“The unions should no longer criticise from the sidelines but recall their membership in special conferences and discuss how to mobilise to defend every single hospital and NHS unit, and make sure this Health Bill cannot be implemented”.
Or go down to the summary
The publication of the Health and Social Care Bill last month heralds dramatic changes for the NHS, which will affect the way public health and social care are provided in the UK. Those changes alone will have huge impact, but it is the formation of an NHS Commissioning Board, and GP commissioning consortia, that will once and for all remove the word “national” from the health service in England. The result, due to come into force in 2013, will be the catastrophic break up of the NHS.
Out go strategic health authorities and 152 primary care trusts and in come several hundred general practitioner consortiums, responsible for commissioning £80bn of NHS care from “any willing provider.” This means Privatisation!
Putting general practitioners (GPs) in charge of commissioning health services for their patients is similar, in some respects, to the fundholding experiment in the 1990s. The principle then was that GPs controlled the budgets to buy the specialist care their patients needed. Fundholding took years to implement, but evidence on short-term or long-term benefits for patients is lacking. In the current Bill, health outcomes, including prevention of premature death, will be the responsibility of the NHS Commissioning Board, which has been asked to publish a business plan and annual reports on progress. That business plan is urgently needed to allow transparent appraisal of how the Board plans to monitor patients’ outcomes.
The UK coalition Government has now been in power for about 8 months. Neither the Conservatives nor the Liberal Democrats included the formation of an NHS Commissioning Board, or GPs’ commissioning consortia, in their health manifestos. There was no mention of their health plans in either of the parties pledges and the plans were not mentioned in the coalition agreement. However, less than eight weeks after the election, an outline emerged in the white paper “Equity and excellence: liberating the NHS.
The speed of the introduction of the Health and Social Care Bill is surprising, especially given the absence of relevant detail in the health manifestos. The Conservatives promised, if elected, to scrap “politically motivated targets that have no clinical justification” and called themselves the “party of the NHS” — a commitment that seems particularly hollow now.
The NHS was unsurprisingly absent from the 2010 election campaign because satisfaction levels with the NHS were at an all time high, and for most of the electorate the NHS was a non-issue. In the words of Simon Stevens, president of global health at United Health Group, a company that stands to benefit from the reforms,“The inconvenient truth is that on most indicators the English NHS is probably performing better than ever.”
The House of Commons Health Committee’s report, “Commissioning 2011” points out that the proposed changes are to be implemented at the same time as annual efficiency savings of 4% over four years. The report says,“The scale of changes is without precedent in NHS history; and there is no known example of such a feat being achieved by any other healthcare system in the world. ”To pull off either of these challenges would therefore be breathtaking; to believe that you could manage both of them at once is deluded. Since its establishment in July, 1948, the aim of the NHS has been to offer a comprehensive service to improve health and prevent illness. Health care for all, for free, has been the common ethos and philosophy throughout the NHS. On July 3, 1948, in an editorial entitled “Our Service”, The Lancet commented: “Now that everyone is entitled to full medical care, the doctor can provide that care without thinking of his own profit or his patient’s loss, and can allocate his efforts more according to medical priority. The money barrier has of course protected him against people who do not really require help, but it has also separated him from people who really do.”
Now, GPs will return to the market place and will decide what care they can afford to provide for their patients, and who will be the provider. The emphasis will move from clinical need (GPs’ forte) back to cost (not what GPs were trained to evaluate). The ethos will become that of the individual providers, and will differ accordingly throughout England, replacing the philosophy of a genuinely national health service. As it stands, the UK Government’s new Bill spells the end of the NHS.
Moving to consortiums will incur the costs of transition in addition to their recurring costs. On the basis of past National Audit Office data, the government has put the cost of the NHS reorganisation at £2-3bn. The white paper’s key financial pledge was to reduce the NHS’s management costs by more than 45%. GP consortiums would replace primary care trusts, which have administrative costs of over a billion pounds a year (for a population of 51 million) The potential consortiums have learnt that their running costs will be capped at between £25 and £35 per head of population which equals around 1.5billion a year (based on a £30 cap). So where’s the saving?
The government’s recent “bonfire of the quangos” provides an instructive example of how a rush job doesn’t necessarily guarantee the best outcome. Earlier this month, the parliamentary select committee on public administration criticised the axing of 192 public bodies and the merging of 118 more as poorly managed. It also said that the government’s NHS plans would not deliver significant cost savings or better accountability—two of the government’s key aims. The committee’s chairman said that,“The whole process was rushed and poorly handled and should have been thought through a lot more.”
Rationalising a few hundred arm’s length bodies hardly compares with turning the NHS upside down, yet the proposed timescale for the health reforms is dizzying. The bill promises that all general practices will be part of consortiums by April 2012, yet it took six years for 56% of general practices to become fundholders after the introduction of the internal market.
The health secretary has made much of these changes being evolutionary rather than revolutionary. People “woefully overestimate the scale of the change,” he said. After all, practice based commissioning, choice of provider, an NHS price list, and foundation trusts already exist. But a week later came the revelation that hospitals would be allowed to undercut the NHS tariff to increase their business. Health economists queued up to say what a terrible idea this was, citing evidence that it would lead to a race to the bottom on price, which would threaten quality. Taken with the opening up of NHS contracts to European competition law, it was the last piece of evidence needed to convince critics that the government was unleashing a storm of creative destruction onto the NHS, with the imperative: compete or die.
