Phase 2 /Trying to save NHS

Sent to MP 20.08.12

Dear Mr Reid,

It must be really good to have your certainty about the NHS. You gave no proof in your Ileach statement that the long-term aim of this government isn’t privatisation of our NHS.
The LibDems are either deluded or disingenuous.
Tory politicians had NHS privatisation in mind before the last General Election. It’s part of their ideology even though David Cameron said “No more top down reorganisations” in a pre-election promise.
Don Hannan MEP “The NHS is a mistake…we have lived through this mistake for 60 years now” Fox News USA
Oliver Letwin “The NHS will not exist within 5 years of a Conservative victory”…”no limits” on privatisation. Sunday Times
Michael Portillo “They (the Tories) did not believe they could win an election if they told you what they were going to do” to the NHS. This Week.
It was not previously part of LibDem ideology but the Health and Social Care Bill was railroaded through Parliament aided and abetted by LibDems. NHS efficiency before the Coalition took over was questioned regularly in order to justify the changes.
“The ultimate reason for British pride in its universal healthcare system, is exactly that the system is universal. Public monies go to a collective good: public health. In a time when the middle class is being gutted and life for most of us has become increasingly precarious, this should be the envy of the world” New York Times
However it is obvious that the endgame of the UK government is a USA style healthcare service. Nick Clegg has been quoted as admiring this type of system.
Millions of Americans think differently:
“In the U.S, health care is not a right but a privilege granted only to those who can afford to pay for it. Because of this mean-spirited attitude, there are millions of people in the U.S. that have no health insurance cover at all; meaning they have no access to health care (especially preventative care) except for emergency care offered by emergency rooms of public hospitals (which catch many illnesses long after the time when they could have been treated). Because of this, over 45,000 people die each year for no better reason than lack of health insurance; deaths that could have been prevented if they had insurance allowing them to get preventative care on a regular basis from a doctor of their choice.” USA - JOBSANGER
Pro rata this number could be 10,000 people in England in a few years time if these policies are allowed to be fully implemented.
People are not believing what’s happening because it seems impossible and news coverage of the changes, in the press and on TV is almost non-existent. By the time parents can’t afford vital medicines for sick children it will be too late. Eventually, patients will not be treated according to need but according to whether or not they can cover the cost of their medical needs. Virgin, Serco and Care UK have taken over contracts throughout England to provide healthcare services. These private providers, receiving mega bucks from our UK-wide taxes, will be aiming to make big profits. It is proving to be a perfect “cash cow” for them. The Coalition couldn’t get away with it all in one go, but it’s creeping insidiously all over England.
At a conference that covered ‘Income generation – new markets for the NHS and the
private sector’, Earl Howe, minister for health in the House of Lords, assured the attendees of ‘big opportunities for the private sector here’ for both corporate providers and those hoping to sell commissioning support services to clinical commissioning groups. This agenda has been rumbling on for ages. In 1988, the pro-market Centre for Policy Studies (CPS) published a series of short studies exploring this agenda. One study was published as a pamphlet entitled “Britain’s biggest enterprise” by Conservative MPs Oliver Letwin and John Redwood. Around this time, both of these MPs headed NM Rothschild Bank’s international privatisation unit. In 1988 Oliver Letwin published a book, “Privatising the world: a study of international privatisation in theory and in practice”, with a foreword by John Redwood. A useful formulation of how this privatisation could be effected is given by Lucy Reynolds and Martin McKee in “Opening the oyster: the 2010–11 NHS reforms in England” in Clinical Medicine 2012, Vol 12, No 2: 128–32.
The Health and Social Care Bill was opposed by all but one of the 26 professional bodies in the UK; but the professionals were ignored and without the LibDems it could not have passed through Parliament. LibDems should be ashamed of selling the NHS down the river for individual financial gain and political power.
