| Year 2007 No. 50, September 20, 2007 | ARCHIVE | HOME | JBBOOKS | SUBSCRIBE |
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Workers' Daily Internet Edition: Article Index :
Safeguard the Future of the NHS! No to Privatisation! Our NHS – We Must Decide!
Save Whipps Cross! Your NHS – Your Say!
NHS “Surplus” Is As Fraudulent As Its “Deficit”
Report Highlights Soaring Cost of PFI in the NHS
Nurses Worried over Quality of Care
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As can be seen from the accompanying report of the Save Whipps Cross Hospital Campaign meeting, all the powerful and rational arguments of those concerned for the future of the NHS are against the government’s policy of “investment with reform”, which is a programme of privatisation, closures and cut-backs. These arguments are deepening the conviction of the vast majority of the people who are involved with the NHS as workers, professionals or patients that the campaign against the direction the government is taking the NHS must and will succeed.
The Whipps Cross Campaign meeting exemplified what is to be found up and down the country where similar campaigns to defend the NHS are taking place. The overwhelming sentiment of the people is to demand a modern, efficient health care service that meets their needs and to reject the government’s vision of the health care service as a source of maximum profits for the health care monopolies. It also exemplified the growing anger that people are feeling about their disempowerment and the way fraudulent consultation processes are set up in which their voice counts for nothing and which are then used as a cover under which to justify the implementation of the very programme of privatisation and cuts to which they are opposed.
The times call out for the working class and people to put on the table the question of taking hold of the decision-making power so that they can shape the type of health care service that they require.
Whose NHS? Our NHS!
Who Decides? We Decide!
On September 18, a well attended meeting of local people in Waltham Forest, called by the Save Whipps Cross Hospital Campaign, addressed the burning issue of how to not only save the local hospitals from being downgraded but also how to resist the government drive to break up the NHS and hand health care over to the private monopolies.
Charlotte Monro, chair of the campaign who also works in Whipps Cross Hospital, opened the meeting by outlining the victories that have been achieved by the workers, patients and local people over the last year in their efforts to save the hospital from being downgraded. She pointed out that the local people’s demand to keep Whipps Cross as a fully functioning district general hospital fully funded as part of a full health care service for local people had been taken everywhere and had had such an effect that it had shown that closing Whipps was not an acceptable option. She stressed that in this work, the committee had succeeded in uniting people from all different political strands. However, she pointed out that all the options being put forward for public consultation under the Fit for the Future Review involved the loss of 637 beds in outer north east London, either at Whipps Cross or at King Georges in Redbridge. She concluded by saying that the meeting had been called so that people could put forward their own agenda as to what the NHS should be. It was also called to act as a rallying point for the defence of the NHS and of mobilisation for the national demonstration in defence of the NHS which is scheduled for Saturday, November 3.
She then introduced the main speakers for the night, who were Professor Colin Leys, Honorary Professor at the Centre for International Public Health Policy, Edinburgh; Norma Dudley, a local health visitor and activist in Unite/Amicus; John Morton, a representative of the local PCT and Dr Alan Hakim, a consultant at Whipps Cross.
Professor Leys congratulated all involved on their efforts to save the hospital and said that the NHS was facing radical changes. He explained that the Department of Health (DoH) has a very clear vision for the future of the NHS in which health care in the country would be provided by different businesses, a significant proportion of which would be privately owned and run for profit. He continued that in this vision, health care was considered to be no different from any other commodity produced in a factory or pizza in a fast food shop. He argued that such a model could not be applied to health care which relied on the numerous interactions between patients and specialists for its success. He pointed out that the NHS had already been broken up into competing units and that the recent market reforms, including Payment by Results (PbR) had led to a significant rise in admin costs within the NHS. He also noted that the introduction of independent sector treatment centres was a further sign of the privatisation of health care and argued that this was allied with a drive to move clinical care out of hospitals. He concluded by saying that over the next five years all the financial risks associated with the introduction of these centres would be borne by the NHS and that these would only be able to function if there was a substantial transfer of NHS staff into the private sector. In fact, he noted that by 2017 it is estimated that 50-75% of all NHS care will be provided by the private sector. In a very interesting point which highlights the corruption inherent in the whole privatisation push, Professor Leys pointed out that Simon Stevens, a former advisor to Tony Blair on health policy and one of the main architects of the privatisation drive has recently been appointed President of UnitedHealth (Europe), the recently established European division of the USA health monopoly United Health Group which has targeted the NHS as a major area for penetration. Its website states “ UnitedHealth Group is already working with the British National Health Service, and it is the success of that partnership that has prompted the launch of the new company”.
