NHS SOS

Raymond Tallis, Jacky Davis

• Publisher: Oneworld Publications
• Year: 2013
• eBook ISBN: 9781780743295
• Topic: Politics & International Relations
• Subtopic: Public Policy
• Index: Politics & International Relations

An exposé of the back-door deals and negligence that threaten to destroy the NHS – and a 10-step manifesto for saving it The Coalition Government passed into law an unprecedented assault on the NHS. Doctors, unions, the media, even politicians who claimed to be stalwart defenders failed to protect it. Now the effect of those devastating reforms are beginning to be felt by patients – but we can still save our country's most valued institution if we take lessons from this terrible betrayal and act on them.Contributors to this eye-opening dissection include Dr Jacky Davis, Oliver Huitson, Dr John Lister, Stewart Player, Prof. Allyson Pollock, David Price, Prof. Raymond Tallis, Dr Charled West and Dr David Wrigley.Proceeds from the profits of this book will go to Keep Our NHS Public (www.keepournhspublic.com).

‌1

‌Breaking the Public Trust

John Lister

All politicians lie, just like the rest of us, only more so.

Polly Toynbee

It could be said that the National Health Service as we know it was abolished in April 2013, just three months short of its sixty-fifth birthday. This was not a peaceful process. There is no consensus behind the highly contentious Health and Social Care Act 2012, which after a belated, lengthy tussle through Parliament eventually passed to set the new framework.

The old NHS is being painfully put down, rather than pensioned off – but there is some hope for reviving it, if the public comes together to fight for it. It is consistently high in the public’s affections. When David Cameron’s Coalition Government took office it had received a decade of record investment, allowing it to meet ambitious targets to cut waiting times and improve care, and was achieving record levels of public satisfaction. It was not broken, and did not need fixing.

Indeed, far from fixing or improving the NHS, the massive unwanted Tory ‘reforms’ have a very different purpose, enabling profit-seeking private companies and non-profit social enterprises to emerge and challenge for a growing share of health budgets, win contracts – and find inclusion on a new, lightly regulated register of so-called ‘Qualified Providers’. Meanwhile, public sector (NHS) providers are being continuously cut and squeezed into downsizing, mergers, centralisation and closures. Cynical ‘reconfiguration’ plans being driven through across England mean only a reduced number of short-staffed, demoralised, overloaded ‘centralised’ units will remain, covering only those services that the private sector does not wish to provide.

The eclipse of the public sector delivery of health care is no accident. In place of what was for many years a unified system, one that publicly provided a comprehensive range of services to the whole population on the basis of clinical need rather than ability to pay,‌¹ the NHS has been quite deliberately reduced by the Health and Social Care Act 2012 to little more than a fund of taxpayers’ money through which services are purchased from a variety of providers. This continued role for public funding has – for the time being at least – allowed health ministers to insist that the proposals are ‘not privatisation’, since treatment will still be free at point of use, despite the fact that the provider of elective and community services is increasingly likely to be a private company or social enterprise.‌²

Previous Conservative governments have not scrupled to reorganise health services that once were free at point of use, so that very large numbers of patients are now subject to charges for their care. The most obvious examples have been the disappearance of NHS dentistry for many, and soaring charges even for those who can still access NHS dental services; the removal of free eye tests and almost all free provision of NHS spectacles; and, of course, the biggest privatisation of them all so far: the effective privatisation of social care.

Under Margaret Thatcher’s so-called ‘community care’ reforms (following the 1988 Griffiths Report), long-term care of the elderly, which had previously been financed through the NHS and through social security entitlements, was in 1993 removed from the brief of the NHS and handed over to local council social service departments, where it has remained subject to means-tested charges. As a result, each year thousands of people have to sell their houses to pay for care that once was free. A majority of older people in care homes now pay most of the costs of their own care, while almost all home help and domiciliary services for the frail elderly have been privatised. Councils levy charges based on a person’s income and assets: the charges are being constantly driven upwards by central government funding cuts, even as eligibility for support has been reduced to those with the most extreme needs, leaving others to fend for themselves.‌³

Flashback

The 2010 White Paper by then Health Secretary Andrew Lansley, cynically entitled ‘Equity and excellence: Liberating the NHS’, began with an explicit commitment to enforce the target of £20 billion in cost savings to be achieved by the NHS by 2014.

The subsequent Health and Social Care Act 2012 is a major turning point. When the NHS was founded in 1948 it represented a historic, qualitative leap forward over any previous system, superseding the crisis-ridden ‘mixed economy’ of health care that had preceded the war and which quickly proved unable to meet demand. Today, it is being replaced by a new ‘mixed economy’ of health care, a change that the public has never called for or supported, and a system that will cost more but be less efficient and deliver less care. Driven not by evidence but by ideology, the Tories have reinvented the flat tyre.

