2012: how the NHS became privatised and the impact that has had


10:23 am - December 18th 2012

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by Alex Nunns

2012 will go down as a cataclysmic date in the history of the English health service. It was the year when the virus of privatisation finally gained control of the cell nucleus of the NHS and began its destruction in earnest.

If you listen to the politicians you wouldn’t know it. According to David Cameron, “we will not be selling off the NHS.” If you believe Nick Clegg, “there will be no privatisation.” They have been able to get away with this deception because the transformation they unleashed is messy. It is happening everywhere, but not uniformly. It is hidden by its very scale and spread.

But take a step back and the patterns are unmistakable. The controversial Health and Social Care Act passed in March 2012 ended the English National Health Service in all but name by abolishing the 60-year duty on the government to provide comprehensive healthcare for all. In its place is not so much a new structure as a process with its own dynamic-that of a snowball tumbling down a hillside.

All across the country treatments that patients used to receive are no longer available to them. Hip and knee replacements, tonsillectomies and cataract operations are among the procedures being restricted, forcing patients to wait longer, suffer in pain, or go private. Surgeries, wards, units and community services have been closed and clinical staff shed as the NHS desperately seeks to make “savings” of £20 billion.

Private GP surgeries near you
With perfect symmetry, the private sector expects to win £20 billion of business from the NHS, according to the corporate finance adviser Catalyst. Huge slices of the health service are being awarded to the highest bidder. With remarkable speed a few gluttonous companies: Virgin Care, Serco, Care UK – have secured dominant positions in the market, gobbling up services from Cornwall to Cumbria. The defenders of the reforms talk about competition driving improvements, but already it is consolidation, not competition, that we are seeing.

There may be a GP surgery near you that is now run by Virgin. Until March 2012 Virgin Care did not exist, although it had been operating under another name since 2010. It now runs at least 358 GP practices. Behind the friendly PR façade of the bearded entrepreneur, patients see a different face, cold and sinister. Take the Kings Heath Practice in Northampton. Since Virgin took it over from the NHS, patients have had to wait up to three weeks for an appointment instead of three days, three GPs have been reduced to one, and three nurses cut to one part-time nurse. And while the company boasts about the surgery’s opening hours, often there are no clinicians present, just an open empty building. Locals complain that Virgin has “brought Third World medical standards to Kings Heath.

Consolidation is also happening in out-of-hours GP cover. In November Care UK took over out-of-hours services for up to fifteen million people across England by simply buying Harmoni, a company that started as a GP co-operative. The only competition patients see is between their health needs and the profit margin. People in Cornwall know which wins out: an official report in July found the Serco-run out-of-hours service in the county was under-staffed and falsified data to meet targets.

The biggest privatisations are taking place in community health services. The government’s “any qualified provider” policy means whole services must be subject to competition, leading to the demise of NHS-run options. Local NHS bodies have already been instructed to outsource 39 types of service. Dubbed the “39 steps to privatisation,” this covers everything from autism care to wheelchair provision. Even publicly provided vasectomies are for the chop.

The ‘logic’ of privatisation
The logic of privatisation favours a few big winners over the co-ops, charities and social enterprises that act as window dressing for the policy. A prime example came on April Fools’ Day, 2012, when Virgin Care took over a £500 million contract to deliver community services in parts of Surrey. The joke was on Central Surrey Health, a “social enterprise” formed by former NHS staff that was praised by David Cameron and hailed as a model for the Big Society. Central Surrey Health scored the most points in the bidding process, but the contract was given to Virgin because of its financial backing.

Not even hospitals offer shelter from the destructive gale blowing through the NHS. Many Hospital Trusts are being pushed to the financial brink by the disastrous legacy of the Private Finance Initiative (PFI), under which new hospital building was financed by a deal that is akin to paying by credit card, leaving Trusts with crippling debts to the banks.

This has led to some Trusts literally going bankrupt, such as the South London Healthcare Trust which serves over a million people in three hospitals. Its PFI debts, like a black hole, have sucked in surrounding hospitals and units, like Lewisham’s A&E department which is now facing closure. Patients are left high and dry. As for the Trust, it is to be carved up and offered piece by piece for privatisation, with the familiar vultures-Virgin, Serco, Care UK and Circle-picking at the remains.

In a first for the private sector, in February 2012 Circle took over an entire general hospital at Hinchingbrooke in Cambridgeshire. The hospital has since fallen 19 places in the patient satisfaction rankings and its finances have worsened, forcing Circle to ask for a bailout after just six months.

Private income at NHS Hospitals
Combine this with another controversial aspect of the Health and Social Care Act-the ability for NHS hospitals to earn half their income from private patients-and the implications are scary. A chilling investigation by ITV’s Exposure program secretly filmed doctors assuring a private patient that her money would buy priority over NHS patients within the same hospital. It revealed a tragic case where a consultant left half way through a dangerous birth to carry out a private caesarean section. The baby later died. A two-tier health system is not on the way; it is already here.

The drive for profit is insatiable, not least because many of the dominant players in the new market are owned by ruthless private equity firms. Similar funding models to that which led to the collapse of the Southern Cross care-home company are now in the NHS. For example, Hospital Corporation of America, which is entering into joint ventures with NHS hospitals, is majority owned by three private equity firms including Mitt Romney’s notorious Bain Capital.

All of this comes before the most high-profile part of the Health and Social Care Act has even been fully implemented-the replacement of PCTs with Clinical Commissioning Groups (CCGs). Sold to the public as “giving power to GPs,” this transfers responsibility for spending £60 billion of public money to largely unaccountable new groups, who will in turn outsource the work to privatised “commissioning support units”-allowing the private sector to decide how taxpayers’ money is spent. If that sounds complicated, it is. David Nicholson, the head of the health service, fears it could end in “misery and failure.

