own home. Private companies called ‘End of Life Service Providers’ are to get the lucrative contracts.
Disintegration of care
What we had in the NHS was primary care; (GPs and community care), which was local and personal; secondary care (DGHs and teaching hospitals); embracing all aspects of hospital care on one site and providing training for the next generation of doctors and other staff; and tertiary care (more specialised hospitals for less prevalent conditions such as neurosurgery, burns, etc).
The Darzi plan proposes to disintegrate care into seven models:
Elective surgery centres;
Major acute hospital;
Academic Health Science Centres.
Polyclinics and elective surgery centres would be owned and run by private corporations.
The latter hospitals have to become Foundation Trusts by 2008 so these would be run as businesses.
Local Hospitals would be starved of funds from tariffs as their elective services moved into polyclinics. They could end up being gradually run down. There would be no NHS left.
‘Commissioning can only drive change if it has a direct impact on the income of healthcare providers.
Funding flows need to be used to incentivise the best practice contained in this report. At its simplest, this means commissioners defining the best practice for a patient pathway and then ensuring that this and only this is the best practice they pay for.’
These stark words say it all. The commissioners will dictate so called ‘best practice’. If that means a patient can only be seen by a nurse practitioner in a polyclinic and not by a consultant at a specialist hospital, so be it.
The commissioning role of PCTs is now being outsourced so that the private corporations themselves will be laying down the rules of so-called ‘best practice’.
The money for this massive new investment plan is to come from the sale of NHS lands and assets.
The report makes clear that ‘demand management’ will reduce large areas of care provision.
Lastly, and not mentioned in the report, the posts of hundreds of hospital doctors, consultants, staff grades and junior doctors will be lost if the DGHs are allowed to close.
The Darzi plan must be totally rejected. It represents a huge reduction in the volume and quality of care for Londoners in the interests of big business.
The BMA should unite with other unions in fighting to defend the NHS.