NHS Cuts and privatisation

Watch this video from Keep Our NHS Public:

Full Version Wake Up Call Episode 1 – No Decision About Me Without Me – Full Version from Health Emergency on Vimeo.

For a year health minister Andrew Lansley has been refusing to publish a civil service report on the risks he’s taking with the NHS. Now the Information Commissioner has ordered him to publish it. The Information Commissioner’s ruling lists Andrew Lansley’s arguments for why he wants this report kept secret. Lansley argued that releasing the report “would have jeopardised the success of the policy”! The Evening Standard reports that the “Department of Health twice breached the freedom of information law” to keep this report secret. Why is Lansley going to such lengths to keep it secret from us?[3]

He’s kept us, MPs, and members of the Lords in the dark deliberately because he’s worried that making these risks public could derail his plans [1] But he could still keep it hidden for another month – until after more key votes have taken place. [2]

We can’t afford to wait that long. The House of Lords is debating the NHS plans right now. If the report on risks to the NHS is released immediately, it could persuade key members of the House of Lords to stand up to the government. Please take two minutes to ask your MP to demand the NHS risks report is made public immediately:
The NHS belongs to all of us. We all pay for it, and we all rely on it to care for us and our loved ones. We don’t want it put at risk – that’s exactly why we’ve been campaigning together all these months. We have a right to see what this report says.
[2] The Information Commissioner has ordered Lansley to release the report within 35 calendar days. But Lansley could even appeal to drag things out even longer.
[3] You can read the full Information Commissioner judgement here:

The story so far

Jaqueline Davis has written in the Guardian “After the so-called “listening exercise” many commentators are talking about a humiliating U-turn by the government over the NHS ‘reforms’ and claiming there have been significant changes to Andrew Lansley’s health and social care bill. But they are the victims of a massive PR coup by the government, which must be delighted with its strategy.”  “A well-orchestrated political storm greeted the report of the Future Forum, with Liberal Democrats claiming they had ticked nearly all their boxes.”
Keep Our NHS Public members (including Prof. Allyson Pollock) have writ

ten a response, saying: … ”the amended Bill was published on 19th July, the day Parliament was scheduled to rise for the summer recess… and although minor changes have been made the underlying aim to turn the NHS into a competitive commercial market remains unchanged.”   

So, there remain two main threats to the NHS.  The first is 20 billion pounds of cuts that are already taking place and will mean major job losses in Calderdale.  (See also the Guardian article: Don’t be fooled by the lull). The second is the amended coalition health and social care bill which will have its third reading early in September. The bill will still have devastating effects in two crucial areas:  The first is the removal of the duty on the secretary of state to provide universal healthcare, which turns back the clock to 1948 when the duty was given. It removes the responsibility for care from society as a whole and devolves it upon the individual. To clarify  the mechanism for this 38 Degrees have commissioned a team of lawyers to go carefully through the bill + amendments 

  The second area involves throwing open the NHS to commercial companies. .  (See also the Guardian article: ) These private companies are not democratically accountable, unlike the Secretary of State. If they provide a bad service, we have no democratic recourse to do anything about it.  The overall aim is therefore still to replace the NHS with an American style service which costs far more than the service here and fails to provide for 53,000,000 people. 

Some recent notes based on ‘keep our NHS public’  articles including extracts from  David Price*, a senior research fellow at Queen Mary, University of London and  from False economy blog**.

The NHS is presently one of the most efficient health services in the world, according to a recent report by the Journal of the Royal Society of Medicine. It has saved more lives for every pound spent than any other country in the world, except Ireland, over the past 25 years. The largely privatised system in the US is among the least efficient.

If it goes through, the new bill will be the end of the NHS. We won’t have a universal system free at the point of need. We’ll have an increasingly insurance-based system designed to limit the health care that is available.

