With the failure of the last challenge to Andrew Lansley’s wretched NHS reform bill in the House of Commons, where Labour’s emergency debate was defeated by 328 votes to 246, I have to ask: how is it possible, in a so-called democracy, for a government without a mandate to ignore the complaints of healthcare professionals, at every level, and push ahead with a bill that will do more damage to the NHS than anything in the health service’s 64-year history?
Criticism of Andfew Lansley’s bill, throughout the NHS, has been intense from the moment it was first unveiled last January, as I reported last February, in an article entitled, Battle for Britain: Resisting the Privatization of the NHS and the Loss of 100,000 Jobs, and in March the BMA (the British Medical Association), which represents 140,000 doctors and medical students, voted to “call a halt to the proposed top down reorganisation of the NHS” and to “withdraw the Health and Social Care Bill.”
After a temporary halt to the bill, and a fake “listening exercise,” the government resumed its assault on the NHS, as I explained in two articles in September, Save the NHS: Make No Mistake, the Government Plans to Privatise Our Precious Health Service and Save the NHS: As Lib Dems Vote to Support Tory Privatisation Plans, The Last Hope is the House of Lords, in which I quoted Colin Leys, an author and an honorary professor at Goldsmiths College, who, in an article entitled, “The end of the NHS as we know it,” complained that “many, if not most, of the political elite no longer care whether they are carrying out the wishes of the electorate, and barely pretend that we are any longer a democracy,” and spelled out what the bill means:
The bill will end the NHS as a comprehensive service equally available to all. People with limited means will have a narrowing range of free services of declining quality, and will once again face long waits for elective care. Everyone else will go back to trying to find money for private insurance and private care. More and more NHS hospital beds will be occupied by private patients. Doctors will be divided into a few who will become rich, and many who will end up working on reduced terms and with little professional freedom for large corporations (the staff of the hospitals that are being considered for handing over to private firms will have noted that the firms in question want “a free hand with staff”).
The costs of market-based healthcare — from making and monitoring multiple and complex contracts, to advertising, billing, auditing, legal disputes, multi-million pound executive salaries, dividends and fraud — will soon consume 20% or more of the health budget, as they do in the US. Neither the Care Quality Commission nor NHS Protect (the former NHS Counter-Fraud Unit) are remotely resourced enough, or empowered enough, to prevent the decline of care quality and the scale of financial fraud that the bill will introduce.
Colin Leys’ article coincided with the House of Lords passing the bill at its first reading. 400 senior doctors and public health experts then called on the Lords to throw out the bill at its second reading, but these entreaties failed as well.
As other challenges emerged — a petition launched by 38 Degrees, which has now been signed by nearly 600,000 people, amendments in the Lords designed to make the bill better (or less bad), and a successful Freedom of Information challenge in which the government was ordered to release the strategic risk register regarding the dangers associated with its proposed reforms — health professionals renewed their complaints.
Last month, nearly 100,000 GPs and physiotherapists called for the bill to be scrapped, adding their opposition to that already voiced by the Royal College of Nursing and the Royal College of Midwives, and on March 7 NHS workers held a rally in central London at which they stoutly defended the NHS’s founding principles, at the same time that the Royal College of Surgeons agreed that the bill would “damage the NHS and widen healthcare inequalities, with detrimental effects on education, training and patient care in England.” There were also other challenges — apparently from inside the Tory cabinet, and from the public, 52 percent of whom said, three weeks ago, that the bill should be dropped. Over 170,000 people also signed an e-petitiion by Dr. Khalash Chand calling for the bill to be dropped.
The most recent professional opposition to the bill came last week, when the Royal College of Physicians (RCP) polled its 25,417 fellows and members, and 49 percent of those who responded (8,878 members in total). said they wanted the RCP to “seek withdrawal of the bill.” The survey, as the Guardian explained, “followed the college’s recent extraordinary general meeting to decide its stance on the bill, after some members said it was not being robust enough in its opposition.”
In a specific question to members asking them “what their main concerns were related to the bill and the wider health agenda,” the results “showed that large numbers of hospital doctors fear it will have a negative impact.” As the Guardian described it, “Concern about possible privatisation of the NHS, and the planned extension of competition between healthcare providers and choice for patients, loomed large, though many are also worried about the effect of handing control of £60bn of patient treatment budgets from April 2013 to local groups of GPs called clinical commissioning groups (CCGs),” which “will exercise considerable power, including over the commissioning of services for patients from hospitals.”
The poll “also found widespread unease about issues already facing the NHS at the frontline, including the quality of patient care, budget cuts, staff shortages and patients not getting continuous care.”
