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Privatised Disasters

Ellie Keen — Thu, 12 Jun 2008 15:49:06 +0000

BACK in 1995, in the days of hope and expectation that a Labour government would represent a qualitative change from the Tories, Labour leader Tony Blair gave a solemn pledge.

He promised that, under Labour, there would be a “publicly owned and publicly accountable railway.”

Not only did Labour renege on that pledge but, these days, despite the obvious failure of the railways sell-off and the overwhelming popular opposition to privatisation, it has become a champion of this shabby Tory policy.

Rail Minister Tom Harris told a BBC Wales programme on Tuesday night: “Ideologically and practically speaking, a private railway has provided a level of investment, innovation and imagination that wouldn’t have happened if British Rail had stayed as it was.”

He seems unaware that the privatised railways attract around four times the subsidy that British Rail received and one of the touted benefits of privatisation was that the privateers would profit from their efficiencies and phase out subsidies.

We were fed lies then and we are still being fed lies. Privatisation is not a policy based on sober assessment of its benefits. It is a matter of neoliberal dogma.

No Labour government has ever announced its intention of abolishing council housing. Neither has Labour conference voted for such a benighted policy. But that is, in reality, the government’s policy, from which it will not be diverted.

It uses public finance to draw up plans for stock transfers of entire housing estates to the private sector, authorises public funds to put out slanted pro-private propaganda and refuses to allow refurbishment of local authority properties if tenants vote to remain with the council.

Nor has any Labour government ever announced its intention of privatising the NHS.

But the Gordon Brown government, like that of Tony Blair before him, is carving the heart out of the NHS, once again deploying public funds to make health care a commodity out of which the privateers can gouge profit.

Mr Brown’s flawed private finance initiative obsession is still used to replace NHS hospitals and clinics with new facilities that are privately owned and leased back to the NHS at extortionate rates.

Similar developments are taking place in other public services such as state education and the Prison Service, where the efficient, economic and democratically accountable public alternative is systematically undermined and discarded in favour of the sleazy, expensive but hugely profitable private option. And that’s without taking account of the plunder of the previously public utilities such as water, electricity and gas, which were milked of their assets for overseas investment.

Barely a week passes without another scandal in the private sector, with sky-high profits for banks, oil companies and other sectors and directors touching for multimillion-pound pay-offs for either success or failure.

The new TUC Touchstone pamphlet will add to public awareness of the scandals associated with privatisation, but we should not expect any acceptance by new Labour that it is wrong and that it will change course.

The case for public ownership has never been more pressing. It must become a major labour movement campaigning issue now, because our entire post-World War II gains are at risk.

NHS strike looms as GMB reject pay deal

tim — Fri, 06 Jun 2008 14:37:52 +0000

Published online 31/05/08

A threat of industrial action across the NHS intensified yesterday when health workers in the GMB union voted by an overwhelming majority to reject the three-year pay deal offered by the government.

If their decision is confirmed by the 450,000 NHS workers in Unison next week, the government may be forced to abandon its attempt to reach a long-term settlement.

In those circumstances Johnson has warned that he would be obliged by the Treasury to cut the pay increase that staff are banking on getting this year. Such a move would be likely to provoke a wave of hostility across the NHS, including overtime bans that could derail ministers’ plans to cut waiting times for patients.

GMB members, representing 25,000 NHS staff in England and Wales, rejected the deal by more than 96% in a ballot with high turnout. The offer was worth 8% over three years, with 2.75% paid immediately this year – the best terms available in the public sector in the current pay round though still way below inflation, amounting to a cut in real wages. Ambulance workers, porters and cleaners in Unite had already voted to reject the deal by a majority of six to one. This week the Royal College of Midwives said a consultation of members found 99. 7% were opposed.

The GMB, which represents ambulance crews, porters, catering staff, ancillary workers, blood collection, nursing assistants and practitioners, cleaners, laboratory workers, drivers and maintenance staff, said it would seek a meeting with Johnson. Dame Karlene Davis, general secretary of the Royal College of Midwives, said this week: “Given the outlook for the economy in future years, acceptance of the three-year deal would represent a vote for a real terms pay cut.”

Unison and the Royal College of Nursing negotiated the deal on behalf of the smaller NHS unions and were expected to recommend it. But the Unison leadership failed to win a majority on its health executive. The RCN is poised to accept the three-year deal.

This represents the stirring of health workers as part of the wider movement of unrest amongst public sector workers with the threat of strike action also coming from civil servants, refuse collectors, teachers, academic staff, local government and others.

NHS Whistleblower speaks out

tim — Tue, 27 May 2008 12:35:59 +0000

Senior mental health nurse Karen Reissmann was sacked last year after being found guilty of gross misconduct by Manchester Mental Health and Social Care Trust for speaking out against NHS cuts. Tom Haines-Doran catches up with her to ask about the latest in the campaign to have her reinstated.

Where are you at with the campaign to get you reinstated?

The campaign started when I was first suspended [June 2007] for bringing the Trust into disrepute. We had 700 people on strike for 14 days of action, followed by further action in November. My appeal was turned down and is now going to an employment tribunal. MPs will be asked to sign Early Day Motion 443 which calls for my reinstatement and there may be further days of strike action. We’re trying to persuade Alan Johnson to sign the motion. It’s ironic that I am being supported by Stephen O’Brien the Shadow Minister for Health, and not his opposite in the Labour government.

Is the return to work something that can keep the campaign alive?

The campaign is not going to fizzle out. I have received an incredible amount support from my colleagues and many others. People are worried about the Health Service; there is a fear of speaking out and a number of health workers are saying they’re glad that I did. One of the questions I was asked by the management was ‘what loyalty do you have to our organisation?’ I said I have plenty of loyalty to the patients, but what they wanted to know was what corporate loyalty I had to the individual trust. The aim of my suspension was to break our union, but now we have seven more Unison stewards than at the start. The fight to stop staff cuts in our service, the campaign that led to my suspension in the first place, has been won – the managers have conceded they will keep the original staffing levels.

During the campaign you brought in many activists from the Trade Union movement and the left. How was this achieved?

One of the first things we recognised was that we needed to mobilise political pressure from the outside. There was a deliberate strategy of including trade unionists and service user groups and networks. We have fought to get users heard. They overcame the stigma of mental illness and have been articulate in their defence of the service. We made an effort to write to every Unison branch to pass information on and particularly helpful were the CWU and RMT unions who made donations to the campaign and invited us to speak at their meetings.

Regarding the NHS in general what would you say are the key issues?

One of the key problems is the tendering process. It identifies areas of work, for example, hip replacement operations and parcels them off. The idea is to create a competitive market within the Health Service. South Manchester Psychiatric Unit is run by a Private Finance Initiative that uses a private contractor to clean the ward and it costs the NHS four times what it did when the work was in-house. Also more of the work is target-driven.

As an NHS employee how would you say working conditions have changed during your career?

When I started 25 years ago we provided a service to patients. Now targets are the be all and end all and we can no longer prioritise in terms of need. On the other hand 25 years ago nurses’ wages were worse because they were less unionised. But with this slight improvement in wages has come a greater workload. The pace is unrelenting. For example occupancy rates are much higher. Now there are 20 beds for 24 or 25 patients with occupancy rates at 120 per cent to 130 per cent. This leads to stress amongst the staff and patients.

