The NHS will be quietly privatised from April 1st, but the media ignores it

1:05 pm - March 24th 2013

by Sunny Hundal    

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The British Medical Journal has published an extraordinary (and scary) interview about how the NHS is being quietly privatised from 1st April 2013.

The BMJ is doing the work that hardly any media organisation in the UK is doing – informing us of upcoming changes to the NHS in a clear way.

Here are the key excerpts from the full interview.

Now those regulations [section 75] are with us, and those regulations provide the jet engines to make that privatisation go ahead. So all of the rest of the plane was put in place last year, and now at the very last minute before this whole thing happens on 1 April 2013 the regulations are coming into place to show that everything has to be put out to competitive markets by CCGs [clinical commissioning groups] and the national commissioning board. That will create rights for private providers to supply which will not only allow them to take quite a lot of the share of the NHS budget for their business right now, it also potentially makes the privatisation irreversible in the future.

LUCY REYNOLDS: We’re not going to have a big bang privatisation for the NHS. We’re going to have a very quiet one.

What has happened is that all of the rules that control health financing have been gradually changed since the New Labour times. Overall, we now have the NHS reorganised in such a way that it can be relaunched as a mixed market, so not just the public health sector service, but also a healthcare industry. The rules are structured in such a way that there will be a gradual transition between those two groups. The public sector will shrink away, and the private sector will grow.

But because there will never be an announcement in parliament that the NHS is privatised, and because the private providers will be allowed to use the NHS logo for anything that they are getting NHS funding for, it is very likely that the general public will not be aware that the private sector has in fact come in and taken over whatever bits of the NHS it finds profitable until probably service provision gets fairly bad.

LUCY REYNOLDS: Well, it sounds like a good idea to have diversity and options and these kinds of things, and that would be fine if it weren’t for the fact that the rules of the market are thoroughly stacked. We know for certain that organising [healthcare] as a public sector service is the cheapest and most effective way of providing healthcare. And that is broadly because the market model does not fit healthcare. The market model includes assumptions that both parties are in possession of all information about the subject of the transaction. In markets where the consumer has to rely upon the supplier for guidance, what you get isn’t a market that clears down to a minimum price and is efficient. What you get is soaraway inflation and abuse within that market.

It’s utterly shocking that the national media (including the BBC) is ignoring all these huge changes coming over the next few weeks.

Lucy Reynolds adds that she expects a lot of public providers to go bust, as public providers that get passed over for contracts are shut down because a private provider has slightly undercut them. And what happens if it turns out that the private provider offers you a worse service?

They don’t exist any more. So you’re stuck with a worse service… and those companies are free to raise their prices later if needed.

Read the full interview here

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About the author
Sunny Hundal is editor of LC. Also: on Twitter, at Pickled Politics and Guardian CIF.
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Reader comments

1. the a&e charge nurse

Here is the full interview with Lucy Johnson setting out the road to NHS privatisation

GP practices are mostly small busineses and have long been so. Privatisation of healthcare services is therefore no very big deal.

What really matters is the quality of patient care and we need monitoring statistics to identify bad cases of patient care – as exemplified by the NHS Mid Staffordshire Hospital Trust.

I’m more worried about the imminent abolition of the NHS Primary Care Trusts at the end of March as these had a monitoring function and acted as intermediaries for patient complaints about their GPs and care in local hospitals.

The scandal of what happened at the NHS Mid Staffordshire Hospital Trust was a clear demonstration of how the public sector could woefully fail to deliver patient care. What sanctions are there to deter this? Fining the Hospital Trust simply means that there is less for the Trust to spend on patient healthcare.

In the news on Sunday is this, which seems far more important an issue than privatisation of healthcare:

The head of the Royal College of Nursing has warned of a major health risk to patients as it emerged that 5,000 nurses have left the NHS since the coalition government came to power, while nearly 6,000 lower-paid and less well-qualified healthcare assistants have been taken on since 2010. The figures fuelled fears that cheap labour is being sought to plug holes in services.

