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.
HospitalDr reports on the actually widely known outsourcing of NHS treatment under Labour to reduce waiting lists. Private companies were paid regardless of whether they actually did the operations.
Cuts to Diabetic Specialist Nurses adversely affects treatment of Diabetes.
Staff cuts at Epsom General Hospital.
A claim that coalition conflict is damaging the NHS.
Guardian Comment is Free praises Nick Clegg. I suggest that it is important to realise that Clegg is not outright opposing competition in the NHS or the issue that the Health Secretary should provide a comprehensive healthcare system. Clegg has until recently been a wholehearted supporter of this bill. We could do with a fact check as to whether Clegg & Co are complying with the resolution of their Spring Conference. I suspect that they are not. Interesting comments to this article.
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.
A MARCH organised by York doctors concerned about NHS reforms took place in the city centre at the weekend.
About 150 people worried about the scale of the Government’s NHS changes attended the protests, organised by Defend Our NHS York.
The march made its way to Parliament Street where the speakers included Baroness Haleh Ashar, a member of the House of Lords and professor of politics and women’s studies.
Protesters were joined by shoppers and tourists when speeches were made by the fountain in Parliament Street followed a chorus of “three cheers for the NHS” led by Dr James Chan.
Speaking to the crowd, Dr Chan, who is based at York Hospital, said: “We are here to stop these cuts because they are going to destroy the NHS.
“This is York’s voice against these reforms, which are the wrong plan at the wrong time, and you are all NHS heroes.”
Baroness Afshar said “There are times when the public knows best, and this is one of those times.
“These reforms make no sense and what we want is more transparency.
“I don’t know any GP who supports these reforms because they do not have the expertise and they do not have the information.
“It is nonsense from beginning to end, so I urge you to please, please protect our NHS.”
Private firms were paid millions for operations that never took place in overly generous contracts drawn up by the Department of Health, in a Labour plan to cut waiting times and improve choice.
The independent providers – ISTCs – received more cash for their buildings when contracts came to an end, and were even paid compensation when a second wave of clinics was cut back, a study by the Bureau of Investigative Journalism has found.
Another part of the £1.5billion scheme intended to allow busy workers to see doctors near offices – or polyclinics as they became known – but the new walk-in centres were under-used and most are closing down.
As controversial reforms to the NHS will provide even greater opportunities for private providers, it is feared that more public money will be wasted on similar projects to the doomed Independent Sector Treatment Centre initiative.
The number of diabetic specialist nurse (DSN) posts unfilled across the service has doubled within a year. A survey of 385 hospital trusts and primary care trusts (PCTs) by Diabetes UK found that 218 jobs were vacant last year, even though the number of people with diabetes is rising by 150,000 a year.
“At a time when numbers of people with diabetes are increasing, a decrease in the number of diabetes specialist nurses is very concerning,” said the charity’s chief executive, Barbara Young. “This will mean longer waiting times for specialist support, more unnecessary amputations, more people losing their sight and far poorer health outcomes. This is simply not acceptable.”
The research also reveals that the proportion of DSN posts lying unfilled because of cost-saving programmes had risen to 43% – up from 34% in 2009. PCTs and hospitals in England have increasingly been reducing their staff and cutting back on the services they provide as they struggle with the demands of a £20bn NHS efficiency drive, flat budgets and rising costs. The new findings confirm a growing tendency among bosses of cash-strapped NHS organisations not to replace specialist nurses – who also help patients with cancer, multiple sclerosis, Parkinson’s disease and other conditions – when they retire, move on or are made redundant. However, these nurses are popular with patients and their families, have a proven record of clinical success and an ability to save the NHS money by helping patients stay at home rather than in hospital.
David Cameron and Nick Clegg have been told to end their public “arm-wrestling” over the NHS because their divisions are worrying health professionals.
They should resolve the coalition’s deepening difficulties on the issue and make the service’s future clear as soon as possible.
The sharply-worded intervention in the increasingly fractious debate between the Conservatives and Liberal Democrats comes from Prof Chris Ham, chief executive of the King’s Fund health thinktank and a member of Downing Street’s “kitchen cabinet” on health policy.
“These arguments between the political leaders are worrying and unsettling people in the NHS. If you are running a hospital or primary care trust or pathfinder consortium of GPs you are now very unclear about the direction that the government is going in on these reforms,” Ham said.
“Everything is back in the melting-pot. We are worried about the adverse effects on the NHS if this current uncertainty continues much longer.”
Nick Clegg is making a real difference. These are not common words to read these days, and yet they are becoming hard to dispute with the stalled English health reforms. It is true that the deputy prime minister would be better placed to claim credit if he had not initially nodded Andrew Lansley’s bill through, and true, too, that not all the sweeping concessions he now demands fit with the scepticism about the NHS he has sometimes shown in the past. Nonetheless, Mr Clegg has responded decisively to his party’s democratic will, and is training his sights on the heart of the Lansley plans.
First, he drew a red line around the crucial clause that tasks the regulator with “promoting competition”, and he has now done the same with the legislative invitation for “any qualified provider” to take on the NHS. The deputy PM must now apply a third veto to the unacceptable plan to allow private firms to discharge the core public function of spending health service money. He will then have removed the three greatest drivers of privatisation from among the 80-odd clauses that create an NHS market. Assuming, of course, that he can strong-arm the Conservatives into agreeing. He can afford no compromise. Savaged in Scotland, ravaged in the referendum and trashed in town halls, Mr Clegg retains a grip over his parliamentary party that surprises many outsiders. To keep it, however, he simply has to win this fight.
One reason to be optimistic is that the tide of opinion seems to have decisively turned. Marketising medicine had been steadily becoming entrenched as the orthodoxy, ever since Tony Blair made it his millennial mission. The bust-up over the bill, however, has made the whole approach controversial again. Suddenly Labour’s John Healey, who spent a lonely autumn developing all the criticisms of the Lansley blueprint that medics and Lib Dems now voice with such passion, concedes that his own party wrongly pursued “competition for its own sake” through overpriced and underutilised private treatment centres.
