Our NHS in mortal peril?

Britain seems to be waking up belatedly to the fact that the NHS is in mortal danger. The sad truth is that our leaders have been quietly selling it off piecemeal for a very long time and any US-UK trade deal will merely be the culmination of years of policy by successive governments.

Mrs Thatcher’s legacy

When leader of the opposition in the 1970s, Mrs Thatcher interrupted a presentation of the Conservative Research Department by slamming down a book by Friedrich Hayek saying “This is what we believe!” [i]

Hayek thought that a welfare state leads to totalitarianism – either communism or fascism –  in the long run and Mrs T signed up to that.

Her close political ally Nicholas Ridley in a report to the Conservative Party’s Economic Reconstruction Group in 1977 said that a frontal attack on nationalised industries – including the NHS – was not recommended.

“Instead the group recommends preparing the industries for partial return to the private sector, more or less by stealth,” he wrote.

Oliver Letwin and John Redwood go for US style health insurance

In 1988 Oliver Letwin and John Redwood drew up a pamphlet called “Britain’s biggest enterprise: Ideas for radical reform of the NHS”. It was a blueprint for the privatisation of the health service which would no longer be free at the point of delivery. This was to happen covertly and over a long period of time. We would go over to a US-style insurance model of healthcare in spite of the manifest failures of the American system.

Former cabinet minister Mr Letwin sought to distance himself from the pamphlet when it came to light in 2016. But as late as 2004 he told a private meeting that the NHS would “cease to exist” within five years of a Tory government.

New Labour and PFI

The Blair and Brown administrations, far from reversing the trend, inaugurated the notorious Private Finance Initiative for capital projects which has burdened the NHS (as well as schools and other infrastructure projects) with huge debts. The money to service these debts is ring-fenced and has to be paid before a single pound is spent on patient care.

Over £11 billion was borrowed for new hospitals but over £80 billion will have to be paid back over the decades. The loan was structured to become more onerous as the years went on and it was never explained to the public in a way that they could understand, according to doctor activists such as Bob Gill and John Lister.

The decision to do this was “profoundly secretive” and taken “behind closed doors”, says Dr Lister of Save the NHS.

The Health and Social Care Act

And the Health and Social Care Act of 2012 which passed almost unnoticed compounded the loss of much of our most precious and beloved NHS.

Prof Allyson Pollock of Newcastle University said under the new Act the Secretary of State no longer has the duty to provide care throughout the country but has the duty to “arrange care”. This, she says, is legalese for contracting the work out.

The Act was accompanied by the biggest ever hospital closure and land disposal programme, she said. Hospitals – 124 of them – with no PFI debt were closed to pay for the debts of hospitals built under the PFI scheme.

Dr Gill has said: “The biggest lie is that markets and competition improve health care. The evidence shows that the more you privatise, the more waste there is, the more conflict of interest.”

He added that tens of billions of pounds are siphoned off for running the market system, servicing PFI debts, out-sourcing and management consultants before patient care gets a look in.

Before privatisation administration accounted for five per cent of NHS and social care budgets. Now it’s up to 20 per cent.

According to a Bristol University study in 2014 the NHS spent £640 million on management consultants and in 2018 a further report from the university showed how much waste and inefficiency was now part of the NHS[ii].

Failure of the private sector at Hinchingbrooke

During the coalition government Hinchingbrooke Hospital – which, it must be acknowledged, was struggling – became the first NHS hospital to be sold off to the private sector, to Dr Ali Parsa of Circle Health.

Dr Parsa proved a charismatic enthuser and promised that the hospital would thrive as a business with staff owning 49 per cent of the business.

At first impressed, Lead Nurse Patricia Flanagan quickly became disillusioned. An important part of her job now was conducting ward rounds to see who could be discharged every day so that planned admissions could be made straightaway – that’s where the profits lay.

“The sad thing was that nurses were put up against each other,” she said, adding that they had lost the cohesiveness which was previously a feature of their working relationship.

“I didn’t want shares, I just wanted to do my job,” she said.

Things did not go well.

After three years Care Quality Commission put the hospital in special measures because of concerns about risks to safety. And it was a disaster financially.

Circle Health abandoned the hospital three years into a ten-year contract. The NHS had to pick up the pieces.

Nye Bevan would be astonished

It could be argued that the architects of the NHS such as Aneurin Bevan would be astonished at some of the people at the heart of our health service today.

The CEO of NHS England is Sir Simon Stevens who spent 10 years working for United Health Care in the United States. UHC has been rocked with scandal over shares and huge fines since 2006.  There is no suggestion that Sir Simon was involved but the point is that UHC makes millions out of sick people and a person steeped in this ethos is now in charge of our health system in England.

The current Health Secretary Matt Hancock has given his personal endorsement to Babylon, owned by Dr Parsa – see above, which aims to replace thousands of GPs with an app using private doctors – and, indeed, robots.

Sir Richard Branson’s company Virgin Care sued the NHS in 2017 when it failed to get a contract for childcare in Surrey. How could this possibly have happened? Check out the Health and Social Care Act 2012.

Tragic mismanagement of Covid 19

The Covid 19 outbreak has changed all our lives possibly forever. But our government has used the disaster to further privatisation.

According to an article in The Guardian published on 4 May, the Government is using the pandemic to transfer NHS duties to the private sector. Companies like Deloitte, Unipart and Serco have secured taxpayer-funded commissions to manage Covid-19 drive-in testing centres, the purchasing of personal protective equipment (PPE) and the building of Nightingale hospitals.

The newspaper claims to have seen a letter from the Department of Health to NHS trusts instructing them to stop buying any of their own PPE and ventilators but to use the services of these companies instead.

Prof Pollock said: “We are beginning to see the construction of parallel structures, having eviscerated the old ones,” she said. “I don’t think this is anything new, it just seems to be accelerated.”

Elizabeth – a case study

Elizabeth[iii], a young woman suffering from an eating disorder, has been hospitalised more than 40 times. Some of her admissions have been into NHS units but she has also been in three hospitals in The Priory franchise in Richmond, Marchwood and Bristol.

The figure varied between 80 and 100 per cent but her fellow sufferers were overwhelmingly national health patients. In other words the British taxpayer was paying for their treatment, the shareholders’ dividends and company’s profits. The farming out of NHS patients to private hospitals is not an occasional event when the NHS is experiencing a logjam. It is written into the very structure of our health care system.

Paradoxically Elizabeth received worse treatment in the expensive private sector. Typically the units are understaffed and depend on agency nurses, many of whom have no training or experience of eating disorders. The NHS units who have cared for her in Dorset and Wiltshire were properly staffed with trained and experienced staff. Sharen Green

This paper is based largely on John Pilger’s documentary The Dirty Wars on the NHS.

 

[i] The Constitution of Liberty. She had also been deeply influenced by Hayek’s earlier work The Road to Serfdom while an undergraduate.

[ii] http://www.bristol.ac.uk/policybristol/policy-briefings/management-consultancy-inefficiency-in-nhs/

[iii] Her name has been changed to protect her privacy