Is this the knife poised to finally kill the NHS and the post 1945 social settlement?
Throughout the 80s under Thatcher, but particularly since the Health and Social Care Act (2012), contract after contract for health provision has gone to the for profit private sector. Sometimes the NHS has won contracts, sometimes the privateer, but overall during this last 6 years, our taxes / resources have been drained from public (NHS) to private providers. Stresses on the NHS have been exacerbated by cuts in financial support and staffing, increased demands and by immigrant doctors, nurses and other staff being unwelcome here following the Brexit vote, and it’s liberating a nasty racism. Remaining staff have been exemplary in trying to cope with these demoralising and exhausting situations, but burn-out is now common, staff are sick with stress, continuing to leave or just hanging on for their retirement. Working life for everyone is just not as good as it used to be. Most Trusts in England are now in deficit. Local Authority Social Care is almost non-existent now, again as the result of Thatcher’s immediate and savage cuts in the 80s, and the situation is worsened as local authority funding from central government has been slashed since 2010, and will disappear entirely by 2020. Yet somehow, these combined deficits are all supposed to transform the red to the black by combining health and social care. The latest vehicle in the alphabet soup of acronyms to assist this introduction is Integrated Care Organisations (ICOs) which come with a small money sweetener. However, this money is temporary; almost certainly a one-off as we know this government does not support the public sector and wants it demolished. As Oliver Letwin, the right wing Tory MP said the NHS will have gone by the next election if we win it.
So how is this to happen? Since the Health and Social Care Act, Section 75 has REQUIRED commissioners to put out to tender everything that couldn’t be provided by the NHS, so hospital services like cleaning, diagnostics, catering etc… have gone already. Now, under the proposed ICOs, Section 75 regulations create rights for commercial providers to promote their interests by rules written by US corporations; these enable any private provider which FAILS to get a contract to compensation by the government if that service returns to the public sector. We have already a foretaste of this, as Virgin claimed and received compensation when it failed to get an NHS contract in Surrey (? Can anyone provide me with the specifics?) In the past, the Labour Party, the Royal College of GPs and the BMA have demanded that these regulations be scrapped, since clearly the government could not afford to compensate privateers for every contract which had not been accepted – in fact, it would be a great fail-safe money-spinner to submit silly tenders with guaranteed compensation for no service costs at all, especially if those tenders are for 15 years, as is now commonplace! Do I recognise similarities to PFI? ICOs also require to be paid in full for a year BEFORE they actually provide any service, and that money is fixed irrespective of the number or complexity of the procedures they undertake. It looks very much like a ‘race to the bottom’, safeguarding profits by providing the least and cheapest they can. Is this another echo of PFI? Originally, the commissioners were assured they would not have to use competition in health services, but this seems to have been forgotten and presumably disappears if Section 75 is implemented. When a public contract has been lost to privateers, the service, personnel, equipment and buildings cannot be mothballed, everything is dismantled, and that’s forever. We have so much evidence that privateers ‘cherry pick’ the services which are predictable, easy, most profitable leaving the complex and difficult to the NHS, and if problems arise at some stage in the private service, patients are immediately transferred to the NHS where comprehensive teams of specialist staff, not available in the private hospital, can meet all emergencies IF there’s a spare bed.
There is no evidence that private services provide a better quality service, in fact, they are not as accountable, nor are they as monitored as is the NHS. Competition / marketisation has led to greater inequalities, increased inefficiency, higher costs and greater public dissatisfaction according to Robert Evans, the Prof of Economics at the University of British Columbia.
Judith Varley 19.10.18