Scotland’s healthcare system is safe; so you say, Mr Reid. So in a few years when patients in England are faced with large bills to pay for insurance or healthcare where will they look to receive free services? I suspect NHSiS will be inundated with England’s poorer citizens. Will there be a new law in Scotland to prove residency before patients are treated here? Will Scotland have to employ many more health professionals, at so much extra expense, to cope with the expected onslaught? Whatever the shade of the government in Scotland, this will potentially be a huge nightmare scenario. I suggest that private providers will eventually be welcomed as an answer to this problem and Scotland will follow England’s example into privatising NHSiS.
Under the Health and Social Care Act, Monitor, the new economic regulator, has a mandate to drive competition in the NHS ( to “prevent anti-competitive behaviour”). Under the HSC Act a healthcare provider must be “licensed” before it can provide NHS care.
Monitor has drawn up the licence conditions which are now open to consultation.
Within these conditions are :
Condition G8 – Patient eligibility and selection criteria
1. The Licensee shall:
(a) set transparent eligibility and selection criteria,
(b) apply those criteria in a transparent way to persons who, having a choice of persons from whom to receive health care services for the purposes of the NHS, choose to receive them from the Licensee, and
(c) publish those criteria in such a manner as will make them readily accessible by any persons who could reasonably be regarded as likely to have an interest in them.
2. “Eligibility and selection criteria” means criteria for determining:
(a) whether a person is eligible, or is to be selected, to receive health care services provided by the Licensee for the purposes of the NHS, and
(b) if the person is selected, the manner in which the services are provided to the person.
This clearly says that private providers can reject patients as long as they do so according to already published “selection and eligibility criteria”. This legitimises cherry-picking. Eg: a provider could say that they will not treat someone over a certain age, or someone with a BMI over a certain value, or someone with a complicating condition like diabetes or asthma. Area of residence in the UK might also be a factor; at the discretion of GPs. Indeed it is likely that their criteria could be summarised as “we only treat fit, health people living in England”.
Where will the rejected patients go? Back to an NHS safety net. This is not “patient choice.” It is provider choice - and it is designed to allow private providers to choose the easy cases upon which they can make the most profit.
THE HEALTH AND SOCIAL CARE ACT was passed 27 March 2012
Crucially and most seriously, it removes the UK government’s obligation to provide universal healthcare in England, something so fundamental it amounts to the abolition of the NHS. As Dr Jacky Davis, co-chair of the NHS Consultants Association says: "After the passage of the unwanted, unneeded and deeply undemocratic NHS bill, we no longer have a national health service."
1) THE FORCING THROUGH OF THE HSC BILL
The overwhelming opposition from the medical profession (eg: from the BMA and 25 out of the 26 royal medical colleges) was not communicated by the mainstream media, particularly the BBC. Although the NHS affects every man, woman and child in the UK, most remain in the dark about what has happened. The government of Tories and LibDems has played a big role in this. It repeatedly concealed the purpose of the bill - to make possible the gradual dismantling of the NHS and its replacement in the medium-term (few years) by a market system, based on ability to pay rather than need.
The government also used mis-information to justify its reforms. According to Portillo, Tories had to do something about the "incredible inefficiency" of the NHS http://tinyurl.com/d64qov6. The truth is the NHS is one of the fairest, most efficient and cost-effective healthcare systems in the world http://tinyurl.com/3qf92zc with half the per capita costs of the US health system, which is not universal, and it has a higher life expectancy and lower infant mortality (OECD figures).
The government defied a legal ruling (Freedom of Information) to make public the risk assessment of the bill, despite the commissioner's verdict of "exceptional public interest".
There was a massive conflict of interest, with 25% of the MPs and Lords who voted for the Bill having financial stakes in private health companies that stood to benefit by from the bill's passage http://tinyurl.com/7gcsaqf. “Care UK”, a private health company donated significant money to the office of health secretary Andrew Lansley. Surely a conflict of interest.
2) SPECIFICS OF THE HSC ACT
In addition to removing the universal right to healthcare, which has existed since 1948, the Act also opens the door for charges (without limit) for NHS services. It permits private providers to take over any NHS services and it allows up to 49% of the business of NHS hospitals to be private. Apart from the fact that the intention is almost certainly to eventually increase this percentage to 100% - ie: create a US-style insurance-based system - this will create a health system with two queues: one for the poor and one for the rich. In a cash-strapped system, a rich person with a minor ailment will be treated over a poor person with a more serious ailment.
