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Volume 46 Number 22, October 1, 2016 ARCHIVE HOME JBCENTRE SUBSCRIBE

The Battle for the Future Direction of the NHS

BMJ Blog on the Privatisation of the NHS

Alex Scott-Samuel, a senior public health academic and joint chair of the Politics of Health Group, blogged in the BMJi website that the government's present programme of privatisation of the NHS set in motion by the Health and Social Care Act 2012 was given a further boost in July in two policy papers, the Strengthening Financial Performance and Accountability in 2016-17ii and the NHS Improvement Business Plan 2016/17iii. He says that the government aimed at a "quiet publication" by issuing them during the Parliamentary recess but that these are "the latest set of instructions on the implementation of NHS chief executive Simon Stevens' Five Year Forward View (5YFV)".

The papers are clearly aimed at bolstering the plan to railroad NHS Chief Executives, NHS Trust boards and CCGs to sign up to the Sustainability & Transformation Plans to facilitate the privatisation of the NHS by the end of this Parliament in 2020. The hallmark of the 5YFV has been the creation of a universal set of NHS trust financial deficits based on arbitrarily imposed cash limits over five years, limits which cut the budgets of the NHS so that present services can no longer be maintained without wholesale closure of hospitals, hospital beds, A&Es, and community services and the massive outsourcing of the non-clinical services to the private sector as "back office". In other words with the government body Monitor enforcing compliance NHS England is now using those "deficits" to legitimise impossibly tight controls on hospital trusts, clinical commissioning groups (CCGs), and other NHS agencies to ensure they conform to central proposals for cuts and mergers between NHS institutions.

Alex Scott-Samuel points out that the plan states that providers will be required "to transform services in line with the 5YFV and this will include making use of new care models and innovative organisational forms." A priority for 2016/17 is "to facilitate independent sector providers to form NHS partnerships".

He says we are told: "We intend to bring together the most promising potential areas for formal collaboration between NHS Improvement, providers, independent sector partners, NHS England, and other key stakeholders into a new work programme. The key elements of this programme in the first instance will examine the opportunities in the areas of:

- mainstreaming clinical capacity for elective, outpatient, and diagnostic care;

- joint ventures and/or outsourcing of new, novel, or restructured clinical services;

- joint ventures and novel financing for facilities and/or technology;

- independent sector management models to support capability and leadership challenges."

This is with the aim of promoting mergers, cuts, and closures in the publicly provided NHS and introducing community based "integrated packages of care", which are readily amenable to private sector provision and insurance funding - as occurs in the US Accountable Care Organizations on which this particular "new model of care" is based. In other words, he is saying that the direction is forcing the bigger Trusts to not just outsource their "back office" services to private companies but to form partnerships with the private sector for this "new model of care".

Alex Scott-Samuel concludes that "it is no coincidence that the House of Lords is currently calling for evidence to be submitted to its new select committee on the long term sustainability of the NHS. This inquiry, supported by government ministers, is likely to make recommendations that will legitimise the aims of Stevens' five year plan, including the 'inevitability' of top-ups, co-payments, charges, and of the short term personal health budgets and longer term health insurance system that would be required to fund them. This toxic combination of an increasingly insurance based and increasingly privately provided health service will signal the final dismantling of what was once our National Health Service in England - a horrific and destructive act, which we now know to have been first proposed by Prime Minister Theresa May's predecessor Margaret Thatcher in 1982."

i Alex Scott-Samuel: Tory plans for NHS privatisation released during parliamentary recess
http://blogs.bmj.com/bmj/2016/08/05/tory-plans-for-nhs-privatisation-released-during-parliamentary-recess/
ii https://improvement.nhs.uk/uploads/documents/Strengthening_financial_performance_and_accountability_in_2016-17_-_Final_2.pdf
iii https://improvement.nhs.uk/uploads/documents/Final_Bus_Plan_16-17_13july.pdf


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