Category Archives: NHS Privatisation

Briefing: The NHS Reinstatement Bill 

The NHS Reinstatement Bill has its second reading in the House of Commons on Friday 24th February 2017. Here is a briefing written by Roger Gartland and adapted for NHSpace by Deborah Harrington.

What does the Bill do?

The NHS Reinstatement Bill abolishes twenty five years of commercialisation of the NHS.  Everything from Labour’s internal market and purchaser provider split to the Coalition’s NHS England and competitive tendering will go.  In their place will be provisions to bring the NHS back into public ownership, including reducing PFI debt, protecting the NHS from trade treaties and bringing the staff’s employment terms and conditions together under an NHS Staff Council. Most importantly, the Bill reinstates the duty of the Secretary of State to secure the NHS for the public good as a service in which private profiteering has no place.

What difference does public service make to the NHS?

In the current climate of cuts and closures the biggest impact of the bill will be substantial savings which can be redirected to patient care. Aneurin Bevan reported the cost of NHS administration in its first year as 3% of budget.

£10bn a year could be saved by ending the market in the NHS

In 2010 the Commons Health Select Committee found the cost of administration in running the NHS as a ‘market’ was 14% of budget. In April 2014 (in the week when Simon Stevens, after ten years at the top of “United Healthcare”  of America, took over as CEO of NHS England) Dr Jacky Davis, Consultant radiologist and co-chair of the NHS Consultants’ Association, stated £10bn a year, the 9% difference in administration costs could be saved by ending the market in the NHS.

Who supports the Bill?

The Bill was first put forward by Lord David Owen in 2013 as a response to the Coalition’s Health & Social Care Act. Supporting the Bill has been one of NHA’s policies since then. The Bill was developed by Professor Allyson Pollock and Peter Roderick and was first tabled in parliament by Caroline Lucas of the Green Party. A letter was published in the Guardian in support of the Bill with more than 300 famous names from the arts, sport and the academic world, such as Alan Bennett, Jonathan Pryce, Darcey Bussell, Helena Kennedy QC and Sir Raymond Tallis.

In addition Lucas was backed by cross-party support from 77 MPs; a unanimous resolution in support from Unite together with endorsement from the BMA and 63,733 names on a ‘38 Degrees’ public petition. But to carry weight the Bill must be supported by the Opposition – and that means the Labour Party.

To carry weight the Bill must be supported by the Labour Party.

Rachael Maskell MP, Unite’s Head of Health and an NHS physiotherapist for 20 years before being elected to parliament in 2015, called all Labour MPs to a meeting in June 2016 in the Commons to brief them, “on how the NHS is currently undergoing a massive reorganisation in order to reduce its services and to further privatisation, and how this will not be stopped without the NHS Reinstatement Bill.”

What’s happening next?

Margaret Greenwood, Labour MP for Wirral West, will bring the Reinstatement Bill back to Parliament for its second reading on Friday 24 February 2017. She tabled it under the parliamentary ‘ten minute rule’ on 13 July 2016. It is not likely to be given any time, but showing support for it is one of the best ways an MP can demonstrate a real commitment to bringing our NHS back into public hands. Ask your MP to make time to see Peter Roderick, the Bill’s co-author in the House of Commons tomorrow and Tuesday, 30 & 31st January.

www.nhsbill2015.org

Why Are Doctors Striking Again?

The BMA are planning a further series of walkouts, this time stretching to five consecutive walkouts each month (8am-5pm). But why are doctors still unhappy? NHSpace looks at some if the reasons.

1 – The contract still isn’t fair

There are some serious problems with the contract that Hunt is imposing, including poor treatment of pregnant women and parents who work part-time. The latest version of the contract pretends to fix these, but the fix is time-limited so that future doctors will suffer. Hunt is treating the contract like a broadband contract, offering a good deal initially but a bad one in the long run. Doctors care about their future colleagues and aren’t about to sell them out.

