So David Cameron was out schmoozing on Monday, telling nurses in Ealing that he loves the NHS, but that reform is needed to save it, and claiming that he doesn’t know who Mark Britnell is.
A former director of commissioning for the NHS, who is now head of health at the accountancy giant KPMG, Britnell’s unguarded comments to a conference in New York last October, first revealed on the Internet (see these articles on Spinwatch and Political Scrapbook), and then exposed on the front page of the Observer on Sunday, have blown a hole in claims by Cameron and his health minister Andrew Lansley that their NHS reforms are not privatisation by stealth.
At the conference, as the Observer explained, Britnell said, “GPs will have to aggregate purchasing power and there will be a big opportunity for those companies that can facilitate this process … In future, the NHS will be a state insurance provider, not a state deliverer.” He added, “The NHS will be shown no mercy and the best time to take advantage of this will be in the next couple of years.”
Cynically, although Britnell was, in the Guardian‘s words, “invited to join a group of senior health policy experts in Downing Street earlier this month” in a “‘kitchen cabinet,’ which includes former NHS executives and the former Department of Health permanent secretary Lord Crisp,” and which was “assembled by Cameron’s special adviser on health, Paul Bate,” Cameron’s response to the exposure of Britnell’s giddy expression of the type of privatised greed that has actually mobilised politicians from Margaret Thatcher onwards has been to try to disown him.
As the Guardian reported on Wednesday, the Prime Minister told MPs, “He [Britnell] is not my adviser,” and insisted — unconvincingly, surely — that he had “never heard about this person in my life” before Britnell’s damaging remarks received wide publicity on Sunday.
Britnell, however, is not the only problem. As the Guardian reported last week, “Prof. Steve Field, chairman of the NHS Future Forum — set up last month to undertake the coalition’s “listening exercise” — flatly rejects the health secretary’s plan to compel hospitals to compete for patients and income, which he says could ‘destroy key services’” Adding that “Lansley’s plan to make the NHS regulator Monitor’s primary duty to enforce competition between healthcare providers should be scrapped,” he explained that, “Instead it should be obliged to do the opposite, by promoting co-operation and collaboration and the integration of health services.”
Moreover, on Tuesday, Dr. Kailash Chand, a GP for 30 years who chairs Tameside and Glossop NHS, and Dr. J.S. Bamrah, a consultant psychiatrist and honorary senior lecturer at North Manchester General Hospital, wrote an article for the Guardian in which they explained:
No one says the NHS is perfect. But health secretary Andrew Lansley’s recipe of GP commissioning, abolition of primary care trusts and strategic health authorities, with no coherent structures to replace them; the introduction of private providers into the NHS, and emphasis on cost rather than quality of service lays personal dogma before rational political justification for reform […]
The PM would be forgiven if he thought the doctors and nurses who are so opposed to the bill have a vested interest, but surely it would be folly to ignore the writings of scholars, non-doctor led organisations, and now the managers — 94% of whom have said that the reforms are “dangerous and irrelevant” […]
This is the wrong reform, not just now but at any time in the future. This bill is radically different to any health legislation since the inception of the NHS. It removes the health secretary’s duty to provide or secure the provision of universal healthcare to the general population.
The bill puts in place the legal framework for a commercial system in which the NHS is reduced to the role of paymaster to multiple willing providers. GP consortiums will determine which services are needed within the framework of the NHS, while other more lucrative bits might be farmed out to other providers. A consortium does not have a duty to provide a comprehensive range of services but only “such services or facilities as it considers appropriate”. Across the country, consortiums will behave differently, leading to fragmentation of the NHS.
Now don’t get me wrong. I don’t blame the Tories exclusively for their impulses to privatise — after all, in many ways, they’re just following up on the damage already wrought by the Labour government, which invested heavily in the NHS, but also began the process of privatisation, as the academic Colin Leys explained in an important article on Open Democracy on April 8, the week before his book, The Plot Against the NHS, co-written with Stewart Player, was published. Ley’s article began as follows:
The common view of the changes proposed in the government’s Health and Social Care Bill is that they would be the most radical changes ever made to the NHS. In one way this is correct: the changes do mean replacing a comprehensive, universal system of care with a US-style healthcare market, consisting of providers, all governed by the bottom line. There will be a limited, ‘basic’ package of services for everybody, funded by the state; and better-quality treatments, on payment of a fee or co-payment, for those who can afford to pay.
