Clegg promised no back-door privatisation of NHS. But new white paper opens the front door
falseeconomy.org, 19 July 2011
One of the most significant features of the NHS is summed up in the very first clause of the National Health Service Act 1948:
"It shall be the duty of the Minister of Health to promote the establishment in England and Wales of a comprehensive health service designed to secure improvement in the physical and mental health of the people of England and Wales and the prevention, diagnosis and treatment of illness, and for that purpose to provide or secure the effective provision of services in accordance with the following provisions of the Act."
An excellent description is given on the Bad Medicine blog, but the key parts are:
· to promote the establishment in England and Wales of a comprehensive health service
· to provide or secure the effective provision of services
These say that the NHS is a comprehensive (ie, not restricted to specified treatments) and universal (ie available to all) service. They say that it is the duty of the Secretary of State for Health (currently Andrew Lansley) to provide these services.
The first draft of the Health and Social Care Bill removed this duty and changed this clause to:
"the Secretary of State ... must act with a view to securing the provision of services"
This is incredibly weak when compared to the original act. This new clause worried many people and the NHS Future Forum, in its final report, says:
"Nationally, the Secretary of State’s responsibility for promoting a comprehensive health service should be made clearer to the public in order to allay any concerns and remove any confusion. As part of this responsibility, he/she should report to the nation annually."
In response to the accusation of privatising the NHS, the Prime Minister was evasive and deflected the question:
"So let me be clear: as long as I’m Prime Minister there will be, as there are now, private providers and voluntary providers. But let me also be clear, no: we will not be selling off the NHS, we will not be moving towards an insurance scheme, we will not introduce an American-style private system."
This is not the same as saying "no privatisation". The Deputy Prime Minister, however, is more forthcoming:
"That’s why I have been absolutely clear: there will be no privatisation of the NHS."
And in a later speech he says:
"You told us you were worried about privatisation through the back door. So we have made that impossible."
Has the government listened? No, the Bill has now completed the second Committee stage after the Future Forum pause, and now the clause says:
"the Secretary of State must exercise the functions conferred by this Act so as to secure that services are provided in accordance with this Act"
Again, no duty to provide, merely to "secure that services are provided". If the Secretary of State accepts a duty for provision then why change the wording of the first clause of the NHS Act 1948? The reason is that the government does not want the responsibility of providing the NHS. Last week the government published the Open Public Services white paper which says the following (section 5.2):
"In the services amenable to commissioning, the principles of open public services will switch the default from one where the state provides the service itself to one where the state commissions the service from a range of diverse providers."
This specifically says that the government does not want the state to provide the NHS (or any services), and instead, it wants the state to buy services from "a range of diverse providers" (ie private companies). If a service that was provided by a public provider is then provided by a private company then that is privatisation. The OPS is simply announcing the privatisation of the NHS.
Richard Blogger writes about the NHS and social policy at NHS Vault
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Patients to get choice of providers
The Independent, 19 July 2011
Patients will be given a choice of providers for mental health and community NHS services, the Government has announced.
The move, which opponents argue will lead to an increasingly privatised NHS, comes into force from next April and covers services worth millions of pounds.
Health Secretary Andrew Lansley said it was "a big day for patients", who will be able to choose care from providers who meet NHS standards on quality, price and contracts.
Providers will compete to offer services and are likely to include private companies, charities and voluntary organisations, as well as the NHS.
Eight NHS areas - including musculoskeletal services for back pain, adult hearing services in the community, wheelchair services for children and talking therapies for adults - are being opened up for competition.
A minimum of three services must be offered in each area of England by September 2012.
The concept of "any qualified provider" has caused huge controversy, with opponents saying it represents privatisation of the health service.
Mr Lansley was forced to water down some of his plans in the Health and Social Care Bill but insists choice is good for patients.
He said: "There is often confusion about these policies - a mistaken idea that competition is there for the sake of it, or to increase the independent sector's role in the NHS.
"But let's look at what this is really about: it's about children getting wheelchairs more quickly.
"It's about people with mental health conditions choosing to receive their care somewhere closer to home.
"It's about older people being able to choose a service that will come to their home - perhaps the vital difference between staying at home or having to move into care.
"It's about real choices for people over their care, leading to better results.
"We are taking a phased approach, offering choice for services where it will improve outcomes, responding to the recommendation of the NHS Future Forum which supported the Government's policy to offer patients greater choice of provider."
Unison head of health, Christina McAnea, said: "Patients should not be fooled - there are huge dangers lurking in plans to allow any qualified provider into the NHS.
"It leaves the door wide open for privatisation of our health service.
"Patients will be little more than consumers, as the NHS becomes a market-driven service, with profits first, and patients second.
