Whose NHS? Our NHS!

Workers' Daily Internet Edition: Article Index :

Whose NHS? Our NHS!

Huge Demonstration against NHS Cuts in West Sussex

Whipps Cross Should Remain Full Acute Hospital

Government Overpays Private Groups £222m for NHS Treatments

PFI Debts Might Stay Off Balance Sheet

Only Dogma and Corporate Capture Can Explain This

Tomorrow, Saturday, the national march and rally to celebrate and defend the NHS is taking place in central London. With the attacks on the health service as part of the anti-social offensive, an NHS that cannot provide for their needs is being imposed on the people in the name of “modernisation”. The workers of the NHS are being segmented and left to fend for themselves and fight their own corner, instead of being enabled to have the power of their collectives to organise against the selling off of their NHS. Inappropriate business models abound. For example, ambulance service trusts sell their services to the hospitals, funds are available for only a fraction of the vehicles needed, and individual drivers are said to be responsible for the running and upkeep of ambulances. Is this an NHS to celebrate? What should we be building?

            We should be building an NHS that is owned and controlled for the public good with the conscious participation of the health workers and professionals organising the running of this social service to the best that we as human beings can attain. This would be a health service that solves the problems of the people’s health care, coming up with the solutions to get rid of the adversity of ill health, and acting preventatively to avert illness. In this way, people can be treated as human beings who have their rights fully recognised to be aided in staying healthy and not blamed for their own illnesses or denied treatment on this basis.

            The workers of the NHS must be militant in standing for this kind of health service which is run by them for the benefit of the whole society. This is the significance of celebrating the achievements and defending the core values of the NHS. It is defending the right of all to health care, and standing firm against the agenda of the monopolies for enrichment.

            The time is not to despair that this is the last chance to stop the destruction of the health service. The task of the moment is to unite in a powerful force to safeguard the whole future of the NHS. Big business and governments that represent the interests of the privateers must not be allowed to decide its future. We are the ones to decide!

About 14,000 people took part in a demonstration over NHS plans to reorganise West Sussex hospitals. The turn-out in Haywards Heath made it the largest NHS protest in the county to date. The protest on October 13 was to show opposition to downgrading Accident & Emergency and maternity services at the Princess Royal Hospital in Haywards Heath.

            Campaigners said 70,000 people had now signed their petition, thousands had attended public meetings, and 180 GPs had spoken out against the plans.

            Under NHS restructuring, only one of three West Sussex hospitals will remain a major general hospital, the county's primary care trust (PCT) has said. West Sussex has hospitals in Worthing, Haywards Heath, and Chichester.

            Singer Vera Lynn was among those who took part in the protest. She told the assembled crowd: "We need our hospital. We must have it, and it is essential we fight for it."

            The rally comes a week after several hundred people took to the streets of Uckfield to show support for the Princess Royal Hospital, in Haywards Heath, and Uckfield Community Hospital.

  (source: BBC NEWS)

The national emergency access director has recommended that Whipps Cross University Hospital trust should remain a full acute hospital.

            Professor Sir George Alberti made the recommendation alongside a series of other suggested next steps in his clinical case for change published as part of the Fit for the Future review into healthcare services in north east London.

            As a result of Sir George's review, NHS London has decided to put the consultation on major service change on hold until further work, including improvements in hospital and out of hospital care, is achieved.

(source: Health Service Journal, October 10, 2007)

The government is overpaying private hospital operators by more than £200 million to carry out surgery for NHS patients.

            The government launched a programme in 2005 to outsource some routine surgery to the private sector. It says that it is committed to buying £1.4 billion of services from independent surgical treatment centres (ISTC), including hip replacements, cataract surgery and diagnostics, during the initial phase of this programme.

            However, according to the Department of Health, the scheme is running at 16 per cent below capacity in value terms, meaning that only £1.18 billion of services are provided by private hospitals for NHS patients. The remaining £222 million of public money is being paid regardless because most of the hospitals’ operators have negotiated “take or pay” clauses in their contracts with the NHS. It means that they are paid the same sum regardless of whether the NHS sends enough patients.

            A spokesman for the department said: “Whole programme utilisation of the wave-one ISTC programme is currently 84 per cent. Utilisation is the value of procedures used as a percentage of the procured value.”

            Mercury Health’s St Mary’s NHS Treatment Centre in Portsmouth is running at just 80 per cent of capacity, according to its owner, Care UK. It was contracted originally to perform 435,000 individual procedures for the NHS over five years. On current trends, it is expected to perform tens of thousands fewer than this.

            Another ISTC, Capio Healthcare’s centre in Reading, was also undershooting significantly, although it has increased patient numbers recently and in July was operating at 90 per cent of capacity.

            Graham Kendall, spokesman for the NHS Partners Network, the organisation representing independent healthcare providers, said that take-or-pay clauses were common and were crucial at the programme’s outset to justify the initial investment of building and equipping the centres.

  (source: The Times, September 19, 2007)

The Treasury has indicated that hopes for transparency around the Private Finance Initiative (PFI) debt might be premature.

            In last April’s Budget, then chancellor Gordon Brown pledged that from 2008/09 government departments and other public sector bodies would adhere to International Financial Reporting Standards. That led to expectations that £29bn of PFI assets currently “off balance sheet” would be moved on, as IFRS rules differ from current UK practice.