But in another way the common view is wrong: the changes that were made under New Labour were more radical. A simple consideration makes this clear. If Mr. Lansley had taken office last year facing an NHS as it still was in 2000 his project would be unthinkable. In 2000 there were no foundation trusts; no payment by results for hospital treatments; no private health companies already providing NHS acute care and GP services; no independent regulator of a healthcare market (Monitor). Without all these changes, and many others, what Lansley’s Bill now proposes would be unthinkable.
All of these changes were major. Yet most people were largely unaware of them, and certainly unaware of where they were leading – and that includes many MPs and even many clinicians. And not just because the NHS is complex, and organisational changes don’t make sexy headlines. It is above all because the changes were made covertly, using government powers that did not require primary legislation.
I urge readers to explore more of the background to the story of the NHS in the 21st century, as analysed by Colin Leys and Stewart Player, but for now, as the media reports the ongoing struggle between Nick Clegg and Andrew Lansley, particularly over the role of Monitor, with Clegg, echoing Prof. Steve Field, insisting that its role “should be explicitly to protect and promote the interests of patients,” I’d like to leave you with a warning by Richard Whittell, a healthcare expert at Corporate Watch, who focused unerringly on the manoeuvrings of private health care providers in comments he made to yesterday’s NHS reforms live blog on the Guardian‘s website:
When arguing for the reforms, coalition ministers have tried to avoid mentioning that the companies they are encouraging to come and do more of their business in the NHS will make a lot of money from it, preferring to talk about ‘unleashing the power of competition’, and so on.
But the companies themselves are under no illusions. Health Investor magazine reported last week that CEOs of major healthcare companies think there will be ‘huge long-term opportunities’ in the UK. Such opportunities have made these companies very popular with financial investors. When Netcare, the South African healthcare giant, took a majority share in UK based BMI healthcare, it called the UK ‘one of the largest and most attractive healthcare markets globally’, while Bridgepoint private equity, which bought Care UK, the largest independent sector provider to the NHS, in 2010, notes ‘excellent growth prospects and consolidation opportunities’.
Private equity investment funds –- notorious for their debt-fuelled takeovers, asset stripping, secrecy, job cuts and tax avoidance during the financial boom — have shown a particular interest in healthcare companies. Spire Healthcare is owned by Cinven private equity for example, HCA International by Bain Capital, Merrill Lynch Bank of America and Kolhberg Kravis Roberts & Co, who also own Alliance Boots.
The first priority for all these companies and their owners, plus the huge, publicly listed companies such as US based UnitedHealth, is not ‘patient choice’ or ‘empowered professionals’, but profit, and as much of it as possible. For all the talk of ‘independent sector providers’ and nurses’ co-ops, if the reforms go through most of the business they generate will go to multinational corporations subject to the uncertainties of the global market. No doubt they will unleash competition in the NHS, but it’s hard to see how they are going to improve it.
Note: For further action, please visit the website of UK Uncut, the clever young activists who have designated Saturday May 28 as a day of events named “Emergency Operation,” and who are encouraging supporters to transform their local high street bank into a hospital, and providing the following encouraging messages: “Tell the government to leave our NHS alone; it’s the banks that are sick,” and “We want to keep our healthy NHS and fix our broken banking system. Whilst the NHS is being dismantled, the banks that caused this crisis in the first place have been left untouched. Reckless gambling, obscene bonuses and a global financial crisis are symptoms of a disease that requires a drastic intervention.”
Readers can also visit the following websites, where there are a number of petitions and letters:
Save the NHS: A petition (hosted by 38 Degrees) telling the government, “Don’t break up our health service and hand it to private healthcare companies” and “Listen to the the real experts — doctors, nurses and patients — when they give warnings about these plans” (over 387,000 signatures so far).
Save Our NHS: A petition urging MPs to vote against the bill (over 40,000 signatures so far).
Keep Our NHS Public: A statement “call[ing] on organisations, healthcare workers, patients and the public to campaign to protect the NHS from further privatisation and fragmentation, and to keep our NHS public.”
Royal College of Nursing: A letter opposing the cuts.
Andy Worthington is the author of The Guantánamo Files: The Stories of the 774 Detainees in America’s Illegal Prison (published by Pluto Press, distributed by Macmillan in the US, and available from Amazon — click on the following for the US and the UK) and of two other books: Stonehenge: Celebration and Subversion and The Battle of the Beanfield. To receive new articles in your inbox, please subscribe to my RSS feed (and I can also be found on Facebook, Twitter, Digg and YouTube). Also see my definitive Guantánamo prisoner list, updated in July 2010, details about the new documentary film, “Outside the Law: Stories from Guantánamo” (co-directed by Polly Nash and Andy Worthington, on tour in the UK throughout 2011, and available on DVD here — or here for the US), my definitive Guantánamo habeas list and the chronological list of all my articles, and, if you appreciate my work, feel free to make a donation.
