Make Sure things Don't Work So People Get Angry
The Link between Funding Cuts and Privatisation
Anyone who has watched TV this week will have seen film of people lying on beds in corridors, heard about A&E departments needing to close and of patients with complex care needs being restricted to 15-minute home visits.They may also have seen Jeremy Hunt being interviewed and looking genuinely shocked or telling the House of Commons that it is all due to too many people having the sheer effrontery to get ill at the same time.
So what is actually going on: is the Government just useless? The answer I think is in one sense they are, of course, profoundly useless but that does not mean there is no methodology to what is happening.
The underlying strategy for all this lies with the passing of the 2012 Health and Social Care Act. This amounted to a massive top-down re-organisation of the NHS (precisely what David Cameron had promised would not happen in the 2010 election campaign).The Act, which largely seemed to slide through Parliament unnoticed by anyone including the Opposition, did a number of things but key points were:
- Section 1 of the Act actually removed responsibility for providing day-to day-health care from the Secretary of State and vested it in a newly created body called NHS England to oversee the NHS. This has proved handy for the Government and led to occasions when we have seen Jeremy Hunt critique the health service as if it had nothing to do with him!
- It replaced existing Primary Care Trusts with 211 CCGs (Clinical Commissioning Groups) with responsibility for commissioning health care in their geographical area. There are 5 such groups in the Derbyshire area and their duty is to “commission" (buy-in) healthcare services. They are supposedly GP-led with local GPs voting their colleagues onto a Governing Committee alongside lay members and "specialists". CCGs control 60% of the NHS budget - around £60 billion.
- The key section though, is Section 75 which required that all primary care facilities be put out to tender with bids being allowed from “Any Qualified Provider”. This has allowed organisations as diverse as Serco, Circle and Virgin to successfully bid for healthcare contracts - resulting in the slow privatisation of the NHS.
All of this was sold to the public on the basis of patient choice and democracy - putting GPs in charge of funding NHS services. In practice few GPs have the financial skills involved to deal with what is actually a complex tendering process or the interest in doing so (being occupied with trivial matters like running their practices) and it is common either for positions not to be taken up at all or, in some cases, taken up by GPs with interests in companies bidding for contracts. It should be stressed that there is a duty to declare any such interests and no suggestion of impropriety is being made against any specific CCG including those in Derbyshire.
One outcome of this has been a proliferation of payments to "advisory" bodies such as accountants and lawyers to ensure that complex tendering procedures are followed and that CCGs are not sued by large private bidders arguing that their bid has not been fairly treated.
Alongside all of this has come an effective freeze on budgets in real terms. During the last parliament David Cameron claimed to have put an "extra 12.5 billion" into the NHS . Over the 5 year period this comes out at just 0.1% above inflation and takes no account at all of a population that is increasingly living longer and the cost of drugs which is rising well above inflation. Independent estimates claim that increases of between 3 and 4% above inflation are the minimum required just to keep the service at the same level.
Another interesting stat bandied about is that only 6% of the NHS has so far gone into private hands. The Coalition Government repeated this like a mantra.This figure is also misleading as it fails to take account of the fact that the private sector is only interested in some parts of the NHS as it is perceived that only some areas will ever make money and if you take into account only the areas the private sector would actually want the figure is about 13%.
One area that is not considered to ever be an effective "cash cow" is A&E. Curious is it not, that this is where the greatest burden seems to be falling?
Which brings us back to the quote from Noam Chomsky part of which forms the heading for this piece. The full text is:
"That's the standard technique of privatisation: defund, make sure things don't work, so people get angry; you hand it over to private capital"
In summary what is happening is every bit as vile and awful as you think it is but it is not accidental. Opposition to what is happening should highlight the full implications of what is going on and should drag the Government's agenda fully into the light of day. The Shadow Health Secretary telling Mr Hunt to "get a grip" is fair comment but nothing like enough if we are to prevent the gradual undermining of Labour's greatest achievement.
Finally let me acknowledge that most of the information for this piece has come from "NHS For Sale, Myths Lies and Deception" by Jacky Davis, John Lister and David Wrigley. This is one of a number of books written recently which seek to highlight what is happening in the NHS. Well worth reading.