NHS Privatisation: Protest on Sunday, as 400 Doctors Accuse Government of Planning “Irreparable Harm,” and Lords Prepare Opposition

Tomorrow, Sunday October 9, UK Uncut, the British activists opposed to the Tory-led government’s ideologically driven austerity cuts, have organised a mass protest in London — “Block the Bridge, Block the Bill” — against the government’s plans to privatise the National Health Service (NHS), which I have been writing about extensively over the last year (see here, here, here, here and here), and my experiences of the NHS this year, after I became ill, can be found here.

UK Uncut’s activities, involving street theatre, the creative occupation of banks and tax-avoiding retail outlets, and its simple, focused message — tax the banks, stop corporate tax evasion — has been an inspiration over the last year, not only reviving a rich seam of creative dissent in the UK, but also, evidently, helping to provide inspiration for movement elsewhere — and specifically the “Occupy Wall Street” movement that has seized the imagination of Americans across the country, inspiring hundreds of similar occupations.

UK Uncut’s “Block the Bridge, Block the Bill” action will involve thousands of people occupying Westminster Bridge — dressing up as doctors, nurses and patients, playing dead, performing fake operations — to send a message of collective defiance to Parliament, where the House of Lords will begin debating the government’s Health and Social Care Bill on October 11.

This is how UK Uncut describes Sunday’s action:

The government is just weeks away from destroying the NHS forever. This is an emergency. On Sunday October 9th at 1pm, join UK Uncut on Westminster Bridge and help block the bill.

On one side of Westminster Bridge is Parliament. On 7th September, MPs in the Commons voted for the end of the NHS as we know it. Yet the coalition’s Health and Social Care bill was not in the Lib Dem manifesto. It was not in the Tory manifesto. None of us voted for this.

On the opposite side of the bridge is St Thomas’ Hospital, one of Britain’s oldest medical institutions. If the bill passes, hospitals like St Thomas’ will be sold to private corporations, the staff put on private payrolls and beds given over to private patients. Despite the government’s lies, this bill represents the wholesale privatization of the NHS and, with it, the destruction of the dream of comprehensive healthcare provided equally to all.

On October 11th, the bill moves to the Lords, and a huge Liberal Democrat rebellion is brewing. We have one last chance to save our NHS.

The dissent in the House of Lords is clearly real, as I discussed in a recent article, “Save the NHS: As Lib Dems Vote to Support Tory Privatisation Plans, The Last Hope is the House of Lords,” following the capitulation of a majority of the Tories’ coalition partners, the Liberal Democrats, in the House of Commons, where the bill was passed by 316 votes to 251.

400 senior doctors complain to the government about “irreparable harm” to the NHS if the bill proceeds

I discuss the mounting opposition in the House of Lords below, but  the other significant event in the resistance to the Tories’ plans to privatise the NHS took place on Monday, when, as the Guardian reported, more than 400 senior doctors and public health experts called on the House of Lords to throw out the bill, saying that it would do “irreparable harm to the NHS, to individual patients and to society as a whole”.

The signatories, the Guardian noted, “include Professor Sir Michael Marmot, the author of several reports on the links between wealth and health that suggest children born into poverty are penalised for life,” who, until now, has “not been openly critical of the coalition’s approach, and instead has offered encouragement for David Cameron and Andrew Lansley’s apparent enthusiasm for public health.” Now, however, he “and others in senior positions” have “concluded the bill will damage all aspects of the health service.” Their letter states:

While we welcome the emphasis placed on establishing a closer working relationship between public health and local government, the proposed reforms as a whole will disrupt, fragment and weaken the country’s public health capabilities. The government claims that the reforms have the backing of the health professions. They do not. Neither do they have the general support of the public.

The letter also explains in detail the fundamental damage to the NHS that will result if the bill is passed:

It ushers in a significantly heightened degree of commercialisation and marketisation that will lead to the harmful fragmentation of patient care; aggravate risks to individual patient safety; erode medical ethics and trust within the healthcare system; widen health inequalities; waste much money on attempts to regulate and manage competition; and undermine the ability of the health system to respond effectively and efficiently to communicate disease outbreaks and other public health emergencies.