However, none of this has been enough to derail the bill. Just 11 days ago, the government lost its appeal against the release of the risk register, prompting Lord Owen to table an amendment yesterday calling for the House of Lords to delay approving the bill on its third reading until the risk register was published, and could be analysed, but even that failed, losing by 115 votes, as did another amendment by Baroness Thornton, Labour’s health spokeswoman in the Lords.
Her amendment, which was defeated by 95 votes, called for the bill to be stopped because it “does not command the support of patients who depend on the National Health Service, the professionals who are expected to make it work, or the public; will not deliver the promised objectives of genuinely empowering clinicians in the commissioning process and putting patients at the heart of the system; will increase bureaucracy and fragment commissioning; will allow Foundation Trusts to raise up to half their income from private patients; and, despite amendment, still creates an economic regulator and regime which will lead to the fragmentation and marketisation of the National Health Service and threaten its ethos and purpose.”
In an interview prior to the vote, Baroness Thornton not only explained how the health service would end up as “a terrible bureaucratic, expensive and fragmented NHS,” but also highlighted how the government was still lying about it. As an example, she pointed out that the government “promised patients would get local champions to challenge the NHS over decisions,” even though, “it emerged last week that these bodies would not be ‘statutory,’ leading to allegations that the government would instead be ‘privatising patient voices,’” as the Guardian described it.
As Baroness Thornton said, “Look at the idea that patients would get local champions so that there would be, in the government’s own words, ‘no decision about me without me’. It was just a lie. We are left with something totally inadequate.”
The government’s last hurdle came this afternoon, with an emergency debate in the House of Commons, secured by the shadow health secretary Andy Burnham, to ask, as Lord Owen did in the Lords, for a delay because the risk register has not been published. That too was defeated, however, with Andrew Lansley brushing off the request for a delay, breezily stating that he couldn’t say what the government’s response would be to the full ruling from the information tribunal about the risk register because he hadn’t seen it, leaving Andy Burnham to complain that the government “should respect the law,” pointing out that ministers “do not have the permission of the people of the country to put the NHS through its biggest re-organisation in history,” and that they are making a “catastrophic mistake.”
After the vote, Andy Burnham was left to lament:
The only hope I can give to people worried about the future of the NHS today is that this might be the end of the bill, but it is just the beginning of our campaign. The NHS will find a way of working around these changes. It won’t deteriorate overnight. And we will be working to mitigate the worst effects of this bill …
While on a day like today it’s hard for me to give any encouragement people worried about what the Government is doing, I can at least say this: that we will repeal this bill at the first opportunity and restore the N in NHS. We have given this fight all we had. All I can say is our fight will go on to protect and restore our party’s finest achievement.
Andrew Lansley’s wretched bill will now become law, and today is, therefore, a very dark day in British political history. The only hope is that it kills the Tories and the Lib Dems at the ballot box, and that Labour, learning from its own mistakes in paving the way for Lansley’s bill through its own obsession with privatisation and corporate interests, continues to campaign for the bill to be repealed.
In conclusion, for an up-to-date analysis of the disastrous effects of the bill, I’m cross-posting below an article by Colin Leys, published in the Guardian three weeks ago.
I don’t know what else to do now, except to urge people to continue to register their dissent, and to work with unions, and other people within the NHS, who are determined to continue to oppose the worst effects of the changes.
Andrew Lansley and his colleagues assure us that under their plans to privatise the NHS, “services will still be free at the point of use”. But they fail to add a key proviso: provided the services are still available. In reality, a growing list of services won’t be available, and so won’t be free.
Of course, some services that the NHS originally provided, such as long-term care for frail older people, have long been officially withdrawn; and others, like prescriptions and dentistry, are still provided but subject to charges. Under the health and social care bill there will be further contraction of what is provided free on the NHS. Local clinical commissioning groups, not the secretary of state, will decide what services it is “reasonable” to provide out of the budgets they are given, and the package will gradually contract.
This process has already begun under the pressure of the so-called productivity savings recommended by McKinsey. NHS services are being withdrawn in an unannounced, piecemeal and unaccountable way.
In 2006, Croydon primary care trust drew up a list of 34 procedures that would not be paid for in cases where they were judged ineffective or “cosmetic”. But the list also included cataract surgery and hip and knee replacements, on the grounds that their benefits were minimal in “mild” cases. Obviously, what is considered a mild case is liable to be modified by financial pressures. By 2010, the Croydon list was being used widely by other PCTs as a means to save money. In some areas, one commentator noted, “only ‘urgent’ treatment — cancer, fractures and A&E — are funded, and all other procedures are either delayed or the patient is denied funding”.