The Labour party, after its record in government of opening the way for privatisation, has changed tack in opposition, repeatedly pledging to repeal the Act and scrap the market if elected. These are important commitments that it must be held to.

But the quantity of contracts currently being signed may take the NHS over a tipping point, where the “facts on the ground” cannot be reversed. That is why it is crucial to monitor, expose, slow and disrupt the destruction of the NHS now, while there may still be time to save it.


Alex Nunns is an NHS campaigner, writer and editor whose blog about a job offer from Care UK went viral in July 2011. This article was sponsored by the NHS Support Federation

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Reader comments


“repeatedly pledging to repeal the Act and scrap the market if elected”

I got the repeal the Act bit. When did they pledge to scrap the market?

Watch out for direct payments – personal health budgets. Huge Trojan horse there.

Simple question: will the NHS still be free at the point of use?

Because if you have to pay to access healthcare then it’s definitely privatised. If not then there’s not really that much difference from when Labour moved in private companies to build and own hospitals, handle admin and various other things formerly handled directly by the state.

Oh, by the by, a point about hospitals being allowed to make just under half their income from private sources – this represents a great improvement from the last Labour government when hospitals could legally make up to 100% of their income from private sources.

Incidentally, a very Merry Christmas to the admins of Liberal Conspiracy for apparently putting me on auto moderation so my comments no longer show up in real time. Thanks for that.

The thread header is more propaganda than truth. As Adolf wrote: “The great masses will more easily fall victim to a big lie than to a small one”

George Potter: “Simple question: will the NHS still be free at the point of use?”

Compare the national social insurance scheme for healthcare in France:
http://en.wikipedia.org/wiki/Health_care_in_France

By many accounts and surveys, this has led to better healthcare outcomes for patients, and longer cancer survival rates, as compared with Britain. Average life expectancy at birth in France is longer than in Britain. According to OECD sources, there are almost twice as many physicians per head of population in France compared with Britain.

What France doesn’t have is a state-run virtual monopoly of healthcare provision. The hospitals and clinics are independent of state control.

@4 I’ll think you’ll find it’s just that the site is laggy and buggy to all hell. The only thing that really dumps you into auto-moderation is posting two links or more in a comment.

The pro-market plan for the NHS is quite simple;

Stage 1 – free at the point of use
Stage 2 – free at the point of use, and crap at the point of use
Stage 3 – all treatments subject to sliding scale of nominal charges…and still crap at the point of use.

George – you’re not put on moderation. The system is cached, so comments show up after a delay and pages are not updated immediately to free server load

No surprise to see the idiotic George Potter (our resident apologist for the LIE DEMS.) trying to support this policy.

If there is any justice , which I doubt , the Health bill alone will condemn the Lie Dems to obscurity for a thousand years. Now we see clearly why tories all banged the cabinet table like the scummy public school boys they are when this bill passed. They could not believe their luck. It was not in the tory manifesto. It was not in the Lie Dem manifesto, and it wasn’t even in the co-alition agreement.

Of course, we all know that this policy was drawn up before the election, and the tories lied. They even had their leader parade his dying son as an electoral prop to convince people of his support of the NHS. Their tame civil servants were sent to Washington to tell their corporate masters that the privatization of the NHS would go ahead, and they should get their snouts in the trough. The health secretary’s wife had a vested interest in destroying the NHS. Yummy, smell all that lovely corporate welfare.

And then along came the idiotic naive Lib DEms who either know full well what they have unleashed. In which case they will never be taken seriously as a party of the centre left. Or they are clueless, naive political morons who do not understand politics or the the evil of the tory party and their agenda. You would think they would have learned their lesson after the referendum debacle of the true nature of the tory animal. But no.

The most sinister aspect of all this is the complete news blackout, particularly from the BBC. The BBC’s refusal to even question what is going in health shows that they have long gone to the dark side. In their attempt to appease the brown shirt tory party they are reduced to a meaning less Tory Pravda. It is revealing that only Channel 4 and ITV have run programs about this. Most of the public are quite clueless as to what is happening. Only as they wake up to the reality of Branson running their GP surgery is the horror coming home to roost. But the damage is done. The private sectors main concern is to kill off the NHS as quickly as possible. Then they can hold govts to ransom by demanding lots of juicy corporate welfare or they will shut down the service.

And again remember all this is happening under a minority tory govt. All this is only possible thanks to Nick Clegg and his spineless traitor Lie Dems. If the Labour party has anything about them they will hang this round Cleggs neck at every election from now on. Trouble is,I fear the damage is done. So long NHS, nice to have know you. You saved my dads life. And many other people I know as well. I hope the heat is turned up on Branson. He is not the lovable bearded business man, but a man who is stealing the NHS from under the public’s nose. But we know how devious business men are. They come with their corporate lawyers and their bribes of the political class. I’m sure if it looks like Labour are going to win the next election they will bribe Labout MPS to not take away their corporate welfare.

10. gastro george

@Bob B

You should really read your wiki link before posting it.

French hospitals are 62% public owned, plus 18% by mutuals.

French healthcare is better because they spend more per head. OK, that doesn’t always hold true because the US spends more. But that is because the US has vampire squids sucking money out of the system, which is what is intended here. France, in contrast, doesn’t run any kind of “free market” in healthcare pricing, but has a well-established and large bureaucracy that sets the price that will be paid – so limiting private profits.