Would you recommend a job in the Health Service to people?

I love the work and the people I work with are fantastic. If you do a job that is helpful to others it is generally more satisfying. But more time is spent filling out forms and battling bureaucracy. I would say ‘do it’ but you’ll have to fight your corner.

Michael Moore’s documentary Sicko gave an overview of what a privatised health system looks like in the US, is that something that could happen here?

Nothing is automatic about the NHS. People who fought in the Second World War weren’t prepared to go back to the provisions available in the 1930s. Unlike the Tories, this government dresses up privatisation in complicated proposals. They don’t say they will privatise it but they are in effect creating a market – they’re saying that 15 per cent of the Health Service should be outside the NHS. Not only has the NHS management chosen private operators to run aspects of the service but now private companies are set up to do this on their behalf.

Unhealthy Influence

eddie — Sat, 10 May 2008 13:41:56 +0000

As MPs on Thursday question former Health Minister, Lord Warner, over his lobbying activities, the Alliance for Lobbying Transparency (ALT)[i] calls for the system for monitoring the revolving door between Westminster, Whitehall and business to be radically tightened.

Lord Warner, who currently holds paid jobs with 7 private sector companies, many in the health field, has been called to give evidence to the current inquiry into lobbying alongside former Sports Minister Richard Caborn MP, who is a paid consultant to nuclear services company Amec[ii], and Stephen Haddrill, Director General of lobbying body the Association of British Insurers (Thursday 8 May 2008).[iii]

Lord (Norman) Warner was until December 2006 Health Minister with responsibility for NHS delivery, which included overseeing the troubled NHS IT programme. A member of the House of Lords, his current, paid private sector jobs include:

· Non-executive Chairman of UK HealthGateway, a company which aims to facilitate private contractors’ access to NHS contracts

· Adviser to Xansa, a technology firm, and Byotrol, an antimicrobial company, which both sell services or products to the NHS

· Adviser to DLA Piper, which advised Ministers on the £12billion NHS IT project

· Part-time adviser to professional services company, Deloitte

· Adviser to private equity investment group, Apax Partners.

Lord Warner is just one of a number of former Department of Health officials to have recently gained employment in the private sector. These include:

· Former Health Secretary Patricia Hewitt landed two paid jobs with Boots and a company that owns 25 private hospitals earlier this year.

· Former Health Minister Alan Milburn MP is a paid member of the Lloyds pharmacy’s Healthcare advisory panel, and Pepsico’s nutritional advisory board.

· Former Public Health Minister Melanie Johnson became an advisor to the lobbying organisation, the Association of the British Pharmaceutical Industry in 2006.

While all Ministers have to consult the Advisory Committee on Business Appointments prior to taking a job in the private sector, the system has come in for much criticism for reasons including the limited time banning them from lobbying Government, and the lack of checks on whether former ministers and senior civil servants are following the advice of the committee regarding restrictions on lobbying.

Prof David Miller of SpinWatch, a member of the Alliance for Lobbying Transparency said: “There is a now a real need for the public to know in whose interests officials are working – the public’s or those of the businesses who hire them. Across all sectors, the revolving door is clearly out of control and a longer ‘cooling off’ period urgently needs to be introduced. If we are to protect services like the NHS, we need tougher rules to ensure that companies are not given privileged access to Government and that any lobbying by them is out in the open.”

For further information please contact Tamasin Cave on 07973 424 015; tamasin@SpinWatch.org. Alliance for Lobbying Transparency website: www.lobbyingtransparency.org

involNotes to editors

[i] ALT is an alliance of civil society groups who are concerned about the growing influence of lobbying on decision-making in the UK. It is campaigning for the regulation of lobbyists, and improved ethics regulation for politicians and public officials to raise standards and restore public trust in decision-making. www.lobbyingtransparency.org

ALT’s key demands are:

· A mandatory public register of lobbyists, with full financial disclosure

· Enforceable ethics rules for all lobbyists

· Enhanced rules on ethics for politicians and public officials on the so-called ‘revolving-door’ syndrome between lobbyists and public bodies; and to halt privileged access to decision makers.

Current members of the Alliance for Lobbying Transparency are: Action Aid; Campaign Against Arms Trade; Campaign for Press and Broadcasting Freedom; Corporate Watch; Enough’s Enough; Friends of the Earth; Greenpeace; National Union of Journalists; Pesticides Action Network; Platform; SPEAK Network; SpinWatch; Unlock Democracy; War on Want; and World Development Movement.

[ii] According to the Register of Member’s Interests, Richard Caborn MP is paid up to £75,000 for his role as a consultant to Amec.

[iii] The current Parliamentary inquiry into lobbying is being conducted by the Public Administration Select Committee. For details, visit: http://www.parliament.uk/parliamentary_committees/public_administration_…

Welfare Reform Act to force sick and vulnerable into work

tim — Sat, 10 May 2008 12:05:25 +0000

The draconian measures laid out in the Welfare Reform Act 2007 are now being implemented in Britain by the Labour government of Prime Minster Gordon Brown. The Act represents a wide-ranging attack on millions of the poorest and most vulnerable people who rely on Incapacity Benefit (IB). Recipients of the benefit are deemed unable to work due to poor physical or mental health.

Under the new legislation, their entitlement to financial support is being replaced with new, conditional Employment and Support Allowance (ESA). From November, those registering for the first time as too sick or unable to work will only be entitled to ESA, whereby payments are determined by national insurance contributions, and are subject to means testing. All existing IB claimants will then be transferred to the ESA.

The main aim is to force people into work under threat of poverty. The government has stated it intends to cut the number of Incapacity Benefit claimants by 20,000 each year.

Attacks on welfare have been a central plank of Labour’s policies since coming to power in 1997. Unemployment benefit has been restricted and Lone Parent Benefit reduced.

The government has stated that 2.4 million people currently receive Incapacity Benefit and that up to one million should not be entitled to it. This figure is actually a distortion as statistics from the Department for Work and Pensions (DWP) show that only 1.4 million of the 2.4 million unable to work due to illness actually receive any additional payment. The rest receive standard national insurance credits only.

Since the measures were first mooted in 2006, a campaign based on demonising Incapacity Benefit claimants has swung into operation. This has been fuelled by incessant media scare stories about Incapacity Benefit “scroungers”, “spongers” and “cheats” who claim the benefit “fraudulently” instead of working.

According to recently published research, the number of cases of Incapacity Benefit “fraud” is so low it is almost impossible to measure accurately. It is estimated to account for less than 0.3 percent of total Incapacity Benefit payments.

The tabloid press would have us believe that recipients of “generous” Incapacity Benefit live a life of luxury. But those who are on the benefit are among the poorest people in society. Basic Incapacity Benefit payment ranges from £63.75 on the “short-term lower late” to £84.50 on the “long-term higher rate.” Research conducted by the Joseph Rowntree Foundation in 2004 found that claimants on Incapacity Benefit and or Disability Living Allowance/Income Support met only 28 percent of the costs of people with low-medium needs, 30 percent of the costs of people with intermittent/fluctuating needs, 35 percent of the costs of deaf people and people with visual impairments and 50 percent of the costs of people with high-medium support needs.