On Facebook, Andy Horsman wrote:
It’s all so Milton Friedmanesque as far as I can see Andy, and that, as history repeatedly tells us, is a recipe for disaster!!
Sod You wrote:
GP surgeries are allocated to 15 minutes each patient and we had to make an appointment now cause some of the GPs’ surgeries are already run by American company United Health.
Margot Paisley wrote:
Does surgeries = patient visits to doctor’s office?
Deborah Emin wrote:
It is so funny when the men who want us to believe they are telling the truth lie so well and keep at it no matter the cost to those of us who must rely on these services.
Thanks for the comments, everyone, and thanks also to those of you who have shared this. I’ve been so busy with Guantanamo and the Wikileaks story for the last month that I’ve unfortunately had to neglect all the other pressing business — including the political battleground here in the UK, and recent developments in the Middle East. Hopefully I’ll find some more time now to catch up on these stories.
As for UnitedHealth, here’s the story of their much-criticized involvement in GP services, and how they have now moved on to other aspects of business within the NHS:
US healthcare giant UnitedHealth has sold off its network of GP surgeries and pulled out of the UK primary care market in order to concentrate on offering GP commissioning support.
The deal will transfer ownership of UnitedHealth’s GP provider company and all six of its GP practices to The Practice Plc — which already employs 220 GPs at 50 GP practices — with immediate effect.
UnitedHealth now plans to refocus its UK business to concentrate solely on commissioning support, as it seeks to exploit the opportunities presented by the Government’s NHS reforms.
The move signals an end to UnitedHealth’s controversial tenure as a provider of GP services in the UK, with their take-over of practices in Derbyshire, Leicestershire and Camden in north London attracting vehement opposition from anti-privatisation campaigners.
The company said it had made ‘real improvements’ to the six surgeries since taking them over with increased patient lists and improved QOF results, but said it would no longer be competing to provide primary care services in the future.
Instead, it plans to expand its commissioning support in areas such as data analytics, demand management and medicines management.
Willy Bach wrote:
Andy, it sounds like the ideological maniacs have got their hands on the syringe that is full of steroids – disaster for the NHS in Britain. Who were those people who voted in the old Etonians?
Willy Bach wrote:
Andy, yes, hardly a democracy worth writing home about is it? People who were pissed off with Labour went and voted for even worse. Those who voted for the Lib Dems won’t bother at all next time – an even lower voter turnout. Then, to make things worse, the referendum to change the voting system from first past the post to something no better than Australia had forty years ago failed. Proportional representation a la Germany or New Zealand was not even allowed on the menu. I think Costa Rica has more idea. Um Nigeria, sorry not Nigeria.
Andy Horsman wrote:
In short Andy, in my humble opinion, democracy like capitalism is rapidly going to hell in a handbasket. No mandate is really necessary when people are repeatedly brainwashed into believing they are being saved from them selves, in a purely economic sense. Post Cold War, we have a new bogey man, the mad mullah to help create a modern McCarthyism to blind the masses into thinking the powers that be are here to protect us.
Tashi Farmilo-Marouf wrote:
“Tell the government to leave our NHS alone; it’s the banks that are sick” — hilarious! And so true! They want to ‘reform’ (obliterate) the health system and leave the morally sick bankers free to operate as they please – however egotistically. No problem for them – the rich can afford to get sick. God help the rest of us!
Thanks, Willy, Andy and Tashi.
Certainly our current systems are failing us, but the biggest problem seems to me to be the large number of citizens who are taken in by the lies, or who claim not to care about politics at all.
Fortunately, despair is not an option, but it’s incredibly disappointing that people can effectively live as though there is no history, and as though their minds have been wiped clean of all the struggles that took place over many centuries to secure voting rights, education, healthcare — everything that is now being taken away or regarded as irrelevant.
Tashi Farmilo-Marouf wrote:
That is the problem with our human nature, we don’t appreciate what we have – unless we struggle for it – or until we lose it! Then we cry for it and start the struggle all over again!