"Care will never again be according to need but ability to pay," says Dr Clare Gerada, Chair of the Royal College of GPs.
The Faculty of Public Health's risk assessment warns of 1) Loss of a comprehensive health service, 2) Increased costs, 3) Reduced quality of care, 4) Widening health inequalities http://tinyurl.com/7z2nf2f In a nutshell: "NHS: integrated, comprehensive, cost-effective, accountable. Mix providers: fragmented, unaccountable, expensive, only profitable services." (‘integrated’ means that data is shared – which was not the case with the private companies involved with the recent breast implant scare – and that patients receive care from a multi-disciplinary team of doctors, nurses, physios, radiographers, district nurses and so on. ‘Comprehensive’ means that all people and all ailments are treated. ‘Accountable’ means that problems and finances are made public and not concealed by commercial contracts)
The risks highlighted by the Faculty of Public Health are all short term. The NHS is being removed gradually (No government would dare remove it in one go. At the time of the last election, it had the highest-ever public approval rating). However, the end-game is obviously an insurance-based system like the US.
Without health insurance, you will not be able to get treatment for you or your family. The term NHS will be meaningless. "The NHS will be reduced to a logo, a budget and a few qangos," says public health physician, Dr Alex Scott-Samuel.
3) WHAT HAS HAPPENED SO FAR
Most people remain in the dark about what the HSC Act does because of failure of the mainstream media. If the BBC covered economics like it has health, nobody would know there had been a global financial crisis. On the day the Act was passed the strap-line across the bottom of BBC News broadcasts said "Bill which gives power to GPs is passed". It would be difficult to find a GP who agreed with that. At a time of severe financial pressure, huge sums of money – estimated at more than £3 billion - are being diverted from patient care to fund reorganisation necessary to implement the HSC Act . This is creating huge amounts of duplicated bureaucracy which is the principle cause of the high cost of healthcare in the US. Some of it is spelled out here by the editor of Nursing Standard http://tinyurl.com/cu8lkjg
Gradually, the government is deliberately starving the NHS of money. As hospitals run out of money - and the exorbitant repayments on PFI deals are a major factor here - they become prey to takeovers by private companies. This has already happened, with Serco taking over Newmarket Hospital. Not only does a private company cherry-pick profitable services but it gains infrastructure paid for by the taxpayer. It can also give preferential access to equipment such as kidney machines, blood and organs that were specifically, freely donated by the public to the NHS for use by everyone.
NHS services must now be put out to tender. The core business of the transnational corporations that are bidding, is winning government contracts as they have the experience, deep pockets and legal expertise to do so. Small enterprises and local GPs cannot compete with them in tendering for services, as has already been seen in the Virgin takeover of community services in Surrey and childrens' services in Devon. When private companies fail, like the company with the contract for GP services in Camden, patients are left high and dry. The starving of the NHS of money to force the pace of its sell off to private companies has forced the imminent closure of 4 out of 9 A&E departments serving NW London.
Trusts are getting together in cartels to force down nurses' pay, though nurses have experienced a pay freeze (ie: pay decrease, taking into account inflation) for several years now http://t.co/VMzJDI7T Dr Peter Carter, Chair of the Royal College of Nurses is predicting the loss of 56,058 nursing jobs.
Fragmentation of the NHS is reducing data sharing, making it ever more difficult to assess how healthcare is worsening. “This is the worst crime against our country by a government in my lifetime” - Marcus Chown (award winning writer & broadcaster); with whom I heartily agree and thank for much of the above data.
Mr Reid, it’s time you and your Party opened your eyes and ears to what you are condoning. You have sold the NHS off to facilitate the AV referendum and House of Lords reform; neither of which worked. Your Party will be remembered as that which allowed the demise of the NHS; the most important system in the UK. How can you justify your actions?

Yours sincerely,

Patricia M Farrington MBE

( With many thanks to Marcus Chown )

CC: The Ileach for reference.