On April 4, the Daily Express ran a sensationalist headline “Outrage At £8.5m A Week For Jobless Junkies And Winos,” claiming that “Taxpayers are forking out £8.5million a week in benefits to support jobless drink and drug addicts.”

The article cited statistics from the DWP revealing that 51,410 people whose medical record included a diagnosis of alcoholism received long-term Incapacity Benefits. The figures also showed that a further 49,890 on Incapacity Benefit were drug addicts.

That so many people, including young people, are victims of alcoholism and drug addiction is a societal problem—not only an issue of dependency, which constitutes a genuine illness that causes untold suffering. The turn to alcohol and drugs is exacerbated by the steady erosion of stable job opportunities, the decline of many industries, and decreasing access to quality education, health care, and to drug treatment programmes.

Most of those in receipt of Incapacity Benefit reside in inner city areas in London, the North-West, the North-East, Scotland and Wales. Many of these workers would have previously been in secure, relatively stable jobs in industries like mining, steel and shipbuilding. Over the past 25 years these jobs have been decimated, with millions forced into lives of poverty and the attendant problems such as debt and ill health.

Currently claimants have to pass a rigorous “personal capability assessment” (PCA) in order to quality for IB. A new “work capability assessment” is to target all Incapacity Benefit claimants, with only the terminally ill excluded from the requirement.

Under the remit to “focus on what people can do, not what they can not,” a distinction will be drawn between “being eligible for benefit and being capable for work.” If it is found that the claimant is capable of doing some sort of work, they can receive benefit only on the condition that they retrain and look for work. The penalty for not doing so will be the loss of benefit.

Under the new rules, eligibility for benefit will be decided on a DWP doctor’s evidence and “capability for work” could be assessed by other unspecified “health professionals”.

At present, the severely mentally impaired are exempt from being assessed. Under the new measures, these claimants are required to be assessed and have to agree to look for work in order to qualify for ESA. They are also obliged to attend courses to improve “employability.” They will also be compelled to “manage their health” in work and undertake therapy for their mental health problems.

In order to speed up the number of claimants denied benefit payments, doctors and “care teams” will be directly involved in ensuring that their patients are removed from IB and forced into employment. The Welfare Reform Act follows proposals made in 2005 to allow “employment advisors” from Job Centres to be based in doctors’ surgeries. The pilot schemes began in 2006 in six areas of the UK.

“A revolution in our welfare state”

The Conservative Party has proposed its own assault on Incapacity Benefit. In January, Shadow Work and Pensions Secretary Chris Grayling announced what he termed “revolutionary” welfare proposals.

Under a Tory government, anyone who failed a “work capability” test would automatically lose their entitlement to Incapacity Benefit. They would then be placed on Job Seekers Allowance, immediately resulting in a welfare payment cut of £20 a week.

The plans also specify that those on IB with the “potential to work” would be referred to “welfare to work” providers. These would include private-sector companies.

In preparation for their welfare announcement, the Tories studied welfare systems in a number of countries, and were particularly praiseworthy of measures taken in the American state of Wisconsin, which had cut the number of people on benefit rolls by 82 percent in three years.

Grayling said of the proposals, “For Britain such an approach marks a revolution in our welfare state. It marks an end to a situation where the receipt of incapacity benefit is an unconditional entitlement. In the future, it will carry with it the responsibility to do everything that you can to get back into work and help lift yourself out of the poverty trap that the benefit can represent for so many people.”

The response from the government was merely to complain that the Tory proposal would cost too much to implement. Peter Hain, the Work and Pensions Secretary, said, “The Conservative proposals could cost an extra £3 billion to £4 billion on top of planned spending in this area.”

Labour and the Tories agree that public spending must be slashed in order to make the British economy more competitive with its European and world rivals. When the initial bill was first proposed in 2006, Secretary of State for Work and Pensions John Hutton said the welfare state “must help UK companies succeed in the global economy.”

As well as forcing IB claimants into work, the government is also targeting 300,000 more lone parents and one million additional older workers, including those over retirement age.

Welfare and health provision and the private sector

A critical element in slashing access to benefits such as IB is to facilitate the privatisation of both welfare and employment service. Over the past decade, the private sector has been utilised to step up attacks on the welfare state and to profit from providing services.

A prime example is Atos Healthcare, a subsidiary of a French-based computer firm, which employs 50,000 people worldwide and has annual revenues of 5.4 billion euros. The new Employment and Support Allowance medical assessment system is to be run by Atos Healthcare.

Atos Healthcare was awarded a £500 million seven-year contract by the DWP in 2005 to provide medical advice and assessment services. These include Incapacity Benefit, Disability Living Allowance, and Industrial Injuries Disablement Benefits.

Employees of the company were recruited to be on the technical working groups which drew up the new harsher, Work Capability Assessment. The increased cost of examinations is expected to be in the region of £200 million up to August 2015.

The company also plays a direct role in the provision of medical services. Then known as Atos Origin, the firm won an £8 million contract to operate the first privately run walk-in NHS clinic for local residents and commuters near Manchester’s Piccadilly railway station in 2005.

In January this year, Atos won a 10-year contract to run St Paul’s Way Medical Centre in Tower Hamlets, East London. The former state-run surgery was one of the first to be taken over by a private company. The Tower Hamlets takeover prompted a demonstration by dozens of doctors, nurses and local residents. One doctor who has worked in the area since 1983 told the BBC, “This practice is in one of the poorest areas in the country. There is overcrowding, poverty and a lot of people who are having difficulties with English. There is a huge amount of ill health. The residents are very angry that their health care is going to be sold for profit rather than for personal care.”

In London alone, the government has identified a further 150 GP surgeries that could be taken over and run by private firms.

The Great Consolidation

Ellie Keen — Tue, 29 Apr 2008 20:49:50 +0000

Everything is getting bigger and further away. Hospitals, post offices, schools and prisons are being “rationalised” and “consolidated”. The government says that this process improves efficiency. Instead, it outsources inefficiency: we must travel further to use public services. This is bad for the environment, bad for community life, bad for universal provision. But we haven’t seen anything yet. We are about to be confronted with the biggest shutdown of all: the government has started the process of closing England’s network of doctors’ surgeries.

If you know nothing of this, don’t blame yourself. The announcement was buried in an interim report published last October by a health minister(1). The report was 52 pages long, and the policy was explained in a single paragraph on pages 25 and 26. Rather than being brought before parliament, it was released four days before MPs returned from their recess. Since then there has been no further public announcement. But in December the Department of Health sent a letter to all the strategic health authorities in England, demanding that the policy be implemented immediately(2). The greatest transformation in the history of the NHS is taking place without public debate, public consent or formal consultation.

The government’s policy is to consolidate doctors’ surgeries into a series of giant health centres or polyclinics. Thousands of small practices will be closed and patients will be processed in buildings containing up to 50 GPs. The new clinics will also house some services currently provided by hospitals, which allows the government to claim that it is bringing healthcare “closer to home”. The net effect will be a massive reduction in convenience.

