Ever since the coalition government introduced its Health and Social Care Bill, it has been obvious that what was planned was nothing less than the destruction of the NHS as a universal healthcare provider, and the gradual privatisation of the service, leading to greater profits for private companies and, simultaneously, cuts to services.
Understanding this, the professional bodies representing those who actually work in the NHS have opposed the bill. Amongst other bodies, the British Medical Association, the Royal College of Nursing and the Royal College of Midwives have opposed the government’s plans, and last week, in an editorial published simultaneously in the British Medical Journal, the Health Service Journal and Nursing Times, the editors of those magazines described the government’s plans as a “damaging … unholy mess,” and stated that the NHS “is far too important to be left at the mercy of ideological and incompetent intervention” and that “we must make sure that nothing like this ever happens again.”
In a second British Medical Journal editorial last week, Kieran Walshe, professor of health policy at Manchester Business School, explained how abandoning the bill now would save over £1bn in 2013. As he explained, “Going ahead with the bill means setting up the NHS Commissioning Board (with an annual running cost of £492m), 260 clinical commissioning groups (with an annual running cost of £1.25bn), and the new economic regulator, Monitor (with its anticipated annual running cost of £82m). Each of these new statutory organisations will have additional set-up costs — perhaps amounting to a one-off spend of £360m. If the bill were stopped now, it would save all those set-up costs, and at least £650m in annual running costs — just over £1bn in 2013.”
On Wednesday, a group of 365 GPs, specialists and health academics urged the government to drop bill, which, they said in a letter in the Daily Telegraph, will “derail and fragment” the NHS. As the Guardian described it, the letter urged the government to “drop the bill altogether and focus instead on the ‘real issues,’ namely improving safety, efficiency and the quality of patient care.”
The letter stated that the clinical commissioning group leaders who have backed the bill “do not represent the majority of GPs who believe the bill will seriously damage patient care,” and the signatories added, “The NHS is not in peril if these reforms don’t go ahead. On the contrary, it is the bill which threatens to derail and fragment the NHS into a collection of competing private providers. The bill will result in hundreds of different organisations pulling against each other, leading to fragmentation, chaos and damage to the quality and availability of patient care.”
Also last week, the Royal College of General Practitioners, which represents 44,000 GPs in England, and the Chartered Society of Physiotherapy, which has over 50,000 members, called for the bill to be withdrawn.
Dr. Helena Johnson, the chair of the Chartered Society of Physiotherapy, said, “Together with many other health professionals, we have tried to engage constructively and make sensible suggestions throughout the bill’s passage through Parliament. But time and time again, the views of patients and health professionals have been ignored. The government seems determined to press ahead with these reforms.”
The most damaging criticism, however, came from the GPs, because, as the BBC noted, the BMA and the nurses’ and midwives’ organisations are unions, and their complaints allowed a deeply cynical government “to suggest they were motivated by the dispute over pay and pensions, whereas the RCGP is part of the professional arm of the health service which sets standards.” The GPs’ criticism is also hugely significant, of course, “because GPs are widely thought of as one of the main beneficiaries of the reforms, as they are supposed to get more control over how NHS funds are spent.” In fact, that is putting it mildly, as GPs are supposed to take over NHS commissioning with a budget of £60 bn, even though the details of how this is supposed to happen have not been explained.
As a resident of Oxfordshire, Bernard Dod, explained in a letter to the Guardian last week, although the government claims that GPs will play a key role, “Oxfordshire has 83 GP practices comprising hundreds of individual doctors. When I asked representatives of the current (soon to be abolished) primary care trust how in practice all these doctors would be able to make so many important decisions, they said that nobody knew: the new system has not been trialled. The government has embarked on a massive, destructive and expensive reorganisation without knowing how it will work, and without producing a shred of evidence that it will result in a better, fairer and cheaper service.”
Perhaps some GPs are also aware that power is only being handed over to them so that they will, in turn, hand it on to private providers. Or, as Ben Goldacre tweeted:
In an attempt to fend off further criticism last week — from the GPs, in particular — the ever desperate, but ever obstinate health minister Andrew Lansley offered further concessions, including a promise that the health minister would retain the ultimate responsibility for the NHS. When this abdication of responsibility first became obvious last year, it caused understandable alarm, because it revealed explicitly how the government was seeking to make the NHS unaccountable to either voters or the government — or, in other words, how it was in fact planning to privatise the NHS.
In response to these concessions and others resulting from criticism by the Lords, including what the BBC described as “strengthening the requirement of the regulator to ensure the different providers competing for patients also work together to provide seamless services for patients,” RCGP chairman Dr. Clare Gerada said:
This decision was not taken lightly, but it is clear that the College has been left with no alternative. We have taken every opportunity to negotiate changes for the good of our patients and for the continued stability of the NHS, yet while the Government has claimed that it has made widespread concessions, our view is that the amendments have created greater confusion. We remain unconvinced that the Bill will improve the care and services we provide to our patients.
