Unison fiddles while health service burns

A 1,000 amendments later and the health bill that returns to Parliament today still contains the plan to deepen market penetration and competition in the NHS, building on the previous New Labour government’s handiwork.

Remember Alan Milburn, the health secretary in the first post-1997 Blair government? When Frank Dobson was removed after abolishing the internal market, his replacement Milburn announced in 2002 that in future Foundation Trusts (FTs) would run the NHS.

That was followed by the creation of private treatment centres. They have been a financial disaster for the taxpayer. Only 12 of the original 31 contracts, worth at least £1.47bn in total, are still operating.

FTs are “public benefit corporations”, are free from central government control and can raise capital from both the public and private sectors. Trusts can retain financial surpluses – and, of course, have to bear losses and make cuts to balance the books. Up to 20 hospitals are in serious financial difficulties and the government has started talks with profit-driven corporations to take over their management.

Already, whole wards within Foundation hospitals are restricted to private, fee-paying patients only. Existing limits on the extent of private facilities are to be abolished by the Coalition’s bill. So too is the secretary of state’s present legal commitment to maintain a health service free at the point of use.

As two clinicians warn today: “Over time, all hospitals will have to become Foundation Trusts (FTs), effectively commercial bodies. They would have the power to close services without public consultation, and caps on income from private patients in NHS hospitals will be removed, tempting many to increase their income at the expense of NHS patients.

As in any commercial organisation, the main objectives for these FTs will be profit generation, they write, warning: “A profit driven model will undermine all that is precious about the NHS. Furthermore, it will produce an underclass of patients with chronic, debilitating illness, who will be seen as pariahs by those organisations who seek financial benefits over and above good health.”

Add in whole new layers of paralysing bureaucracy created by the bill, plus the £20 billion of “efficiency savings” announced by the previous government, and the wrecking of the National Health Service as originally conceived by the first post-war Labour government is well and truly at hand.

The response of the leaders of main health union Unison has, as usual, been pathetic. Having sat on their hands while New Labour undermined the NHS, Unison has restricted its present campaign to publicity drives. The current Labour leadership under Ed – I want a prosperous capitalism – Miliband also remains committed to market “solutions”.

Christina McAnea, the union's head of health, says the public “will not forgive Lib Dem MPs for colluding with the Tories to break up and privatise the NHS” and that “voting through this Bill will be the end of the NHS as we know it.” We await with bated breath Unison’s fine words being turned into action against the government.

The Coalition is driven by the deepening economic crisis to create conditions for a “return to growth” at any cost, which includes opening up the NHS to the corporations. A similar strategy is being developed around local government services. As the experience of private treatment centres shows, competition allows the private sector the privilege of state guaranteed-profits while services deteriorate.

Taking the profit out of health and other services will require more than fiddling with bits of legislation. We have a market state committed to doing whatever takes to revive a broken capitalist economy. The present parliamentary system and corporate power are the problems, not the solution. Replacing them with democratic, truly accountable people’s assemblies is the best way to answer the Coalition’s onslaught on the NHS.

Paul Feldman

Communications editor

Healthcare and markets will make you sick

Even the right-wing Coalition government is well aware that the National Health Service is embedded in the social being of Britain. So while savaging the rest of the public sector, they have committed to real terms increases in health spending. There’s a big sting in the tail, however.

The government’s White Paper on the NHS proposes major changes. At the heart of them is the plan to involve private sector corporations and impose competition and market forces in the running of the NHS. This dramatic change is part of the attempt to restore the bankrupt for-profit capitalist system to health. It cannot be allowed to succeed.

Many of the changes in the White Paper look good on paper. The intention to move from quantitative output targets that distort clinical decision-making to qualitative health outcomes has seemed like an unattainable dream for decades. “The government’s objectives are to reduce mortality and morbidity, increase safety, and improve patient experience and outcomes for all.” Who would argue with that?

There’s a whole new public health initiative, handing responsibility to local authorities. There’s even talk of "health and wellbeing boards" and employee-led organisations. Good stuff all round.

We’ll get more choice over where we go and who we get to treat us. We as patients will share the decisions on the care we get with clinicians. We’ll be able to share our records with who we like. Fantastic. And good riddance to the suffocating layers of target-driven management built up during 11 years of New Labour and the overpaid hordes of management consultants.

So where is the downside? The market is back with a wholehearted bang. Whilst the majority of NHS funds will be in the hands of consortia of GPs, they will be buying services from Foundation Trusts and any other “willing providers” including those in the private and voluntary sectors.

Companies like Assura Medical, Tribal, Bupa and even the commercial wing of Imperial College can already be heard rubbing their hands together in anticipation of the spoils. Foundation trusts have had their private income capped to date, but this is to be lifted. They have already said they will compete with private firms for patients and launch joint ventures with companies. University College Hospital in London has already gone down this route with a private US health firm which has located a private unit on its site for cancer treatment.

Monitor, the regulator for NHS Foundation Trusts will promote and enforce competition in the market. Its powers, so far only outlined, are nevertheless awesome. The White Paper says that Monitor will have powers to “help open the NHS social market up to competition”,

Competition, then, is the termite infestation that will eat away at the heart of the NHS. Experiments with introducing private provision of services into the NHS have been underway for many years, so far with little success.

The National Health Service is the strongest possible concrete evidence of the altruistic, collective, needs-satisfying potential of the human race once freed from the absurdities of social relationships based around property ownership, and activities motivated by profit.

It has established, in practice, the universal right of access to healthcare free at the point of delivery based on clinical need, not the ability to pay. It is provided by a network of public sector organisations employing close to 1.5 million people.

Aside from the need to earn a living, the majority of the nurses, doctors, paramedics, scientists and technicians, estate maintenance and administrative staff, cooks and cleaners, and, yes, even managers are motivated by the health needs of people they care for, twenty four hours a day, seven days a week.

By any measure it is a stunning achievement. Despite its many faults it has become a model for the rest of the world. That it exists is a source of astonishment and envy. The response to the White Paper surely has to be to fight for the extension of the principles and practises of socialised, not-for-profit health care to the rest of the economy.

Gerry Gold

Economics editor