The policy was launched by Ara Darzi, a colorectal surgeon who has been raised to the peerage and made under-secretary of state for health. He wrote his interim report in three months, during which he claims to have spoken to thousands of people. But it contains no record of who they are, how they were selected or what their answers were: he reveals only that “their views have helped shape this interim report.”(3) His final report will not be published until June, but the Department of Health has instructed England’s primary care trusts (PCTs) to advertise for bidders for the new polyclinics by May 2008(4): the first notices have already been posted in the Health Service Journal.

During a parliamentary debate launched by the Conservatives last week, Alan Johnson, the secretary of state for health, claimed three times that this policy is not being imposed on primary care trusts. “There is no national policy,” he said, “for replacing traditional GP surgeries with health centres or, indeed, polyclinics”; “we are not specifying polyclinics as any part of the exercise”; “[the Tories say] we are imposing a system of polyclinics throughout the country. We are not.”(5) Three times, in other words, he misled the House. The letter sent by the Department of Health in December ordered that “each PCT will be expected to complete procurements during 2008/09″(6). In a parliamentary answer in Febrary, the health minister Ben Bradshaw confirmed that “every PCT in the country will be procuring a new … health centre during 2008-09.”(7) A press release published by the Labour Party on April 15th confirmed that the new health centres would be built “in every town and city.”(8) I hope MPs demand that Alan Johnson apologise to parliament.

Lord Darzi insists that polyclinics will offer “a more personalised service”(9). This is nonsense: in the huge new centres we are less likely to be able to see the same GP and more likely to get lost in the system. A recent paper in the British Medical Journal reveals that “patients in small practices rate their care more highly in terms of both access and continuity” and that small practices “achieved slightly higher levels of clinical quality than larger practices”(10). The new centres will be built not where they are most convenient for patients but – as Darzi revealed to the Commons health committee – where the NHS happens to own land(11). If you live in a village or a distant suburb and depend on public transport – as many elderly and sick people do – visiting the doctor could take all day. Ara Darzi is the new Dr Beeching, shutting down the branch lines of our primary health service.

So why is this happening? In seeking surreptitiously to privatise healthcare, the government has a problem. Primary care is already in private hands: GPs run their own practices. But they are the wrong hands: the corporations demanding guaranteed streams of income from the taxpayer can’t play. Polyclinics are perfectly designed to let them in, while preventing doctors from competing.

It’s not just that GPs can’t raise the capital; because the contracts are much bigger than ordinary practices’ and involve many different services, the tendering process is expensive and fiendishly complex. The big service companies can produce the same bid for any number of clinics: they need spend their money only once. The Department of Health says that primary care trusts should use a type of contract called Alternative Provider Medical Services(12), which is designed to allow corporations to bid. This is not a public-private partnership: it is the outright privatisation of primary healthcare.

Do I need to explain the implications? The US health system, which the British government seems determined to emulate, is both more expensive and less efficient than ours; those who can’t afford to pay are either excluded or treated like battery pigs(13). The independent sector treatment centres (ISTCs) – private clinics performing routine operations for the NHS – that the government introduced in England in 2003 have been a costly disaster. Private companies receive their money whether or not they carry out the work they are contracted to do. The government refuses to release comparative figures, but the little evidence we have suggests that their costs are much higher than the public sector’s(14). The risks have been transferred back to the taxpayer and in some cases the standards of treatment are appalling. In 2006 Angus Wallace, professor of orthopaedic and accident surgery at Nottingham University, told the Guardian, “We expect failures of hip replacements at approximately 1% a year and knees at about 1.5% a year. But we have got some of the ISTCs that are looking at 20% failure rates.”(15) Because they put profits first, companies that run these centres have generated a stack of litigation claims and a huge NHS bill for repairing the damage they have caused(16). Far from reversing its policy in the light of this evidence, the government is setting up a competition panel, to ensure that the health service never discriminates in favour of the public sector when awarding contracts(17).

Did any of us ask for this? Are there crowds on the streets demanding the privatisation of the NHS? Even the Tories, for God’s sake, have come out against it: David Cameron’s speech last week placed them to the left of Labour(18). Why, after the 60-odd consecutive quarters of growth that Gordon Brown keeps boasting about, can he not maintain a public service founded in the midst of poverty and rationing? What mysterious hold on policy do the corporations possess, that they can persuade this government to wreck Labour’s finest achievement and damage its chances of re-election?

www.monbiot.com

References:

1. Ara Darzi, October 2007. Our NHS, Our Future. NHS Next Stage Review: Interim report. National Health Service. http://www.ournhs.nhs.uk/

2. Ben Dyson, Commissioning and System Management Directorate, Department of Health, 21st December 2007. Letter to SHA Directors of Commissioning.

3. Ara Darzi, ibid, p3.

4. Ben Dyson, ibid, para 14.

5. http://www.publications.parliament.uk/pa/cm200708/cmhansrd/cm080423/debt…

6. Ben Dyson, ibid, para 5.

7. http://www.publications.parliament.uk/pa/cm200708/cmhansrd/cm080229/text…

8. The Labour Party, 15th April 2008. NHS on your side. http://www.labour.org.uk/nhs_on_your_side,2008-04-15

9. Ara Darzi, ibid, p30.

10. Martin Roland, 22nd March 2008. Assessing the options available to Lord Darzi. British Medical Journal, vol 336, pp625-626. doi:10.1136/bmj.39510.702234.80

11. Professor Lord Darzi of Denham KBE, 25th October 2007. Minutes of Evidence taken before the House of Commons Health Committee. Answer to Q94. http://www.publications.parliament.uk/pa/cm200607/cmselect/cmhealth/uc11…

12. Ben Dyson, ibid, Annex A.

13. During the Commons debate last week, Richard Taylor MP cited two recent papers about the failures of the US medical system, published in the BMJ and the New England Journal of Medicine. http://www.publications.parliament.uk/pa/cm200708/cmhansrd/cm080423/debt…

14. Allyson M Pollock and Sylvia Godden, 23rd February 2008. Independent sector treatment centres: evidence so far. British Medical Journal, vol 336, pp421-424. doi:10.1136/bmj.39470.505556.80

15. Quoted by Sarah Boseley, 1oth March 2006. NHS forced to fix bungled private sector hip replacement operations. The Guardian.

16. See also Stewart Player and Colin Leys, April 2008. Under the knife. Red Pepper magazine.

17. Nicholas Timmins, 16th March 2008. NHS providers to win right of appeal. Financial Times.

18. David Cameron, 21st April 2008. Speech on Primary Care.
http://www.conservatives.com/tile.do?def=news.story.page&obj_id=143765&s…

Under the Knife

Ellie Keen — Sun, 06 Apr 2008 19:02:01 +0000

Tom Nairn recently described parliament as ‘a dry-rot infested ruin where one shame succeeds another’. Decay appears to be spreading rapidly. The speed with which former health secretary Patricia Hewitt, and the former health minister Lord Warner, have transferred their services to private healthcare companies appears less and less shocking. It’s not simply the snouts-at-the-trough aspect that is of concern. What their actions show is that the advance of private healthcare at the expense of formerly public provision is sufficiently entrenched to make them confident of a lucrative future.