*Put simply, the legal effect of the bill is to abolish the statutory basis of a national health service by repealing duties to provide a comprehensive and universal service. The change is effected by creating clinical commissioning groups (CCGs) with an obligation to cover fewer services and responsibility for fewer patients and residents than primary care trusts (PCTs). Whereas PCTs act on behalf of the secretary of state, CCGs will exercise functions in place of him or her but without a clear primary legislative framework. The bottom line is that commissioners and providers in the new market will have freedom to select patients and services on financial grounds and to redefine eligibility for NHS care and in so doing introduce charges for care.*

**For example, at some time in the future your local CCG may look at its finances and decide that patients must pay for diagnostics like blood tests and x-rays. It is a local CCG that will make this decision, whereas at the moment it is the Secretary of State. If Andrew Lansley were to say “patients will now have to pay for blood tests” there would be uproar. Lansley would be hauled onto Newsnight or the Today programme to justify his decision. The political fallout would be huge and Lansley would rescind this decision. This is why we have politicians responsible for the NHS: they are accountable. If a CCG says “patients will have to pay for blood tests”, what will happen? The first time this happens the relevant CCG Chair will be hauled onto Newsnight to justify the decision. The Chair will say “we do not have enough money, we have had to prioritise”. The Secretary of State will then make a bland statement like “NHS providers must cut bureaucracy and invest this money back into patient care” and shirk any responsibility. This first case will get a lot of publicity, and then our fickle media will ignore subsequent cases – and eventually the policy will be implemented throughout the country.  If CCGs pare down the services that the NHS will pay for it will result in patients having to pay. An honest Bill will make this clear. An honest and equitable Bill will have a clause saying that if CCGs bring in additional charges for care then there will be a mechanism to means test patients to ensure that the poorest get care even though they do not have the money to pay for it. This is not an honest Bill and it is not equitable. It is not even well thought out: there is no provision in the Bill to give care to those who cannot afford it.**

*The blurring of boundaries and responsibilities for funding and provision will make it almost impossible for parliament to hold health bodies accountable for the various elements of their expenditure or for the secretary of state to carry out his or her duty to promote a comprehensive health service throughout England.

The key features of the bill are therefore the move from comprehensive, universal, geographical duties and the assignment of extraordinary discretion to CCGs and the NHS commissioning board. These elements are laid down largely in part one of the bill – in the first instance on clause 1, which deals with the existing duties of the Secretary of State, and clause 10, which sets out the new powers of CCGs.*

The bill effectively abolishes the duty of the Secretary of State for Health to provide a health service for all. In fact there is currently very little democratic control over the NHS, except for the responsibilities of the health secretary. What accountability that does exist will be fatally undermined by the bill.  

The situation will be worsened by the £20 billion of cuts currently being made to the NHS budget under the guise of “efficiency savings”.   Reports of drastic cuts to NHS frontline services lie behind the extreme urgency with which the government is pushing its changes. In fact, admin or “transaction” costs will increase from a current rate of 5% to the American level of 20-30%. Cuts on the scale envisaged are only possible if the duties laid on government by parliament are abolished.  

The new National Commissioning Board will have no obligations to distribute funding in socially beneficial ways. Their primary task will be to ensure “choice” – ie competition. EU competition law may become a further lever in promoting competition within this new healthcare marketplace.  The current regulator, Monitor, will also play a role in rooting out “anti-competitive” behaviour.

Hospitals will be run as autonomous businesses and expected to operate a budget surplus. There will be no limit on the number or proportion of beds taken by private patients in hospitals. Hospitals that seek to serve more NHS patients or address health inequality will be likely to go bust.  Fixed personal budgets will be introduced for many chronic conditions. This will create a two-tier system, where those who can afford to do so will “top up” their treatment privately, leaving the rest to make do with an increasingly limited “basic” level of provision.

After passing through the Lords this bill will be still some way from becoming a reality. It is likely that that the battle for the NHS will come to the boil when these changes actually start to be implemented.  


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