Nye’s nightmare

Health secretary Alan Johnson maintains that in backing centralised GP 'super-surgeries' he is staying true to the dream of the founder of the NHS. Tom Foot says the reality is more like Nye's nightmare

At a celebration of the 60th anniversary of the National Health Service last year, Alan Johnson revealed his inspiration for introducing the polyclinic. 'Nye Bevan did not want lots of isolated GPs,' said the health secretary. 'With the introduction of polyclinics I am trying to create Nye's dream.'

The super-sized surgeries, where GPs work alongside a range of other health care professionals in centralised health centres, are set to replace thousands of 'single handed' practices across the country. But Nye's dream has become rather warped along the way. What Labour is now proposing is fast becoming a recurring nightmare for those who prize the NHS - and it's not just the Bevanites who are losing sleep.

In stark contrast to the public health centres Bevan sought to establish, the government is bending over backwards to ensure that these health centres are run by a strange clique of private companies.

Last April (2008), UnitedHealth was awarded contracts to run three surgeries in Camden, north London. The American health giant - recently indicted with defrauding American patients out of $1.3 billion of health insurance claims - was easily able to under-cut bids from local doctors by 25 per cent.

Within weeks, two popular locums - including one who had been at the Camden Road surgery for 18 years - were sacked, a popular baby clinic was closed and patient assessment times were cut by five minutes. In May, two directors from the IT firm Ingenix, a subsidiary of the Minnesota-based UnitedHealth Group that was responsible for wrongly calculating US patient insurance claims, were dispatched over the Atlantic to run operations here.

In a parliamentary debate following the takeover, former health secretary Frank Dobson asked: 'UnitedHealth have been indicted for swindling taxpayers and patients - would you employ a company that had a record like that?' But UnitedHealth's raid on the NHS is not altogether surprising: the former Downing Street advisor Simon Stevens is chairman of its UK board.

When Camden PCT (primary care trust) announced in June it was planning to bundle Bloomsbury practices into a polyclinic in the University College London Hospital, patients feared UnitedHealth would again be first choice for the privatised project. It turned out to be Virgin Healthcare, but Richard Branson's empire pulled out of the project because the scheme would not be profitable enough.

The multinational software firm Atos Origin, another of the Department of Health's 'preferred suppliers' of polyclinics in London, recently announced it was pulling out of its contract to run local doctors' services in Tower Hamlets. After just seven months, patients were told that a reduced service would be operating until the split.

It is no wonder that doctors and patients in Haringey fear the worst when the contracts to run five polyclinics are put out for tender in April.

Patient campaigner Janet Shapiro speaks for thousands when she says: 'There is no democracy in the NHS. There's no way of forcing the PCT to listen to us and that's why these problems arise. We have been trying to get them to engage meaningfully with us from the start, with little success.'

No PCT has consulted the public, meaningfully or otherwise, on whether private firms should be allowed to bid for health contracts - because EU tendering rules mean private firms cannot be excluded from the bidding process.

There remain, in these uncertain economic times, question marks over who will pay to build these vast privatisation-domes. Department of Health rules state that all new health centres must be built and owned by a consortium of private contractors that rakes in a huge profit by renting the facilities back to PCTs for periods up to 35 years. Until the banking crash, these contractors had secured loans with ease - but getting credit isn't so easy these days.

The entirely avoidable process of committing to costly Private Finance Initiative schemes has not gone unnoticed in Islington. In January, that borough's PCT agreed to sell the Finsbury health centre. The Grade I listed building was designed by the Russian architect Berthold Lubetkin in 1938 and commissioned by the radical Labour council of the day to redress chronic deprivation. For the first time, health professionals including podiatrists, physiotherapists and children's specialists and doctors worked alongside each other under one roof.

The model, which archive documents show informed Bevan on founding the NHS in 1948, was London's first publicly-owned health centre and a precursor to what today are known as polyclinics. On the building's opening, Lubetkin proudly proclaimed that 'nothing is too good for ordinary people'. But according to PCT chief executive Rachel Tyndall, PFI means maintaining that vision is simply 'not worth the money'. And so, in Islington, Nye's dream has been cynically abandoned. Alan Johnson has yet to wake-up to that one.