How to dismantle the National Health Service
I am a GP in the London borough of Tower Hamlets. In 2013 I wrote about the dangers that Britain’s Health & Social Care Act posed to the existence of our National Health Service (NHS). Sadly, my predictions of a further fragmented and underfunded healthcare are day-by-day coming true.
It is not surprising that MP and GP Sarah Wollaston described the Act as a grenade tossed into the NHS. This legislation abolishes the NHS. Except nobody has told you this. This is the reason that I have written a book – How to Dismantle the NHS in 10 Easy Steps – in order to inform the British public. On the surface, nothing appears to have fundamentally changed. You can still see your GP or go to hospital and receive care free at the point of delivery. Underneath, however, everything is being insidiously transformed.
The Act repeals the duty of the Health Secretary to provide a National Health Service. The Act also stipulates that the local Clinical Commissioning Groups (CCGs) only have a duty to provide care ‘appropriate as part of the health service’ – this is really carte blanche for CCGs to ration as much as they like. Their only legal requirement is to provide emergency care.
Most important of all is the AQP, or Any Qualified Provider, which is at the heart of the Conservative’s Open Public Services. AQP means NHS contracts have to be put out to tender and can thus be taken over by the private sector. We have already seen the numbers on this shoot up. More than half of contracts advertised since April 2013 have gone to non-NHS providers. Last year alone, out of the £9.63 billion ($15 billion) worth of NHS deals signed, £3.54 billion ($5.5 billion) – nearly 40% of them – went to private firms. This compounds recent trends, with the portion going to non-NHS providers hitting £10 billion ($15.6 billion) for the first time.
Private firms are cherry-picking lucrative services like cataract and hip replacement operations. This will lead to further dismemberment of health service. Instead of surplus money being put back into the system to be spent on patient care, it is siphoned off permanently to boost corporate profits. This means a smaller pot of money to provide comprehensive services at a time when healthcare costs are rising. In other words, CCGs will find themselves between a rock and a hard place, leading to more rationing. Within the first 6 months of the Act, 1 in 7 CCGs had brought in new restrictions over what treatments people can get, according to a survey by the British Medical Journal.
In a competitive tender, the playing field is not level. Small NHS organizations will struggle to compete with transnationals like Virgin, Serco or United Health – which have whole departments dealing with contracts. The reality is that competition leads to private sector oligopolies. This is a glaring example of the inefficiency of markets. Simply put, we know that markets do not operate well in healthcare. International studies corroborate that a planned healthcare system is cheaper and generally provides better quality of care than market-based systems.
Britain’s Prime Minister David Cameron talks about ring-fencing the NHS budget, but there have been efficiency savings of £15-£20 billion ($23-$31 billion) up to 2015 and these will be extended into the next decade, possibly reaching £50 billion ($78 billion). The attack comes from all sides. General practice has experienced many years of chronic under-funding and under-investment. Some 60 surgeries have been forced to close over the past 2 years, displacing more than 160,000 patients. If the abolition of the Minimum Practice Income Guarantee goes ahead, more than 100 surgeries, in deprived parts of the country, would be threatened with closure. Furthermore, changes to GP tariffs may not take into account the extra spending needed for deprived areas. In Tower Hamlets, where I work, the life expectancy of our patients is 10-15 years less than in other parts of London. Some practices could lose hundreds of thousands of pounds a year. The result will be either closure or a massive reduction in what they can offer. Ultimately, we are likely to see GP surgeries merging into federated organizations in order to survive. This would then be the precursor to privatization of general practice through takeovers and buy-outs.
Over the past 25 years, successive governments have closed over 50% of NHS beds. In 2013/14 there were 135,000 NHS beds, compared with 297,000 in 1987/88. Combine this with cuts to GP numbers and social care; add to the mix that thousands of staff have been axed: there are 5,000 fewer nurses in the NHS now than there were in 2010. Throw in for good measure the one-quarter of NHS walk-in centres that have closed since May’s general election. Then you begin to understand that the NHS crisis has been manufactured as a result of deliberate policies.
Private Finance Initiative (PFI) allows consortia of bankers and construction firms to skim off public money to line the pockets of private shareholders. When South London Healthcare trust went bust, largely due to PFI debts, neighbouring and solvent Lewisham hospital faced the axe. The Lewisham campaign took the Secretary of State for Health, Jeremy Hunt, to the High Court and, remarkably, won. The government’s actions were ruled illegal, setting the precedent that PFI debts could not lead to the reorganization of neighbouring health services. The Conservative Party responded by changing the law, handing special administrators the powers to do just that.
Bartshealth in Tower Hamlets – the largest trust in the country – is home to the most expensive PFI scheme. Hospitals that should have cost around £1 billion ($1.55 billion) to build will end up costing £7 billion ($11 billion), with the extra £6 billion ($9.3 billion) lining the pockets of the private consortium Skanska Innisfree. Richard Sykes, chair of Imperial College NHS trust, points out that Bartshealth have to pay over £100 million ($156 million) in interest per year before they even see a patient. This equates to £2 million ($3 million) a week and will be indexed upwards to £3 million ($4.7 million). I can’t think of many organizations capable of surviving in the face of such overheads.
The final step will be converting the NHS into an insurance-based system. This will be achieved through the devolution of health and social-care spending. This is being implemented in Manchester and will be rolled out to Cornwall. The integration of health and social care is likely to mean that healthcare will eventually be means-tested, like social care. This is in keeping with the plans of David Cameron’s health adviser Nick Seddon, who feels that CCGs should be merged with insurance companies and that those who can should contribute toward their healthcare. Personal health budgets are being rolled out to millions of patients in this Parliament and will open the door to top-up payments and, therefore, insurance.
So where does that leave us? The perfect storm is coming soon to a hospital or GP near you. The post-war NHS architect Aneurin Bevan said that the NHS will continue to exist as long as there are folk left with the faith to fight for it. Find out if there is a PFI hospital near you draining local resources. Write to your MP. Look up which services are being put out to tender to private companies. Join campaigns such as Save Our Surgeries and Save Our Hospitals. Attend your local branch of Keep Our NHS Public or the National Health Action Party. Each one of us is affected by the destruction of the NHS. This is a fight to preserve our NHS for all of us, for our children and for the future.