            But Treasury officials told its independent Financial Reporting Advisory Board on October 8 that they had discovered a substantial problem in adopting IFRS rules. They said the rules clashed with the way the Office for National Statistics and the European Union account for national debt on the balance sheet treatment of PFI deals. Only “on balance sheet” deals count in calculations of public sector net debt. As other countries would continue to keep a large amount of debt “off balance sheet”, Britain would be disadvantaged.

            In the accounting treatment of PFI projects, less than half of the £53bn capital value of signed projects are recognised in public sector balance sheets.

(source: Public Finance Magazine, 12-Oct-2007 )

UnitedHealth is the largest healthcare corporation in the US, making billions of dollars a year out of cherry-picking patients and treatments, squeezing costs and restricting benefits to 70 million Americans forced to get by in the developed world's only fully privatised health system. Its chief executive, Bush donor William McGuire, paid $125m in 2004, had to step down last year in a share-option scandal.

            Last month, UnitedHealth agreed with insurance regulators in 36 states to pay out $20m in fines for failures in processing claims and responding to patient complaints. That follows a string of other fines over delayed payments, Medicare fraud and "cheating patients out of money" in New York State.

            Other major US health corporations, such as Aetna and Humana, have also faced repeated fines for shortchanging doctors, using unlicensed agents, payment delays, failures to give information to claimants or fraud. In one case of a cancer patient who was refused payment for a failed experimental treatment its own doctors recommended, Aetna was ordered to hand over $120m damages after it was found by a California jury to have committed "malice, oppression and fraud".

            All three companies figure prominently in Michael Moore's new film Sicko, a compelling indictment of the US health system – under which 18,000 Americans die a year because they are uninsured. Hardly the ideal players, you might think, to take a central role in the reform of the National Health Service.

            But it is precisely these three corporations, along with 11 other private firms including KPMG, McKinsey and Bupa, that the government this month announced have been lined up to advise on or even take over the commissioning of the bulk of NHS services. Primary care trusts, which control most of the NHS's £90bn budget, will now be encouraged to buy in advice from the 14 selected companies on health needs, contracts and local provision. Potentially, these corporations could take over the management of the heart of the NHS.

            For the first couple of months after Gordon Brown became prime minister, it had seemed that the new administration was pulling back from the privatising excesses of the Blair years. One of Alan Johnson's first moves as the new health secretary was to announce that there would, after all, be no "third wave" of controversial private surgery and diagnostic units, known euphemistically as independent sector treatment centres.

            But the award of a framework primary care contract to the 14 privateers – only mildly watered down from an earlier incarnation – and Johnson's backing for a key private-sector role in 150 new health centres and 100 new GP practices, have set the seal on the Brown government's commitment to the continuing market-driven reconstruction of Labour's greatest social achievement.

            Under the banner of choice and reform, New Labour has struggled to create an artificial market in health and turn an integrated system of universal provision into a tax-funded insurance system tailored to the private sector. The move to outsource service commissioning will now pave the way for private companies to decide the range of services provided and use their access to information to pick the most profitable services to bid for in other areas. Allyson Pollock, head of Edinburgh University's international health policy centre, calls it the "last piece in a jigsaw" that opens the door to a US-style health maintenance organisation model – dominated by corporations like UnitedHealth.

            Ministers have always insisted that using private companies is all about improving services and value for money. But the evidence is that far from making better use of the extra cash pumped into the health service, privatisation has been expensive, inefficient, destabilising, unaccountable and led to closures, cuts and job losses.

            The costly and underfunded private finance initiative, which has landed the NHS with a total bill of £50bn for new hospital buildings, is already milking £700m a year from NHS trusts and fuelling the financial crisis across the service. The private treatment centres used for elective surgery are not, as the Commons health select committee found, more efficient than NHS units, nor have they mostly increased capacity; they are in fact more expensive, have heavily underperformed their contracts and often ended up taking over NHS staff.

            Add to that the huge transaction costs of administering the new market system and it's hardly surprising Labour's own conference last year declared that the "major cause" of the financial crisis in the NHS was the "move to a competitive, market-based system" and "the continued use of PFI". Meanwhile, it's become clear that bargain-basement contract cleaning has been a key factor in the rise of hospital infections. In Wales, where cleaning is now carried out in-house rather than by contractors, MRSA infection is less than half the English rate.

            Given the evidence on cost and inefficiency, and its unpopularity among medical staff and voters, the government's determination to press on with privatisation and marketisation might seem baffling. Why insist on heading off in the direction of a health system with the highest per capita cost and inequalities while courting its main beneficiaries? The only sensible explanation has to be that what New Labour derided as the influence of producer interests has been replaced by corporate capture: a mixture of market dogma, business lobbying and a revolving door syndrome that saw Simon Stevens, former adviser to Tony Blair and a succession of New Labour health secretaries, move effortlessly on to become European president of UnitedHealth.

            The risk is now that with a continuing patchwork privatisation and cash squeeze, public support for the principles of the NHS could erode, opening the way to charges, top-up fees and private insurance. Both the Tories and Liberal Democrats either accept private provision or are gagging for more of it, so not much help can be expected there. But Wales and Scotland have mostly resisted the worst of the health service's English disease – and support for the kind of socialised health system Michael Moore lauds in Sicko is deeply rooted in Britain. What's needed now is to turn that sentiment into pressure for a real change of direction.