Next, Norma Dudley spoke on the basis of her experience as a health visitor working in the local area and provided a chilling picture of the crisis that the government reforms are creating for those patients who rely on the community health services. She explained that two years ago the community nurses were told that they were too expensive and needed to “operate more like Ryanair and less like BA”. She continued that local job freezes and the refusal of the local Primary Care Trust to replace staff who had left, had put the remaining community nurses under extreme pressure as they try to provide high quality care. She stated that this could endanger the lives of vulnerable patients who rely heavily on the community nursing services. She pointed out that over the last seven years alone the ratio of health visitors to children in Waltham Forest has deteriorated from 1 health visitor to 395 children to the present 1 health visitor to 687 children. She opposed the privatisation of community health services and pointed out that while the PCT was unwilling to spend money on hiring new health visitors, in the financial year 2005-6 it had spent £578m on consultancy fees.
John Morton from the local PCT outlined the plans of the PCT with regard to the consultation process over the Fit for the Future review and the health care priorities it had set for the local area. He pointed out that the local consultation would now have to take account of the London-wide consultation which would also be taking place with regard to the recently published Darzi Report. Following his presentation, there were a number of contributions from the floor as he had to leave early. A number of important points were made in these contributions. One speaker expressed her alarm at the fact that the drive to push services out of hospitals into the community was leading to a situation where staff were carrying out procedures which they were not qualified to do. A number of speakers raised their opposition to the rundown of community health services, while others wanted to know where the PCT would find the funds for its development priorities given the large deficit it has and what plans were in place to deal with the likelihood of increased accidents resulting from the massive construction in the area for 2012 Olympics. A number of speakers focused in on the consultation process. People wanted to know how the consultation process would be organised so that their views counted and were not simply dismissed as they had experienced in the past. Mr Morton replied that as the PCT was in deficit, they were heavily constrained by central government in terms of what they could do and so the PCT was determined to get back into balance. With regard to the modalities governing the consultation process, he said that these were governed by the law.
Finally, Dr Hakim spoke about developments with regard to the future of Whipps Cross and the significance of the recently published Darzi Report. He said that the work that had been done at Whipps in terms of improving efficiency had moved it from being vulnerable to being much stronger. He stated that the case for keeping Whipps as a fully functioning district general hospital fully funded as part of a full health care service for local people was based not on a sentimental attachment to the hospital but on the basis that it was efficiently providing good quality health care to the local population and there was no need to change it. He drew attention to the Darzi Report which he said was based on the idea that health care could be provided on the basis of a “factory model”. He went on to say that none of the proposals in this report had been piloted in Britain and that there were many unanswered questions relating to staffing, finance, implementation and quality assurance and governance. After Dr Hakim’s contribution, there were further comments from the floor including from the local MPs Ian Duncan Smith, Lee Scott and Harry Cohen. Tony Philips from the Campaign called on all present to be confident in our ability to defend the NHS, adding that our strength is our numbers.
It was announced at the end of August that the NHS is on course to record a surplus of nearly £1bn this year. The NHS forecast shows a £983m surplus at the end of the financial year, compared with the £510m surplus recorded last year. The statistics also showed that 22 NHS trusts were in deficit. Some recorded a worsening financial position while others went into the red for the first time.
Dr Peter Carter, general secretary of the Royal College of Nursing (RCN), said: "It is, of course, very important that the NHS is on a firm financial footing but we have to ask at what cost this has been achieved. In our view, freezing and deleting health workers' posts, cutting services to patients and raiding training budgets is not the right way to balance the books. We now have a curious situation where the NHS is forecasting a surplus of nearly a billion pounds but is unable to find jobs for thousands of newly-qualified nurses desperate to put their new-found skills and commitment to work."
The NHS “surpluses” and “deficits” come about only because public health budgets are being set at arbitrary levels following government policy. They do not and cannot represent a “surplus” or “deficit” of income over costs of production of selling some mythical commodity called “health care”. This language is being used to cover over the fact that the government is refusing to fund the health care needs of the people. It is blocking the claim of the people for health care on the national social product, and instead is meeting the claims of the monopolies in the private sector and is paying the rich.
