Get Red Pepper's email newsletter. Enter your email address to receive our latest articles, updates and news.

×

NHS wreckers play hide and seek

Caroline Molloy looks at the state of the NHS as healthcare workers gear up to fight privatisation through the back door

February 3, 2016
10 min read

14984176227_3c8c5a4ebb_oCampaigners from the People’s March for the NHS. Photo: The Weekly Bull/Ron F/Flikr

One of the easiest ways to get a round of applause from an audience is to declare that we should ‘get politics out of the NHS’. But in fact — as the NHS reels from another turbulent year — the alternative to a ‘political’ NHS isn’t a paradise of benevolent doctors in charge.

As doctors are realising themselves, if we remove proper political accountability for the NHS as the 2012 Act did, we end up with unelected and unaccountable technocrats. We end up with corporate lobbyists and consultants deciding who gets what healthcare from whom. We end up with unelected government stooges launching inquiries into dismantling our publicly owned, tax-funded, extensive and highly skilled system, and replacing it with less fair, less efficient ways of providing less and lower quality healthcare. All of this is happening now.

Health Secretary Jeremy Hunt — since 2012, no longer responsible for securing comprehensive and universal health care for the nation — now hides behind minimally accountable local and national bureaucrats. At every new sign of crisis he tells us that the NHS is now following ‘its own plan’. More on this later.

Meanwhile Hunt and George Osborne hold the purse strings — and frontline hospitals are getting squeezed into submission. The majority are now in the red, having lost up to a quarter of their income through a combination of cuts to ‘tariff’ payments, fines if they fail to meet targets, and private sector cherry picking of the cheap and easy procedures they used to cross-subsidise themselves with. Unsurprisingly, waiting lists are climbing inexorably, and increasing numbers of hospitals and clinics are failing quality inspections.

This is classic ‘defund/criticise/privatise’ stuff — but Hunt is busy picking fights with, and trying to silence, the doctors, nurses and other health staff: the very people who are best placed to point this out.

NHS hospitals — forced to compete with each other as well as with the private sector — are now discussing how they can shed unprofitable patients and procedures — something made far easier by the 2012 Act, which took away NHS hospitals’ responsibility to provide a mandatory list of services.

The other set of local NHS bureaucrats, the Clinical Commissioning Groups (CCG), who administer funding locally, are cash-strapped partners in this increased gatekeeping of health services. Many now reward GPs if they postpone hospital referrals, even of cancer patients. It’s getting harder and harder to get things like hearing aids on the NHS. And the largest CCG in the country, Devon, tried to deny all obese people and smokers the right to routine operations on the NHS. They failed, but experts saw it as the ‘shape of things to come’.

Like other aspects of ‘austerity’, these attacks are not driven by necessity. The NHS actually returned billions in underspends to the Treasury in recent years. It’s routinely rated the most cost effective system in the world, far cheaper than those of Germany and France, for example. Instead, the attacks are driven by an ideology that abhors the idea that we have a right to the healthcare we need, provided by the state. And it’s also driven by visions of the profit streams to be wrung out as the state withdraws and a more expensive, less equitable system expands into the void.

Expenditure on running the NHS as an inappropriate ‘market’ is conservatively estimated to be £5bn a year, though some put it as high as £30bn. From the banker-friendly PFI system of financing hospital buildings, to the endless paperwork as every patient appointment is coded, priced and internally billed for, to the lawyers and consultants creaming off a hefty fee from every single commission and tender — imagine if these billions were spent instead on frontline care.

A plan for the market: towards a ‘pay NHS’

Yet this is not the direction the ‘NHS plan’ — the one Hunt uses to bat away political criticism — is going in. After a reorganisation ‘so large it could be seen from space’, there’s another stealth reorganisation underway, put together by NHS Chief Executive, the ex-United Health boss and long-time Blair privatisation advisor, Simon Stevens.

Stevens’ ‘new models of care’ are being rolled out through a hydra of supposedly local ‘vanguards’, ‘success regimes’ and ‘devolutions’. After the spectacular failure of the poster-child for full-scale hospital privatisation, Hinchingbrooke, and the political backlash against Lansley’s 2012 Act, Stevens now talks of collaboration and integration, not competition – of collaborative hospital chains, not standalone Foundation Trusts. But collaboration and integration with whom? And to provide what?

For one, local decision makers are being pressured to hand decisions over to private firms, including ‘lead providers’ like Optum, a subsidiary of Stevens’ old firm, United Health, and to shift away from expensively trained staff to ‘an army of volunteers’ and an array of dubious technology.

Stevens’ 5 year plan also sets out how ‘at their most radical’ his new care models are based on the approach of firms like the US’s firm Kaiser Permanante — where an annual sum is paid to your insurer, who partners with hospital and ‘community’ providers to ensure that all the financial incentives depend on keeping you out of hospital — with hefty ‘co-payments’ expected from you if you do manage to find your way through the hospital doors.

