Fight to Safeguard the Future of the NHS!

NHS England chief executive Sir David Nicholson announced a major review of NHS strategy in an interview with the Heath Service Journal and in an address to the NHS Confederation conference. Jeremy Hunt, Secretary of State for Health, also addressed the conference, which is the NHS employers’ organisation representing NHS Trusts and private health companies. Also reported is that NHS England will publish a “case for change” in the coming weeks and then “lead a national discussion with the public” on a three-to-five year NHS service strategy.

David Nicholson, who recently announced his retirement as Chief Executive of NHS England next year, set out in his interview and speech to the confederation that he intended “a new strategy for change”. He said the NHS should “start to build a new organisation and a new system to make change happen in the NHS”. Talking about how he had led the NHS over the last seven years, he said that the strategic direction “just kind of emerges from the political arrangements that we are in” and how that change is then related to the agenda to “make some changes happen” or “batten down the hatches”. Therefore, he said, the NHS “stands at a crossroads in relation to all of this and we cannot allow the tyranny of the electoral cycle stopping us from making the real and fundamental changes that we need to make to the NHS, we cannot allow that to happen this time”.

The argument could not be clearer that this time at the heart of David Nicholson’s new strategy for the NHS is that he and his successor should carry forward the anti-social direction for the NHS regardless of “the tyranny of the electoral cycle”! In other words, it is a strategy of the ruling circles to make the direction set by the successive governments and accelerated by the government’s Health and Social Care Act unchallengeable even by the electorate.

For David Nicholson these statements of “not being stopped” from developing an ongoing “new strategy for change” avoid the fundamental question of what ongoing change he is talking about. In his interview with the Health Service Journal he made some comments aimed at confusing the commentators about the real direction when he said he was “thinking about the possibility of mutual [organisations and] social enterprises, and also about whether the straightforward commissioner-provider split is the right thing for all communities”. It is basic truth that the commissioner-provider split sets a fundamentally wrong direction for the NHS. Yet the direction proposed by Sir David is the same reactionary corporate austerity and anti-social agenda against the public good and the interests of society for a public health care system that meets the needs of all. However, he tries to create illusions that the NHS is still under “NHS” control.

The reality is that even though he claimed in his interview that NHS England is “not a regulator of commissioners” that is exactly what it is. He is Chief Executive of a regulator of purchasers of health care and not the providers of health care. When the Health and Social Care Act 2012 set up the NHS Commissioning Board to regulate Clinical Commissioning groups, from being chief Executive of the National Health Service David Nicholson was demoted to Chief Executive of the NHS Commissioning Board England. The fact that the name was subsequently changed to “NHS England” does not alter that fact. The grenade that the government has thrown into rhe NHS in the form of consolidating competition and privatisation means that the “strategy for change” in the NHS will be set more and more by the board rooms of private health monopolies and the anarchy of a capitalist market in health.

David Nicholson's “new strategy for change” is that he wants to lead the NHS even faster down this road. In bemoaning the fact that he will not now take this forward himself but instead hand this direction to a successor he says, “I think I would have had to have committed another five perhaps seven years in the job and genuinely I thought at this particular time we needed someone who was going to go and see that through and I certainly don't see myself as a kind of a Margaret Thatcher figure going on and on in relation to all of that.” What is chiefly remarkable about this outburst from David Nicholson is the arrogance of ignoring over the last seven years of his leadership of the NHS, the crisis to which it has been plunged and the refusal to draw the appropriate conclusions of the failure the direction that both the Labour government and the Coalition government have taken. The direction of fragmenting the NHS as a public service into separate underfunded NHS Trusts, of setting up the commissioner-provider split, the continued robbery of the funding for the NHS through imposed “efficiency savings" to NHS organisations and the undermining the GP services, which have all led to failures such as identified by the Francis report, has caused such a disastrous direction for the NHS.