The signatories “include around 40 directors of public health from around the country,” who, in the Guardian‘s words, “have taken the difficult decision to go public with their concerns.” They are joined by “two senior members of the Faculty of Public Health, one of whom, Dr John Middleton, is a vice-president,” and other prominent figures include Professor John Ashton, director of public health in Cumbria, and Professor Michel Coleman of the London School of Hygiene and Tropical Medicine.

In conclusion, the signatories say that the bill “will erode the NHS’s ethical and co-operative foundations” and “will not deliver efficiency, quality, fairness or choice.”

Dr David McCoy, consultant in public health medicine at the Inner North West London Primary Care Trust, who was one of the organisers of the letter, said “he was surprised at the number of people prepared to sign,” as the Guardian described it. He explained, “I think if we had continued to collect signatures, I’m quite sure we would have collected another 200. It is having a snowball effect. I think the feeling is incredibly strong.” He also said:

There was a lot of debate about whether we should call for outright rejection or amendments, but there is a feeling the whole package of reforms is harmful and we need to express our position in the strongest terms. I think there was a feeling the forthcoming reading in the House of Lords is the last chance of minimising the harm and damage.

As the Guardian noted, “the public health community has not spoken out in this way before.” Dr. McCoy explained, “I think there has been an attempt to work with the reforms and work behind the scenes to optimise the proposed reforms.”

That attempt has clearly failed. Dr. John Middleton called the letter “a recognition from the public health community that the reforms proposed around the NHS are deeply damaging to the public health in themselves,” describing, as the Guardian put it, “concern that they would lead to inequalities in healthcare and less access for the poorest and most deprived to the services they need.”

He also said, providing a crucial analogy with other countries, “The experience of other countries that have ‘liberated’ their health systems has resulted in very poor health services for their communities. I’m thinking of Russia and China where a free market in health resulted in major falls in life expectancy and systems that had provided some safety net cover have failed.”

Lords Owen and Hennessey propose detailed scrutiny of the NHS bill in the House of Lords

A month ago, I explained how opposition to the bill in the House of Lords was being spearheaded by Baroness Shirley Williams, who had written an article for the Observer, and Lord Owen, who had written about his opposition to the plans in the Independent, back in April, and as the bill makes its way to the Lords on Tuesday. Lord Owen has spoken out again, accompanied by another peer, Lord Hennessey, as Parliamentary Correspondent Mark D’Arcy explained in an article for BBC News on Tuesday.

D’Arcy wrote, “Hard on the heels of the letter from 400 public health experts who wrote to peers to warn that the Bill would cause ‘irreparable harm,’ comes another letter to noble Lords from two eminent crossbench peers, urging that key sections should not be debated in detail by the full House of Lords, but instead scrutinised by a special select committee — it would be a ‘two-speed appraisal’ of the much delayed and rewritten Bill.”

Lord Owen, who is qualified to deal with NHS matters, being a former surgeon and a former Labour health minister, and Lord Hennessey, described as a “leading constitutional academic,” have stated their belief that one particular section of the bill “has serious constitutional implications — and deserves much more detailed consideration than it could be given in a regular Committee Stage debate in the House of Lords,” as the BBC described it.

That particular section involves the nine clauses in the bill dealing with the responsibilities of the Secretary of State for Health. As the BBC explained, “The Lords Constitution Committee, which examined the constitutional implications, suggested that Peers would need to consider ‘whether these changes pose an undue risk either that individual ministerial responsibility to Parliament will be diluted or that legal accountability to the Courts will be fragmented.'”

This seems hardly in doubt, as legal experts consulted by the campaigning group 38 Degrees established that Andrew Lansley was working out how to wash his hands of the responsibility for the NHS that ministers have had since its founding. As I explained last month, Jacqueline Davis, a consultant radiologist in north London, the co-chair of the NHS Consultants’ Association, and a founder member of Keep Our NHS Public, focused on the lawyers’ findings in an article for the Guardian, in which she wrote:

They [the legal experts] found that the bill does indeed “remove the duty of the secretary of state to provide or secure the provision of health services which has been a common and critical feature of all previous NHS legislation since 1946.″ Furthermore, a “hands-off clause” will “severely curtail the secretary of state’s ability to influence the delivery of NHS care to ensure everyone receives the best healthcare possible.” They conclude the government can now wash its hands of the NHS, while the likelihood of a postcode lottery increases and local accountability decreases.