In this respect, far from a £983m “surplus” being a cause for welcome from Prime Minister Gordon Brown, it represents a deficit of almost a billion pounds (and more) in what should have been spent on the health service.
The annual cost of private finance initiatives to the NHS in England is set to increase five fold from £470 million to £2.3 billion over the next eight years, according to a report from the University of Edinburgh.
The study, by the University's Centre for International Public Health Policy, highlights how the costs of PFI contracts are already causing financial problems for trusts involved, particularly those that have signed up to high value schemes.
The researchers draw attention to the significant shortfall that trusts face in making payments for capital costs, which include the “rent” paid to the private sector for use of PFI buildings combined with capital charges for publicly-owned assets. Their report shows that trusts that have signed up to PFI schemes worth more than £50 million were, in 2005-06, confronted with an average shortfall of at least 4.4 per cent of their income to meet these payments.
Mark Hellowell, lead author of the research, said: “Under PFI, trusts have capital costs that are much higher than average. Many NHS trusts therefore have a funding shortfall under the current financial regime. Despite cutting services and selling off assets, many NHS trusts have shortfalls in funding. As trusts struggle to attain financial balance, in line with government policy, further closures are being considered. The impact will be felt not just among trusts with PFI contracts but across the wider health economy. Non-PFI hospitals are seeing services cut because their asset bases and staffing levels are less fixed than under PFI. This gives them a greater flexibility in terms of service redesign.”
One example detailed in the paper includes South East London, where the total deficit of two trusts with large PFI schemes, Bromley and Queen Elizabeth, was £151 million by the end of last financial year. The research observes that planned cuts will focus on public, rather than PFI, assets.
There are more than 80 signed PFI contracts in England's NHS and charges to be paid over the 30-60 year contracts total £52 billion. This is almost six times higher than the £8.5 billion construction cost. There will be 126 PFI schemes in operation, taking into account current planned projects, by 2013-14. This will lead to a five-fold increase in annual PFI charges from £470 million paid for 2005-06 to £2.3 billion by 2013-14. The charges include both the “rent” (also known as the availability charge) and charges for non-clinical services.
Mark Hellowell said: “The payments to PFI consortia are an albatross for the NHS and are associated with service cuts. As the PFI programme expands, the problems will become even more acute.”
The full report can be found at: http://www.health.ed.ac.uk/CIPHP/Documents/CIPHP_2007_PrivateFinancePublicDeficits_Hellowell.pdf .
(source: www.thepfi.net 12/09/2007)
More than half of nurses in Scotland feel they are too busy to provide the standards of care they would like for patients, with the majority having concerns over staffing levels, according to a major new survey of morale and workload issues, published on September 2. The survey is carried out every two years by the Royal College of Nursing (RCN) Scotland.
The research found that 56% of NHS nurses feel they are too busy to provide the care they would like, an increase of 8% from 2005. Just one quarter believe there are sufficient staff in their workplace to provide a good standard of care. More than 80% also viewed their workload as too heavy and their pay poor in comparison to other professional groups.
The findings come at a time when there is increasing reliance on nurses to provide services – such as out-of-hours care – in the NHS. However, nursing leaders have warned that a target-driven culture is having a detrimental impact on staff.
Anne Thomson, acting deputy director of RCN Scotland, argued that those in charge of running the health service had different priorities from those working in it. "There is a lack of staff, constant change and government pressures around what they want delivered, as opposed to asking staff what they think needs to be delivered," she said. "This can manifest itself in things like the emphasis on clearing waiting lists, whereas a nurse or a doctor's priority is to provide the best possible care to someone who is ill." She added: "It is almost as if it is about the quantity and volume – rather than about the quality – of patient care."
The survey of more than 700 RCN members also revealed that a quarter of nurses working in community settings are aged over 50, compared to 17% working in hospitals. Thomson said this raised concerns over proposals outlined in the Kerr report, which was published two years ago, as the future "blueprint" for the NHS.
"There are a lot of nurses coming up to retiral, particularly in the community," she said. "That is a big worry, because if we look at the Kerr report it is about shifting the balance of care from acute to community settings, so that is where we really need to invest in nursing. We need to do something about positively regarding our older nurses and keeping them in the workforce – for example, phased retirals or perhaps taking them away from the frontline into more supervision roles."
