Tag 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

Let’s End The NHS “Bottomless Money Pit” Myth

NHSpace questions the common assertion that the NHS is an insatiable resource sink.

Read about the NHS in the media, and you’ll find plenty of comments about how expensive the NHS is. Just the other day, BBC health correspondent Nick Triggle was referring to ministers being ‘frightened’ by ‘how much cash the NHS is swallowing’. The prevailing idea is that we’re already spending too much, and that the government is having to be tough and draw a line.

If you’re reading this, you’re probably willing to question this assertion. But if we want to keep the NHS running as a universal service, how much more funding does it need? Can we as a nation afford to spend that much? And is frontline care benefitting from the increased spending, or is it being siphoned off thanks to government reforms?

The NHS certainly needs more money to continue in its current form. Virtually every NHS Trust in England is now in deficit. If it were just a few isolated cases, you might blame poor financial stewardship. But, as the King’s Fund states, for the vast majority to suffer a shortfall indicates that central funding isn’t keeping pace with the demand for healthcare services.

If we actually want a universal health service able to follow current best practices, how much more do we need to spend right now? Based on the fact that NHS trusts were balancing their books up until 2012/13, NHAspace previously calculated that the NHS is currently underfunded to the tune of £15bn. This assumes that the cost of running the NHS had increased by around 4% each year, which is the historical trend. But can we afford to put in this extra funding?

The simple answer is yes. According to the OECD and WHO datasets, the UK still spends less (both per capita and as a % of GDP) on healthcare than France, Germany, Austria, Holland, Denmark, Norway, Belgium, Canada, Japan, and various other western nations. Per capita, the NHS costs less than half as much as the US healthcare system. But there’s no need to match US spending! Even with an additional £15bn per year, we’d still be lagging behind France’s expenditure per head of population.

The final question then – is the funding reaching the front line? A CHPI report estimates that, following the introduction of the external market by the Health & Social Care Act 2012, the NHS now has 53,000 contracts with the private sector, requiring 25,000 staff and an annual budget of at least £1.5bn to administer. Adding this to other administrative costs brings the total spent on market bureaucracy to an estimated £4.5bn.

Meanwhile the cost of PFI deals, in which the government has tied the NHS into loan repayments for several decades, is at least £2bn per year. And thanks to poor workforce planning and the resulting shortage of permanent staff, the NHS currently pays around £3.5bn per year to agencies for temporary staff.

Between marketisation, PFI loans and agency costs, at least £10bn a year of NHS funding is being diverted. (And that’s in addition to the £12.2bn or more being handed to the private sector each year to run the outsourced NHS services.)

So, next time you hear someone say that the NHS is a ‘bottomless money pit’, remember to point out that we can afford the NHS, but we can’t afford the government’s mishandling of it. We should increase NHS funding to meet demand, but we should also renationalise the NHS and stop the siphoning off of funds by the private sector.

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.

Labour values, the NHS and me – Marcus Chown

Popular science author Marcus Chown has been a victim of the Labour purge. Here’s his response.

It is 5 days since I received an e-mail from the Labour Party telling me it had reason to believe I did not support its aims and beliefs and it was excluding me from voting in the leadership election. I have voted Labour in every election since I was 18. I have been a full member of the Labour Party and even campaigned on the doorstep. But I did not agree with Labour’s policy of privatisation of the NHS (Public funding of private health companies, according to the WHO definition, is privatisation). So I joined a party, formed by doctors, nurses and patients, to truly defend the NHS.

David Cameron explicitly promised “no more top-down reorganisation of the NHS”. But, when the Conservatives came to power in 2010, they introduced the Health & Social Care bill, which they had concealed from the electorate during the election and which was bigger than the bill that had created the NHS in 1948. It removed the government’s “duty to provide” healthcare for you and your family, a founding principle of the NHS, replacing it by a mere “duty to promote”. Even the health minister would no longer have responsibility for your health. It would be left to the “market”. In effect, the bill made possible to gradual abolition of the NHS.

My publisher had got me to do Twitter and, at the start of 2012, I noticed a tweet about Dr Clive Peedell, a consultant oncologist, who was trying to highlight the H&SC bill by running 160 miles to Downing Street from the former South Wales constituency of Nye Bevan, the founder of the NHS. I was training with my wife, an NHS nurse, for the London Marathon. So, on a freezing day, we jogged out to Notting Hill. And that is how I met Clive and ran the final kilometres to Downing Street with him and Clare Gerada, chair of the Royal College of GPs (and her Jack Russell, Lucy). Nine months later, Clive founded the National Health Action Party with ex-MP Dr Richard Taylor and other doctors, nurses and patients who were appalled at the way all the main political parties were wedded to the privatisation of the NHS, which all evidence shows is worse for patients.

I can’t remember how I got invited to an executive meeting (I should stress I have never been on the executive committee) but I remember, when it came to “any other business”, saying the party’s Twitter feed was full of acronyms and doctor jargon. Little did I know that, Clive, sitting across the table, was NHA’s Twitter feed! To his credit, over a cup of tea and cake, he said: “Why don’t you help with our Twitter? Here’s our username and password.”

NHA saw the London euro election of 2014 as an opportunity to raise public awareness of what the government was doing to the NHS, which the UK media had failed to cover or critique, ignoring the overwhelming level of opposition. NHA’s candidate was inner London GP Dr Louise Irvine, who had run the Save Lewisham Hospital campaign. When a court supported her and ruled that the government had acted illegally in downgrading Lewisham’s A&E and maternity departments, the government simply changed the law. Every party was allowed 8 candidates, in the London euro election, with all accumulated votes going to Louise. I got asked to stand and surprised myself by saying, yes. The others included an A&E consultant, a nurse, trainee surgeon, and actor and comedian Rufus Hound.

I should point out that NHA is not a party of power. It has resources only to contest a handful of seats. In the 2015 GE election it was careful not to inadvertently help a Conservative into power, recognising that the Conservatives are a bigger danger to the NHS than Labour.

And so I come to the point of this statement. Rules are rules. I understand that. And, yes, I have helped another party, which rules me out from voting in the leadership election. But NHA, the party I have helped, stands for exactly what the Labour Party should be standing for. I joined NHA in desperation because Labour had been heavily involved in privatisation of the NHS, and PFIs, which have plunged hospitals into enormous debt. Admittedly, Labour’s 2015 manifesto called for the repeal of the H&SC Act. But it pledged simply to “stop the drive towards privatisation” and “cap the profits” of existing private providers. The party said nothing about ending the wasteful “internal market”, which is estimated to divert 15 per cent of NHS money away from patients into bureaucracy.

It seems odd to be accused of not sharing Labour values when I have always voted for Labour and support a party whose values should be shared by the Labour Party – the desire for a publicly funded, publicly delivered NHS, which all evidence shows is the best system for patients not to mention the most cost-effective and efficient. NHA would never have formed in the first place if Labour had been true to its values on the NHS.

It does not seem right to accuse me of not sharing Labour values simply because I have criticised its NHS policy. I would like the Labour party to get into power with a leader who is committed to a publicly funded, publicly delivered NHS, which is what is wanted by the overwhelming majority of people in the UK.