They also conclude that the bill “will increase competition within the NHS at the expense of collaboration and integration and/or make it almost inevitable that UK and EU competition law will apply as if it were a utility like gas or telecoms.” So despite the coalition’s repeated denials, this legal opinion believes that “these plans will lead to a system geared heavily in favour of private companies.”

As well as recognising the problems with the bill that are outlined above, Lords Owen and Hennessey “also want a committee to look at Part 3 of the Bill relating to the NHS competition quango, Monitor,” whose role, envisaged by Andrew Lansley, is to enforce competition above any other requirements. Monitor’s role has been widely criticized, not least by Nick Clegg back in May, but as Lords Owen and Hennessey recognise, the problems with Monitor’s role have not been adequately addressed. In the BBC’s words, “They hope a select committee would flesh out its precise purpose and operational methods and consider the implications for EU competition law. And they want a longer look at the role for public involvement and local government, in the running of the NHS.”

If they have their way, Lords Owen and Hennessey will ensure that some of the most troubling aspects of the bill will be thoroughly scrutinised, because a select committee, with witnesses allowed to give evidence, will provide scrutiny that was sorely lacking the House of Commons. As the BBC noted, they also want a select committee “to hire a parliamentary draughtsman ‘to help with the wording and the presentation of the many amendments that this very large Bill is likely to attract.'”

This, as the BBC also noted, “is rather more than a procedural wrangle about how to handle the Bill, and the good news, on Tuesday evening, was that Baroness Thornton, Labour’s spokesperson on health in the House of Lords, announced that Labour peers would support the Owen-Hennessey amendment. That, as the BBC stated, “means it has an excellent chance of coming to pass, since Lady Williams and other Lib Dem dissidents have been complaining that the Bill has not had the scrutiny it deserved in the Commons. Labour Peers, plus some Crossbenchers, plus some rebel Lib Dems could well put together a majority, especially if bolstered with Conservative Peers from the Constitution Committee — whose worries were quoted by the wily Lords Owen and Hennessey.”

As Lady Thornton said, “Lord Owen’s amendment means an important and complex part of the Health Bill will now be subject to the close scrutiny it failed to get in the Commons. A committee of experts will be able to take evidence — something normal procedure in the Lords does not allow. They will also be able to recommend whether these parts of the Bill make sense and how they might be improved.”

Those concerned with defending the NHS can take advantage of an excellent website, “Peer Pressure,” allowing them to analyse MP’s opinions, and to contact them to urge them to support resistance to the bill, but make no mistake: resistance is urgently needed, not just to prevent the government from privatising the NHS in future, but to prevent the privatisation that is already taking place.

Prepare to fight, because the Tories’ privatisation of the NHS is already underway

As Polly Toynbee noted in an alarming article for the Guardian on Friday, entitled, “This shocking NHS bill is without sense or mandate“:

They [the House of Lords] should be constitutionally affronted that this colossal reorganisation is already imposed on the NHS without waiting for their consent. No one can remember a similar case of pre-legislative implementation, as if parliament were irrelevant.

Without waiting for them, 300 clinical commissioning groups are taking over, nominally run by GPs. Private sector involvement is already compulsory: by this month every commissioner must find at least three outside providers for diagnostic tests, audiology, primary care psychological therapies, treatment for back pain, feet and other services.

Department of Health website instructions say: “Commissioners cannot refuse to accept providers once they have qualified.” That’s what “any qualified provider means” and it’s happening now — forget the law. McKinsey and other consultants are already being paid millions by commissioners to work out the payment system.

As she also noted:

The Lords should be alarmed that no one in parliament will be accountable for the NHS. The NHS Commissioning Board, a gigantic £80bn quango, will run it with the secretary of state forbidden by law from interfering. MPs will be shocked when the Speaker has to rule out of order any questions about hospital scandals, closures, waiting lists and all the imminent NHS crises.

These are powerful words, but words alone will not stop the Tories from destroying the NHS. If you’re in London tomorrow, please consider protesting, and please also consider contacting individual members of the House of Lords via “Peer Pressure.”

However, if things go badly, we need also to prepare for civil disobedience. The government seems to be counting on the fact that British people can be substantially disenfranchised, and will merely shrug their shoulders and say, “mustn’t grumble.” It will be a disaster if the NHS is privatised while people look the other way, leaving them only to lament ruefully afterwards that, perhaps this time, they should have stood up to be counted.

The time to stand up and be counted is now.

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.