I think that might well be a valid commentary on the welfare state, Tashi — over roughly a hundred year period up to 1979, we had communal infrastructure, voting rights, the introduction of education and healthcare for all, and then Margaret Thatcher introduced wholesale privatisation in 1979, which was then taken up by Reagan, and since then it’s been a process of losing everything that was gained, and that people fought for and died to achieve. I tend to think that another revolution will be the end result, but only when everything has gone, and only when people remember, in sufficient numbers, how to wake up.
Sharon Askew wrote:
It’s ironic that Fidel Castro based Cuban health care on the NHS, to then compare the two and see what Cuba has achieved with a blockade and where we are headed without one.
Margaret Thatcher changed many things we have since struggled to undo and I think your so right Andy “another revolution will be the end result, but only when everything has gone” sadly.
Thanks, Sharon. Good to hear from you, and yes, thirty years on and we’re still trying to put back together things that Thatcher wrecked.
George Kenneth Berger wrote:
I’ll read this Andy. Good that you found it. I missed it.
Eileen Brophy wrote:
The UK voters can always organise a protest like the protest here in Spain demanding a REAL democracy instead of the farce we have at present!!
We are on the way to a new Revolution folks :-0))
George Kenneth Berger wrote:
The KPMG White Paper, written by Britnell, shows how they think and what they wish to do: http://www.kpmg.com/UK/en/IssuesAndInsights/ArticlesPublications/Pages/NHSWhitePaper-aBlueprintforRadicalChange.aspx
Well, I hope so, Eileen!
And George, thanks for the link. This is definitely worth people focusing on, even though I find the entire “consultancy” context — and the very specialized jargon — genuinely chilling.
No surprise that there are also links to KPMG’s thoughts and advice on the university funding “reforms” that the Tories pushed through the Commons in December with the support of the LibDems:
George Kenneth Berger wrote:
PS. The links in Andy’s article to *spinwatch* and *scrapbook* are crucial. The latter shows Britnell with his big mouth, the former confirms that the *scrapbook* piece is genuine. When I first found it I could hardly believe what I was reading. Then I found the *white paper* I link to above, and then *spinwatch.* Every civil servant in the Netherlands, e.g. me, was financially disadvantaged by KPMG. At that time I could not know that this was a move towards a sort of privatisation of almost all Dutch healthcare. The system is now quite bad, and the credit crunch is being used to disadvantage and marginalise the elderly. I’m one of them.
George Kenneth Berger wrote:
Dugg and sharing now.
George Kenneth Berger wrote (in response to 19):
Right Andy. That ‘White Paper’ is revealing.
The Jargon is chilling. Let me pick out two such phrases I noticed when I found the paper.
’Business and commissioning services they greatly need.’ = Helping get private insurers to run the consortia.
’[I]ntegrated.’ Read: The system that replaces the NHS.
Thanks, George. It really does trouble me that so many supposedly intelligent people — in politics, in consultancies, in various businesses devoted to profits above everything else — have lost all sense of community, and all sense of responsibility to others, and justify what are essentially crimes against their fellow humans through self-serving jargon. Disgraceful.
Eileen Brophy wrote:
So people like my mother, with Alzheimer’s and my sister (who has bone cancer) will need private insurance for health treatment? The UK people are SO STUPID voting for a Tory Government in these times of crisis!!
George Kenneth Berger wrote:
That’s right Andy. My take is that the credit crunch makes these supposedly intelligent feel they *must* act now, in a time of panic of many, to save themselves and to get what they have always wanted. It is very bad. Well, my pleasure.
A Swedish weekly I subscribe to, ‘Arbetaren’ (the worker), said it nicely in a headline: The bankers saw the crisis coming. They saved themselves and left the check for the rest of us (my translation).
The Swedish article’s title about the bankers precognition is one conclusion of an official American committee here: http://fcic.law.stanford.edu/report
I do know that the Swedish government placed tight regulatory constraints on all Swedish banks. The internet bubble warned them. So my take is that most banks strongly suspected near-future trouble (now), yet continued with all the bad practices their respective governments would permit.
George Kenneth Berger wrote:
Eileen–You are probably right. That’s the case in Holland right now.
[...] also of the planned privatization by stealth of the NHS. Resistance to the reality of the plans, revealed through the legally enforceable obligation for [...]
[...] for leeches to take without giving.As Colin Ley explains, and as I noted in May, in my article, “Act Now to Save the NHS, as Government Advisor Claims Reforms Will Show “No Mercy” and Allow “…,” the key players in this are “private healthcare companies and consultancies like McKinsey and [...]
Investigative journalist, author, filmmaker, photographer and Guantanamo expert
Email Andy Worthington
Please support Andy Worthington, independent journalist: