NHS news is dominated by the British Medical Association (BMA) representing doctors calling for the Bill to destroy the NHS to be abandoned entirely. Unite health worker members believe that the NHS is going to be privatised for the benefit of private companies. Nick Clegg and Labour’s John Healey are to make speeches on the NHS today,
Conservative election poster 2010
A few recent news articles concerning the UK’s Conservative and Liberal-Democrat coalition government – the ConDem’s – brutal attack on the National Health Service.
Nearly 90 per cent of Unite health sector members have ‘no confidence’ in the coalition’s handling of the NHS ‘reforms’, a new survey has revealed.
The massive vote of ‘no confidence’ from Unite – which has 100,000 members in the health service – comes as the coalition’s ‘listening exercise’ on the Health and Social Care Bill draws to a close.
The snapshot survey of specified professional groups represented by Unite also revealed that two-thirds said that they had seen the treatment and care of patients/service users reduced or rationed in the last six months.
Unite Head of Health, Rachael Maskell said: ‘Those working in the NHS have no confidence that the universal service that they have dedicated their working lives to is safe in Tory hands – they fear that it is going to be privatised and broken up for the benefit of profiteering private healthcare companies. No matter how it is dressed up.’
Nick Clegg will seek to maximise the Liberal Democrats’ influence over the imminent changes to the government’s NHS plans with a major speech on Thursday setting out his party’s demands.
The deputy prime minister will outline the substantial revisions he expects to see made to the health and social care bill to ensure that his MPs feel able to support it when it returns to parliament.
He will also make clear why the NHS needs reform. Party sources say it will echo a keynote speech last week by David Cameron and endorse the prime minister’s view that, although some of health secretary Andrew Lansley’s proposals will be rethought, the service in England will still be expected to embrace far-reaching changes so it can cope with growing financial and clinical pressures.
John Healey, shadow health secretary, will accuse Cameron of refusing to amend the bill enough to ensure that it does not harm healthcare. “David Cameron is a PR man looking for a PR answer.
The BMA demanded a number of changes to the proposals, including putting an ‘explicit duty’ on commissioning consortia to involve doctors in secondary care, public health and academia.
It said: ‘The existing duty in the Bill on commissioning consortia to “obtain appropriate advice” is insufficient to ensure that the best clinical practice is enshrined in commissioning.
‘Clear guidance should be developed on models for how this can be achieved in practice, such as by developing clinical networks alongside the strategic and decision-making functions of commissioners.’
The BMA also called for economic regulator Monitor’s primary role to be amended to protecting and promoting high quality, integrated healthcare services, not promoting competition.
The NHS is under serious attack from the Tories and faces rampant privatisation. Colin Leys, co-author of a new book on the NHS, spoke to Yuri Prasad about what the cuts mean—and how this is the logical conclusion of policies pursued by New Labour
Many say that if the government’s health and social care bill were passed in its present form it would mean the end of the NHS as we know it. Does that overstate the threat?
Colin Leys I don’t think it overstates the threat at all. The bill removes the secretary of state’s responsibility to provide a national health service and doesn’t assign it to anyone else. She or he would only be charged with “promoting” it.
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Selected excerpts from ‘The Plot Against the NHS’ by Colin Leys and Stewart Player. Chapter One is available here. I highly recommend this book available from Merlin Press for £10.
Shameless liar Nick Clegg claims that “There will be no privatisation of the NHS” at Prime Minister’s Questions. He is definitely a Tory and a liability to the Liberal-Democrats and they should dump him.
Wales and Scotland are to have more severe NHS cuts that England.
Conservative election poster 2010
A few recent news articles concerning the UK’s Conservative and Liberal-Democrat coalition government – the ConDem’s – brutal attack on the National Health Service.
Unite, Britain’s biggest union has cautiously welcomed news that Linda Hamlyn, head of the NHS blood service has expressed optimism it will escape privatisation amid suggestions the government is becoming worried about the political backlash against competition (see http://www.hsj.co.uk/5030170.article.)
The Department of Health (DH) is currently leading a review into ways the NHS Blood Service could cut costs. As part of the review the DoH have been talking to private providers.
Unite launched a media and online campaign against the potential privatisation of parts of the blood service and raised the issue with MPs who asked questions in the house. A recent independent poll of 18,000 people commissioned by Unite showed that 74 per cent opposed the privatisation of any part of the blood service. Over 50,783 people signed a petition started by Unite against privatisation.
Unite national officer, Rachael Maskell said: “This is a step in the right direction but we will continue to keep a careful watch over this very precious service. Privatisation of any part of the blood service contaminates the whole of the blood service. Our campaign struck a chord with the general public, who were outraged when they learnt that the government was prepared to even consider privatising parts of the blood service.
“It is totally wrong to allow private sector companies to profit from men and women who freely donate their blood to help others. The government got the message that the people of this country were saying no to blood money but we will remain vigilant to ensure that these proposals have not just been kicked into the long grass for the time being.”
David Cameron‘s pledge to increase the NHS budget in real terms has been challenged by a leading health economist who claims the service’s spending power is set to fall. The NHS budget in England will be 0.9% lower by 2014-15 than it was in the financial year that ended last month, Professor John Appleby writes in the British Medical Journal.
Although ministers are giving the service more cash in each of the remaining four years of this parliament, inflation will mean its purchasing power is eroded so much that it will drop, he says.
Appleby, chief economist at the King’s Fund health thinktank, contradicts Cameron and health secretary Andrew Lansley’s repeated promises to deliver year-on-year rises in real terms. They claim the NHS will receive an extra £11.5bn over the next four years thanks to protecting the health budget, increasing it from £103.8bn in 2010-11 to £114.4bn by 2014-15.
Appleby does not dispute the cash increases but insists that “by 2014-15 the amount of money the NHS has to spend in real terms, its purchasing power, will have gone down by 0.9%.”
He based his predictions on Treasury estimates of inflation in the economy as a whole, and the likelihood of NHS staff pressing for pay increases once the current three-year freeze ends in 2013.
“When we tell him his plans aren’t working, he doesn’t seem to want to hear what we’re saying.”
– Dr Hamish Meldrum, Chair of the British Medical Association, May 2011
It’s hard to listen with two fingers stuck in your ears. That’s the message 38 Degrees members have sent Health Minister Andrew Lansley this morning.
Newspaper ads funded entirely by thousands of donations from 38 Degrees members have been published in five daily papers, the Guardian, Mirror, Mail, Express and Metro. The combined circulation is a whopping six million people. These ads were driven by people power with thousands of contributors raising over £90,000 in just a few days. And not only did 38 Degrees members fully fund the ads, they also contributed important feedback during the design process.
Lansley still isn’t listening. His sham “listening exercise” draws to a close at the end of the month and today 38 Degrees members have sent a message he can’t possibly ignore. The future of the NHS is too important for us to let it be decided behind closed doors.
CONCERNS have been raised that a shake-up of NHS care in the county could see health services move away from Cheltenham.
Town MP Martin Horwood yesterday warned the proposals put forward by health bosses may continue the “drip, drip” erosion of services at Cheltenham General Hospital.
This week saw a consultation begin on plans affecting stroke care, outpatient breast cancer services, trauma cases and emergency treatment for children.
Mr Horwood greeted the proposals with caution. He said: “I’m relieved that, as promised, there is no suggestion that Cheltenham’s A&E is going to close and that there are no further threats to maternity or other key local services.
“But it’s clear that the consultation is leading people to endorse a further shift in key emergency services from Cheltenham to Gloucester.”
Under the plans, those who suffer a stroke and trauma patients may be treated at one site in the county. There is also a proposal to have one dedicated children’s emergency unit at Gloucestershire Royal.
The body that represents most of the organisations in the NHS has refused to back the government’s planned health reforms. The NHS Confederation argues that the reforms will provide neither the productivity gains nor financial savings needed. It says the proposals need a ‘significant overhaul’ and are being implemented against an ‘arbitrary’ timetable.
In its submission on the Health and Social Care Bill, the confederation, which represents more than 95% of NHS organisations in England, Wales and Northern Ireland,has said it is in favour of reform of the NHS. But it believes the plans need to be ‘better focused on the challenges that the NHS now faces’.
The proposed reforms would transfer health care commissioning transfer from primary care trusts to consortiums of GPs. It would also open up NHS services to bids from ‘any willing provider’ to provide care.
The reforms were put on hold on April 4 when Health Secretary Andrew Lansley said that the government would embark on a ‘listening exercise’ on the plans, dubbed the NHS Future Forum.
The NHS Confederation’s contribution to this consultation agrees that part of the reforms, including the introduction of clinical commissioning led by GPs, ‘have real merit’. It also backs the use of competition in the NHS where it can show benefits to patients and taxpayers.
However, it argues that the case for the breadth of the government’s reforms ‘has yet to be clearly made’, adding that the changes are not ‘sufficiently focused’ on the problems facing the NHS, including the need to save £20bn by 2014/15.
Nick Clegg today insisted the Government’s healthcare reforms did not amount to NHS privatisation.
The Deputy Prime Minister was repeatedly pressed over the coalition’s shake-up of medical services at Commons question time, with Labour MPs lining up to accuse the Government of backdoor privatisation.
But an angry Mr Clegg told them: ‘There will be no privatisation of the NHS.’
Deputy Labour leader Harriet Harman told MPs: ‘People are worried about the NHS being turned from a public service into a commercial market.’
Wales is facing the worst NHS cuts in the UK, a review of spending suggests.
The analysis, by Professor John Appleby, of the King’s Fund think tank, suggests the Welsh NHS budget will fall by nearly 11% in the next three years, once inflation was taken into account.
Northern Ireland faces a 2.2% cut over four years, he says, with the long-term picture in Scotland less clear.
England came out best, but even it is facing a cut of 0.9% over four years – despite promises to protect the budget.
Prof Appleby said this was because new inflation figures, which were higher than expected, had counteracted the small rises for the NHS in England that were announced last autumn.
Speculation concerning the future of the Destroy the NHS bill and the coalition government.
The King’s Fund response to the Destroy the NHS Bill proposes greater intergation and collaboration to improve services.
Further health funding cuts in Manchester.
Waiting times rise.
NHS Central Lancashire is considering making GPs redundant.
Lansley admits that the NHS Bill may be delayed by further scrutiny by MPs.
Conservative election poster 2010
A few recent news articles concerning the UK’s Conservative and Liberal-Democrat coalition government – the ConDem’s – brutal attack on the National Health Service.
The Lib Dems have a lot to answer for when it comes to the deeply unpopular Health and Social Care Bill. The Orange Book wing of the Lib Dems, of which Nick Clegg is a key member, actually supports the idea of a social insurance scheme with private providers to replace the NHS, which is a key objective of the current bill.
The Lib Dem election manifesto promoted the idea of a market-based healthcare system and abolition of SHAs. The coalition agreement on health reform was signed by Nick Clegg and reviewed by Danny Alexander. The final page of the Bill itself (p367) has the Lib Dem names of Nick Clegg, Vince Cable, Danny Alexander and Paul Burstow as supporters the Bill.
Finally, Lib Dem MPs have fully supported the Bill through its first two readings in Parliament.
However, the political landscape changed when the scale of the public and professional opposition became clear. The Lib Dem’s Spring conference, along with other factors such as the Royal College of Nursing vote of no confidence in health secretary Andrew Lansley, was crucial in terms of changing Nick Clegg’s stance on the reforms and gaining a natural “pause” in the Bill.
The King’s Fund has called for significant changes to the government’s health reforms to enable the NHS to provide a ‘new model’ of care that meets the challenges of the future.
In its response to the government’s listening exercise on the Health and Social Care Bill, the Fund says it supports the need for reform but argues that it must be based on a clear diagnosis of NHS performance and the challenges it faces. It calls for the NHS to be re-orientated to deliver a new model of ‘integrated’ care, based on stronger collaboration between health professionals and more effective co-ordination of services.
The response argues that integrated care offers the best prospect of improving services for patients and addressing the key challenge facing the NHS – demographic change and the increasing number of people with long-term conditions such as diabetes, asthma and dementia. It draws on evidence from the NHS and the United States showing that integrated care delivers better outcomes for patients with long-term conditions and improves the quality of specialist services such as cardiac, cancer and stroke care.
The Fund calls for a number of significant changes to the Health and Social Care Bill and wider health policy to deliver integrated care.
The NHS is under-managed but over-administered, a report from the King’s Fund finds.
It calls for a new style of leadership to overcome unprecedented financial pressures and adapt to future challenges.
High-quality, stable management is be key to high-performing health services, it finds. Yet across the NHS, the average chief executive spends just 700 days in post. In part, this reflects a culture where ‘heroic’ leaders grapple with problems only from the top of the organisation, or are ‘parachuted in’ to replace individual managers and ‘turn around’ troubled NHS services. The report advocates a new type of ‘shared leadership’ involving leaders at different levels of the workforce working collaboratively with all those involved in patient care to lead change and improve services, rather than only tackling problems inside specific institutions.
The report criticises the government for not assessing the future needs of the NHS before imposing a 45% cut in NHS management posts and 33% cut in administration costs.
It says: “There is no persuasive evidence that the NHS is over-managed, and a good deal of evidence that it may be under-managed. While administration and management costs will have to take at least their fair share of the pain as real-terms growth in NHS spending ceases, a more sophisticated approach to the reduction in both is needed.”
The number of patients waiting more than 18 weeks from referral to treatment is greater than at any time since mid-2008, the latest NHS statistics for England reveal.
More than 35,000 patients waited more than 18 weeks for treatment in March, breaking the NHS constitution-enshrined right for 18 week waits for the second month running.
The figures show that 10.4% of patients waited for more than 18 weeks from referral to treatment in March, up from 10.2% in February.
The numbers of patients waiting for more than 18 weeks has increased steadily since ministers removed the formal target of admitting 90% of patients within 18-weeks last summer. The target had been strictly enforced until last June but still remains a patient right under the NHS Constitution.
Figures for non-admitted patients showed the numbers being treated within 18 weeks had stayed stable on around 97% since the beginning of the year. Some 25,578 non-admitted patients waited for longer than 18 weeks in March.
Exclusive: Salaried GPs employed by a PCT face being made redundant as NHS managers charged with cutting costs turn their attention to general practice.
NHS Central Lancashire has placed a series of salaried GP positions under review as the PCT looks to restructure the organisation and realign costs.
Dr Edoardo Cervoni, a full-time permanent salaried GP employed by the PCT to work in practices in Preston and Ormskirk, is one of several GPs to be told their contracts are due to be terminated by the trust.
Dr Cervoni was informed in April that salaried GP positions had been placed under review and has now been told to expect to be made redundant at the end of July.
‘I was told that the PCT was going to stop providing clinical services and it had been planned that salaried GP positions “had to go”,’ said Dr Cervoni, a GP specialist in ENT medicine with 17 years’ experience.
‘Being made redundant is not nice and it has a negative impact on your career and particularly on your family life. I hope I may remain one of the very few GPs to have to experience the feeling, but it really seems that the process of dismantling the NHS is well on the go.’
The changes to the government’s flagship NHS bill could be so substantial that it has to undergo fresh scrutiny by MPs – delaying its passage through the Commons, the health secretary said on Monday.
The bill has already passed through the committee stage, where it was scrutinised line by line by MPs, but the proposals have been paused for a “listening exercise” with NHS staff and the public. A panel of experts, known as the Future Forum, was tasked with hearing concerns about the bill – a process that ends next week.
In an online question and answer session with Guardian readers, the health secretary, Andrew Lansley, answered a post about “recommitting” the bill to the house. “We won’t decide that until we have received the NHS Future Forum report and have responded to that. I told the House of Commons on 4 April that we would ensure proper scrutiny of the bill – we have done that so far and we will continue to do so,” he wrote.