Regardless of the true motivation behind the governments plans, such radical reorganisations always adversely affect service performance. They are a huge distraction from the real mission of the NHS, “to deliver and improve the quality of healthcare” that can absorb a massive amount of managerial and clinical time.
With an estimated one billion pounds of redundancy money in their pockets, many of those made redundant in the reorganisation and “efficiency savings” of the NHS are likely to be employed by the new GP consortiums in much their same roles. It raises the question: if GP commissioning turns out to be simply primary care trust commissioning done by GPs, aren’t there less disruptive routes to this destination?
Meanwhile, government cuts haven’t gone away. Although the impact assessment of the new bill calculates that savings will have covered the costs of transition by 2012-13, the reorganisation will not have made any savings to contribute to the £15-£20bn efficiency savings the government requires from the NHS by 2014-15.
East Sussex GPs Oppose Consotia
A recent survey of East Sussex GPs, conducted by the BMA found that more than 70 per cent of them fear patient care will suffer when changes to the NHS are given the go-ahead. The vast majority of GPs surveyed slammed government plans to put GP consortia in charge of health care. Just 7.7 per cent of respondents were convinced that GP consortia will be up to the task.
Although 58 per cent of the GPs believe too much money is wasted on bureaucracy in the NHS, just one in ten GPs approved government proposals to hand purchasing power to GPs. Under government plans, GP consortia will replace the East Sussex Downs and Weald Primary Care Trust by 2013 and will be responsible for buying 80 per cent of health services.
Dr Michael von Fraunhofer, of the Eastbourne consortium steering committee, said local consortia could be hamstrung with more than £30 million in debt from the outgoing PCT. He warned: ‘This will cripple patient care and the blame will fall on GPs unfairly. No matter how good, dynamic or inventive we are, we will be making massive cuts in choice and services just to stay afloat.’
Private Health Care Company, Care UK
Meanwhile, private health firm, Care UK has won a £53m prison hospitals contract, despite an NHS bid offering a better service. The company has won the contract to run health services at eight jails in north east England, with its cheaper, lower quality bid. About 200 nurses’ jobs and pay could be under threat. Glenn Turp, of the Royal College of Nursing, said he was worried about infection control as Care UK ‘had no plans in place’.
An NHS executive who lost the contract, Les Morgan, sent an angry email to the Health Commissioning Unit which decides who should run healthcare at the eight jails. Morgan wrote: ‘Our bid was judged better on quality, delivery and risk. ‘We are keen to understand the large difference in scoring on price.’ Care UK’s then boss John Nash and wife Caroline donated £200,000 to the Tories before the general election, including £21,000 to Health Secretary Andrew Lansley’s private office.
BMA Discusses Strike Action
BMA boss, Dr Hajioff said, The British Medical Association will put ‘absolutely everything’ on the table including strike action when members determine their response to the government’s NHS Health and Social Care Bill. His comments come as health unions are planning further protests against plans by Barts and The London NHS Trust to cut 635 posts to save £56m over two years. This includes the loss of 250 nursing jobs and a 100 beds.
Similar plans are taking place all over Britain. The Royal Surrey in Guildford has already seen 400 redundancies and the loss of beds. BMA Council member Anna Athow said in a recent interview: “‘The Health Bill aims to accelerate the plans of the last government to physically close and destroy hospitals and make their staff redundant on a massive scale, in order to privatise the NHS”.
She continued; “The unions should no longer criticise from the sidelines but recall their membership in special conferences and discuss how to mobilise to defend every single hospital and NHS unit, and make sure this Health Bill cannot be implemented”. “The recalled Special Representative Meeting of the BMA on March 15 should discuss all options in this campaign. Hospitals must be occupied by local staff and campaigners in Councils of Action to stop them closing.’
1. Andrew Lansley’s Health and Social Care Bill will encourage ’any willing provider’ to cherry pick profitable slices of NHS services. It’s the biggest-ever privatisation of health care anywhere in the world,
2. The Bill will turn the NHS into a free market, cost billions to implement, and be far more unequal in its provision of services than the current system.
3. GP consortia, with their budgets squeezed to create £20 billion of savings will have to restrict access to hospital care.
4. GP consortia will have to employ private management consultants, who are the only people to have welcomed Lansley’s plans.
5. Patients will be even less informed as existing public bodies are replaced by local GP consortia, that function in secret sessions, and a remote national NHS Commissioning Board.
6. Health care services are to be privatised, with EU competition laws forcing GPs to put any service out to tender.
7. All limits on the money Foundation Trusts hospitals can earn from private medicine are to be scrapped. Hospitals will then prioritise attracting wealthy private patients.
8. Price competition is to be introduced in clinical services, despite warnings that this will undermine the quality of care.
9. The limited ’scrutiny’ proposals are a fraud: GP consortia and the Commissioning Board will take their decisions in secret, and are not even obliged to go through the motions of consultation.
10. The Bill is opposed by the health unions and the TUC, the majority of GPs, and virtually every organisation of health professionals, including the Royal College of GPs and the BMA.
That’s why Lansley must be stopped. It’s time for urgent political action to Kill Lansley’s Bill.
Read: “Kill Lansley’s Bill 10 good reasons” from the PCS Union.
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Protest To Save The NHS on 9th March
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