2 – The government is slashing the NHS

Groups such as the NHA have been aware of the STP hospital closure plans for several months. Now that these ‘secret plans’ are finally being reported in the media, you can be certain that every doctor is aware of the latest hatchet job being performed on the NHS. The idea that Hunt could achieve a ‘truly 7 day NHS’ with no additional funds was nonsensical; expecting it to happen in the midst of massive service cuts is utterly ridiculous.

3 – Whistleblowers are still being punished

The Chris Day case highlighted the fact that doctors in training posts has no whistleblowing protection and could lose their careers just for speaking up. The BMA has made some headway by asking Health Education England to acknowledge their duty as a de facto employer, but you can expect doctors to push for a cast iron commitment to whistleblower protection.

4 – The government are privatising the NHS 

The STP hospital closure plans will create huge gaps in England’s healthcare system; gaps which the private health companies will be happy to fill, for a fee. Healthcare is already being rationed (ask anyone applying for routine surgery that requires ‘funding approval’), but the STPs will take us to the point where co-payments and top-up health insurance become the norm. This isn’t what today’s doctors signed up for.

Read more about privatisation: 5 Forms Of NHS Privatisation You Should Know About.

5 – Jeremy Hunt was reinstated

By inviting Jeremy Hunt to continue as Health Secretary, Theresa May has shown a lack of respect for medical professionals. But in all honesty, Hunt is just a figurehead. The gradual sell-off of the NHS and mistreatment of its workforce is a core Conservative policy, both due to the party’s ideology and their ties with corporate party donors, many of whom own shares in private healthcare. Doctors will express their anger at Hunt, but of course the problem goes much deeper.

5 Things You Should Know About STP

The Sustainability and Transformation Plans have divided the NHS in England into 44 local areas, and each has been told to cut services as part of a nationwide ‘financial reset’. But what’s actually going on, and how much of the government’s reasoning is just spin? NHSpace brings you a handy myth-busting guide.

1 – NHS Trusts aren’t overspending

The narrative of STPs is that our hospitals are in debt due to overspending. That would be true if the government had matched the NHS budget to the actual healthcare needs of our country, but they haven’t.

The cost of healthcare increases by 4% each year. In the UK, this is referred to as ‘NHS inflation’. If NHS funding doesn’t keep pace with this inflation, then services have to be cut or closed.

David Nicholson and Simon Stevens have both used their time as NHS England CEO to implement austerity measures, leading to a cumulative shortfall in funding of at least £35bn per year by 2020:

Year Increase Needed Actual Increase Shortfall
2010-2015  £20bn  £7bn  £13bn
2015-2020  £30bn  £8bn  £22bn
Total (2010-2020)  £50bn  £15bn  £35bn

The NHS is underfunded, and is actually spending less than it should on healthcare. That’s quite the opposite of an ‘overspend’!

2 – The NHS isn’t unaffordable

Pundits love to tell us about the new challenges facing the NHS, claiming that we now cannot afford universal healthcare. We are told that hospitals are overspending and that they are in debt.

In fact, the NHS is extremely affordable. Here’s a list of healthcare spending in several westernised countries in 2014:

Country Per person ($) % of GDP
Belgium 4,884 10.6
Canada 5,291 10.4
France 4,959 11.5
Germany 5,410 11.3
Holland 5,693 10.9
United Kingdom 3,935 9.1
USA 9,402 17.1

As the table shows, the UK could easily choose to dedicate an extra percent of its GDP to healthcare, providing the NHS with the funds needed to sustain a modern health service.

3 – Hospitals aren’t overstaffed

The ‘financial reset’ planned for the NHS includes a limit on staff recruitment, the implication being that hospitals need to cut back on excessive hiring of permanent staff. Considering the billions spent on hiring agency staff to fill rota gaps, this is certainly not true.

The underlying issue here is safety. Following the Francis Report into the Mid Staffs scandal, hospital managers decided that they would rather exceed their budgets and hire more staff, than be guilty of manslaughter. Fed up with being ignored, the DoH is now coming down on managers with an iron fist. Anyone caught protecting staffing levels by overspending will be subject to a ‘failure regime’.