It should make what is happening clearer to the public too. Since 2000, the year of the NHS Plan, a central feature of government policy for the NHS has been the concealment of its real trajectory. At the acute healthcare conferences organised annually by private healthcare analysts Laing and Buisson, for example, ministers and top civil servants have for several years given detailed policy briefings to companies on new private sector healthcare opportunities, while Hewitt was constantly assuring journalists that NHS privatisation was ‘out of the question’.

Creeping privatisation

Nowhere has concealment of the government’s real aims been more rigorously applied than in the independent sector treatment centre (ISTC) programme. Ostensibly designed primarily to harness additional capacity from the private sector to reduce waiting times for elective (non-emergency) operations such as knee replacements and cataract removals, privately owned ISTCs – 23 of them, spread across England, plus one in Scotland – have in reality served as a bridgehead for market penetration of the NHS, the first time that NHS surgical care has been systematically handed over to for-profit providers.

So far this has meant ensuring adequate and financially risk-free levels of clinical activity, encouraging companies to set up in business to compete with NHS hospitals and treatment centres. It also involves significant and ongoing transfers of NHS staff. But because the NHS remains one of the most popular institutions in the country, replacing public with private services involves enormous political risk. How many MPs – including Conservatives, at least in marginal seats – would be prepared to declare that NHS treatment should increasingly be handed over to private companies, like the railways? Managing and mitigating that risk involves a wide array of mechanisms.

A key example is an exercise in spin called ‘integration’. In reality the only way the private ISTCs can carry out the number of elective procedures they have contracted to provide is to have NHS staff transferred to them. Originally, because they were supposed to bring in ‘additional capacity’, they were not allowed to employ anyone who had worked for the NHS in the previous six months. This rule was repeatedly diluted, either through secondment of NHS staff, or by applying it to an ever-shrinking number of specialties.

By September 2007 ISTCs could use NHS consultants for almost all surgical procedures. A key method in enabling this change has been calls by various bodies, notably the BMA consultant committee leadership, and the Healthcare Commission, to integrate ISTC facilities with those of NHS hospitals in the interests of patients.

While the overall threat of NHS privatisation is denounced, measures to ensure that NHS staff are transferred to the new private employers are supported. For example, the BMA’s Dr Paul Miller told a 2005 BMA conference that ‘as things stand, I would not accept an MRI scan or elective surgery from these ISTCs’ – yet the leadership firmly resisted a motion opposing the centres, arguing that ISTCs could bring about ‘a sustainable expansion of capacity’ and that NHS consultants should be allowed to work in them. A year later, commenting on the health committee’s report, Miller stated: ‘For the last three years, the BMA has been shouting from the rooftops about its concerns regarding ISTCs. I am particularly pleased to see the committee agrees that the Department of Health needs to go further in enabling NHS doctors to work and train in ISTCs, as I believe this will benefit standards and integration of patient care.’

Revolving doors

Political risk has also been managed through the development of a ‘policy community’ of insiders committed to marketisation. The rapid interchange of personnel between government and the private sector – policy makers, management consultants, and healthcare company executives – has been particularly glaring in health policy circles.

The example of Tony Blair’s senior health policy adviser, Simon Stevens, who left to become president for Europe of the giant US company UnitedHealth, is well known. Another example is the former special adviser to both the prime minister and the health secretary, Darren Murphy, who became director of corporate lobbyists APCO UK. APCO’s clients rapidly came to include all the companies involved in the ISTC programme. By February 2006 these companies had formed an ‘NHS Partners Network’, under the aegis of APCO, and had a meeting with Tony Blair where they were warmly welcomed into ‘the NHS family’.

Tom Mann, formerly head of the Department of Health’s ‘national implementation team’ which imposed the first ISTC contracts on sometimes highly reluctant primary care trusts, subsequently became chief executive of Capio, which won a large number of these contracts. Patricia Hewitt’s defection to the healthcare venture capital group Cinven, which now owns Bupa’s former hospitals, and Lord Warner’s to the health insurer AXA PPP, are only the latest in a long line. And within the NHS itself a new ‘national leadership network’ has been formed, consisting of some 150 ‘clinicians and managers from partner organisations’ (i.e. including the private sector) to provide ‘collective leadership for the next phase of transformation, advise ministers on developing policies … and promote shared values and behaviours’. What these values and behaviours are is kept secret. Access to the network’s webpage is restricted to its members, and publications, resources and contacts are all password-protected.

Concealing data

These restrictions are a good example of another key means of limiting political risk – information control. Such control was particularly sensitive in relation to the quality of operations done in the private centres. The first official quality assessment of ISTCs, carried out in October 2005 by the National Centre for Health Outcome Development (NCHOD), found that poor data returns rendered ‘any attempts at commenting on trends and comparison between schemes and with any external benchmark futile’.

The one direct indicator of clinical outcomes at ISTCs had been completely ignored. This did not stop Lord Warner declaring that the NCHOD’s report provided ‘heartening’ evidence of a ‘robust and comprehensive quality assurance and reporting system’. A further study was undertaken by the Healthcare Commission, but in July 2007 it had to report that the necessary information was still lacking. Yet the data concerns NHS patients, whose health and lives are at risk.

Concealment would appear to have been essential, as many first-hand reports by NHS specialists on clinical quality in ISTCs have been highly critical. For example, the professor of orthopaedic surgery at Nottingham University, Angus Wallace, told the Guardian in March 2006 that: ‘We expect failure rates of hip replacements at approximately 1 per cent a year. But we have got some of the ISTCs that are looking at 20 per cent failure rates.’ A study by Dr Gordon Bannister, a leading orthopaedic surgeon in Avon, found that 9 per cent of hip and knee replacements carried out at a nearby ISTC had to be reoperated on, compared with 0.6 per cent in the local NHS hospital – in spite of ISTCs being able to select simpler cases. Notably the surgical repair work fell on the local NHS hospitals.

Such results are hardly surprising. Most of the surgeons originally involved in the first wave of ISTCs were brought in from overseas. They were often unfamiliar with NHS surgical techniques, sometimes had language problems, and were under pressure to achieve high levels of productivity. Release of information about their results therefore had to be kept to a minimum. Once sufficient numbers of NHS consultants have transferred to ISTCs the availability of outcome data will no doubt improve.

All these measures to limit political risk show that ministers and their advisers are acutely aware that the risk is real. The counterpart of this is that if the public clearly understood what is being planned, there is an excellent chance that this path to privatisation would have to be abandoned.

Stewart Player’s and Colin Leys’ new book, Confuse and Conceal: the NHS and Independent Sector Treatment Centres, is published by Merlin Press at £10.99

The Patient Stalkers

JamieSW — Tue, 11 Mar 2008 12:48:42 +0000

This was surely a victory for the people. We have lost, over the past 20 years, all kinds of public services, but next month one is due to expand. After heavy bludgeoning by the government, Britain’s general practitioners have agreed to open their surgeries late into the evening and on Saturday mornings. As Gordon Brown says, the health service is “too often centred on the needs of the providers rather than those of patients.”(1) Now we will have a service better matched to the pattern of our lives.

This, at any rate, is the government’s story, and at first sight it is plausible. The truth, as always, is stranger and more complex. It begins with a bare-faced lie.