This is marketed as ‘preventative medicine’, which of course we do need. But reducing the availability of hospital beds and hitting patients who use them with fees is the wrong way to ensure people do more to look after their health.

Earlier this year, a BBC editor who’d drunk a little too much of the Kaiser Kool-Aid analysed it thus: ‘The scheme involves an all-out attack on unhealthy lifestyles …”We do not need hospitals”, one member of Liverpool’s CCG exclaimed – with only a little exaggeration.’ Liverpool, like other regions, is facing the closure of a hefty chunk of its hospital provision.

As revealed in a leaked correspondence, junior health minister Lord Prior also thinks that we could close half of our remaining hospital beds, despite already having the second lowest number in Europe).

And in July Prior — hiding in the relative obscurity of the House of Lords — quietly proposed an inquiry into moving towards a ‘pay NHS’, or at least some ‘co-payments’. Prior has attended a string of US meetings with private firms on ‘how to set up a national health insurance scheme’. Cameron has yet to properly disavow Prior’s inquiry.

Introducing such a scheme nationally would of course cause outcry. But do it locally, and throw social care in to muddy the waters, and the politics changes somewhat. Hiding behind the rubric of ‘personalisation’, many regions and some of the sickest patients are now trialling personal health and social care budgets, where you can shop around for providers — and face lengthy renegotiations and the prospect of having to make top-up ‘co-payments’ if your ‘annualised care package’ doesn’t cover the care you turn out to need. It’s hard to see how this is different from the old Thatcherite vouchers idea — and Stevens plans to roll out to 5 million of us by 2018.

Last rites for the NHS?

For the last few years, demoralised staff — the backbone of the NHS — have been leaving in droves. But as the stakes finally rise impossibly high, as even NHS bosses talk of charging patients £75 a night for hospital beds as a way of solving this manufactured crisis, green shoots of a vociferous fightback have also emerged.

Campaigners have banded together, and new networks like the NHS Campaigners Network and Health Campaigns Together have been set up. They are not only calling for more money to get the NHS through its current crisis, but also, an end to the expensive market madness. It’s possible; Scotland have done it, and in terms of delivering that change, there’s a growing consensus of support amongst grassroots groups for Allyson Pollock’s NHS Bill,  backed in parliament in July by both Caroline Lucas and the new Labour leader Jeremy Corbyn.

Since May, campaigners and health staff alike have realised that there is no option but to fight, and that the NHS will not survive 5 more Tory years unless they do. So they have redoubled their efforts to see off the twin threats of privatisation and cuts. There have been successes. After occupying an anonymous looking CCG building in Bristol, local campaigners won their battle to stop Virgin taking over childrens’ health services in the City.

Most notably, junior doctors — the backbone of our hospitals — have had enough. For the last three months they’ve been taking to the streets in their tens of thousands to protest the imposition of a contract that considers working at 10pm on a Saturday no longer an ‘anti-social’ hour worthy of recognition and reward. Pay could fall by up to 40%, BMA negotiators have suggested. But it’s not just about pay. The doctors have recognised they — and their patients, who don’t want tired doctors — are the sacrificial lambs in a bid to make hospitals a more attractive proposition to corner-cutting privatisers.

Campaigners and health staff know that the question is not ‘whether to reorganise the NHS’ but what kind of reorganisation we want. The one currently underway, towards an even more fragmented, profit-driven, two-tier health service, with timely access to quality services increasingly restricted unless you have the means to pay? Or one which restores the NHS to its core values: a comprehensive, universal, high quality, timely, publicly funded service? This is what the public understand, and love about the NHS. Politicians who hide behind others as these values are eroded are not taking the politics out of the NHS, they are throwing it to the wolves. And it’s time we stopped them.

Caroline Molloy is the Editor of Open Democracy’s OurNHSPart of this article originally appeared on Open Democracy

OurNHS is currently raising money to continue its output of stories on the NHS as it enters a crucial period in it’s history.

Red Pepper is an independent, non-profit magazine that puts left politics and culture at the heart of its stories. We think publications should embrace the values of a movement that is unafraid to take a stand, radical yet not dogmatic, and focus on amplifying the voices of the people and activists that make up our movement. If you think so too, please support Red Pepper in continuing our work by becoming a subscriber today.
Why not try our new pay as you feel subscription? You decide how much to pay.
Share this article  
  share on facebook     share on twitter  

The new municipalism is part of a proud radical history
Molly Conisbee reflects on the history of citizens taking collective control of local services

With the rise of Corbyn, is there still a place for the Green Party?
Former Green principal speaker Derek Wall says the party may struggle in the battle for votes, but can still be important in the battle of ideas