4 – This Isn’t About Centralisation 

Centralisation of specialised services can improve outcomes for patients with specific illnesses. But trauma, cardiac and stroke services have already become centralised. For many other illnesses, and for maternity and step-down care, it’s important to have smaller District General Hospitals (DGHs) and Community Hospitals. These provide care closer to home and take the pressure off the big, specialised centres.

So don’t be fooled. Closing A&Es and taking services away from local hospitals isn’t centralisation. It’s un-evidenced vandalism in the name of cost savings.

5 – This Is About Creating A Two Tier System

The level of cuts and closures required by the STPs is such that the NHS will become unable to provide a universal service. Rationing will increase, so that most routine procedures will be refused funding. Once various DGHs have closed, the hospitals still standing will struggle with their increased catchment areas and will be forced to provide essentials only.

This was already envisaged by Simon Stevens, who is keen to separate emergency care from routine care. Emergencies will be handled in NHS hospitals, whilst the routine work will be handled by the private sector. Patients wishing to undergo non-essential procedures will find themselves needing to pay to have their cataracts and hernias treated or their tonsils removed.

Bye Bye, Heidi

NHSpace reflects on the sudden departure of the Labour shadow health secretary.

To be honest, we were hoping this day would come. Meetings involving Heidi Alexander have all ended in disappointment. The shadow health secretary persisted in supporting Simon Stevens and his privatising Five Year Forward View. She was a damp squib when it came to the doctors’ strikes, and she did nothing to support the NHS Reinstatement Bill.

As one NHA executive member puts it:

“I have been in 2 meetings with HA. She refused to go on [junior doctor] picket lines. She refused to even wear a BMA badge. Her stance on health policy supported the ongoing privatisation in the form of Stevens 5YFV. Quote ‘I believe Stevens has the best interests of the NHS at heart’. A former UnitedHealth president here to complete the transition to an American style insurance system has her confidence. That says it all.”

Now that the Blairites liked Heidi Alexander are leaving Corbyn’s cabinet, there’s hope that JC will install someone who truly supports the NHS as his shadow health sec. Someone who will come out strongly in favour of a renationalised NHS, and recognise that things don’t have to be the way that Hunt and Stevens want them to be.

The STP hospital closure plans are already being rolled out, and it won’t be long before A&Es and DGHs start being forced to close in order to pay off local NHS ‘debts’. Labour need to start shouting from the rooftops about these sorts of healthcare issues. With the right MPs in charge, maybe they will.

#PublicDuty Twitterstorm

Last January, we organised a mass-whistleblowing. NHS campaigners and staff united to send 30,000 tweets exposing the Tories, with the hashtag #PublicDuty trending UK-wide on Twitter that day. The catalyst was this tweet from Dr Clive Peedell:

clivetweet

Now we’re calling for a repeat performance. The Tories have done nothing in the last year but anger and upset thousands of NHS staff, patients, and members of the public. We want to take that energy and focus it, exposing the Tories with a coordinated action on the eve of the next doctors’ strike.

Here’s how you can help:

  1. Sign up to our Thunderclap campaign, which will schedule an automatic tweet for you at the start of the Twitterstorm.
  2. Join us on Twitter at 7pm, Tuesday 8th March and tweet with #PublicDuty. We suggest tweets along the lines of “As a (job) with (number) years NHS experience, it’s my #PublicDuty to inform you that the Tories are dismantling and privatising the NHS“.
  3. Use the Twitter search box to find and retweet other #PublicDuty tweets.

Thank you in advance for your support. Together we can cut through the spin and send a clear message to the public.

The NHS Privatisation Bubble

Some investigative work by Private Eye has uncovered a worrying new development in the world of NHS privatisation. Private firms that are failing to turn a profit on NHS work are surviving thanks to the promise of further contracts, thus creating the potential for a huge equity bubble funded by taxpayers’ money.

Until now, we’d assumed that private companies would want to cherry-pick the easier, more profitable work. There’s more money to be had in minor surgery than in complex and unscheduled care, so companies would tend to build surgical centres rather than emergency departments and geriatric wards.