Last week, a report from Audit Scotland warned that the decision by nearly all GPs to opt out of treating patients outside surgery hours had increased pressure on other parts of the NHS. It said nurses, paramedics and the telephone helpline NHS24 were now being relied upon to help provide out-of-hours care.
(source: Judith Duffy, Health Correspondent, Sunday Herald)
A Rally and Demonstration were held in Birmingham on September 8, 2007, with the demands, “Defend the NHS! No to NHS Privatisation!”. They were organised at the initiative of the West Midlands Pensioners Convention (WMPC). We reproduce below the speech given by Ron Dorman of the WMPC at the Rally, attended by just over 200 people.
When it comes to the NHS it is certainly true that things ain’t what they used to be. The founding of the NHS, by Aneurin Bevan and the 1945/50 Labour government, was Labour’s flagship providing free health care, including prescriptions, for everyone from the cradle to the grave. All this was put in place while Britain was still suffering the ravages and deprivations of the Second World War.
Now nearly sixty years on, and Britain the fifth richest country in the world, things are very different. The Thatcher/John Major years holed the NHS flagship and ten years of New Labour have seriously crippled it.
According to the hospital trusts’ own survey one in every three hospitals is unclean and too often patients come out of hospital with MRSA or C Difficile because they are dirty. The situation is so bad that many elderly people think twice now before going to hospital for treatment. Nursing staff have been cut in several hospitals, there have been ward closures and what the Sunday Telegraph describes as the botched recruitment system for junior doctors creating the "biggest crisis in the medical profession for a generation".
The NHS National Programme for IT, designed to put everyone’s patient record onto a national electronic system, that many people objected to, has been very lucrative for big capital. Initially this programme was to cost £2.3bn and take 2 ¾ years to implement but has now been extended to ten years at a staggering cost of £12.4bn – over five times the original amount. The BT IT system fouled up the child vaccination record system across London. The health Protection Agency said: "comparing the year 2005/6 with 2004/5 the number of children missing from the COVER programme is nearly 40,000. This example shows the weakness of putting all our eggs in one centralised IT basket. As one GP has pointed out there are other mechanisms available such as the telephone, e-mail and fax. Last year ex-Health Secretary, Patricia Hewitt, referring to the NHS, said: "A penny wasted is a penny stolen from the patient." £12.4bn is probably more pennies than could be counted in a lifetime! Better to scrap this IT system than sack nurses and cleaning staff. And cleaning contract firms responsible for dirty hospitals should given their marching orders for breaking their c ontracts and cleaning brought back in-house.
Neil Turner, Labour MP for Wigan, says introduction of market forces and "choice" into the NHS has brought health and financial inequality. He says the document: "Mapping Poverty in Wigan" shows:- where a low employment blackspot exists, so does a high disability blackspot; where a low skills blackspot exists, there is a high coronary disease blackspot; and where there are high numbers of children on free school meals, there are high cancer rates. The MP said that countrywide the blackspots of deprivation and low health match almost exactly and that the market forces factor system reinforces those inequalities and should be ended.
How did Blair and Brown respond to this call to end market forces in the NHS? Did they heed the warning? NO! Instead, they recently appointed R Channing Wheeler, a senior executive from US health insurance giant United-Health, to a top position in the NHS to commission services from private and NHS providers. This deliberate action is likely to continue health inequality. How long before the present 45% of private beds, paid for by the NHS, rises to 50% and above?
The creation of the internal market is itself costly as departments within hospitals are charging each other for services rendered and creates an unnecessary bureaucracy.
Growing privatisation, which is at the heart of problems besetting the NHS, is being pushed through because it is a very lucrative market, one of rich pickings for the transnational companies that you and I, as taxpayers, will pay for.
In 1993, the then Conservative government informed the NHS that PFI must be considered before releasing money for building NHS hospitals. The reason for doing so was it was supposed to be cheaper and more efficient.
At that time, Labour scorned the idea of PFI. Harriet Harman, then shadow Health Secretary, said in 1996, “NHS employees will be strangers in their own hospital – public servants in a privatised hospital.” However, within one year of Labour taking power Health Minister, Alan Milburn said, “When there are limited resources available it’s PFI or bust.” It’s more likely the NHS will bust because of PFI.