"And they could be left without the services they need as forward planning in the NHS becomes impossible.
"Staff will suffer too - their wages, terms and even their jobs could be at risk.
"Far from giving out advice to take this policy forward, the Department of Health should be scrapping this policy and going back to the drawing board."
Ruth Owen, chief executive of the charity Whizz-Kids, said: "We believe any qualified provider will remove the barriers to faster, better wheelchair services by enabling organisations like ours to work collaboratively with the NHS to provide unmet needs, shorten waiting lists and drive innovation."
Sophie Corlett, director of external relations at Mind, said: "Mind is in favour of extending choice and availability for individuals in psychological therapies - both of provider and of type of therapy.
"We would hope that this enables people to have access to treatment in a provider near to their home or workplace and in a manner or by a therapist of their choosing."
Dr Hamish Meldrum, chairman of the British Medical Association (BMA), said: "We support greater choice for patients, although in an NHS with finite resources it will always be limited.
"What we would question is the assumption that increasing competition necessarily means improved choice.
"When competition results in market failure in the NHS, the ultimate consequence is the closure of services, and the restriction of choice for the patients who would have wished to use them."
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Fear of favours to ‘Tory’ hospital as NHS ‘undermined’ by competition
www.thisisbath.co.uk, 8 August 2011
A Government quango has ordered health chiefs across two counties to send more patients to a private hospital which is owned by two major donors to the Conservative Party.
Union bosses said the decree ‘stinks of cronyism’ and has demanded questions be asked about the relationship between the private hospital firm and the Government.
The Government’s new Co-operation and Competition Panel (CCP) was given the job of enforcing new competition rules within the NHS, which campaigners say is a ‘back door’ way of privatising the health service.
Earlier this year, CircleBath, a private hospital in Peasedown St John, near Bath, complained to the CCP that local health trusts weren’t sending enough patients to it for routine operations.
Circle said NHS Bath & North East Somerset and NHS Wiltshire, which commission services jointly at the Royal United Hospital in Bath, weren’t playing fair in setting a cap of £6 million on operations it would fund at the new private hospital, while it spent £160 million at the RUH.
The CCP has now ruled in Circle’s favour, saying the two NHS trusts had breached the new competition rules by favouring NHS hospitals like the RUH over private hospitals like Circle. It has now given health bosses in Bath and Devizes a fortnight to respond to the ruling and outline what they are going to do.
CCP director Andrew Taylor said setting a maximum spend on using private hospitals was unfair to CircleBath, and meant a worse deal for patients. "The panel considers that the majority of the aspects of conduct raised in this complaint impose costs on patients and taxpayers that are not outweighed by any of the benefits that may arise from such behaviour. We are now keen to consult on what would be an appropriate remedy to the conduct in question,” he said.
It means more patients will be given the choice of going to CircleBath on the NHS, but union leaders have questioned the politics behind the decision.
Circle is a national firm with a small but fast-growing number of hospitals.
The firm is 49 per cent owned by its staff, with 51 per cent owned by private investors – primarily two hedge funds in the City – Odey Asset Management and Lansdowne Holdings.
Since 2003, Crispin Odey and Lansdowne’s Paul Ruddock and David Craigen have between them donated more than half a million pounds to the Conservative Party. The CCP itself is chaired by Lord Carter, who made his fortune in the private healthcare industry. "This is all about making sure the health service of the future is run for the benefit of profiteers, not patients and at the expense of taxpayers,” blasted Tanya Palmer, the regional manager for Unison South West., which represents thousands of workers in NHS hospitals.
"This is what we said the Government’s NHS plans are all about – making sure the privatisation of the health service comes about through the back door, by actually forcing the NHS to go private and give the money straight into the hands of the cronies.
"This stinks of cronyism,” she added. the people behind the private hospitals like Circle, who need the NHS cash to make their profits – are the hedge fund managers in the old boys club network who are Tory supporters.
"The problem is that CircleBath will only take the simply, routine operations involving healthy people. If you’re old or unhealthy already or even slightly overweight, then they don’t want you and you haven’t got a choice. So you’ll have a two-tier health service with a selection going on. And the NHS will be left with the tough, expensive operations, and fewer of them, while the privateers cream off their profit,” she added.
"It will destabilise the NHS, leaving it disjointed and fragmented,” she added. Both NHS trusts involved declined to comment until they had come up with their official response to the CCP’s ruling, but CircleBath strongly rebutted claims its links to the Tory Party had influenced the decision.