Our position has not changed, and the concerns we expressed when this Bill was at the White Paper stage 18 months ago have still not been satisfactorily addressed. Competition, and the opening up our of health service to any qualified providers will lead not only to fragmentation of care, but also potentially to a ‘two tier’ system with access to care defined by a patient’s ability to pay.
We support a greater role for GPs in the planning, design and delivery of services within their local communities, but as the organisation representing the views of over 44,000 GPs, we cannot support a Bill that will damage the care and services that GPs deliver to patients and ultimately bring about the demise of a unified, national health service.
Our view is that what is required now is to rapidly consolidate the current organisational structure, such that PCT clusters remain, with GPs placed as the majority of the Board so that we may address the serious issues facing our NHS. There should be a debate as a matter of urgency to determine what the NHS can provide, how it should be funded, and how we deal with the major health and social care problems facing our population.
In a key passage, Dr. Gerada explained:
We cannot sit back. Instead, we must once again raise our concerns in the hope that the Prime Minister will halt this damaging, unnecessary and expensive reorganisation which, in our view, risks leaving the poorest and most vulnerable in society to bear the brunt.
In conclusion, she stated:
We will continue to do everything we can, both as a College and in partnership with our colleagues in the Academy of Royal Colleges, our nursing colleagues and across the wider health and social care sectors, to bring about change for the good of our patients and preserve the principles of the NHS that has served millions of patients so well for over 60 years — a universal healthcare service, free at the point of need.
Dr. Gerada also spoke to the BBC, telling the Radio 4 Today programme that the bill would “turn the National Health Service into thousands of different health services, all competing for the same patients, the same knee, the same brain, the same heart. Patients will find their care will be fragmented, it will be on different sites, it won’t join up, it will be difficult to hand over care and it will be phenomenally expensive to keep track of all these competing parts of the NHS.”
Next week, this wretched bill will return to the Lords, where it can expect more damaging criticism, but don’t be fooled: the government still doesn’t want to give up on its dreadful plans. To keep up pressure on the government, please sign the 38 Degrees petition (which is currently very close to 500,000 signatures), and the Keep Our NHS Public e-petition on the government’s website (which is currently close to 50,000 signatures).
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 June 2011, “The Complete Guantánamo Files,” a 70-part, million-word series drawing on files released by WikiLeaks in April 2011, and details about the documentary film, “Outside the Law: Stories from Guantánamo” (co-directed by Polly Nash and Andy Worthington, and available on DVD here — or here for the US). Also see 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 Digg, cosmicsurfer wrote:
Of all the concepts to be threatened by the corrupt neo-liberals of the “coalition” in the UK, the corporatization (the truth behind “privatization”) of social/medical services is one of the worst. “How to destroy a country” should be the biography of the coalition.
If allowed, the UK will find the cost of health care churn to US levels through the avarice of the corporations involved.
I wonder how many corporations will be American?
Maybe it’s just that Cameron is jealous that he wasn’t fitted with a studded dog collar like the trained poodle, Blair wore…..WOOF
According to the CIA America spends 16.2% of its GDP on health care while England spends 9.3% of its GDP on health care.
For profit health care is a proven failure. America has it and our costs are twice the average for the civilized world. Oh, and the services rendered for that astronomical price is seriously third world as Vietnam, cuba, and Slovenia do a better job of caring for their citizens.
Thanks for that. One of the many great things about the NHS is that British people don’t have to deal with insurers concerned only with making a profit. If you lose your automobile in an accident, say, and an insurer finds a way not to pay you, all you’ve lost is an automobile, but if the same people play with your life in the same manner it’s no joke.
As the figures show, the Tories and their advisors are salivating with unadulterated greed at the prospect of liberating 7 percent of Britain’s GDP and pocketing it. I just hope my fellow citizens wake up before it’s too late.
Lisa Nilsson wrote:
Nottingham Indymedia | Demonstration against Atos & police repression
Thanks, Lisa. All contributions pointing out the shameful activities of Atos – the French company responsible for finding people with mental and/or physical disabilities fit for work – are welcome.
On Digg, cosmicsurfer wrote (in response to 4):
Andy, one of the worst things that can happen to the UK is for the government to be allowed to forget its promise to the people.
The UK has a history of feudalism and appears to be attempting a return.
Greed makes people forget that it is the middle classes that build a country and keep it strong. It keeps them protective of that country and its government; it allows for expansion of trade and technology and it grows the wealth.
Every hundred years, that lesson appears to be forgotten.