So a new postcode lottery for treatments has developed, largely unreported. NHS North Central London has a relatively short list of 36 treatments it won’t pay for unless there are special circumstances. South West Essex has a list of 213. In effect, people who need these treatments have to pay for them privately and if they can’t pay for them, they have to do without.
On top of this, GPs are being prevented from referring patients to specialists. In some areas indebted primary care trusts have simply limited each GP to a maximum of four referrals a week, regardless of how many patients need specialist attention. In other areas GP referrals are being intercepted by referral facilitation services (a name that might have been invented by Orwell himself), also called “referral gateways”, run by private firms. One of the first was in west London, where the American health insurer UnitedHealth has a contract to override GPs’ judgments and tell patients to have physiotherapy or use more painkillers instead of seeing a specialist.
A patient with good communication skills and determination may manage to overcome this obstacle. One west-London patient whose NHS surgeon had previously told her she needed a new knee, but who was denied it by UnitedHealth, had to pay over £1,000 and spend a year getting a scan and other surgeons’ opinions to finally prove she needed it, and get back onto the NHS waiting list. But for many this is not possible. For them, free specialist services turn out not to be available.
Under the bill the range of what is available for free seems certain to contract further. Commissioning groups will have fixed budgets. The for-profit “support organisations” that are being lined up to do most of the commissioning for them will have a strong incentive to limit costs, and therefore the treatments to be paid for. CCGs also look likely to be free to decide that some treatments recommended by hospital specialists are “unreasonably” expensive, and refuse to pay for them, as health maintenance organisations do in the US.
A core of free NHS services will remain, but they will be of declining quality, because for-profit providers will cherry-pick the most profitable services. NHS hospitals will be left with the more costly work, so staffing levels and standards of care will be forced down and waiting times will get longer. To be sure of getting good healthcare people will increasingly take out private insurance, if they can afford it. At first most people will take out the cheaper insurance plans now on offer that cover just what is no longer free from the NHS, but gradually insurance for most forms of care will become normal. The poor will be left with a limited package of free services of lower quality.
What is available on the NHS should be determined nationally, in a transparent and democratic way, not by unelected local bodies. The bill will allow the secretary of state to deny responsibility when good, comprehensive, free care has become a thing of the past.
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 please also consider joining the new “Close Guantánamo campaign,” and, if you appreciate my work, feel free to make a donation.
On Facebook, Allison Lee-Clay wrote:
oh dear gawd… don’t let Stephen Harper & his OilBerta Conservatives hear about this… we already have US corporations chewing & pounding at Canadian healthcare while the Canadian College of Physicians & Surgeons moans & snivels about how they “deserve to live” like their gringo compatriots…
they don’t object to the massive educational funding they get via Canadian taxation… but they object to having to provide affordable healthcare for everyone… *whahhhh!*
Well, unfortunately, Allison, I would expect that profiteering scumbags everywhere will be taking great comfort from this triumph of greed. What a sad day.
Adrienne Murphy wrote:
The future is starting to look bleak
Ruth Gilburt wrote:
I’m miserable about this, Andy – it’s making me physically sick….x
Thanks, Adrienne and Ruth. Disturbing times. Politicians are more interested in cosying up to corporations than they are in representing the interests of a state-owned triumph – the NHS – and the people who depend on it, while far too many people don’t know or don’t care what’s happening. I’m also struggling with the realisation that even a petition that gets 600,000 signatures, like the 38 Degrees petition, can be brushed aside, as though it didn’t exist, by politicians who no longer care what we think, reminding me that we need to be out in the streets, in their faces, as well as supporting good causes online.
Adrienne Murphy wrote:
A government with no mandate, nor any desire to put the interests of the people first – welcome to democracy. Still believe this country will see civil unrest as people get desperate they will do desperate things. And all for the greedy despots who put profit first. One day people will sit up and do something I only hope that when it happens it won’t be too late.
Thanks again, Adrienne. Unfortunately, there’s little sign that people are waking up from their self-obsessed materialistic slumber in any significant numbers — and when they do, given everyone’s sense of “entitlement,” whether rich or poor, I expect they’ll be lashing out blindly rather than developing a conscious appreciation of the evils of early 21st century capitalism. On a more cheerful note, at least some of us know what’s happening, and I expect that our numbers will continue to grow, so we can at least look forward to a spring and summer of discontent. I’d rather have justice and fairness, of course, but I understand that they’re values that are close to extinction.
