A guest post by my friend Deborah Harrington demonstrating what seems a clear case of putting a frog (NHS users, i.e. all of us) in gradually boiling water:
1983 Start with the little stuff that no one cares about, like ‘outsourcing’ cleaning. Nibble away at the structure for a few years relatively unobserved until….
1990 NHS and Community Care Act creates hospital trusts and Strategic Health Authorities along with GP fund holders, all ‘commissioning bodies’. These replace the old direct allocation of resources ‘freeing’ NHS purchasers to buy services from each other. The internal market is created…
1997 the Finance (NHS) Act creates the possibility of the NHS raising money from the private sector in a radical extension of Major’s public-private partnerships.
2000 Simon Stevens masterminds the ‘NHS Plan’
Over the next few years trusts will be pushed into becoming Foundation Trusts, non governmental (ie no longer public) bodies. They will be told PFI is their only way of raising funds for modernisation. There will be a lot of persuasion that new (often out of town) buildings (owned by the PFI consortium) are better than modernising old (town centre, high land value) buildings. The old ones are sold off cheaply and luxury flats are built in their place. The NHS has swapped publicly owned buildings for privately rented ones. Staff reductions and pay cuts are made to pay for this fixed and very high cost.
New hospitals have fewer beds and fewer staff. Surgery is split into ‘elective’ and emergency. Patient choice is introduced. Elective surgery can be pre booked to suit you. It is provided via Independent Sector Treatment Centres, run by United Health.
Simon Stevens leaves the NHS team to work for United Health. He is part of a team which lobbies the EU to include the NHS in TTIP.
Payment by results is brought in. This is a radical change to NHS financing and completes the market structure started in 1990. Each ‘health transaction’ is itemised and billed. Within each hospital individual services are separated out and each becomes a time limited ‘service contract’.
(In 1990 admin costs of the NHS were approx 5% of total budget, by 2010 with the addition of commissioning and transaction costs it had risen to 14.5%)
2006 NHS Act makes three important changes. One is to your data, which can now be excluded from confidentiality. The other is to ownership. Not only is ownership no longer public but premises no longer have to be used for health purposes. And last, but not least, introduces the Unsustainable Provider Regime and the Trust Special Administrators. For the first time in the history of the NHS a hospital can go broke.
2012 the Health and Social Care Act completes the privatisation plan, leaving only the individual elements to be fulfilled. The NHS is now open to full competition within the market. To facilitate the commissioning process SHA’s are replaced with Clinical Commissioning Groups. Sold to the public as ‘GP led units which understand your local needs’ they are nothing of the kind. They are not destined to remain GP led. Few GPs have the skills for commissioning (those that do are generally crap GPs…) and so the CCG Boards end up with a mix of GPs and management company employees. They also need Commissioning Support Units, to actually run the tendering processes.
NHS England is created and Simon Stevens returns from United Health to be its CEO. Tory, Labour, Lib Dem all cheer enthusiastically. Monitor is created to regulate competition and ensure everyone puts all their contracts out to tender and doesn’t try and protect the NHS’ status. All the property that used to belong to the SHAs is put into the PropCo.
Simon Stevens writes the Five Year Forward View for the NHS. This is designed to create US style Accountable Care Organisations. Tory/Labour/Lib Dem all approve.
NHS England creates a Lead Provider framework for Commissioning Support Units, where a small group of ‘providers’ are given approved status to combine into consortia with CCGs. In 2014 an extra provision is passed into law allowing those ‘local GP led’ CCGs to combine into larger consortia in order to provide services over a larger area. These will roughly coincide with the devolution areas and will be matched up with one of 6 CSUs.
One of the six is United Health.
Meanwhile budgets are cut. Foundation Trust hospitals are now businesses, so when they can’t afford to run the hospitals as well as pay their PFI, nearby hospitals with no PFI have their services closed and transferred to the PFI hospital, along with the income that goes with them. When they carry on going broke they are closed and sold off.
Every transaction, whether it is negotiating the PFI deals, being the Trust Special Administrator, advising on the setting up of CCGs and CSUs, closing hospitals, monitoring hospitals, setting up rescue deals for hospitals, there are several names which are always there. Come rain or shine they are handed £million++ contracts -without competition- time and time again. They are McKinsey, PwC, Ernst & Young, Capita……all the usual bloodsucking leeches.
As for who runs the contracts within the hospitals, Serco, Circle, G4S, Virgin Health, United Health, Optum (a subsidiary of United Health)…..Bain Capital runs the blood and plasma service. None of these companies has doctors, nurses or equipment of their own. They simply take over the management of an existing ward or service and cut staff and pay to take a profit.
As NHS hospitals lose beds and services, or close, so more and more planning permission is granted to private hospitals. As service in the public NHS deteriorates so people go looking for private insurance, continuing the privatisation process themselves (I don’t blame them, but wish they wouldn’t…).
The mantra of choice and ‘care closer to home’ is sold to the public. Personal Health Budgets will be given to people who are chronically ill or disabled to ’empower’ them to make choices. It’s just another way to encourage people to think about self-pay. These funds will be withdrawn once insurance takes over.
We have been systematically done over for 30 years.