“Simple question: will the NHS still be free at the point of use?”

Simple answer – yes if you are prepared to wait ever increasingly longer times before you receive the treatment.

Actual Answer – the taxpayer will end up funding treatment from a list of politically popular* procedures. The rest of it will carry charges as people get used to the idea of topping up their treatment.

Also expect fewer services to operate from rural and small town district general hospitals, meaning more travel costs for patients to be able to keep appointments.

* = i.e those medical conditions that (a) celebrities have suffered from, (b) have lots of organizations employing competent press officers to raise the profile of the condition, and (c) where the treatment involves throwing money at big pharma rather than something more boring and mundane.

“It revealed a tragic case where a consultant left half way through a dangerous birth to carry out a private caesarean section. The baby later died. A two-tier health system is not on the way; it is already here.”

Sensational anecdotes are the whole truth!

Let’s be clear about the bill’s wording by the way, there is no chance of the NHS starting to charge for it’s services (outside of changes to prescription charging, I think) without new legislation. It’s all well and good to make any argument you want about privatisation being on the way…but *another* bill will have to go through parliament to make that happen. Call me optimistic, but despite Labour’s failing to oppose the last bill in a grown up manner, the outcry was pretty large considering a free-at-the-point-of-use NHS was retained…I don’t, even with “thin end of the wedge” arguments, see the public opting in to a paid model any time soon.

And remember: The tenets this bill are built on is patient care. It is a legal duty for the Sec of State to improve healthcare, if those GP surgeries are falling behind…waiting times getting worse, satisfaction dropping, then the state has a duty to not stand by and let it happen, to do so is breaking the law.

15. the a&e charge nurse

[13] ‘I don’t, even with “thin end of the wedge” arguments, see the public opting in to a paid model any time soon’ – the one thing we have learnt from the Health & Social Care Bill is that it is virtually irrelevant what the public want – the agenda is being set by lobby groups for the health conglomerates.

No more top down reorganisations ….. ha, ha, ha, ha
http://www.youtube.com/watch?v=nH2EmVGowCk

16. the a&e charge nurse

“NHS franchising: the toxic world of globalised healthcare is upon us”
http://www.guardian.co.uk/commentisfree/2012/aug/27/nhs-privatisation-toxic-world-healthcare?INTCMP=SRCH

@7 – true, but the gullible public will still be scratching their heads, even when the first set of charges are being announced.
I wonder if the invoices will have blue NHS logos on them?

Lee Griffin you are delusional. They could not go from State run NHS to American model in one go. The first thing was to kill off all State run services. And that is what will now happen over the next 10 years. All hospitals and GP services will pass, by stealth to the private sector. Even if local people don’t want it. (tory choice for you)

Already Branson is using the (cearfully worded bill drawn up by the tories private masters) to challenge existing NHS services under the ruse of predatory pricing. Yes , that is right, a private company is suing a state run service because it is cheaper than the private sector. Once all this is in private hands, it will be much easier to just shut off the state money. And tell people to buy insurance.

The only way they could push this through , was by lying. Not in tory or lib dem manifestos. or Coalition agreement. And you have the nerve to talk about Labour acting in a grown up manner. I take it you support lying politicians.

You lib dems are morons. your naivety is mind blowing in a so called serious political party of govt. you have been played like a piano by the tories. On health, on voting systems referendums. Yet you can’t see it. Or are too stupid to see it.

18. the a&e charge nurse

“How the NHS was lost” and other gloomy tales of why SERCO and their ilk will lower health care standards
http://www.nhsca.org.uk/docs/newsletters/sept2012.pdf

10 Gastro: “French hospitals are 62% public owned, plus 18% by mutuals.”

What matters to patients are whether French hospitals are centrally micromanaged, as in Britain, and the extent to which patients have a choice of hospitals and clinics.

Shortly after Frank Dobson was appointed the first New Labour health minister, I had occasion to visit my GP who prescribed some medical tests. I asked if I could go to the nearest hospital but he said that was no longer an option as the new minister had decided that the GP’s surgery belonged to a different catchment area so I had to attend the more distant hospital appropriate to the surgery’s catchment area.

Fortunately, choice has recently been restored to patients although, for reasons of continuity and habit, I still attend the hospital to which I was allocated under the Dobson regime, which was explicitly intended to outlaw competition in healthcare provision. As it happens, that hospital is now under extreme pressures to make “efficiency savings”, including the closure of its A&E and maternity units as well as the associated children’s hospital and other measures to reduce the quality of patient healthcare.

A few months back, a friend with a malfunctioning heart pacemaker and a defibrillator went to then still open A&E unit at the hospital on a Saturday evening but was turned away and told to see her GP on the following Monday. On returning home, she phoned her GP on the Saturday night who ordered another ambulance to take her to a different hospital with a specialist cardiovascular wing. Fortunately, she survived to relate her experience.

According to this survey by a Swedish healthcare think-tank, the NHS ranks as mediocre by European standards:
http://www.healthpowerhouse.com/files/Index-matrix-EHCI-2009-090917-final-A3-sheet-substrate-5.pdf

The NHS rated at 14 out of 33 countries covered in the survey.

By media accounts of salary surveys a few years back, NHS clinicians were the best paid in Europe.

@ Lee – there are already a substantial amount of people with private health insurance.

No further bill is necessary. In a tight financial climate and increasingly ageing population waiting lists are inevitably going to get longer – we are seeing it with hip and knee ops already. Furthermore with “value based pricing” (a processs extremely open to abuse) on the way to add to existing internal markets the scene is already set for a major growth in private healthcare. No new bill is needed – merely an acceleration of current trends.