So why, then, are private firms taking on work that doesn’t pay? The answer is that the firms are in many cases owned by hedge funds who make large profits using the money given to the firms by the NHS. This can only continue as long as the firms continue to win new contracts – as the Eye puts it, “private companies losing money from NHS work survive entirely on funding secured on the promise of… yet more NHS work”.

Such a system sounds like a Ponzi scheme, but it also has all the hallmarks of a bubble. Firms desperate to be given more money will take whatever contracts they can get, growing their share of NHS work for as long as they can. If the bubble bursts early on, the firm goes bankrupt and the NHS is left to pick up the pieces. However, if the bubble grows for long enough, these private companies could become too big to fail, leaving the government to choose between a massive bailout and a healthcare collapse.


NHSpace has chosen not to name individual firms, for obvious reasons. You can read about the specifics on page 37 of the current edition of Private Eye (issue 1393).

5 Forms Of NHS Privatisation You Should Know About

Anyone who knows what’s happening to the NHS should know that a large part of the NHS budget is now controlled by CCGs, who are forced to offer NHS contracts up to private companies. You’d be forgiven for thinking that was the only form of privatisation taking place in the NHS. It’s not. Here are five forms of NHS privatisation that you really should know about.

1 – PropCo

NHS Property Services Ltd (PropCo) was launched in April 2013 and now owns £3 billion worth of NHS land and buildings. These assets were once held by the now-abolished Primary Care Trusts and Strategic Health Authorities; now PropCo is responsible for selling them off to property developers. Furthermore, while the government currently owns all of PropCo’s shares, the Act that created PropCo allows for private firms to buy the majority of these shares. Thus large swathes of NHS land could quickly pass into private hands.

2 – PFI/PF2

You’ve probably heard of the Private Finance Initiative and its sequel, PF2. You may think these are merely expensive loans with Wonga-style interest rates. Certainly these deals are bad value for the taxpayer and have pushed many hospitals into the red, but they’re more than just that. For at least the 25-30 year repayment period, the private firm providing the loan actually owns the hospital. Thus, more than a hundred NHS facilities are owned by banks and shell companies.

3 – Commissioning Support Units

Although CCGs were created by the 2012 Act to decide where the money goes, it is the CSUs that provide the infrastructure. CSUs are there to run tenders, manage contracts, provide IT and HR services and other back-office admin functions. The Act created CSUs as part of the NHS structure, but from 2016 the CSUs will become independent businesses to be bought out by private firms. In fact, the sale has already begun. If private firms take over the CSUs they will have a huge influence on the funding and rationing of healthcare in this country.

4 – Personal Health Budgets

Personal Health Budgets (PHBs), in which an individual is allocated a limited amount of money to cover their healthcare needs, are already being introduced in England. While there is the obvious spectre of ‘top-up’ payments for those who exceed their allocated budget, there is another issue here. The classical pattern of funding in the NHS is that money is allocated to Trusts according to the amount of work they need to do. PHBs allow for a move to the private insurance model, where everyone pays in a premium (in this case their PHB) and the private firms then decide who gets treated/which claims to pay out on. You can just imagine the worried well opting to pay their PHB into a private insurer in return for cheaper gym membership and money off their holidays. Meanwhile, the genuinely-ill would end up paying top-ups to access increasingly rationed basic NHS treatment. Combine universal PHBs with privatised CSUs and you get an American-style health system.

5 – Foundation Trusts and Mutualisation

If the land, buildings, back office and budgets have all been privatised, what does that leave? That’s right, the NHS Trusts themselves. All hospital trusts now have a mandate to become independent businesses known as Foundation Trusts. These are standalone organisations which have to keep themselves in the black, and can do so by taking on as much private work as they want. As with the CSUs, the FTs are units ripe for privatisation, which in this case is dressed up as warm and fuzzy “mutualisation“. This means passing from public ownership into the hands of ‘stakeholders’. That’s right, privatisation.


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