3. the a&e charge nurse

‘It’s utterly shocking that the national media (including the BBC) is ignoring all these huge changes coming over the next few weeks’ – yes, and it seems slightly shocking that some of the regular LC crew have also failed to understand the endgame.

Why the double-standards?

what has happened to the BBC? does the entire board have shares in health care profiteers? why has it stopped serving the public?

What matters to patients is the quality of the healthcare in prospect, not whether the provider is in the private or the public sector. It wasn’t any comfort to the elderly victims of the appalling healthcare at the Mid Staffordshire Hospital Trust to know that it was a fully-fledged NHS hospital in the public sector hell-bent on meeting its official NHS targets regardless of the consequences for patients.

This was a news item in my local press a few days ago:

Croydon University Hospital is one of the worst in the country at meeting patient needs, according to a new report.

Only six hospitals in the UK were rated worse than Croydon’s by consultancy MPH Health Mandate, which ranked NHS trusts according to patients’ priorities.

The report, published last week, placed Croydon 140th out of 146 hospitals for overall performance. . .

St George’s in Tooting was the only hospital in South-West London to fare worse than Croydon.

It happens that the NHS Croydon University Hospital is the closest hospital to where I live although it is not the hospital I go to when I need to. The closest regional hospital for really serious acute cases is the NHS St George’s Hospital, Tooting, which is a medical school.

On the reported evidence, I’m unclear as to why I should believe NHS hospitals are indisputably wonderful.

I don’t understand why this is ‘irreversible’ privatisation. If the govt can rush through a bill literally rewriting the law around workfare, as it did this week, surely nothing is irreversible?

“If the govt can rush through a bill literally rewriting the law around workfare, as it did this week, surely nothing is irreversible?”

In what passes for Britain’s constitution, Parliament is sovereign and no Parliament can bind its successors. But what can be achieved through new legislation is constrained by what is practicable. For most of our healthcare needs, we reply on GPs running private businesses. No one is seriously proposing to nationalise GP practices even if that would be within the legislative power of Parliament to do so.

“For most of our healthcare needs, we rely on GPs running private businesses.”

You say this like it is a given but why? Since when is this the case and why is it a good thing?

Violet: “You say this like it is a given but why? Since when is this the case and why is it a good thing?”

I’m just stating the facts of life. GPs have always resisted being taken into public ownership and no government has attempted to change that.

There’s nothing especially reassuring about the public ownership of healthcare provision in Britain.

Patient outcomes as measured by cancer survival rates are not as good as those in the national heathcare systems of most other west European countries, average life expectancy at birth in Britain is marginally lower and independent surveys of patient satisfaction in W European countries show the NHS to be at best middling. We have far fewer physicians per head of population than in France, for example.

For a collection of healthcare indicators in OECD countries, try this:

The scandal of the appalling care of the elderly in Mid Staffordshire Hospital Trust happened in an NHS hospital. There is no point in fining that hospital as that would just cut spending on patient healthcare. Prosecuting the hospital managers or medical directors would simply result in a costly trial where the defendants would say that they were just working to official NHS targets. I doubt a jury would convict in those circumstances. After all, the scandalous lack of care in that hospital continued for years without the central management of the NHS or the care watchdogs doing anything about it.

On the reported evidence, I can’t think of any reason why I should be reassured to know that my local hospitals are part of the NHS and not private. We should look to healthcare systems in other W European countries for models to emulate.

#9 It may be a fact but I’m wondering why this is the best state of affairs.

Underperforming hospitals in the NHS such as North Staffs are a major cause for concern I agree, but my question is why private provision would lead to any better outcomes.

I will have to study the link you gave me in detail, but if the NHS is not performing as well as it could be in general terms (even though public satisfaction with it was reportedly very high in 2010) does this not just mean that it is underfunded and needs more public money?

Exactly how will healthcare improve if the NHS has to spend time and money tendering bids to compete with private companies, with all the extra admin and staff this requires, rather than simply treating patients?

And is it not the case that private hospitals in this country will send their patients to the NHS if they develop complications or need emergency care? What does this say about the quality of the NHS as opposed to private provision? Is the govt not making a massive leap into the unknown by assuming that private companies will provide better A&Es for example?