Although the NHS is now said to be £510m in the black 20% of hospital trusts and PCTs apparently are still in debt. The £510m surplus was achieved at the cost of NHS nurses’ and other jobs. Tory Andrew Lansley has said that for a PFI investment of £8bn we, the taxpayers, have to pay a grand sum of £53bn – a 540% return on capital. This is obscene but bears out what the NHS Consultants Association 2005 report stated. It said using the private sector to fund capital developments is more expensive because of higher interest rates and shareholder profit. There is no evidence that private investors are willing to accept a higher risk or that private sector capital is more efficient than adequately funded NHS initiatives. Private investors take as few risks as possible, risks jeopardise profits hence PFI payments are the first charge on the NHS irrespective of the consequences. Coventry University Hospital is a case in point where, because the PFI annual payment this is £56m, the compulsory sacking of 200-300 staff is being considered and a £1.2m subsidy that kept car-parking charges down has been scrapped in an effort to balance the books. Consequently, car-parking fees are to go up.
The NHS Consultants report also says there is no evidence that enforced purchase of private sector services provides more efficient or effective healthcare than investing the same funds in the NHS. However, it does attract key staff from existing public institutions in the UK, and from hard-pressed healthcare systems overseas.
The government says Independent Treatment Centres (ITCs) are to reduce waiting times but uses them for enforced purchase of their services. ITCs perform the easier types of operations such as hip replacements and cataract removal leaving the NHS with the more difficult operations. ITCs are paid a 40% higher tariff than the NHS for the same operation, are given a guaranteed number of operations to perform and paid for them whether performed or not. This guarantees profits for ITCs whilst simultaneously helping to ensure NHS hospitals go into debt causing more closures.
Key to NHS financial problems and privatisation is the private finance initiative (PFI) and was introduced to keep government borrowing off the books according to Sam Galbraith, when he was a Labour frontbencher. He thought it was fraud to do so. So why did the Tories start PFI and why has Labour embraced it so strongly?
Although rarely, if ever stated, PFI was introduced to satisfy the deficit rules in the 1992 Maastricht Treaty. Treaty Article 104c and the “protocol on the excessive-deficit procedure”, attached to the treaty, refer to allowed government deficits. These are 3% of GDP for borrowing and 60% of GDP for debt. Healthcare cuts are happening throughout the EU due to the same cause. What is outrageous is the EU can fine Britain if we overshoot the 3% deficit rule! 3% is a small figure shown by the fact that many of us borrow 200% or more of our income to buy a home. The deficit procedure is now included in the EU Growth & Stability Pact. Secondly, the Maastricht Treaty in Principles, Article 3(g) insists on “a system ensuring that competition in the internal market is not distorted”.
I am not arguing whether we stay in or come out of the EU as that would not be appropriate here. However, we all aware that no organisation is perfect and the matters I have raised together with the directive on privatisation of healthcare, now in preparation, and the Reform Treaty need to be faced up to one way or another. The Reform Treaty, really a constitution that gives the EU legal status, means it becomes a state in its own right and can enforce the competition laws in health.
What is intended is shown by Pat Cox, one-time EU parliament leader who sent a report, Viable financing of health services in Europe, to the EU Commission in February for user or customer payment and competition in health services supply.
I’ve had some people tell me, "I’m alright, I’m private." Well, firstly that’s a selfish attitude, which should be rejected, but secondly it is short sighted.
Learn from American experience of health privatisation. The USA spends over 16% of its GDP on health, yet more than 45 million Americans lack any health insurance. Britain spends less than half that, yet the NHS covers everybody. Following the Americans regarding health provision, as the EU and our government are, will end the NHS as a public service. On Radio 4 on Tuesday morning, it mentioned how some Pop Stars have ended up in poverty in America and dying because they could not afford health care. We have been warned; doing nothing is not an option if we wish the NHS to be publicly owned and controlled.
Therefore we should demand:-
Further, we should:-
Finally, we should all support the trade union NHS rally in London on 3 November. Coaches for the rally are being laid on by trade unions.
In this way, we can way we can stimulate a growing campaign and our demand for a publicly funded, publicly owned and controlled NHS.
Thank you.
Celebrate and Defend the NHS
Saturday, November 3, 2007
Central London
Assemble 11 am Temple Place on Victoria Embankment