With increasing private healthcare and ever limited resources (workforce being just as much an issue as money) it will be increasingly the case that the nhs will just end up with overstretched a+e , limited planned treatments and overworked gp surgeries for the poor.

21. gastro george

@Bob B

My first comment was only replying to your statement: “What France doesn’t have is a state-run virtual monopoly of healthcare provision. The hospitals and clinics are independent of state control.” … which is transparently untrue.

Certainly the French have much greater choice than we do, and the UK system is remarkably inflexible in this respect – that is a systemic problem with GPs being allocated the role of gatekeeper in the system.

But we have to be very careful when we discuss the concept of choice in all public policy matters. “Choice” is far too nebulous a term to convey enough meaning. The US has “choice” – but it’s not much choice if you don’t have health insurance. “Choice” in the UK will still not exist under the new system – the GP groups will still act as gatekeepers and you will be restricted by the contracts that they sign.

The important thing is to have universal coverage *and* a decent infrastructure for delivering it. The NHS can certainly improve in a number of areas, but I’m not foolish enough to think that current policy is designed to do anything other than open the door to profit extraction by the private sector.

Gastro

What matters to patients is whether they have choice of hospitals or are obliged – as I was under New Labour with Dobson running the NHS – to attend a particular hospital at the dictation of the state because Dobson personally disapproved of competition in healthcare.

Post-Dobson, New Labour first introduced the status of Foundation Trust Hospitals, which are all supposed to be financially viable by 2014 as well as independent of central direction, the status that French hospitals have. Failing financial viability, a hospital is at risk of being handed over to private sector management – a fate awaiting the local hospital I attend if it can’t get its running deficit down.

“But we have to be very careful when we discuss the concept of choice in all public policy matters. ‘Choice’ is far too nebulous a term to convey enough meaning. ”

C’mon. That’s sophistry. I can walk down a road in France and drop into any GP surgery with a nameplate, to seek advice during posted visitng hours. I will usually pay a fee but French citizens can recover most or all of that from state social insurance plus any corporate, occupational and private cover a patient has. In principle, there is a choice of hospitals and clinics to attend although that may be limited in practice outside the main population centres. The extent of choice is clear.

By reports, hip and knee replacement operations are being rationed in the NHS – thank heavens I had my hip ops just in time – but that by itself doesn’t imply the NHS is being “privatised”. I know from friends that NHS operations with sufficient medical priority are still going ahead. The fact is that even under New Labour, there was a postcode lottery in healthcare, a national system was a myth in practice, hence this:

“An atlas published by the Government that maps variations in health spending and outcomes across England has highlighted some significant regional differences including amputation rates among diabetics. . . .

“Amputation rates among diabetics showed one of the most striking variations. Data revealed that the amputation rate for patients with Type 2 diabetes in the South West (3 in 1000 patients) is almost TWICE the rate in the South East. The Charity Diabetes UK was also concerned that the data showed less than half those with the disease (Types 1 and 2) had received nine key healthcare checks.”
http://www.mddus.com/mddus/news-and-media/news/november-2010/nhs-variation-atlas.aspx

23. the a&e charge nurse

[22] France may not be the health nirvana you suggest – since you seem interested in care for those with diabetes maybe you have a view on this?

“France is gearing up for a report on one of the country’s biggest medical scandals of recent years. French health experts now believe that the drug known as Mediator, developed for treating overweight diabetics, could have killed between 500 and 2,000 people before it was finally banned. Mediator stayed on the market despite a succession of warnings over its side-effects”
http://www.bbc.co.uk/news/world-europe-12155639

Come to think of it wasn’t the ‘PIP’ implant a French product?
Last I heard 30,000 French woman were advised to remove the dodgy breast implant – 2,700 complaints have been filed against Jean-Claude Mas.

24. gastro george

@Bob B

I kind of struggle to understand what you’re trying to say. If you think that the Tories’ policy is going to lead to anything approaching the French system, then you’re wrong. The similarities with the US are much closer.

23: “France may not be the health nirvana you suggest – since you seem interested in care for those with diabetes maybe you have a view on this?”

I certainly have a view based on extensive personal experience over the past eight years. On being diagnosed, to my immense surprise, with Diabetes 2, my GP prescibed Avandamet (rosieglitazone + metformin), which is now widely banned in Europe and N America. After about a couple of years on that, the local hospital consultant said I should never have been on that drug as it is a recognised cardiac risk. Instead, he prescribed pioglitazone. That failed to control blood glucose levels so, after a year, I was put on long-acting insulin at a low dose.

Last year, it emerged that pioglitazone carries a bladder cancer risk. I’m now on a sufficiently high dose of long-acting insulin to maintain relatively acceptable blood glucose levels but before getting there, I’ve had to almost literally fight off two separate proposals to prescribe Exenatide instead of insulin. The reason I was so averse to Exenatide was after taking the precaution – because of past experience – of doing a google search only to discover official FDA warnings about potential side effects from Exenatide, ranging from frequent nausea through to acute pancreatitis. My concerns about Exenatide arose from what I had discovered on the internet, not from any warnings from clinicians about potential side effect risks. I made it emphatically clear that I wasn’t going to have Exenatide and spelt out all the reasons why with the drug names. I’m sure some clinicians regard me as an awkward codger.