The government launched its campaign a year ago, with a press release published by the Department of Health. This claimed that a report by the Cabinet Office, published the same day, “reveals that nine out of ten” people polled “said they want public services, such as GP surgeries, that are open some evenings and weekends, even if that means they would sometimes be shut during the working week.”(2) This was reported verbatim by the press(3), but it was a complete fabrication. I have read the report(4). It contains no mention of this poll, or anything resembling it. The terms “surgeries”, “evening”, “weekend” and “working week” do not occur.

But on the strength of this fiction, extended opening hours became government policy. It is a bit like the war with Iraq: the decision to go ahead was made before the evidence materialised. Just as the government was publishing its misleading press release, Ipsos Mori was completing the huge poll – of 2.6 million people – that the same department had commissioned. This, surely, would support its fictitious claim. Who would not welcome longer opening hours?

To the department’s intense discomfort, Ipsos Mori found that “the vast majority of patients (84%) say they are satisfied with the hours their GP practice was open during the last six months”(5). Those who must visit GPs most often are the most relaxed about opening hours: only among 18-34 year olds – the healthiest section of the population – does the level of unhappiness rise above 20%(6), and then only by a whisker.

But, like the weapons of mass destruction, if the government said the public demand was there, it had to be. On Thursday Gordon Brown insisted that “people want weekend opening; people want to be able to see their GP in the evenings.”(7) Yes, some people do, but not very many.

The Confederation of British Industry was also unhappy with the results. It commissioned another survey, again from Ipsos Mori. This received responses from just 1,014 people – one 2,500th of the department’s sample size. It asked a slightly different question: “how easy or difficult was it to get an appointment at a time that was convenient to you?”. Thirty-one percent said they had found it “fairly or very difficult”(8).

The CBI issued a report claiming that “a commonly heard complaint is that GP practices are not open at weekends, early in the morning or in the evening … GP services are not responding to clear signals for change from patients”(9). But it produced no evidence: the survey didn’t ask about opening times. There are plenty of reasons why patients might have found it difficult to get a convenient appointment.

But even if the government is using dodgy figures and has misjudged popular support, what’s wrong with longer opening hours? Strange to relate, quite a lot. In some places, where there are large numbers of commuters who travel far to work, it makes sense. But Gordon Brown wants to impose it on surgeries everywhere.

This means, in effect, transferring resources from children, the old and the very sick to working people, who need the services least. GPs will have to work shifts, which undermines one of the most important foundations of the NHS: the continuity of care. It is not clear that longer opening times will in reality be much more convenient for working patients: the appointment clerks, specialist nurses, consultants, physiotherapists, dentists, X-ray departments, biochemistry labs, blood sampling services and computer technicians with whom GPs work are not available in the evenings and at weekends(10), so patients might have to come back to complete the consultation. If the government wants a genuine health supermarket, open all hours, it will have to pay much, much more.

So why is it so keen on this reform? Because it assists a quite different agenda. To avoid the political firestorm big business rains on any government that stands in its way, Gordon Brown must make constant concessions. What business wants most is the 40% of the economy controlled by the state. He must find clever and camouflaged means of delivering it that do not prompt us to take to the streets.

This means waging a public relations war against GPs and the other public sector dinosaurs who impede choice and change. It means a thousand small steps towards privatisation. The government is expanding the number of independent sector treatment centres, even though they turn out to be far less efficient than the NHS and leave the taxpayer with major liabilities(11). It is opening staggeringly expensive polyclinics, operating seven days a week, which will be run by multinational companies(12). It will allow the primary care trust in Birmingham to shut the city’s surgeries and replace them with primary care units franchised to corporations – the promoter of this scheme happily admits to modelling it on McDonalds(13). It is transferring GPs’ surgeries to supermarkets (the first was opened by Sainsbury’s last week(14)) and giving high-street chemists responsibility for diagnosing and treating minor ailments, even though they are not qualified to tell the difference between an ordinary cough and lung cancer. No minister can now discuss the NHS without mentioning “new providers” or “alternative providers”, which is their code for private companies, or “choice” and “reform”, which means privatisation.

The CBI has produced a long list of complaints about GPs’ failure to “rise to the challenge” of the market(15). In truth they are among the most efficient workers in the NHS. One of the reasons why their pay has jumped so quickly is that they have responded more effectively than the government expected to the incentives in their new contract (giving the government a further stick with which to beat them). They are way ahead of the hospitals in their use of information technology. But there is money in primary care, which is why they are now in the firing line. GPs say that the government was hoping they would reject its demand for longer opening hours, knowing that the private sector could then step into the breach.

None of this serves either the customer or the taxpayer. The irony of Brown’s reforms is that they are wholly centred on the needs of the providers rather than the patients – as long as the providers are corporations. So don’t wait to take to the streets. Little by little, the privatisation of the NHS is happening already, disguised as a crusade for patient power.

References:

1. Gordon Brown, 7th January 2008. Speech on the National Health Service.
http://www.number-10.gov.uk/output/Page14171.asp

2. Department of Health, 19th March 2007. More family doctor services for deprived areas.
http://www.gnn.gov.uk/environment/fullDetail.asp?ReleaseID=272142&NewsAr…

3. Eg Sarah Hall, 19th March 2007. Fruit, veg and a trip to the GP as stores are asked to open surgeries. The Guardian.

4. Prime Minister’s Strategy Unit, March 2007. Policy review – Building on progress: Public services. http://archive.cabinetoffice.gov.uk/policy_review/documents/building_on_…

5. Department of Health, 2007. The GP Patient Survey 2006/2007: National Report, p58. http://www.dh.gov.uk/en/Publicationsandstatistics/PublishedSurvey/GPpati…

6. ibid, p60.

7. Gordon Brown, quoted by Daniel Martin, 7th March 2008. GPs grudgingly agree to work evenings and weekends at last. Daily Mail.

8. LLM Future Services, 2007. Survey conducted for CBI, May 30th-31st 2007. Sent to me by the CBI.

9. Confederation of British Industry, 18th September 2007. Just What the Patient Ordered: Better GP Services. http://www.cbi.org.uk/ndbs/press.nsf/0363c1f07c6ca12a8025671c00381cc7/f60cebe0663c98d68025734600573f81/$FILE/CBI%20report%20′Just%20what%20the%20patient%20ordered’%20September%202007.pdf

10. Gruffydd Penrhyn Jones, GP, pers comm.

11. Allyson M Pollock and Sylvia Godden, 23rd February 2008. Independent sector treatment centres: evidence so far. British Medical Journal, vol 336, pp421-424. doi:10.1136/bmj.39470.505556.80

12. See British Medical Association, January 2008. Access to GP services in England. http://www.bma.org.uk/ap.nsf/Content/Gpaccess.

13. Nick Britten, 4th February 2008. GP surgeries ‘could be run by Tesco or Virgin’. Daily Telegraph.

14. Hugh Wilson, 4th March 2008. The Sainsbury’s GPs: checkout, then check-up. The Guardian.

15. See Confederation of British Industry, 18th September 2007, ibid.

Unity in Action

Ellie Keen — Fri, 07 Dec 2007 03:23:50 +0000

On 5 November I was sacked after 25 years from the job I loved as a community psychiatric nurse. Three days later 150 community mental health workers went on strike indefinitely for my reinstatement.