Phil Steele wrote:
It is a bloody disaster, and well done for taking up this campaign. We won’t have these reforms in Wales, but when the NHS goes down we’ll all suffer.
Good to hear from you, Phil. Ah, not to be in England, but it’s home — and I felt pretty much the same under Thatcher, so I’l have to stay and fight, like so many other people. Good luck in keeping these monsters away from Wales.
Phil Steele wrote:
Oh there’s plenty of shite here as well, fear not! Not least this plan to match regional public service pay rates to the private sector. That could finish us off. & the cuts… We’re all tied up in nuclear stuff on the island, too. On the international front it would be nice to invite you back up here at some point… we’re thinking of conferences and the like.
Gareth Phillips wrote:
Everything is to be sold off in a closing down sale. I shall try my best to show our anger at the Royal College of Nursing congress in early May. The last time Dave Cameron spoke to our Congress he promised never to oversee pointless reorganisations of the health service and to keep it as a public service. He lied. Nick Clegg lied. We are into a whole new game as far as politics is concerned.
Thanks, Phil. I’d be delighted to come and visit again if the opportunity arises. And I do understand that small regional reprieves from the Tories don’t add up to an entire economic plan. These revolting people are remorseless — anywhere they can find someone who’s not hugely wealthy, they pounce. I hope they get slaughtered for withdrawing the 50p tax rate tomorrow, while still bleating on about fairness, but too much of the media is on their side — or castrated, like the BBC — so it’s unlikely.
And thanks for the comments, Gareth. Glad to know that it’s so abundantly clear the extent to which Cameron and Clegg lied to nurses. I was glad to see Andy Burnham working so hard against the government, but in general, of course, Labour aren’t trustworthy either, as they got the ball rolling on so much of this. As you say, “We are into a whole new game as far as politics is concerned,” and it’s a dirty game indeed.
I have a question, since I’m not knowledgeable on U.K. politics. Does Clegg and the Lib-Dems have to approve everything the Tories dream up? What do they get out of this? And are Murdoch’s media holdings(TV & newspapers) as bad there as here(with their hate and racism)?
Good questions. On the first, we have so little experience of coalition governments that no one knows what to do. In exchange for power, the Lib Dems have chosen to sacrifice their political independence, and will, I believe, be savagely punished for it at the next election. Obviously, it doesn’t help that they have also drifted so far away from their manifesto that no one can never again believe a word they say, but they could at least partially make amends by pulling the plug on the coalition sometime before 2015.
As for Murdoch, yes, he owns the poisonous Sun newspaper, with its tabloid racism and prejudice, still fostering violent stupidity after 45 years in his control. However, he’s obviously under serious investigation here, because of the phone hacking scandal, which is interesting, and he also doesn’t have Fox News here, which is a great relief for all of us who remain sentient.
George Kenneth Berger wrote:
I’m sharing this, Andy.
Thanks, George. This whole disgraceful failure of democracy has been exhausting, I have to say. I’ve been horribly distracted, in a bubble in my own head, and anxious to get out again. These scumbags. Just when I thought it couldn’t get any worse, after having to put up with Thatcher in my youth, and then with Tony “Crusader” Blair. I’ve spent the last two hours writing about Guantanamo, just to have a break!
George Kenneth Berger wrote:
Andy, now that you have mentioned that, I’ll say that I have not visited the UK since 1981, until 2007 (I was invited to take part in a panel there) thanks to what I thought Thatcher wanted to do. It wasn’t hard to think that, since I lived in the Netherlands then, and filtered my ideas through what I saw directly, namely the similar plans put in place by then PM Ruud Lubbers, who had frequent conversations with Thatcher. I didn’t wish to mention this, but I’m angry enough to do so now. The feeling won’t last. If all goes well I’ll be at a conference in the UK during Easter of 2013.
Barbara Al-Bayati wrote:
Thanks again, George, and thanks, Barbara, for noticing and caring.
I do hope your UK trip happens next year, George. It will be a pleasure to meet you.
Barbara Al-Bayati wrote:
So it appears that the UK is aiming to reach third world status
Yes, and as swiftly as possible apparently, Barbara. The Etonian boys have decided that what we need is a return to good old-fashioned medieval feudalism.
Sylvia Martin wrote:
Sorry to hear it, Andy.
Willy Bach wrote:
Andy, just watched a two-part BBC docudrama on Blair’s coming to power. He wanted to cut benefits to single parents, said it worked in the USA (yer right). Perhaps David Cameron is trying to saddle Britain with the lack of a health system experienced only in the USA. What a stupid mistake to ever let him near the levers of power – and he’s straining at the leash for an illegal war of aggression against the people of Iran.