What conclusions do you think I should draw from that experience – given a career before retirement of a policy wonk who believes in evidence-based policy? Frankly, I’m not impressed. The narrative gets worse. Months before I was diagnosed with diabetes 2, I had a heart attack, fortunately in retrospect it turned out to be a relatively mild one. Because of that, I was put on a regular daily course of Simvastatins to control cholesterol. Diabetes 2 is now recognised as a potential adverse side effect of medium to high dose Simvastatins as best I can tell from internet searches. It is now impossible to discount the possibility that my diabetes is a consequential side effect of taking Simvastatins.

I laugh sardonically when I read of adverse comparisons between the rigors of “medical science” and the “unscientific” character of economic analysis.

Apologies to any readers who find accounts of personal medical histories tedious. Talking this through with friends led to a consensus conclusion that clinicians are too often cavalier about the side effects of medication they prescribe.

24. Yes. The tories who bang on about the French system are deluding themselves. The tory party wants us to become the 51st state of the US. That is the model they have their eyes on. Too early to bring in right now but the private insurance model is their aim. The reason? The public pay more and the rich get tax cuts. Big tax cuts. Oh and more is owned by the private sector. Tories hate democracy. Their aim is to put everything in the hands of a few rich corporations and individuals. Oh and of course union busting. I’m sure being in a union won’t be tolerated once the private sector runs the NHS. Same with education. Destroy the unions and you defund the left. Which is why the Right in America is pushing so called right to work states. It’s all about destroying any notion of democracy.

The American private insurance is a terrible system and very expensive with ludicrous amounts of waste. And if you think health care is rationed now, wait till an insurance company is the go between. And enjoy trying to negotiate with a corporate institution when you are gravely sick and need drugs.

For Cancer press 1, for hip, and knee press 2, For an existing claim press 3. While you wait we will play you Vivaldi. But we do value your custom.

The number of people in US who face bankruptcy when insurance won’t pay out is frightening. But hey Nick Clegg is deputy Prime Minister and that is all that matters to lib dems.

Gastro: “If you think that the Tories’ policy is going to lead to anything approaching the French system, then you’re wrong. The similarities with the US are much closer.”

I just don’t believe that claim – which is long standing NHS propaganda. Extensive healthcare stats are available from OECD. Unfortunately, for private, retired folk like me, the stats are hidden behind costly pay walls but academics and professional journalists have access through institution subscriptions.

What is widely known is that the US spends about the same percentage of GDP on public healthcare as we do and then spends a similar percentage on private healthcare on top of that.

In other words, as a percentage of national GDP, America is spending twice as much on healthcare as a percentage of GDP as we do. For all that, average life expectancy at birth is lower in America. The average infant mortality rate is scandalously high for an affluent country.

Before the Obama healthcare reforms, 46 million Americans had no personal healthcare cover (American figures). Unpaid medical bills were reportedly the largest single reason for personal bankruptcy in America. Prescription drugs are known to be exceptionally costly in America – there is an extensive illicit export trade in prescription drugs from Canada, except that no prescriptions are asked for. When I frequented American forums online, I used to get a steady daily stream of emails from Canadian sources advertising drugs for sale. This is obviously highly dangerous apart from breaches of patents etc.

All that and more is widely known among journalists and academics specialising in healthcare economics while I have only amateur status. For the last 50 years to my knowledge, NHS protagonists have been having it that the American system is the only alternative to the NHS.

That is a patent lie as we can tell from excellent national healthcare systems in other west European countries. Bismark, the first chancellor of the German empire, launched a social insurance scheme for personal healthcare csosts in 1883. He was not “left wing”. He also introduced a state pension scheme. These beginnings of what became the European social market economy long preceded the beginnings of Britain’s welfare state. We just don’t want to admit that or even to know about it. Ignorance is Strength. We are fixated on the “Not Invented Here” obsession.

” it will be increasingly the case that the nhs will just end up with overstretched a+e , limited planned treatments and overworked gp surgeries for the poor.”

Yet this bill, for the first time as far as I’m aware, puts a legal obligation on the state and it’s bodies to not allow that to happen. As I said, patient care and satisfaction is the primary factor against which the NHS is measured. If the state is knowingly letting the NHS get over-stretched then it is acting illegally, failing in their duty.

The question is how people will use this situation, and the balance of where the state is “attempting” to make things good despite failing. I’d say that if funding is being cut despite evidence that it’d impact on patient care, or that no action is taken to rectify lengthening waiting lists, that patient groups would have plenty of grounds to claim against the government.

29. the a&e charge nurse

[28] “I’d say that if funding is being cut despite evidence that it’d impact on patient care, or that no action is taken to rectify lengthening waiting lists, that patient groups would have plenty of grounds to claim against the government” – how would this actually work in reality (claims against the government by, lets say, an 80 year old who can’t get her hip replacement).

Lets reconsider how the bill came into being.

First of all Dave or Nick fail mention (in their party’s manifesto) that they plan the most significant shake up of the countries health care system since 1948 – in fact Dave appears on youtube chortling that there will be no more, pointless top down reorganisations of the NHS.

When the bill finally begins to take shape there is virtually no support from it from any professional body responsible for providing health services, perhaps because it is rich in ideology yet practically evidence free.

The bill finally runs to 3,000 pages and requires over 1,000 amendments – a dogs dinner that not even the finest legal minds will be able to make sense of.

The early signs are that the likes of SERCO will only reduce costs by reducing standards of care – presumably the coalition must recognise that this pattern will play out across the country?
http://www.guardian.co.uk/society/2012/sep/20/serco-nhs-false-data-gps

Why are you such a champion for this bill when so many others fear it – I mean, could you summarise the main benefits that will arise for patients once SERCO, and other private companies have really hit their stride?