I am a heavy user of the NHS due to having long term complex rare conditions. I am exactly the kind of person that the private sector would not like to insure or treat. What happens to me in the new world of the privatised health service where profit takes precedence?

Finally if privatisation of healthcare is AOK why did the Tories feel they had to lie about it in the run up to the 2010 election and actually promise the opposite? Why are they bringing it in by the back door now rather than proudly shouting about it?

If you say it often enough, people begin to believe it. ‘There’s nothing especially reassuring about the public ownership of healthcare provision in Britain.’
Yes there is. The understanding that there is health support when needed and paid for via taxation and run for the public good, not private gain is reassuring. Mid Staffs could have been prevented early on if the old CHCs were in place. But using Mid Staffs as an example to show the NHS as being in crisis is plainly wrong. 5000 nurses gone and replaced by 6000 health support workers is what to expect in the next few years. Cheaper to employ keeps the cost down, but lowers the quality. As Tesco says. When its gone its gone. That is the fate of both the NHS and the patients. Private health companies like Virgin have t satisfy share holders. So some of the money given to these private health companies goes to share holders. Better it was used as health care than to boost the share price and dividend.

12. the a&e charge nurse

[9] can you not see the economic and cultural differences between a GP, or small practice who run their own business as opposed to services run by the likes of CareUK, Virgin and Serco?

I mean what is it about the £100 billion health budget that interests the fatcats?

By the way, I think our politicos are definitely listening to their constituents rather than corporate healthy lobbyists.

Correction: The Mid Staffs Hospital Trust was the source of the scandal, not the North Staffs Trust.

NHS hospitals won’t be tendering for commissioning by the new Clinical Commissioning Groups. It will be more a case of patients making choices, with the advice of their GPs, about which hospital to go to – except in cases of emergency when it will be the nearest appropriate hospital geared up to treat with the kind of care needed. That is where the element of competition comes in. If a hospital can’t attract sufficient patient preferences then it will lose commissioning income and that will show up its annual accounts.

With the news in my local press linked @5, I’m likely to avoid those local hospitals although I was in one for a specialist test 8 years ago.

There’s much evidence to show that healthcare systems in other W European countries work better from the perspective of patients. It is not just a matter of how much is being spent – more is spent in total, public and private, on healthcare as a percentage of national GDP in America than in any other OECD country, yet average life expectancy at birth is marginally lower there than in Britain. Prior to Obama’s reform, over 40 million Americans had no insurance cover for healthcare costs. The scandalous Mid Staffs Hospital is an NHS hospital but other NHS hospitals weren’t treating their elderly patients as badly.

The local hospital I do go to when I need to was declared to be ‘the worst in Britain’ in 2001 by the healthcare watchdog – I joke not and can post the link to the Guardian report in August 2001 if this is challenged – but the hospital has improved greatly since: the chief executive as then left, as did the medical director.

12. the a&e charge nurse
I mean what is it about the £100 billion health budget that interests the fatcats?

Can’t be the £100bn.. can it?

This is what we really need to worry about:

More than a third of GPs on the boards of new NHS commissioning groups in England will have a potential conflict of interest, an investigation suggests.

The British Medical Journal analysed 83% of the 211 boards, which will play a key role in from April, and says potential conflicts will be “rife”.

A code of conduct says board members must remove themselves from decisions if they could benefit from the outcome.

The NHS Commissioning Board (NHSCB) says it will issue final guidance soon.

And this doesn’t even address the fact that a large number of people in government have financial interests in private healthcare companies…

17. Juan DeBaptiste

Why is the surrender of the NHS to private markets a bad thing?

Because an accountant somewhere will be plotting a chart of profit vs acceptable number of deaths.

Businesses will always be shaving those numbers to increase profits/win contracts, and the results are obvious.

At least Thatcher was honest about her sell offs. In Cameron/Clegg’s banana republic there is no place for honesty.

