The Health and Social Care Bill aims to end the NHS as a public service.
It legislates for private companies to do NHS clinical work for profit in England. New commissioning bodies would be set up to bring in the market of private providers.
The aim of the Coalition government is to massively cut the public provision of NHS healthcare through the £20bn QUIPP (Quality Innovation Prevention and Productivity) savings, and to privatise what is left using the Health Bill.
These two plans are inextricable. Both are the work of the US management consultants McKinsey, which have advised successive governments.
The direction of travel is towards an American model of mixed funding; a rump free public service, many services denied or charged for, and a private sector with health insurance.
Individual health budgets in the Bill facilitate this direction of travel.
Millions of patients will be denied access to proper hospital consultant care.
OPEN MARKET OF
PRIVATE PROVIDERS
The bill sets up a market such that ‘Any Qualified Provider’ – private companies or the new commercialised Foundation Trusts (FTs), could compete to deliver NHS clinical services.
Monitor would regulate the market using the rules of the Cooperation and Competition Panel and EU competition law. Price competition is central, with or without tariffs.
PRESENT NHS
ADMINISTRATION
DISMANTLED.
In order to drive in this market, the old NHS administrative structures are to be dismantled; the role of the Secretary of State for Health as an ensurer of the public provision of comprehensive healthcare for the population would end.
The roles of the Strategic Health Authorities (SHAs) and Primary Care Trusts (PCTs) which worked under his direction via the Department of Health (DH), to plan and address clinical need, would be removed.
RELINQUISHMENT OF THE RESPONSIBILITY OF THE SOS FOR HEALTH TO PROVIDE COMPREHENSIVE HEALTH SERVICES FOR THE POPULATION
In their place, the SoS for Health would be nominally accountable for the NHS, but would hand the job of securing care to a new NHS Commissioning Board. (NCB) and its subordinate CCGs (Clinical Care Groups).
These would decide what NHS care would be provided and what not in collaboration with the two other arms length bodies; Monitor and the Care Quality Commission (CQC).
Essentially what health care was provided in England would be up to the arms length bodies and market forces, in the interests of profit. There would no longer be planning for population clinical need.
NEW COMMISSIONING BODIES TO ESTABLISH THE MARKET.
The state-appointed NCB would establish the market, through a ‘choice mandate’ in the Bill. ‘Choice’ means private companies doing the work. The NHS commissioning board is a privatisation board.
It would be given The English NHS budget of £80bn pounds; £20bn for its own commissioning (GPs, dentistry, etc) and other functions (including all the main functions of the old DH); £60bn for the Clinical Care Groups (CCGs – previously called GP Commissioning Consortia) for hospital and community care.
The CCGs work under the direction of the NCB, and also have a ‘choice mandate’.
THE NEW
COMMISSIONING
POWERS TO CUT
NHS SPENDING
Both the NCB and the CCGs are charged under the bill with adhering to budget.
There has been a consistent policy especially in the last nine years of moving funds out of publicly provided NHS acute hospitals into privately provided so-called ‘community’ facilities.
This clamour got louder with the 2007 Darzi plans to close 60 DGHs and transfer elective surgery, endoscopy, diagnostics, walk-in care, into private polyclinics, urgent care centres and treatment centres.
But, this was not enough for the private sector. The McKinsey report of 2009 demanded a £20bn SHIFT of funding for this RECONFIGURATION.
QIPP plus the Bill are termed the Nicholson Challenge, visible from outer space, because no nation has every embarked on such a massive destructive of healthcare.
FOR A SUCCESSFUL TRANSITION FROM PUBLIC TO PRIVATE, THERE MUST BE A MASS HOSPITAL
CLOSURE PROGRAMME.
For the Health Bill privatisation to be successful it is imperative that the McKinsey cuts are carried into action immediately.
That is why Sir Nigel Crisp, former NHS CE, yet again this week demanded instant hospital closures as a matter of urgency and that all care for long term conditions like diabetes, chronic chest and heart disease etc should be provided in the ‘community’.
The NCB, Monitor and the new CCGs have been delegated these powers of reconfiguration.
What we are witnessing is thousands of nurses and other staff being made redundant by cash starved NHS hospitals, said to be ‘in deficit’, as a result of this policy.
Hospitals are being forced to close wards, sell lands and close or merge.