Try the editorial in the periodical of the British Medical Association, the BMJ, on 22 January 2011:

“What do you call a government that embarks on the biggest upheaval of the NHS in its 63 year history, at breakneck speed, while simultaneously trying to make unprecedented financial savings? The politically correct answer has got to be: mad.”
http://www.bmj.com/content/342/bmj.d408

31. gastro george

@Bob B

So let me decode your argument.

1. The NHS is imperfect and specifically offers inadequate “choice”.
2. France has a better health service and offers more “choice”.
3. The US has a worse health service but offers more “choice”.
4. The Tories say that their policy will improve the NHS and offer more “choice”.

None of this is controversial. And I would agree that it would be desirable to improve the NHS in many respects, in some of those towards a system similar to that implemented by the French.

But then, irrespective of the actual design of the changes in terms of organisation and contractual relationships, you deduce that the changes are a good thing, rejecting opposition on the basis that it is NHS propaganda.

A specific question to you: Do you believe that current Tory policy will bring us closer to a French system or a US system?

Gastro: “But then, irrespective of the actual design of the changes in terms of organisation and contractual relationships, you deduce that the changes are a good thing, rejecting opposition on the basis that it is NHS propaganda.”

That is a glaring non sequitur. Check out my quote from the BMJ in January 2011 @30.

There is no reason to suppose there is an undisclosed political intention to transform Britain’s system of healthcare into the dysfunctional American model. As an economist, since the late 1950s, I’ve sometimes read or dipped into occasional monographs on our healthcare system and texts on public policy economics.

The policy option regularly presented to readers has been between the NHS and the American market system. Only in the last decade or so have there been studied comparisons with healthcare systems in other west European countries, which have come out well from the comparisons.

It is manifest nonsense to suggest the American system is the only feasible alternative to the NHS – so I have come to deeply suspect the academic integrity of those writers who have conveyed that impression to a readership that was largely ignorant about the range of European alternatives. Mainland European electorates are not stupid and have much the same concerns about personal healthcare issues as has the British electorate.

Try this:

Almost 12,000 patients are dying needlessly in NHS hospitals every year because of basic errors by medical staff, according to the largest and most detailed study into hospital deaths ever performed in the UK.

The researchers from the London School of Hygiene and Tropical Medicine and colleagues found something went wrong with the care of 13 per cent of the patients who died in hospitals. An error only caused death in 5.2 per cent of these – equivalent to 11,859 preventable deaths in hospitals in England.

Helen Hogan, who led the study, said: “We found medical staff were not doing the basics well enough – monitoring blood pressure and kidney function, for example. They were also not assessing patients holistically early enough in their admission so they didn’t miss any underlying condition. And they were not checking side-effects… before prescribing drugs.”
http://www.independent.co.uk/life-style/health-and-families/health-news/doctors-basic-errors-are-killing-1000-patients-a-month-7939674.html

Much has been made of excessive bureaucracy in the NHS. Two personal experiences in recent years:

In August 2007 I received a letter from the Pathology Department in the local hospital I attend requesting that I return to enable them to take another blood sample as insufficient had been taken for my recent blood test. That seems innocuous enough until I checked to discover that the “recent” blood test had been in the previous April. It took the Pathology Department from April to August to appreciate that it had insufficient blood to complete the prescribed tests. Fortunately, the tests weren’t critical.

In October 2010, just prior to my first hip operation in another hospital, I was presented with a surgery consent form which specified the wrong hip. A little googling established that this is not as uncommon error as might be hoped for – I can post citations.

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“Almost 12,000 patients are dying needlessly in NHS hospitals every year because of basic errors by medical staff, according to the largest and most detailed study into hospital deaths ever performed in the UK.

The researchers from the London School of Hygiene and Tropical Medicine and colleagues found something went wrong with the care of 13 per cent of the patients who died in hospitals. An error only caused death in 5.2 per cent of these – equivalent to 11,859 preventable deaths in hospitals in England.”

What are the figures for other European and north American health systems?

34. gastro george

@Bob B

“It is manifest nonsense to suggest the American system is the only feasible alternative to the NHS …”

Which is exactly what I wasn’t doing.

What I am suggesting is that there *should* be changes but that when considering change we need to analyse the “actual design of the changes in terms of organisation and contractual relationships”.

So I ask you to do that and I repeat:

“A specific question to you: Do you believe that current Tory policy will bring us closer to a French system or a US system?”

Tell us your analysis of this.

It seems to me that you think that some change, any change, will result in the change that you’d like to see. That seems to be indulging in a lot of wishful thinking.

Planeshift: “What are the figures for other European and north American health systems?”

I’ve no idea and would need to search for comparable research studies. The personal experiences that I’ve had have made me especially aware of the chances of NHS errors so I tend to consider carefully prescriptions and treatments, do google searches and document citations.

Some clinicians probably regard that as a pain but it’s a rational response to experience. One worry is that a percentage of healthcare professionals – as well as any other kind of professional or worker – tends to regard anyone obviously aged as verging on senile regardless. That is immensely irritating, especially when the other party isn’t too sharp or isn’t up to speed on their homework. I’ve been recommended to take NSAIDs painkillers when there is much reported evidence on the web of a cardiac risk from NSAIDs drugs if taken long term.

GBS wrote somewhere about professions being conspiracies against the laity. My impression is that healthcare professionals are particularly disposed to engage in such conspiracies so they obfuscate and patronise.

“First of all Dave or Nick fail mention (in their party’s manifesto) that they plan the most significant shake up of the countries health care system since 1948 – in fact Dave appears on youtube chortling that there will be no more, pointless top down reorganisations of the NHS.”

