Try Red Pepper in print with our pay-as-you-feel subscription. You decide the price, from as low as £2 a month.

More info ×

The worst fears confirmed

Elizabeth McGuirk explains the key proposals of the Health and Social Care Bill

January 25, 2011
7 min read

In their Red Pepper article ‘Dismantling the NHS’ Stewart Player and Colin Leys highlighted problematic issues in the July 2010 White Paper ‘Liberating the NHS’. The dire consequences they foresaw were evident in the 19 January first reading of the Government’s Health and Social Care Bill. In the week preceding publication of the Bill, an NHS Confederation report claimed the expected reforms were ‘extraordinarily risky’ and warned that ‘hospitals will have to close’. A letter from six unions, including the British Medical Association and the Royal College of Nursing, was printed in The Times, raising major concerns about the speed and scale of reform and the introduction of ever more commercial competition. Their fears have been confirmed.

The legal instrument of the Bill, which at a lengthy 367 pages is longer than the legislation which set up the NHS in 1948, almost totally dismantles the current NHS infrastructure. It is a complete about-turn from the coalition’s promise that ‘there will not be a major reorganistation’. The Bill paves the way towards a regulated market in healthcare, where NHS, private sector and third sector compete for the provision of health services. Interpretation of its 281 sections will demand detailed, expert attention before the second reading on 31 January for opponents to the Bill to mount an effective counter-argument. Most important is that the population at large understands the reforms. The devil is in the detail.

The existing Primary Care Trusts (PCTs), who commission healthcare, will be abolished by 2013. The new NHS Commissioning Board and GP Consortia, who will purchase health care for their populations, will be the powerful players implementing reforms once the Bill is passed. The Secretary of State and Monitor, the regulatory body for Foundation Trusts – those high performing NHS hospitals given more freedoms and autonomy, including setting staff pay, under the Labour Government – are also set to take on decisive roles in driving the new agenda. By 2014, the Foundation Trusts will be regulated at arm’s length, putting them in the same position as the independent sector, against whom they will compete for services. All existing non-Foundation Hospital Trusts will either become a Foundation Trust, be absorbed into an existing Foundation Trust, or be managed by a private provider.

There will no longer be a cap on NHS Hospitals’ income from private patients, and no assurance that this private income will be re-channelled to the benefit of patients. The lengthening of waiting lists that is likely to result will push NHS patients towards private medicine, kicking into action a vicious cycle with the potential to create a two tier system, and herald the rise of private medical insurance providers. The Commissioning Board will performance manage the GP consortia as well as secure continuous improvement, public involvement and the quality of the patient experience. It will be headed by the current Chief Executive of the NHS, indicating that Secretary of State for Heath Andrew Lansley needs someone onside who can influence staff.

The actual role of the Secretary of State is more difficult to grasp. He will apparently have the power to by-pass parliament in shaping the ‘direction’ of the Commissioning Board, and will judge its success against the objectives he issues, altering who fulfills its functions should the Board be seen to fail. For Lansley, whose vision was that politicians should not ‘micro-manage’ and that the NHS should have more independence, this regulation seems to be at odds with stated beliefs. It is quite disturbing that the ideology of the Secretary of State can now interfere, and influence, what happens in the NHS more directly than ever before.

GP Consortia can be any size from two or more practices. Small consortia will result in higher transaction costs, so it is difficult to envisage that there will be many given the go-ahead. The Bill imposes bureaucracy and legal requirements that Consortia, irrespective of size, will find difficult to comply with while also commissioning for successful outcomes and focussing on patients. The majority have already recruited management expertise from Primary Care Trusts or, increasingly, from the private sector. The pilot Pathfinder Consortia, hailed by Lansley as evidence that doctors and nurses are enthusiastic about taking on commissioning responsibilities, cover just over half the population. Yet it is reported elsewhere that only one in four GPs are interested in commissioning as presented in the Bill.

As Consortia have to commission from ‘any willing provider’, where relationships exist with local hospitals we could see a private company challenging, under EU rules, for the right to outbid. Such a move will undermine clinical involvement and will, even if quality is shown to be improved, foster further mistrust in the system.

Although GP Consortia will be responsible for over 80 percent of the NHS budget (£80bn in 09/10), the Bill is light on governance. It is unclear what would happen if, say, there are differences of opinion between GPs and leaders over referrals or prescriptions. There must be a process for voicing concern otherwise patients will be put at risk. In financial management, potential for conflicts of interest has been ignored. The constitution has to make provision for dealing with such matters but, for example, how robust will this be should GPs commission their own services?

The Commissioning Board can award performance payments to Consortia, the ‘appropriate’ distribution of which is open to interpretation. The rationale for these bonuses may be to operate along the lines of incentive payments used in the USA, where GPs are rewarded for sending fewer patients to hospital. With savings of £20bn to be found, and staff redundancies and longer waiting times already likely, this section of the Bill is seriously worrying, yet has generally been skipped over in media coverage.

If the Bill is passed, all GPs will be legally obliged to be a member of a Consortia, akin to being employed directly by the NHS. Whilst there is merit in a move from them being independent practitioners, the motive does not appear to be based on improving patient care. Rather, if the new commissioning reform fails, as is broadly predicted, GPs will become the scapegoats for government ideology.