I truly hope the people stand very strongly against Cameron and his “coalition”
Good luck…If you win the fight…maybe you can help us with ours.
Thanks, cosmicsurfer. That’s very well put indeed.
I do indeed hope we triumph, but for the most part, it seems, people are far too complacent, or fooled, or asleep. The NHS is an institution I will forever hold up as a triumph of the collective good over narrow self-interest, and a demonstration that all of this can be achieved for less than 10 percent of GDP, and I don’t ever want to be put in a position where I have to speak about it in the past tense.
It is by far and away the most trusted and admired institution in the UK, but I am worried that people are not troubled enough about its future.
On Facebook, Lisa Nilsson wrote:
In Sweden, older people are starving to death in privatized nursing homes, they weigh diapers so the elderly can have them even longer. A dying old person was put in front of television by the staff and had to die alone. Cancer patients receive no pay anymore when they are sick, thrown out of their homes. Our right-wing government has sold our wealthfare to private interests who take our tax money and invest in tax shelters, these are billions. Google at Carema, Attendo
George Kenneth Berger wrote:
I’m digging and sharing this Andy, with some comments. And thanks, Lisa Nilsson; spread this amongst your friends.
On his page, George Kenneth Berger wrote:
The National Health Service is threatened with destruction by fragmentation and privatisation. This will allow private insurers to completely take over healthcare in England. Protests have been building up strongly since the proposal of the Social Care Bill, but in fact about one day after the last General Election, when it became clear that the Liberal Democrats, in government with the Tories, had betrayed their members by actively siding with the Tories. Public healthcare is being trashed in many EU countries, as are other services and the roles of Unions. The reasons are purely ideological, not based on any economic theories except selfishness and a desire for power, budget cutting, and full governmental control over the finances of all EU countries. All this assisted by the panic and uncertainty due to the Credit Crunch.
Thanks, Lisa and George. It feels very appropriate indeed to be stepping up our complaints at this particular time. These scumbags mean business, and they mean to rob us of the state enterprises that benefit us all – or that can benefit us all – so that they can have new areas in which to make a profit, and they’re determined not to let anyone stop them.
I’ve had a break over the last two months from commenting on the savaging of the state for ideological reasons, but it’s never left my mind, and it makes me incandescent with rage that here in the UK, a Frankenstein’s monster of a coalition government, without a mandate from the electorate for any of this destruction, is refusing to back down, even though pretty much the entire medical profession opposes them.
It is too important for us to sit back and wait until the next planned general election in 2015 before we even have the option, in a bent electoral system, to vote these malevolent clowns out of office. We need to be on the streets. Bring on spring. Bring back the Occupy movement. Bring back resistance and direct action.
Malcolm Bush wrote:
I think we must remember that this is not just a question of privatisation or staying with the state system. Yes I personally believe we need the NHS; but we must consider the question of what sort of private companies would be involved in privatisation. We have seen private companies conducting the war on terror; we must ask, are these companies ethical and run with stringent government oversight? Are we inspired to feel safe? We must also ask how safe we would be in the hands of such companies; remember that we do not have access to such information for many years. Honourable Hillary Clinton has recently made an apology for medical skulduggery long in the past, there is much more resent stuff, but that will not be mentioned for many years, if ever.
Lisa Nilsson wrote:
So The Welfare Reform Bill Doesn’t Affect YOU!?! #WRB
Thanks, Malcolm, for your thoughts, and thanks also Lisa for that link to a very detailed article, by a single mum and a survivor of domestic violence, about the dreadful Welfare Reform Bill, and its many, many ways of making the lives of the working poor, the unemployed, the disabled, single parents, and everyone who should actually be protected by a caring society more precarious, poorer, more miserable and subjected to relentless government interference. Even writing this makes me feel angry.
Muhammad Sadeq Chowdhury wrote:
I think the coalition government is trying to import the American health system for our country … but does that mean that we pay lower Tax & NI contributions ???
I would say that wouldn’t happen in a million years, Muhammad. I think the difference between health spending as a proportion of GDP in the US and the UK is what they’re trying to get their hands on for themselves and their mates in the private medical business – so, in other words, 7 percent of British GDP (as the NHS costs around 9 percent of UK GDP, whereas healthcare costs are 16 percent of GDP in the US).
Mezentian Gate wrote:
As the government agencies’ only method of doing anything is killing people or locking them up, confiscating their wealth & making criminals of citizens— why would anyone wish them to provide health care, which requires some degree of compassion in its practitioners, let alone a voluntary relationship?
Or is the NHS essentially a slave camp— where both professionals & patients are prisoners?
“Some degree of compassion,” Mezentian. Yes. And that’s what’s being ruthlessly expunged by the vile opportunists running the country without a mandate.
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