I might have felt a bit of shame and embarrassment if any of the trumped up charges were true, but I was even sent a letter on the day of my suspension promoting me to senior practitioner. My crime was speaking out about government plans to transfer NHS care to the voluntary sector and publicly protesting my innocence.

As a result my colleagues are taking 14 days of strike action. Their amazing commitment of time and energy is not just about freedom of speech and myself; it is driven by the frustration of working in services being cut to ribbons.

For a long time our trust has been underfunded, but it came to a crunch in 2003 when one of our NHS hospitals closed and moved to a private finance initiative (PFI) hospital. The beds cost four times as much in the new hospital, so we only had half as many. We lost 45 beds across the city.

This means that even if a patient has section papers completed they can wait up to three weeks before admission. You end up with a 20 bed ward for 27 patients. Patients are reluctant to go home because when they come back they might have nowhere to sleep.

The trust also managed to turn a £4 million budget increase into a cut for the ten community mental health teams. We used to have 16 nurses, but they reduced it to four, with support workers cut from seven to four. Despite this we only had 10 percent less patients.

All this made people furious, so we went on strike earlier in the year, stopping the redundancies and downgrading. You’re not allowed to strike about cuts in services if you have a job at the end of it but we carried on campaigning regardless. I think they suspended me for continuing to campaign. If I’m a leading trade unionist in the branch and they discipline me, where does that leave individual nurses?

I went to see a junior minister for mental health the other day and I was the sixth person to see him that day about services or my case. It’s on a scale I’ve not seen before, but the trust has been digging a bigger and bigger hole for themselves, upping the stakes when they should be backing down.

In our first set of strikes they closed three wards rather than discuss emergency cover with us. They sent some people home for two weeks, some to a private hospital where people couldn’t leave for the five or six days they were there, they sent another 20 acutely mentally unwell patients or so to Darlington, for three weeks, with no idea when they were coming back, 100 miles from their family and friends. I just think that’s cruel.

They’ve employed private investigators to investigate my case on a couple of hundred pounds a day. They’ve employed a private HR person for my disciplinary hearing. They’ve taken on 20 private beds for the duration of our strike as a contingency plan.

We lost 20 beds when we moved to the PFI hospital and suddenly they turn up in the private sector and we can afford them, but only for the duration of the strike. Now they’ve got a private PR firm employed. The money, time and energy they have squandered trying to get rid of me and break the union could have been spent trying to solve the problems of our service.

What’s so inspiring is the way nurses, occupational therapists, senior support workers and the service users themselves continue to speak out about cuts despite what’s happened to me. People still go to committees, write to MPs, do press interviews, organise lobbies, petitions and demonstrations: all the things my victimisation was intended to stop.

Our strike headquarters is a hive of activity. Over half the strikers are actively involved. Users of our services have been incredibly supportive despite the huge impact our strike action has had on them. They regularly join our pickets and protests, and speak out.

For years our union branch has supported campaigns by our users. We fought for free bus passes and daycare, and to stop Job Centres threatening people about work. People often ask me if I was offered my job back would I want to work there again. Well I couldn’t ask for better people to work with – users, carers and staff alike. We have a passion for what we do, a sense of justice and a laugh. It’s not just about me.

More information is available at the Reinstate Karen Reissmann website.

Only dogma and corporate capture can explain this

JamieSW — Thu, 18 Oct 2007 18:12:23 +0000

UnitedHealth is the largest healthcare corporation in the US, making billions of dollars a year out of cherry-picking patients and treatments, squeezing costs and restricting benefits to 70 million Americans forced to get by in the developed world’s only fully privatised health system. Its chief executive, Bush donor William McGuire, paid $125m in 2004, had to step down last year in a share-option scandal.

Last month, UnitedHealth agreed with insurance regulators in 36 states to pay out $20m in fines for failures in processing claims and responding to patient complaints. That follows a string of other fines over delayed payments, Medicare fraud and “cheating patients out of money” in New York State.

Other major US health corporations, such as Aetna and Humana, have also faced repeated fines for shortchanging doctors, using unlicensed agents, payment delays, failures to give information to claimants or fraud. In one case of a cancer patient who was refused payment for a failed experimental treatment its own doctors recommended, Aetna was ordered to hand over $120m damages after it was found by a California jury to have committed “malice, oppression and fraud”.

All three companies figure prominently in Michael Moore’s new film Sicko, a compelling indictment of the US health system – under which 18,000 Americans die a year because they are uninsured. Hardly the ideal players, you might think, to take a central role in the reform of the National Health Service.

But it is precisely these three corporations, along with 11 other private firms including KPMG, McKinsey and Bupa, that the government this month announced have been lined up to advise on or even take over the commissioning of the bulk of NHS services. Primary care trusts, which control most of the NHS’s £90bn budget, will now be encouraged to buy in advice from the 14 selected companies on health needs, contracts and local provision. Potentially, these corporations could take over the management of the heart of the NHS.

For the first couple of months after Gordon Brown became prime minister, it had seemed that the new administration was pulling back from the privatising excesses of the Blair years. One of Alan Johnson’s first moves as the new health secretary was to announce that there would, after all, be no “third wave” of controversial private surgery and diagnostic units, known euphemistically as independent sector treatment centres.

But the award of a framework primary care contract to the 14 privateers – only mildly watered down from an earlier incarnation – and Johnson’s backing for a key private-sector role in 150 new health centres and 100 new GP practices, have set the seal on the Brown government’s commitment to the continuing market-driven reconstruction of Labour’s greatest social achievement.

Under the banner of choice and reform, New Labour has struggled to create an artificial market in health and turn an integrated system of universal provision into a tax-funded insurance system tailored to the private sector. The move to outsource service commissioning will now pave the way for private companies to decide the range of services provided and use their access to information to pick the most profitable services to bid for in other areas. Allyson Pollock, head of Edinburgh University’s international health policy centre, calls it the “last piece in a jigsaw” that opens the door to a US-style health maintenance organisation model – dominated by corporations like UnitedHealth.

Ministers have always insisted that using private companies is all about improving services and value for money. But the evidence is that far from making better use of the extra cash pumped into the health service, privatisation has been expensive, inefficient, destabilising, unaccountable and led to closures, cuts and job losses.

The costly and underfunded private finance initiative, which has landed the NHS with a total bill of £50bn for new hospital buildings, is already milking £700m a year from NHS trusts and fuelling the financial crisis across the service. The private treatment centres used for elective surgery are not, as the Commons health select committee found, more efficient than NHS units, nor have they mostly increased capacity; they are in fact more expensive, have heavily underperformed their contracts and often ended up taking over NHS staff.

Add to that the huge transaction costs of administering the new market system and it’s hardly surprising Labour’s own conference last year declared that the “major cause” of the financial crisis in the NHS was the “move to a competitive, market-based system” and “the continued use of PFI”. Meanwhile, it’s become clear that bargain-basement contract cleaning has been a key factor in the rise of hospital infections. In Wales, where cleaning is now carried out in-house rather than by contractors, MRSA infection is less than half the English rate.