A source at the company said while it needed City investment to build new hospitals, its operations and management were detached from the money behind it. The CCP also strongly denied it had been ‘unduly influenced’ by Circle, or any private health industry body, in forcing NHS chiefs to go private. "We are completely agnostic on who provides the health care, our only remit is to what is best for the patients and the taxpayer. In this case, the panel found that the two NHS trusts had breached competition rules, and were not providing the best service to the patients,” said a CCP spokesman.
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Public services proposals will not mean more choice
guardian.co.uk, 20 July 2011
David Cameron wants us to believe that rolling back state provision will benefit the public. The opposite is true
Thirty-two years after Margaret Thatcher swept into Downing Street promising to roll back the frontiers of the state, the neoliberal drive towards a fully privatised Britain is entering its final stages. The government's new Open Public Services white paper, revealed by David Cameron last week, may have passed under the radar somewhat due to the scandals engulfing the Murdoch media empire, but it's an important document nonetheless. The coalition claims that "reform of public services is a key progressive cause", and that its proposals "give power to those who have been overlooked and underserved", but in reality there is nothing progressive about its underlying objective to radically change the role of the state from a provider of public services to one that will merely ensure "fair access" to them.
For all its touchy-feely language – added, of course, to gain Lib Dem acceptance – Open Public Services is a document that Sir Keith Joseph and Friedrich Hayek, those two hardcore critics of postwar collectivism, would have had no trouble in endorsing. And the main beneficiaries of the reforms are not likely to be poor and disadvantaged, but private companies who will be able to bid to run a whole host of services currently provided by the state and local authorities.
The white paper claims that the planned reforms are non-ideological, but its assertion that "the old, centralised approach to public service delivery is broken" and its obsession with increasing "choice" and "competition" reveals its inherent anti-state bias. And its assumption that reducing the role of the state and opening the door to "new providers" leads to better services doesn't tally with the experiences of millions of Britons since privatisation started in 1979. You won't read about it in Open Public Services, or on the websites of freemarket thinktanks, but the record of the state was far superior to that of the private companies who have since taken over its responsibilities.
The much-maligned British Rail cost the taxpayer about five times less in subsidies and delivered much cheaper fares than the likes of First Great Western and Virgin Trains. The state-owned National Bus Company and its local subsidiaries also served the travelling public better than today's privately owned bus operators, who, like their train counterparts, suck in huge amounts of public subsidy, yet still have the chutzpah to charge us some of the highest fares in Europe. The state-owned BBC, when all its production was carried out "in house", produced some of the best television programmes made anywhere in the world – certainly better than anything Sky has ever produced. And the NHS, routinely denounced as a Stalinist bureaucracy by rightwing commentators, did rather more to improve the nation's health and increase life expectancy than the woefully inadequate mix of private and charitable hospitals that existed before 1948.
The neoliberal "private ownership good, public ownership bad" mantra also doesn't explain how two of western Europe's most successful postwar economies, those of Norway and Austria, operated a large state-run sector.
Rather than being the disaster that free marketeers claim, the massive increase in the role of the state in the years following the second world war was of huge benefit to the vast majority of ordinary Britons. Dirigiste economic policies ensured full employment, while increased state spending on education, health and welfare led to major increases in the quality of life.
The rolling back of the state since 1979 may have benefited merchant bankers and wealthy investors, but it has come with an extremely high price tag for everyone else. The government now wants us to believe that creating "greater diversity in the provision of public services" will deliver enormous benefits to the public, but our experience with neoliberal reforms of the past tells us exactly the opposite is likely to happen. And while the white paper claims "there is a huge appetite for people to get directly involved with the deliveries of services they use", there is little, if any public enthusiasm for a further reduction of the state. Last month, 38 Degrees handed in a petition of 420,000 signatures against the planned reforms to the NHS. A similar campaign derailed the government's plans to sell off England's forests. Around 70% of people would like to see our railways renationalised. And after British Gas's announcement of an 18% hike in its gas tariffs, having posted record profits of £742m last year, it's highly probable that a similar proportion would favour taking the once state-owned company back into public ownership.
Yet despite public opinion, the government remains hell-bent on reducing state provision. Only yesterday, the health secretary, Andrew Lansley, announced that more than £1bn of NHS services would be opened up to competition from private companies and charities. Once again, all the talk is of providing "real choices for people", but the reality, as the BMA warns, is likely to be the very opposite.
For Labour, the coalition's anti-state obsession provides a golden opportunity. If Ed Miliband is looking for an issue that is both a vote winner and in tune with his party's traditional values, then he could do far worse than to end Labour's flirtation with neoliberalism and champion the progressive role of the state as a provider not just of public services, but of public transport and utilities too. Vigorously opposing Open Public Services and the reactionary rightwing ideology that underpins it would be a good way to start.