Barbara Al-Bayati wrote:
America still remembers the Magna Carta — whether or not its application pertains to us, the peeps!
Charles Lemos wrote:
I just can’t understand how the Lib-Dems can even look themselves in the mirror.
Leanne Amirah wrote:
Shared! I just want to say I love reading your posts and articles and particularly appreciate your efforts at highlighting the injustice of Guantanamo. If only people would wake up and separate themselves from the propaganda machine that is manipulating them into this single political ideology where only certain thoughts can be expressed we might just go half way to realising the power of the collective.
Dejanka Bryant wrote:
Thanks to these capitalist scumbags we are no longer able to build a strong resistance to them. They succeeded, all over the world, to split us with their vile rhetoric. Few days ago, another announcement of redundancies and loss of jobs in northern parts of England is going to happen. People are so scared for their future, not knowing who is going to be left homeless, without any support by this government. At this moment, they are certainly not going to join us in this noble struggle to save our NHS or any other vital institution. As I said on my FB page, after the demo on 17th of March, full of disabled and sick people, who stood there alone to fight for their rights, I was suddenly aware of what these brutal capitalist profiteers did to us. Words of Polly Toynbee, the Guardian journalist, rang in my ears – “It is them, homeless, redundant, unemployed, sick and disabled people who envy us, successful people (paraphrasing).” She got so many positive responses to that article. Shame on them being so vulnerable. Keep on writing, Andy. Shared.
Thanks, Sylvia, Willy, Barbara (again), Charles, Leanne and Dejanka.
I do wonder, Willy, what dark psychological troubles drive Cameron, beyond his obviously deep-seated desire to be some sort of king.
Leanne, I’m honoured by your kind words — and here’s to the untapped power of the collective!
And Dejanka, thank you also. It seems to me that all decent people need to raise their voices at this time, because our leaders are so lacking in basic human decency, and because so many of our fellow citizens have forgotten their own humanity as well, numbed by materialism and selfishness.
Shared to FB. Thanks for this Andy. Keep up the good work.
Thanks, Russ. Good to hear from you.
I think Cameron is displaying all the signs of someone with a Narcisistic Personality Disorder …
Yes, thanks, Universal Citizen. More here: http://en.wikipedia.org/wiki/Narcissistic_personality_disorder
Kathy Fehl wrote:
Horrid. They have such a sublime example of the utter rot that private health care is in the U.S….and it still costs treasury (the tax payer) over $400 billion a year in forgone tax money because health care is deductible. I could go on and on. Private health care is a license to pillage and murder, and symbolizes the enslavement of the people to those whose legal and averred goal is optimizing the bottom line. Full stop. History teaches us that unfettered capitalism does not even work for the big corporations or share holders; eventually, the consumer has no spending money. A series of houses of cards-has it always been so? Or was there once a parabola of progress?
Thanks, Kathy. Very well put. I understand the basic capitalist model — essentially, make something people want and sell it to them for a profit — but now the search for profit — ever greater profit — has become a sickness, devouring people, economies, and entire countries. Time to start again …
I was born in an NHS Barret Maternity Home in Northampton in 1981, my brother too in 1982 and my other brother in the Royal Buckinghamshire Maternity Hospital in Aylesbury in 1986, my sister too in 1990. In future, future mothers will be expected to pay for all of this with American-style health insurance and charging and millions of Britons shall be without health care and perhaps forced to use charity as in Pakistan. Yes, that’s it! That’s Call Me Dave’s (David Cameron’s) plan, to have no welfare state or benefits system, no public sector of any sort- it’ll all be PRIVATISED- and the NHS and even the police are just the start. Thing’s are bad now? The Armed Forces, MI5 and MI6, County Councils, the BBC and Channel 4 and of course the Royal Mail probably either will all be privatised in future or plans have already been announced as to the latter. Even the education system will all be private- just take Acadamies as the benchmark- and NOTHING will be free, fair, accountable or representing the public. Everything will only exist to make a profit not just to serve the public as originally set up to be and people will suffer. Only the rich can avoid all of this and they are making all the decisions to affect everybody.
Thanks, Ronan, for the heartfelt response to the destruction of the state by the Tory-led government. I don’t think anywhere near enough people have realized how horribly radical this government is, and many ministers and their advisers genuinely do want to do away with the state – and all public services – altogether. A savage battle is taking place, but they have almost all the power, and we – it seems – are few, and mostly far too passive.
Resistance is not futile!
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