Only the most devout of free-market ideologues fails to recognise there is a limit to what private enterprise, and the logic of profit, can achieve when it comes to providing public services.
Through our history as the neoliberal heartland of Europe, we have been treated to a smorgasbord of spectacles where the private sector provision of public services has broken down in real time.
From PFI hospitals and schools being left half-built, to companies like G4S defrauding the Department of Justice, but still being awarded a government contract – which they then broke – to manage security for the Olympics. For as long as the State has continued to outsource what were once its social responsibilities we have continued to see the fall of predatory firms like Carillion.
However, the stacking to the roof of body parts, and the storage of toxic waste in leaky shipping containers outside hospitals by Healthcare Environmental Services – a company commissioned by the NHS to dispose of clinical waste – may be the most visceral demonstration of how the logic of capital runs counter to the principles required to run the NHS.
Any notion that this latest public breakdown of the ‘public-private partnership’ model will force the government to abandon the privatisation of the NHS is wishful thinking. In fact, there is a real risk that these scandals distract us from the actual processes by which the NHS is being privatised by fixing our gaze solely at the level of its consequences. We have to look beneath the surface to see the many subtle strategies being used to restructure the restructuring the NHS from beneath.
When we see the GP, we don’t see a sign hanging from the front door saying, “this has been privatised by Virgin Care or Care UK as a result of competition law”. We don’t physically hand over cash or use our card to pay for an appointment – although that could be changing – instead we see the same familiar building, receptionist, GP, NHS logos and outdated magazines in the waiting room.
When an NHS Trust creates a wholly owned subsidiary company to avoid VAT, and places thousands of NHS staff into the private sector – against their will – where their working conditions and pay are attacked in order save money, this isn’t tattooed on the foreheads of the staff, it isn’t presented by a change in their uniform. The PR always stresses the staff will continue to enjoy the same rights and pay as NHS staff. Continuity frames the decision whilst any outward markers of difference are occluded.
We don’t – and cannot – physically see privatisation as a thing; and that’s because it isn’t, it’s a subtle process and social relation which is being manufactured by the State in conjunction with finance.
I’ve previously written that the government and NHS England were attempting to rollout Accountable Care Organisations (ACOs) across England without a vote in parliament. That is still the case. Except this time the government is attempting to rebrand them as Integrated Care Providers (ICPs) as a result of a judicial review. But they are still the same thing. And they still represent the same terrifying prospect: ICPs represent the total privatisation of the NHS.
The government along with the Chief Executive of NHS England Simon Stevens – someone with an extensive history of lobbying for the privatisation of the NHS – is attempting to roll these out across England without a vote in parliament.
They would be private corporations managing the budgets, resource allocation and service provision for entire regions of England for as long as 10 to 15 years a piece. They won’t have the responsibility to provide healthcare coverage for all, but only to those already registered with a GP – thereby putting at risk the health of those with irregular migration statuses and the homeless.
Their status as private bodies, and therefore non-statutory organisations, frees them from mechanisms of democratic oversight such as Freedom of Information requests and judicial reviews. The type of budgets they’ll be managing are designed to increase competition by having money follow patients. This would drastically exacerbate pre-existing geographic health disparities.
We need to act now, especially in light of Brexit. If the Conservatives are still in power whilst overseeing a no-deal Brexit, then it is a certainty that ICPs will be used to lure larger economies – such as the US – into signing free trade deals with the UK. Investor State Dispute Settlement mechanisms will seriously undermine the capacity of any future left-wing government to renationalise the NHS.
There are a number of ways you can fight the rollout of ICPS. You can also sign this petition which will be presented to the government calling for them to scrap the ICP contract. Alongside this you can respond to the NHS’ consultation. It is vital that NHS England knows people are aware of what is taking place. Finally, you can donate to 999 Call for the NHS’ judicial review on Crowd Justice. The last time the government received negative press on ACOs they rebranded them. This time lets make them kill off ICPs for good.
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