Something has to change. What is needed is not Sir David’s “strategy for change” but the fight for an alternative direction for the NHS not as a “new organisation and a new system to make change happen” but as an organisation and a new system that actually places the right to health care in the first place. That would give the NHS a guaranteed claim on the investments it needs, and end private control of its services including ending the scandalous charges for long-term elderly care, social care and dental care. Such a direction recognises that the agenda of the NHS must be set not by governments and chief executives whose changes are aimed at paying the rich, but by the health workers themselves and by the working class and people as part of the fight for the alternative.

Health Secretary Jeremy Hunt, as part of the assault on the overall provision of health care, is on the record as denigrating GPs on the question of out-of-hours services.

Dr Laurence Buckman, the chair of the British Medical Association's GPs committee, in a speech to the BMA’s annual conference on May 23, refuted Hunt’s blaming of GPs for the growing crisis in AE care.

Dr Buckman rejected the Health Secretary’s call for GPs to resume responsibility for providing out-of-hours care overnight and at weekends in England, as they did until 2004 until 90% chose to no longer do so in a revised contract deal with the then Labour government. He told the conference, "Despite all the evidence, Hunt continues to tweet that it is all the fault of the GP contract. This is because he does not want to bother with the facts when he can have a bash at those of us who, on his own admission, are overworked and strained beyond endurance. The fact is GPs are undertaking more consultations per patient and we are diagnosing and treating more conditions than ever before. The fact is that GPs cannot become the providers of last resort for urgent out-of-hours services."

Dr Buckman continued, "While we must play our part in ensuring better continuity of care for our patients, we cannot – and will not – go back to GPs working dangerously long hours or having unrealistic expectations heaped upon us. We need to be freed from the oppression of box ticking and micromanagement."

He accused Jeremy Hunt of ignoring the evidence, saying, "Hunt has continued to spout this rubbish when on Tuesday, he told MPs that our contract had had a devastating impact and that pressures on AE services were direct consequences of the disastrous changes."

Dr Buckman emphasised, "GPs are not prepared to shore up a system that has been rendered unsafe by unwise political meddling. We are happy to work closely with others, including CCGs where there is full GP input, to improve out-of-hours services."

While diverting attention from the government’s role in the crisis in health care through cut-backs and privatisation by blaming all and sundry including doctors, nurses and managers, the Coalition has also been intent on privatising the out-of-hours service.

For example, Hackney Out of Hours (OoH) service has been provided by the private company Harmoni (now owned by Care UK), under an interim arrangement since 2010. Up until January 2013, the PCT that commissioned Hackney Health services (at the time) NHS NELC, had been preparing to allow Hackney GPs to “opt-back-in” to giving 24/7 care for their patients from April 1, 2013.

The plan was to move the service from Harmoni to the not-for-profit organisation CHUHSE, which the GPs had formed in response to alleged failings in out of hours care for their patients.

In January 2013, the Section 75 Regulations were announced. That same month, CHUHSE were blocked from taking back 24/7 care in Hackney, as planned. Instead, the PCT chose to extend the existing provider’s contract for a further nine months (later six months as agreed with Harmoni).

In a report published in May, Harmoni had been found by the Care Quality Commission to have been delivering Hackney OoH service without the necessary clinical staff numbers during the time of inspection. “Our judgement: Overall, there were not enough qualified, skilled and experienced staff to meet people’s needs.”

As the Hackney Gazette explained on May 22, the tendering and re-tendering process encourages potential service providers to keep cutting costs, so as to be competitive against rival bids, to the point that it is no longer possible for the winning provider to deliver adequate care.

The conclusion to be drawn is that with the Health and Social Care Act, and specifically Section 75 regulations, fear of litigation is being put before patients’ care. Not only do Hackney residents now have to continue with the OoH service as provided by Harmoni and found wanting by Care Quality Commission, but concerned GPs are seen not to be able step in and help without being forced into a costly bidding process that will only ultimately reduce the amount of funds they have available for patient care, whether they win the bid or not.

The example of Hackney out of hours services demonstrates the direction in which the government is taking NHS. It is certain that similar examples can be given across England. This anti-social direction cannot and will not be accepted!