Given the evidence on cost and inefficiency, and its unpopularity among medical staff and voters, the government’s determination to press on with privatisation and marketisation might seem baffling. Why insist on heading off in the direction of a health system with the highest per capita cost and inequalities while courting its main beneficiaries? The only sensible explanation has to be that what New Labour derided as the influence of producer interests has been replaced by corporate capture: a mixture of market dogma, business lobbying and a revolving door syndrome that saw Simon Stevens, former adviser to Tony Blair and a succession of New Labour health secretaries, move effortlessly on to become European president of UnitedHealth.

The risk is now that with a continuing patchwork privatisation and cash squeeze, public support for the principles of the NHS could erode, opening the way to charges, top-up fees and private insurance. Both the Tories and Liberal Democrats either accept private provision or are gagging for more of it, so not much help can be expected there. But Wales and Scotland have mostly resisted the worst of the health service’s English disease – and support for the kind of socialised health system Michael Moore lauds in Sicko is deeply rooted in Britain. What’s needed now is to turn that sentiment into pressure for a real change of direction.

Sicko II

christian — Mon, 24 Sep 2007 16:38:55 +0000

Viewers of Michael Moore’s new film will come away convinced that the public healthcare system in this country is superior to its privatised American counterpart, where more than 50 million people are without any kind of care at all. But does the government agree? Or has it instead been taking ideas from the very system revealed in Sicko to be so iniquitous?

The film is very much made for a US audience. Moore does not go into the huge changes that are taking place in European healthcare – and the new, privatising project going on here. It might surprise many British people who see the film to know that, for example, the British government has for years been in contact with Kaiser Permanente, one of the big US healthcare corporations, and is actively trying to remodel the NHS along American lines. All the reforms carried out by the government over the past few years have been aimed at that.

In 1995, civil servants from the Department of Health, fresh from visits to the US, thought they had found the future of the NHS. They invited Kaiser Permanente to look at whether it could deliver health services as part of the new Private Finance Initiative in the NHS. The PFI is a building programme of public infrastructure that brings with it a long-term debt that the government takes out from a private company. But as the medical director of Kaiser Permanente, which is both an insurer and healthcare provider, told me at the time in her marbled headquarters in California, the NHS was not yet ready for Kaiser. Such a system, built on public ownership, control and accountability, was closed to commercial companies. And it was the same story for the whole of Europe. But Kaiser Permanente, which, along with the rest of the US healthcare industry, was known as one of the “darlings of Wall Street” because it made so much money, was restless. It wanted to make more, and had its eye on the rich pickings of European tax funds. And where better to begin than by conquering the UK’s “socialised” NHS, so long the model for much of the world?

Kaiser Permanente didn’t have long to wait. In 1997, the Labour administration swept away the last remaining obstacles to PFI and, in so doing, established the laboratory for the great market experiment in public services.

The accumulated neglect and backlog in maintenance and repair became an excuse to sell off NHS land and assets at knockdown prices. The NHS is now a tenant in hospitals it once owned, leasing back buildings and services from private sector landlords at astronomical rents that are currently consuming £500m a year and will increase exponentially. The diversion of scarce funds from hospital revenues to bankers and shareholders has starved the NHS of cash, and the result has been a major downsizing. For almost every PFI hospital built, three hospitals close. Bed closures and staff reductions occur on an unprecedented scale.

Back in 1997, the NHS had major capacity problems. Waiting lists kept rising, accident and emergency wards were overflowing, public discontent was growing and staff morale plummeting. Tony Blair found a solution one night in 2000 as he was leaving the smart River Cafe. He was introduced to Tim Evans, external affairs director of the Independent Health Care Association, the body that represented the private healthcare industry, who convinced him that the private sector had all the answers.

But the Labour government knew that a public sector NHS was close to the heart of most Britons, and a spin operation was required. So, from the start of the Labour government, ministers dismissed the NHS as Stalinist, a 1940s relic of socialism, bureaucratic and rigid. Then, in 2002, the highly respected British Medical Journal published a paper purporting to show that Kaiser Permanente (them again) was more efficient than the NHS. Within hours, hundreds of emails had poured into the BMJ exposing the flaws in the paper, from the misleading nature of the claims to the authors’ links to the company. But the BMJ’s editor, Richard Smith, declined to retract the paper, correct it or publish a proper scientific rebuttal.

The paper had done its work. Its propaganda was cited and repeated everywhere by academics and policy-makers and, most crucially, by the government in its white papers and documents, including the Wanless Report. The much-despised US healthcare industry, of which Kaiser Permanente is a part, was to be the new model for Britain.

Not long after publishing the article, Smith left the BMJ for a lucrative post as chief executive of the UK subsidiary of the US health corporation UnitedHealth. There he joined its new European president, Simon Stevens, formerly adviser to every Labour health secretary, and Tony Blair, since 1997. The flow of ideas, from him and many others like him, was all one-way: from the US to the UK.

As adviser to Alan Milburn, health secretary from 1999 to 2003, Stevens and his American colleagues helped to shape the NHS Plan 2000. It promised to provide more money, doctors, nurses, beds and capacity. But in the event the funds were directed at building a new parallel system that would be owned and operated not by the people but by the private sector on behalf of shareholders.

Using the mantra of choice, the market was thus disguised. In primary care the government negotiated a new GP contract that would allow commercial companies to run GP services. There are now more than 30 corporations running GP services in England.

It was choice that was used to bring in the highly controversial ISTC (independent sector treatment centre) programme, spearheaded by Texan Ken Anderson, which provides mini- factories for elective surgery. Anderson headed the new commercial directorate of the Department of Health and quickly set about awarding £6bn worth of contracts to healthcare corporations, thereby undermining elective surgery, diagnostics, radiology and pathology provision in the NHS.

Local people from Portsmouth to Scarborough have been protesting against ISTCs draining scarce NHS funds, which has led to service closures and staff redundancies to balance the books. There is not an area of the country where services are not being cut and closed. Protests against the closures of accident and emergency departments and hospital services are happening in Surrey, East and West Sussex, Kent, Worcester, Manchester, Leeds, Durham and Huddersfield; and against the 150 community hospitals in places such as Norfolk, Cambridge, Leicester, Devon, Marlborough and Bromley. The NHS, the government says, has had unprecedented levels of funding – so where has all the money gone if it isn’t into services? Is it really all down to bad managers and greedy doctors and nurses?

All markets need systems for pricing, billing and invoicing. Labour has introduced those: the electronic patient record, part of the £1bn IT disaster. The NHS too is being transformed from within. Foundation trusts such as University College London Hospitals Trust have been given new powers to enter joint ventures with commercial companies such as the Hospital Corporation of America and to spend millions of pounds on advertising campaigns, PR agents, mega-departments of finance and accounting, press officers, management consultants and profits. As in the US, billions of pounds, probably approaching 20% of annual NHS funds – estimated to be £20bn in England in a year – are being squandered on what are called the transaction costs of the market.

Earlier this year the US chief executive officer of UnitedHealth, Bill McGuire, was sacked along with other board members for repricing share options. His annual $126m package was not enough for him. Meanwhile more than 50 million Americans, including 10 million children, go without care – in the richest country in the world. Is this what we want?

Allyson Pollock is author of NHS plc: The Privatisation of Our Healthcare, and professor and head of the centre for international public health policy at the University of Edinburgh.