This is but a glimpse of the destruction and decimation which the new commissioning powers of the NCB and CCGs will wreak.
CLINICAL SENATES.
The Clinical Senates of handpicked ‘clinical leaders’, housed in the NCB, have been introduced into the Bill to make sure that the CCGs adopt a large-scale strategy of concentrating secondary care in fewer more distant hospitals, and that they don’t bow down to patient pressure to keep local DGHs open.
HOSPITALS UNDER THE BILL WILL BE CLOSED OR
PRIVATISED THROUGH THE ROUTE OF
FOUNDATION TRUST STATUS.
The major achievement for the NHS in 1948 was the nationalisaton of the hospital network and the establishment of consultant-led care for the working class.
Under the Bill every hospital trust must become a foundation trust business. These would have new commercial features such as unlimited private patients, making them like private companies.
Given the scale of the QIPP cuts, many hospitals will not be able to make money on the market.
Each will try to ‘cherry pick’ the fitter patients, with less risk, which are more profitable.
The complex patients will rely on what is left of the NHS or go without. Many hospitals will go bankrupt and close. The bill would outlaw them being taken back as NHS trusts, run by the NHS for patient need.
Secret emails of the DH were exposed on Sunday 4th September showing plans to hand over the management of 20 or more NHS hospitals to large private corporations.
This, together with FT status and the PFI provision of the buildings, readies the hospitals for full scale denationalisation and privatisation.
STAFF
Competition on the market will drive private hospitals and commercialised FT trusts to cut staff and drive down terms and conditions in order to maximise profits. Pensions will no longer be public sector pensions. A massive increase in redundancies would be inevitable.
THE POISENED
CHALICE OF THE
CCGS FOR GPS
GPs would be forced to join a CCG through legislated change to their contracts, on pain of losing their job. They would be corporatised into these structures which could be owned and run by a commercial company.
They would be made to put their name to and obey the policies of the CCG – to outsource care pathways, reconfigure hospital care and make the QIPP cuts, ahead of their duty to provide the optimal clinical care, to their patients.
HMOs and THE BILL’S INTEGRATED CARE
GPs would take on a dual role of being doctors and commissioners (purchasers), providers and budget cutters.
This is a major goal of the bill called ‘Clinical and Financial Alignment’, ‘Make and Pay’, to change the nature of the medical profession in England to the US model.
Doctor-commissioning and -providing is a feature of commercial American Health Maintenance organisations, where it is combined with health insurance.
This is the type of ‘integrated care’ the Bill alludes to.
Another is the ‘integration’ of NHS and social care, so that what used to be provided free in the NHS, such as services for pregnant women, could be charged.
THE PRIVATISATON OF COMMISSIONING.
The commissioning support functions of CCGs (eg billing and contracting) can be outsourced and federated.
A huge role for ‘commissioning support’ is being prepared by the DH to be handed over to the large healthcare corporations and management consultants McKinseys, United Health KPMG etc. It has already begun. These multinationals will influence how the £80billion of NHS money is spent in England
THE END OF BRITISH MEDICINE
The national publicly provided medical and education system through Deaneries is ended in the Bill. The market providers are given this job.
THE WAY FORWARD.
1. Every NHS hospital and unit must be kept open. There must be a fight by the unions to protect every job which should be met with industrial action as necessary. Places of work should be kept open with staff occupations calling on the support of local residents, other unions and campaign groups in Councils of Action.
2. There has to be a fight by the unions nationally to defeat the Health Bill. It is the responsibility of the big health unions, Unison, The BMA, RCN, Unite, GMB, to explain to their members and the public that the NHS as a public service free at the point of use is being destroyed and privatised. There should be massive campaigns.
They should coordinate joint industrial action and call on the TUC and all TUC affiliated unions to come out on general strike action, so that this Bill is removed from the parliamentary agenda, the coalition brought down and a workers government that will defend the NHS brought in.
Given that this government is pledged to privatise all the public services, the chances of its changing its mind are zero, so the only realistic perspective is to mobilise action to bring the government down.
It must be replaced with a workers government committed to socialist policies of nationalisation under workers control, to restore the public services run for need and not profit.
3. The need of the hour is the building of a new revolutionary leadership in the unions to remove the treacherous reformist leaders.
Lobby the TUC next Monday with the Young Socialists to demand the TUC takes action to smash the Bill and bring down the coalition.