Monitor’s role will be to license providers, set prices, promote competition and support service continuity. As economic regulator, Monitor will be required to weigh up the balance between the public/private sector and particularly identify where the public sector has an ‘unfair advantage’. One area which is likely to be scrutinised is NHS pension rights, seen as more favourable than those in the private health sector. Any dilution of such rights will cause deep unrest in the majority of NHS staff.

The Deptartment of Health estimates that the cost of transition over the next 2 years will be £1.2bn. By 2014, it is estimated that there will be a £1.3bn saving. How non-staff savings are estimated is unclear. There is uncertainty about estates, training, equipment and IT. Unless these infrastructures are put in place, Mr Cameron will have to justify having created a second rate service.

These are not ‘austerity measures’. Andrew Lansley has promoted these changes since 1997, driven by his belief in giving financial responsibility and power to doctors, releasing hospitals from state-control, and promoting competition. Any suggestions from professional groups and experts that the pace is too quick, or that impact of reforms need to be thought through, are simply ignored. The Keep our NHS Public campaign recently demonstrated outside Richmond House. GP Ron Singer held high a banner reading: ‘They lied about health too.’

This campaign needs more publicity and higher profile, as there is nothing in the Bill to answer major concerns or quell the belief that we are seeing the beginning of privatisation of the health service.

Meanwhile, staff continue delivering high quality health care with the threat of redundancy and uncertainty hanging over them. And in the background, lengthening waiting lists, cancelled operations and hospital closures threaten to expose a stark reality.

Elizabeth McGuirk is a former Chief Executive in a Primary Care Trust.

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  

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

India: Modi’s ‘development model’ is built on violence and theft from the poorest
Development in India is at the expense of minorities and the poor, writes Gargi Battacharya

North Korea is just the start of potentially deadly tensions between the US and China
US-China relations have taken on a disturbing new dimension under Donald Trump, writes Dorothy Guerrero

The feminist army leading the fight against ISIS
Dilar Dirik salutes militant women-organised democracy in action in Rojava

France: The colonial republic
The roots of France’s ascendant racism lie as deep as the origins of the French republic itself, argues Yasser Louati

This is why it’s an important time to support Caroline Lucas
A vital voice of dissent in Parliament: Caroline Lucas explains why she is asking for your help

PLP committee elections: it seems like most Labour backbenchers still haven’t learned their lesson
Corbyn is riding high in the polls - so he can face down the secret malcontents among Labour MPs, writes Michael Calderbank

Going from a top BBC job to Tory spin chief should be banned – it’s that simple
This revolving door between the 'impartial' broadcaster and the Conservatives stinks, writes Louis Mendee – we need a different media

I read Gavin Barwell’s ‘marginal seat’ book and it was incredibly awkward
Gavin Barwell was mocked for writing a book called How to Win a Marginal Seat, then losing his. But what does the book itself reveal about Theresa May’s new top adviser? Matt Thompson reads it so you don’t have to

We can defeat this weak Tory government on the pay cap
With the government in chaos, this is our chance to lift the pay cap for everyone, writes Mark Serwotka, general secretary of public service workers’ union PCS

Corbyn supporters surge in Labour’s internal elections
A big rise in left nominations from constituency Labour parties suggests Corbynites are getting better organised, reports Michael Calderbank

Undercover policing – the need for a public inquiry for Scotland
Tilly Gifford, who exposed police efforts to recruit her as a paid informer, calls for the inquiry into undercover policing to extend to Scotland

Becoming a better ally: how to understand intersectionality
Intersectionality can provide the basis of our solidarity in this new age of empire, writes Peninah Wangari-Jones

The myth of the ‘white working class’ stops us seeing the working class as it really is
The right imagines a socially conservative working class while the left pines for the days of mass workplaces. Neither represent today's reality, argues Gargi Bhattacharyya

The government played the public for fools, and lost
The High Court has ruled that the government cannot veto local council investment decisions. This is a victory for local democracy and the BDS movement, and shows what can happen when we stand together, writes War on Want’s Ross Hemingway.

An ‘obscure’ party? I’m amazed at how little people in Britain know about the DUP
After the Tories' deal with the Democratic Unionists, Denis Burke asks why people in Britain weren't a bit more curious about Northern Ireland before now

The Tories’ deal with the DUP is outright bribery – but this government won’t last
Theresa May’s £1.5 billion bung to the DUP is the last nail in the coffin of the austerity myth, writes Louis Mendee

Brexit, Corbyn and beyond
Clarity of analysis can help the left avoid practical traps, argues Paul O'Connell

Paul Mason vs Progress: ‘Decide whether you want to be part of this party’ – full report
Broadcaster and Corbyn supporter Paul Mason tells the Blairites' annual conference some home truths

Contagion: how the crisis spread
Following on from his essay, How Empire Struck Back, Walden Bello speaks to TNI's Nick Buxton about how the financial crisis spread from the USA to Europe

How empire struck back
Walden Bello dissects the failure of Barack Obama's 'technocratic Keynesianism' and explains why this led to Donald Trump winning the US presidency


29