Cameron lied to the country when he said there would be no major overhaul of the NHS. Clegg ran on a manifesto that said nothing about NHS privatisation. There is no mention of it in the coalition agreement. There has been a news blackout in most of the media. Even the BBC hardly ever covered it. And when it did claimed it was quite minor and about giving power to the GP’s. A blanket of lies , broken manifesto pledge, and media blackout makes me suspect that the fix was in. They couldn’t do this honestly. Very powerful global elites have decided that health, and everything else must be privatised. No matter if the public wants it or not. So the puppet politicians and the corporate media have ,as usual conspired to keep the public in the dark.

Even the way it has been done is cowardly and typically dishonest. The bidding process is rigged and designed to ensure the private sector wins all the bids. Not surprising as the companies bidding wrote the legislation. But the politicians have even lined up a patsy to take the blame when the public wakes up to find it’s NHS has been stolen from them. The doctors will get the blame because the whole concept has been sold on the basis of minor changes to allow doctors to decide. But the doctors have now awoken from their slumber to find the competitive process means they will decide nothing. It’s classic tory lies on choice. But the choice is all about the rich having the choice.(namely the companies who win the bids) The tories have even inserted a clause that allows the new private companies to use the NHS logo so the public is kept in the dark.

And these companies will come armed to the teeth with corporate laywers and confidentiality clauses to keep the public from knowing what is going on. There is a great myth that has grown up over the last 30 years that ownership doesn’t matter. This myth is pushed by the very people who own, increasing everything.

“Because an accountant somewhere will be plotting a chart of profit vs acceptable number of deaths.”

And all the misery and early deaths inflicted on elderly patients in the NHS Mid Staffordshire Hospital trust were the outcome of the staff there striving to achieve official NHS targets.

The NHS hospital I go to was declared to be the worst in Britain by a healthcare watchdog in 2001. On the evidence, having a publicly funded NHS hospital guarantees absolutely NOTHING about the quality of healthcare patients receive.

What you you think happens in the healthcare systems of other W European countries? On independent international surveys, the NHS is rated as rather mediocre. The pathetic attempt here to demonise private healthcare services is not supported by the evidence – especially since most GP practices in Britain are, in fact, privately owned businesses.

What matters to patients is the quality of healthcare they receive and whether it is free at the point of delivery, not whether it is delivered by a state-owned or private hospital.

20. Derek Hattons Tailor

All doctors, including GPs, are self employed and have been since the start of the NHS. They get paid by a combination of people on their list, number of consultations, operations carried out etc. They are not salaried employees. This is why they are free to work what hours they like and to practice in the private sector simultaneously. It’s also worth saying that the GP as budget holder idea is not new – it was tried by the John Major government in the early 90s.

Try this in the FT filed today: Reforms give doctors control of billions

Compare the BBC report @15 of concerns in the BMJ about conflicts of interest in the local Clinical Commissioning Groups (CCGs).

22. Juan DeBaptiste

Indeed Bob B. when you bring business style targets in to the healthcare industry, that is what results. you prove my point.

It matters to me that it will be in the hands of business – that which makes decisions based on profit rather than need.

We are told the NHS has had all the excesses cut out, so after the fat cat managers and owners of these new businesses have been paid, where are the savings to be made?

It is wrong to assume business automatically knows how to run the NHS, or will deliver the same care for less. Looking after People’s lives is not the same as hamburger production.

23. Derek Hattons Tailor

@ 22 I’m not in favour of NHS privatisation but the reality is that whether you have a state or market system, someone has always had to balance supply and demand of healthcare. The NHS does not have a bottomless pit of money, but it does have potentially infinite demand for it’s services. To balance the two decisions are made – currently by the NICE quango – which involve deciding whose lives are worth more – e.g the cancer drug that will prolong someone’s lives by a few months vs the gastric band that will encourage weight loss. Post Nu labour decisions seem to be made on a spend to save basis, so that millions are spent on various campaigns which might produce theoretical savings against future NHS budgets, rather than the immediate alleviation of need. Some would say this shows the health service has lost it ethos of care based on need (no one “needs” a gastric band) and is in effect trying to operate like a business already.

