NHS AUSTERITY – planned by Department of Health


THE government is already drawing up crisis measures to privatise the NHS.

A ‘long list of possibilities’ is contained in a leaked Department of Health memo to the Emergency Strategy Committee, which include:

1. ‘Abolish primary care trusts and franchise health maintenance and delivery’

2. ‘Lift restrictions on the location of primary medical and pharmacy businesses and on professional demarcations’

3. ‘Increase the range of medicines available over the counter’

4. ‘Allow PCTs to suspend GP contracts where quality and productivity fall below minimum thresholds’

5. ‘Commission all primary care’

6. ‘Allow practice-based commissioning groups to take on real budgets’

7. ‘Introduce charges and co-payments’

8. ‘Allowing commercial sponsorship of health care provision’

9. ‘Allowing foundation trusts to become fully commercial’

10. ‘Changing governance arrangements’

11. ‘Changing the retirement age’

12. ‘Pay and reward changes’

13. ‘Effectiveness filters for treatment Rationale’

14. ‘Make the tariff a maximum and allow price competition’

15. ‘Introduce a national, open access, online talking therapy service’

16. ‘Promote health tourism’

17. ‘Renege on previously agreed right to treatment’

18. ‘Induce a large-scale sale of NHS estate’

19. ‘Remove public consultation requirements for proposals involving major service change’

20. ‘Becoming a model employer’

The leaked memo forms Appendix B in the King’s Fund report ‘Windmill 2009 – NHS response to the financial storm’, which opens with the words: ‘The health service is about to enter a new era.

‘After years of unprecedented growth, it faces the prospect of unprecedented austerity.’

Raising the matter in parliament on March 2, Independent MP Dr Richard Taylor said: ‘Appendix B apparently fell off the back of a lorry – it is a leaked Department of Health memo with a long list of possibilities for the Emergency Strategy Committee to consider.’

The NHS Confederation, which represents NHS managers, estimates that there will be funding cuts of at least £8-10 billion to the NHS within the next two to three years – rising to £15 billion in the next five years.

But reports yesterday said that cuts of at least £20 billion were being planned over the next three years, starting from April.

Appendix B to the King’s Fund report says: ‘For the second round of “the storm scenario’’, we introduced the health and social care “emergency strategy committee’’ (ESC).

‘At its first meeting, the ESC asked for a “no holds barred’’ appraisal of the range of interventions and freedoms that could be considered … A leaked memo from the Department of Health outlined a long list of possibilities for the ESC to consider.’

Under Proposal 1, the leaked document says PCT management costs are around £1.2 billion.

‘This proposal would replace PCT commissioning with franchises’ that would bid to provide health care, with bidders ‘competing for the best offer at the best price’.

Proposal 2 on pharmacies says ‘competition could help to drive out inefficient businesses’.

Proposal 3 would encourage people to ‘buy basic medicines directly rather than on prescription’.

Under Proposal 4 on GPs ‘a nationally specified efficiency threshold’ would be negotiated with the British Medical Association.

‘There would be no transitional support for affected practices.’

Under Proposal 6: ‘Practices would have to demonstrate that they were sufficiently strong business organisations’.

Proposal 7 says: ‘A small number of symbolic charges could help to shift attitudes and behaviours, and co-payments would provide an income stream to providers.’

‘Areas where charges could be considered include: a) first GP appointments; b) outpatient appointments where patients fail to attend (if they have not previously notified the provider); and c) inappropriate patient requests for ambulance services.

‘Co-payments might be sought for: a) hospital meals; b) single rooms; c) more expensive drugs; and d) faster and more flexible appointment times.’

Proposal 8 would create ‘Sponsorship schemes … locally negotiated and managed.

‘Some minimal but common sense restrictions would be put in place to protect the reputation of the NHS. For example, tobacco or alcohol sponsorship would not be allowed.’

Under Proposal 9, Foundation Trusts would be treated as ‘competitive businesses.

‘Restrictions that would need to be removed include opportunities to establish commercial or joint ventures, and the private income cap.’

Proposal 10 involves ‘reducing the number of PCTs so they cover a minimum size of 1 million people’.

Proposal 11 would raise the retirement age to 70.

‘Earlier retirements would be allowed, with a corresponding reduction in pension entitlements.’

Proposal 12 would involve replacing part of consultants’ salaries ‘with productivity payments’.

Proposal 13 ‘would allow treatments to be rationed and funding directed to patients with greatest potential to benefit’.

There would be ‘disinvestment for procedures that offer marginal benefits’.

Proposal 15 involves ‘online talking therapy’ to ‘dramatically reduce the costs of care and access to care for low-level mental illness’.

Proposal 16 encourages patients to go to Europe for ‘dental care, plastic surgery and a range of orthopaedic procedures’.

Proposal 17 states All NICE assessments on treatment ‘would be for guidance to PCTs and providers rather than mandatory’.

Under Proposal 18, ‘Foundation trusts and PCTs would be forced to sell land and buildings through a nationally managed scheme.’

Proposal 19 would mean ‘Legal requirements to consult with the public would be removed,’ and Proposal 20 aims to slash sickness absence amongst NHS staff.