Irrelevant in the grand scheme of things. Politicians say things to get elected, shock horror.

“When the bill finally begins to take shape there is virtually no support from it from any professional body responsible for providing health services, perhaps because it is rich in ideology yet practically evidence free.”

Because, certainly at the time of the first drafts it was not protecting patient care, it had very grave issues. The “time to pause” was necessary because the bill was, at that point, utterly flawed.

“The bill finally runs to 3,000 pages and requires over 1,000 amendments – a dogs dinner that not even the finest legal minds will be able to make sense of.”

It’s complicated, yes. I think you’re being more than slightly hyperbolic though.

“The early signs are that the likes of SERCO will only reduce costs by reducing standards of care – presumably the coalition must recognise that this pattern will play out across the country?
http://www.guardian.co.uk/society/2012/sep/20/serco-nhs-false-data-gps

Probably, but the bill states that all care provision must be measured against care quality, care perception and care outcomes. Money isn’t something that is measured against, hence saving money isn’t a reason to make changes. As I say, it’s up to people to make the government stand up to their own laws.

“Why are you such a champion for this bill when so many others fear it – I mean, could you summarise the main benefits that will arise for patients once SERCO, and other private companies have really hit their stride?”

I’m not saying everything is going to be rosy, the proof of this bill’s chops is going to be in people using it to legally challenge the changes being made using the bill as a basis for basic standards of provision.

If courts come down on the side of government when service cuts mean that patient care, quality, and outcomes have all nose dived then it’ll be more than clear the bill doesn’t do what is required of it and allows politicians to pay mere lip service. If the courts come down on the side of the people then there is a legal requirement as well as public mandate to stop the situation of cuts that cause lesser care, and to reverse it.

There is plenty to dislike about the bill, but simply sitting around complaining about privatisation isn’t the way forward. If patient care is failing, private or otherwise, the bill sets out the framework to stop negative changes.

Personally I don’t understand how privatising elements of the NHS can result in better care, but that’s a very simplistic “if you need to make profits, then you can’t be spending as much” analysis that no doubt fails to take in to account productivity and technological changes. The professionals were against it, which is as good a reason not to have supported it as any.

But we have what we have, and if people are saying care is being degraded, use the bloody law already, don’t just sit around waiting for Labour to repeal it (lol).

34 Gastro: “A specific question to you: Do you believe that current Tory policy will bring us closer to a French system or a US system?”

I think there is little to no prospect of Britain ending up with the dysfunctional American healthcare model as too many informed professionals are aware of its drawbacks, especially its costs.

I do think there is the possibility of moving towards some variation of the social insurance systems of other west European countries as NHS hospitals gain Foundation Trust status, as they must by 2014.

A more immediate cause for concern is the pressure to force 15pc to 20pc “efficiency savings” in the NHS over the next four to five years, which is already affecting patient care and introducing rationing of some treatments. Young aspiring professionals are starting to take out regular private healthcare insurance at the beginnings of careers.

I’ve strong reservations about the incoming system for GP Commissioning. Under the outgoing system, if I want to complain about treatments by my GP or a hospital, I can call up the Primary Care Trust (PCT) and ask them to intervene or post a complaint to them. What do I do under the new system, which abolishes PCTs and puts local GPs as judges in their own cause?

Try this from The Spectator in November:

Tory MP and GP Phillip Lee made a striking call this morning for patients suffering from lifestyle-related diseases such as type 2 diabetes to pay for their prescriptions as part of a larger shake-up of the NHS. He was speaking as part of a series of presentations from members of the Free Enterprise Group ahead of next week’s Autumn Statement on their proposals for spending cuts which would allow George Osborne to meet his target of having debt as a proportion of GDP falling by 2015/16.
http://blogs.spectator.co.uk/coffeehouse/2012/11/make-people-with-lifestyle-related-illnesses-pay-for-their-drugs-says-tory-mp/

Why single out type 2 diabetes when that is a recognised side-effect risk from taking Simvastatins? What of cases of drug addicts, heavy drinkers or smokers who develop chronic health conditions? Are they to be denied treatments unless they pay up?

A hysterical claim that we are going to have American healthcare thrust upon us is crowding out important debate about more subtle issues. It would be more illuminating to look into the detail of healthcare systems in other west Euroepan countries to see what can be learned.

The privatisation issue is just a silly distraction – GP practices are private businesses and always have been. Why does it matter for patient outcomes if the NHS buys in treatments from the private healthcare sector? What matters is whether the private sector can deliver quality care within NHS cost limits and to NHS oversight. There is enough evidence to justify substantive concerns about the quality of NHS care.

NB The French do spend more, but the French state does not spend that much more: 9.2% of GDP versus UK 8.2% (OECD data 2009).
They spend an additional 2.6% privately while we spend 1.6%.
Much of that difference comes from the small (25 euro?) charge to see a GP equivalent, plus a small daily charge (20 euro?) for hospital stays.
We will head that way. Hardly a matter for hysteria.

@36. Lee Griffin: “Personally I don’t understand how privatising elements of the NHS can result in better care, but that’s a very simplistic “if you need to make profits, then you can’t be spending as much” analysis that no doubt fails to take in to account productivity and technological changes.”

There are an awful lot of public services that cost a lot of money. There are lots of people who proclaim that those public services can only be provided by spending more money. It is a recipe for failure; at some point there won’t be more money.

The coalition government health care reforms are grubby and, at best, nibble a few pounds off the bills. They stave off the moment when government looks at the books and declares “we can’t afford it”.