More or less the only people celebrating the passing of Andrew Lansley’s controversial bill in March 2012 were in the private sector, itching to get their hands on a larger slice of the £100 billion health budget in England that now is still largely spent with public sector services.‌⁴ The Health and Social Care Act opened the way for that to change.

To make room for a private health sector that has lamentably failed to develop any viable market for its own expansion, it has been necessary to cut the public sector provision, and to create a new competitive health care market in those services that the private companies see as profitable – provided they are backed by government funding.

To do this, the existing structures of the NHS had to be extensively reorganised. Within months of taking office Lansley, as the Coalition’s first Health Secretary, jettisoned his own party’s previous public pledges of ‘no more top-down reorganisation’, and drew up a 354-page bill that was substantially larger than Nye Bevan’s 1946 act which set up the NHS. While Lansley repeatedly insisted that his enormous and complex bill proposed a plan for evolution rather than revolution, the NHS chief executive Sir David Nicholson was marginally more honest when he admitted that the change was so big it was ‘visible from space’.‌⁵

Cutback

This wholesale reorganisation of the NHS required other abrupt policy reversals by Lansley and by Cameron. From 2006 onwards they (with other Tory MPs) had posed as allies, even champions, of several local campaigns against hospital cuts and closures. Then, in the run-up to the 2010 general election they promised to impose a ‘moratorium’ on further closures of A&E and maternity services and to increase NHS spending in real terms year by year.‌⁶ They even made special commitments to safeguard a few hospitals close to Tory Party electoral interests, such as Chase Farm Hospital in Enfield and Queen Mary’s in Sidcup. However, after the election such pledges and the brief moratorium were swiftly dropped. Within months the changes were felt at Queen Mary’s, with the process of rundown accelerated and its A&E closed. The drive to axe Chase Farm was also renewed. These and similar cuts were part of the wave of cutbacks that have been unleashed since Lansley’s 2010 White Paper launched an unprecedented and sustained cash squeeze on the NHS. Hospitals and other health trusts were required to generate cost savings of more than 4 per cent per year, year after year, a cumulative target of £20 billion – with actual cuts dressed up as ‘efficiency savings’.

Cuts, closures and rationing of public sector services run hand in glove with privatisation and the creation of a new market for health care. The aim is to scale down public providers, downgrade and discredit public services, and strengthen the position of private companies such as Serco and Virgin who have their eyes on winning contracts to deliver services, especially in primary care and community health.

It’s no accident therefore that prominent among the cuts have been moves by growing numbers of local commissioners to exclude more and more elective treatments and operations from the list of services available on the NHS.‌⁷ Where the NHS will no longer fund a treatment, such as a hip or knee replacement, or hernia and varicose vein operations, the patient has an invidious choice: go private – and pay up for treatment that once was available to all who needed it free of charge – or go without.

This rationing of health care (which has the effect of restricting access to services sweepingly dismissed as of ‘limited clinical benefit’ to only those who can pay) was one of the extensive series of proposals for cost-cutting outlined in a report written by the giant multinational consultancy McKinsey and Company and commissioned by the Labour Government in 2009.‌⁸ In public ministers always denied that rationing was under discussion, even after Essex became the first of many authorities to explore the possibilities of using rationing and exclusions to save money in the dying days of the Labour Government. More recently, Coalition ministers have been the ones claiming innocence – even as they tighten the financial screw on local commissioners.

To drive through cutbacks and unpopular policies on the scale put forward by the Health and Social Care Act 2012 requires diluting of the already limited accountability of local NHS bodies and service providers. Starting in April 2013, primary care trusts (PCTs) and strategic health authorities (SHAs), which once commissioned and planned health care on behalf of local and regional populations in England, were replaced by ‘local’ bodies that are anything but public – over two hundred clinical commissioning groups (CCGs).

In theory the CCGs are controlled by local GPs, and this has been the main argument used by ministers to defend them. But from the outset it was clear that this was unlikely to happen in any meaningful way. Most GPs remained resolutely opposed to the Health and Social Care Act, and would not step forward for a role invented to support it. For the most part they recognised that if they were forced into the role of commissioners, they would have to take the blame for imposing cutbacks and the rationing of care to their own patients, which were integral elements of the reform package. Some also recognised that GPs would have little day-to-day control over running their local CCG. As clinicians with a caseload of patients, most GPs lack the time, energy and inclination to take on a major strategic management job involving a nine-figure budget, or for planning services in much wider areas than their own practice.

A handful of well-meaning but misguided idealists have hung in and engaged with the development o...

Table of contents

• Contents
• Foreword
• 1 • Breaking the Public Trust
• 2 • Ready for Market
• 3 • Parliamentary Bombshell
• 4 • The Silence of the Lambs
• 5 • A Failure of Politics
• 6 • Hidden in Plain Sight
• 7 • From Cradle to Grave
• 8 • Stop Press: The Final Betrayal
• Appendix 1
• Appendix 2