Fearless Cities: the new urban movements
A wave of new municipalist movements has been experimenting with how to take – and transform – power in cities large and small. Bertie Russell and Oscar Reyes report on the growing success of radical urban politics around the world

A musical fightback against school arts cuts
Elliot Clay on why his new musical turns the spotlight on the damage austerity has done to arts education, through the story of one school band's battle

Neoliberalism: the break-up tour
Sarah Woods and Andrew Simms ask why, given the trail of destruction it has left, we are still dancing to the neoliberal tune

Cat Smith MP: ‘Jeremy Corbyn has authenticity. You can’t fake that’
Cat Smith, shadow minister for voter engagement and youth affairs and one of the original parliamentary backers of Corbyn’s leadership, speaks to Ashish Ghadiali

To stop the BBC interviewing climate deniers, we need to make climate change less boring
To stop cranks like Lord Lawson getting airtime, we need to provoke more interesting debates around climate change than whether it's real or not, writes Leo Barasi

Tory Glastonbury? Money can’t buy you cultural relevance
Adam Peggs on why the left has more fun

Essay: After neoliberalism, what next?
There are economically-viable, socially-desirable alternatives to the failed neoliberal economic model, writes Jayati Ghosh

With the new nuclear ban treaty, it’s time to scrap Trident – and spend the money on our NHS
As a doctor, I want to see money spent on healthcare not warfare, writes David McCoy - Britain should join the growing international movement for disarmament

Inglorious Empire: What the British Did to India
Inglorious Empire: What the British Did to India, by Shashi Tharoor, reviewed by Ian Sinclair

A Death Retold in Truth and Rumour
A Death Retold in Truth and Rumour: Kenya, Britain and the Julie Ward Murder, by Grace A Musila, reviewed by Allen Oarbrook

‘We remembered that convictions can inspire and motivate people’: interview with Lisa Nandy MP
The general election changed the rules, but there are still tricky issues for Labour to face, Lisa Nandy tells Ashish Ghadiali

Everything you know about Ebola is wrong
Vicky Crowcroft reviews Ebola: How a People’s Science Helped End an Epidemic, by Paul Richards

Job vacancy: Red Pepper is looking for an online editor
Closing date for applications: 1 September.

Theresa May’s new porn law is ridiculous – but dangerous
The law is almost impossible to enforce, argues Lily Sheehan, but it could still set a bad precedent

Interview: Queer British Art
James O'Nions talks to author Alex Pilcher about the Tate’s Queer British Art exhibition and her book A Queer Little History of Art

Cable the enabler: new Lib Dem leader shows a party in crisis
Vince Cable's stale politics and collusion with the Conservatives belong in the dustbin of history, writes Adam Peggs

Anti-Corbyn groupthink and the media: how pundits called the election so wrong
Reporting based on the current consensus will always vastly underestimate the possibility of change, argues James Fox

Michael Cashman: Commander of the Blairite Empire
Lord Cashman, a candidate in Labour’s internal elections, claims to stand for Labour’s grassroots members. He is a phony, writes Cathy Cole

Contribute to Conter – the new cross-party platform linking Scottish socialists
Jonathan Rimmer, editor of Conter, says it’s time for a new non-sectarian space for Scottish anti-capitalists and invites you to take part

Editorial: Empire will eat itself
Ashish Ghadiali introduces the June/July issue of Red Pepper

Eddie Chambers: Black artists and the DIY aesthetic
Eddie Chambers, artist and art historian, speaks to Ashish Ghadiali about the cultural strategies that he, as founder of the Black Art Group, helped to define in the 1980s

Despite Erdogan, Turkey is still alive
With this year's referendum consolidating President Erdogan’s autocracy in Turkey, Nazim A argues that the way forward for democrats lies in a more radical approach

Red Pepper Race Section: open editorial meeting – 11 August in Leeds
The next open editorial meeting of the Red Pepper Race Section will take place between 3.30-5.30pm, Friday 11th August in Leeds.

Mogg-mentum? Thatcherite die-hard Jacob Rees-Mogg is no man of the people
Adam Peggs says Rees-Mogg is no joke – he is a living embodiment of Britain's repulsive ruling elite

Power to the renters: Turning the tide on our broken housing system
Heather Kennedy, from the Renters Power Project, argues it’s time to reject Thatcher’s dream of a 'property-owning democracy' and build renters' power instead

Your vote can help Corbyn supporters win these vital Labour Party positions
Left candidate Seema Chandwani speaks to Red Pepper ahead of ballot papers going out to all members for a crucial Labour committee

Join the Rolling Resistance to the frackers
Al Wilson invites you to take part in a month of anti-fracking action in Lancashire with Reclaim the Power

The Grenfell public inquiry must listen to the residents who have been ignored for so long
Councils handed housing over to obscure, unaccountable organisations, writes Anna Minton – now we must hear the voices they silenced


146