DOCTORS will be challenging the government’s privatisation of the NHS at the British Medical Association’s Annual Representative Meeting in Edinburgh, which starts today.
On this 60th anniversary of the National Health Service, our health service has never been under a greater threat.
Last week, health minister Lord Darzi’s NHS Stage Review Final Report, ‘High Quality For All’, was published. It was accompanied by documents on a proposed NHS constitution and on the workforce.
This was followed last Thursday by the publication of the government’s ‘Our Vision For Primary and Community Care’.
These entrench the views of Darzi, as expressed in his previous reports, ‘Healthcare For London’ last July and ‘Our NHS, Our Future’ in September.
The recent Confederation of British Industry (CBI) report anticipated the Darzi NHS review by calling for ‘failing hospitals to be replaced with private clinics’.
The essence of the ‘Healthcare for London’ proposals are that NHS GP surgeries should be phased out and replaced with polyclinics containing 25 or more GPs and a catchment population of 50,000.
Polyclinics would also provide many of the elective services at present delivered by hospitals, such as outpatients, scans and X-rays, other diagnostic tests, minor surgery, endoscopy, etc., comprising 60 per cent of all healthcare procedures.
Earlier this year, it became clear that giving contracts to the corporate private sector in Primary Care was government policy, as London Primary Care Trusts (PCTs) gave contracts to Atos Origin and United Health, against bids from excellent local GPs.
Last September, Darzi said that ‘the days of district general hospitals (DGHs) providing care to high standard are over’ and suggested that half to two-thirds of London’s DGHs would be run down, or closed.
PCTs have been instructed by the Department of Health (DoH) to instigate polyclinics by December 2008.
Plans to close GP surgeries have been put in place. The ‘re-configuration’ and dismantling of hospitals is proceeding apace.
Despite the talk of ‘quality standards’, the main aim of the plans is to make it increasingly difficult for NHS GPs and DGHs to survive.
They are to be saddled with a battery of new targets; for patient satisfaction, staff happiness, cleanliness, outcome metrics, etc., on the basis of which, if they do not score highly, they will lose funding.
In addition, Payments by Results (PBR) tariffs will be altered from fixed national tariffs to the most ‘cost effective’, i.e cheapest, so funding will again be lost.
GPs are to lose their catchment areas and Minimum Practice Income guarantees, in a bid to bring in private corporate competitors.
There is to be more commissioning of Community Care from the social enterprise ‘third sector’ private sector, and individual patient budgets.
The scene is set for nurse and other practitioner-led care to replace doctor-led care.
Every hospital is to become a Foundation Trust, as quickly as possible, and run as a business.
Clinicians are to be trained as business managers and take responsibility for their budgets and make sure that every ‘service line’ makes a surplus.
Darzi hopes this will hasten the day when Integrated Care Organisations (ICOs) come into existence, containing primary, secondary and tertiary care. Polyclinics are already mooted to be built in the grounds of hospitals.
These ICOs would mimic US Health Maintenance Organisations, notorious for charges, cherry-picking patients and denying hospital care.
The proposed NHS constitution is to enshrine that the NHS works ‘in partnership’ with private companies ‘to provide and deliver’ and ensure ‘minimum standards’.
Yet a market of competing corporate private providers can never provide universal comprehensive healthcare.
The door is being opened for ‘minimal services’, top- up fees, Foundation Trust businesses and ICOs, ripe for selling off to CBI corporations.
Patients already realise that their NHS services are at risk and are taking to the streets and campaigning for their hospitals and GP surgeries.
For doctors, not only are their jobs at risk, but their clinical freedom, their training and their national terms and conditions.
Doctors are trained to provide the best clinical care for their patients and act as patient advocates. Their job is not to manage ‘service lines’ and maximise profits.
In the interests of their patients, BMA reps need to take a stand and oppose the government’s privatising agenda.
There are 20 motions opposing polyclinics on the conference agenda.
There are also scores of motions opposing giving NHS work to private companies and deploring the purchaser-provider split, private commissioning and other privatisation ‘reforms’.
It must be clear to BMA members that they will have to turn to their patients and the rest of the trade union movement for support in the fight to defeat this government’s destruction of the NHS and to bring in a worers’ government that will defend and develop it.