Piecemeal or wholesale delivery of health care by private companies won’t fix the problem. All that those companies do is what other successful companies do: specialise in what they do best, use resources efficiently, buy cheaply. Private companies copy best practice; good managers in the NHS do the same.

“Best practice” has limits and sometimes new ways have to be created. I don’t think that this set of government changes will deliver new ideas. I am 100% certain that carrying on as if there is no problem will end up on the buffers.

Lee: “The professionals were against it, which is as good a reason not to have supported it as any.”

Nowt useful gets determined when those with a vested interest set the terms of debate.

40. gastro george

@Bob B

“I think there is little to no prospect of Britain ending up with the dysfunctional American healthcare model as too many informed professionals are aware of its drawbacks, especially its costs.”

And yet you dismiss opposition to the Tory plans from these same informed professionals.

Lee Griffin (Lib Dem apologist) “Irrelevant in the grand scheme of things. Politicians say things to get elected, shock horror.”

WOW, I mean WOW. So there you have it folks. The Lie Dem philosophy in a nutshell. “We are going to lie, and lie, and lie, and who cares.” Not about something smal mind, but the total prioritization of the NHS.

Lee Griffin (Liberal Dem apologist) “Irrelevant in the grand scheme of things. Politicians say things to get elected, shock horror.”

WOW, I mean WOW. Well there you have have it folks. The Lib dem philosophy in a nutshell is this “we are going to lie and lie and lie” Not about something small, but something massive like the selling off of the NHS. They have already lied on the education pledge, now health. They deserve nothing but contempt for the lies and brazen way they boast about it.

And people complain when I call them Lie Dems. But you just heard it from the horses mouth. What is even more shocking is for years the Lie Dems have tried to portray themselves as more honest than the other parties. But now we know a Lie Dem manifesto is worth nothing more than a packet of bog roll. In fact the bog roll is more honest and more useful.

Lie dems really are human vermin. I hope they continue to lose their deposits, and be thrown out on the lying scummy ears. I hope Nick Clegg knocks on my door and asks for my vote. Because I will punch him in the face.

Gastro: “And yet you dismiss opposition to the Tory plans from these same informed professionals.”

That is complete nonsense. The whole point of my quoting the editorial in the British Medical Journal of 22 January 2011, with link, @30 was to show how critical the BMA is of the government’s proposals for the upheaval in the NHS. The quote from the BMJ was:

“What do you call a government that embarks on the biggest upheaval of the NHS in its 63 year history, at breakneck speed, while simultaneously trying to make unprecedented financial savings? The politically correct answer has got to be: mad.”

On the evidence, you seem incapable of following the debate. The NHS is deeply flawed IMO, for the reasons explained, but it doesn’t follow from that position that I support the government’s proposals. Try the analysis @37. The expressed position of the King’s Fund was that the NHS should be allowed time to implement “efficiency savings” to improve productivity before going through massive structural change.

@42. sally: “Lie dems really are human vermin.”

The word “vermin” is difficult to define but “an animal that is annoying to humans” is apt. Consequently “human vermin” is an unhelpful description. In similar spirit, I do not define the local foxes who fuck in my garden as “neighbours”.

Charlieman

There are important subtle issues at stake in reforming healthcare provision so it would be sad if we take heed of abuse and hysterical claims. Heaven knows, from personal experience there are reasons enough for worrying about the state of the NHS. I think we might learn much from researching healthcare systems in other west European countries. On the evidence of independent surveys, those alternative healthcare systems seem to attract greater expressions of customer satisfaction than the NHS.

This privatisation bug seems to generate more heat than light. It seems to get overlooked that GP practices are private businesses.


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  1. Liberal Conspiracy

    2012: how the NHS became privatised and the impac that's had http://t.co/IoVli9z3

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  8. Patricia Farrington

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  9. Rick

    Here's the most important story of 2012, that happened under our noses. Be ashamed we let this happen http://t.co/oJcYTcBq

  10. Brian Kellett

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  11. Mike the Moustache

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  12. Mr Villiers

    Here's the most important story of 2012, that happened under our noses. Be ashamed we let this happen http://t.co/oJcYTcBq

  13. hamadks3

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  14. Lady Bertilak

    wonder if this is a model for the Tories here? “@libcon: 2012: how the NHS became privatised and the impac that's had http://t.co/dHVwQ0If”

  15. Alex Nunns

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  16. diana smith

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  17. Kate McKenzie

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  18. Patricia Farrington

    Alex Nunns @alexnunns: How the NHS became privatised and the impact that has had #NHS #SaveOurNHS #RepealTheAct http://t.co/XHsnLS1G

  19. SantaEmu

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  21. Noodleclaus

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  22. Sarah

    Something we should all read: NHS Privatisation. Especially the comments, some good views there http://t.co/ZuG9HEvm

  23. Abu-Sultan Bakr

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  25. Marion Cromb

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  26. Chris Webber

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  27. Chris Webber

    I am inclined to agree with @RoyLilley . All accurate but its in the language. Interesting perspective however. http://t.co/5KbnKt8W

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  32. Carole Ford

    2012 in review: How the NHS became privatised and the impact that has had http://t.co/NyEAUxGX < comprehensive overview

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  35. Rose-the-pleb

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  36. NORBET

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  37. Carole Ford

    @iancollinsuk 2012: how the NHS became privatised and the impact that has had | http://t.co/8B9JRx5Z via @libcon
    Another difference #NHS

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    2012: how the NHS became privatised and the impac that’s had http://t.co/wJFMHJa5

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