A year ago Peter Martin, the chief executive of Tribal Group plc, which describes itself as a “leading provider of commissioning services to the NHS“, presented his view of the future for the health sector in England. He was bullish. Although he described market conditions as “challenging”, he saw an “improved flow of service delivery opportunities” that would significantly support Tribal’s revenue growth. Andrew Lansley’s 2010 white paper would bring “major changes in structure of UK health markets”. Martin’s goal was to focus Tribal’s health business on the profit-making opportunities these reforms would create. He set out five growth priorities: commissioning for GP consortia, clinical support services, patient management services, informatics outsourcing and hospital management services.
This is the future for the NHS that David Cameron and Nick Clegg have planned for us since the launch of the coalition. Despite their claims to the contrary, they have been laying the ground for wholesale privatisation of the NHS, the destruction (without any democratic mandate) of one of Britain’s most cherished and effective postwar institutions, and the transfer of its stewardship and operations to organisations concerned only with maximising revenues and reducing costs. The word “quality” appears nowhere in Tribal’s vision as communicated to investors.
How has the NHS arrived at this moment of crisis? Colin Leys and Stewart Player provide an indispensable guide to understanding the origins of what they call a plot against the NHS. Surely this is an exaggeration? Not so. Cameron, Clegg and Lansley are merely continuing two decades of policies – begun by Tony Blair, endorsed by Gordon Brown, and supported by successive Labour governments – aimed at introducing markets into the health service. Where Labour tried to hide its intentions, the only difference with the Conservative-Liberal alliance is their shameless transparency.
Looking back at Labour health policy now, I have to ask myself how so many of us were unable to see through the mists of what Leys and Player call the “misrepresentation, obfuscation, and deception” perpetrated by Blair, Brown, and a host of health ministers all too willing to genuflect to the market zeitgeist. Too many of us – whether doctors, nurses, or just members of the public – were willing to be bewitched by Labour’s mellow language of reform. The words are all too familiar now: modernisation, choice, empowerment, diversity, plurality, improvement, contestability, and, most beguiling of all, patient-led.
The Department of Health created a commercial directorate to oversee the plan to privatise the NHS. A group of passionate market advocates were hired to transform a public sector institution into a target for private sector takeover. People such as Mark Britnell, who was the Department of Health’s director general for commissioning when Labour was in office and who later joined KPMG – able to sell his experience in government to the world of management consulting – have now been outed as agents for the merciless dismemberment of the NHS. There was a revolving door between civil servants in the department and McKinsey, KPMG and Deloitte. Ex-ministers, such as Patricia Hewitt and Lord Warner, traded their knowledge of NHS privatisation with those who could benefit in the commercial sector.
Doctors’ leaders were little better. The British Medical Association’s John Chisholm and Simon Fradd, who led negotiations with government to revise the GP contract in 2002, won a huge victory by making out-of-hours care for patients optional. Nine out of 10 GPs stopped offering services to patients from 6.30pm to 8am. This withdrawal of NHS care allowed private providers to step in and take over. After Chisholm and Fradd had succeeded in putting out-of-hours care out for private tender, they set up Concordia Health, a private company, that offered to run those very same services, only now at a profit to themselves.
The networks of health institutions that propped up the case for marketisation and privatisation of the NHS were intricate. They include private providers, such as UnitedHealth (whose president of global health, Simon Stevens, was once a key Labour adviser); thinktanks, such as the King’s Fund (whose trustees have included Stevens and Julian Le Grand, his successor in Number 10); and lobbyists, including several NHS outsourcing and private equity businesses.
Having anatomised the diseased political corpus that has begun to infect the NHS with a commercial ethos that will increase costs, cut services and reduce quality, Leys and Stewart try to look to the future. They mount a strong defence, claiming there is no evidence the NHS is in urgent need of fundamental reform. Given the statement by Steve Field, who is leading Cameron and Clegg’s pause to review the Lansley reforms, that the current Bill could “destroy key services” and destabilise the NHS, it seems that the gathering momentum for markets as the solution to whatever ills the NHS might have could be about to stall.
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Selected excerpts from ‘The Plot Against the NHS’ by Colin Leys and Stewart Player. Chapter One is available here. I highly recommend this book available from Merlin Press for £10.