“It matters to me that it will be in the hands of business – that which makes decisions based on profit rather than need.”

That’s garbage. How do you think national healthcare systems work in other W European countries where, by independent international surveys, patients are more satisfied by the quality of healthcare they get than British patients are?

Don’t tell me that it’s because other W European countries are spending more since America spends about twice as much as a percentage of national GDP on healthcare as we do — roughly the same percentage of GDP is spent on public healthcare there as we do and then about the same again is spent on private healthcare. With all that, average life expectancy at birth is marginally lower than in Britain, where it is marginally lower than in many other W European countries.

Some NHS provision of healthcare services is absolutely rotten – hence Mid Staffordshire Hospital Trust along with the hospital I go being rated in 2001 as the ‘worst hospital in Britain’ by the healthcare watchdog of that time. It was of absolutely no comfort for local people to know it was an NHS funded hospital where care was supposed to matter.

Stop kidding yourselves that care rates more than cost in the NHS. It doesn’t. For starters we don’t have a national system of healthcare, we have a postcode lottery of healthcare in Britain:

“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.”

Through lack of sufficient foresight, I don’t have private healthcare insurance but friends who do tell me they get much better quality of care in the private sector compared with the experience they get with NHS care – their insurance policies restrict how much can be spent on private care in any year.

Private sector providers have a powerful incentive to provide good value in order to attract repeat business and in the hope that their patients will pass on recommendations to their friends.

From a career motto of: Speak truth unto power, I believe in evidence-based policies, not political fantasies.

25. Juan DeBaptiste

The things you speak of again prove my point.

I have no ‘political’ side to bash about, just pointing out my belief that business will not improve things.

I dont have a raft of ‘statistics’ at hand simply the knowledge of what i have seen with the privatisation of several services that has already happened. Profiteering without improvement or real accountability.

“I dont have a raft of ‘statistics’ at hand simply the knowledge of what i have seen with the privatisation of several services that has already happened. Profiteering without improvement or real accountability.”

Like the nationalised coal and steel industries where productivity went down on trend through 1970s? By the end of the 1970s, British Steel was being subsidised at the rate of £1m every day.

I can recall those times when the nationalised BT had a monopoly of the telephone service in Britain – apart from Hull. New businesses had to plead to get a telephone line and then had to wait. Private households were sometimes compelled to share a line – I had that experience until I pleaded special privacy needs. You had to have a clunky BT handset as you weren’t permitted to go out and buy one.

The available evidence shows that other W European countries have better health services than we do. We should look to see why that is.

News update:

More than 60 Mid Staffordshire hospital complaints to Government ignored

Dozens of complaints were made to the Department of Health about Mid Staffordshire hospitals after Sir David Nicholson began overseeing the trust, ministers have revealed.

So much for the supposed benefits of a centrally managed national health service.

As said, let’s have evidence-based policoes, not political fantasies.

28. Derek Hattons Tailor

Bob – That old line about BT is bollocks. The deficiencies you describe were common throughout the world (most of Europe was far worse then the UK in the 1970s) and were due to the limits of what was then current technology. So you had to wait for a phone line – so what ? You had to wait for the post too because email hadn’t been invented.
The point is, as with all privatisations the much promoted benefits – more “choice”, lower prices, greater investment either didn’t materialise or were in fact still funded by the taxpayer.

29. Liza Brett

Take note! What can we do about this?

Allow me to relate my own significant healthcare experience in recent years.

Because of officially diagnosed “severe osteoarthritis”, I’ve had two hip replacement operations spaced about 18 months apart. Both were at the Elective Orthopaedic Centre in Epsom, which is self-funding. That means, it has to earn its upkeep from the income it attracts from incoming NHS patients from SW London – and sometimes beyond.

If insuffient patients are attracted, it would need to shrink its operations. In fact, it runs an industrial scale operation and has therefore accumulated a huge range of working experience. Hip and knee replacement are part science, part surgeon’s skill and care quality in recovery. Based on that, the recommendations of knowledgeable friends and the guidance of my GP, I opted to go there for both operations.

The second time round, I noticed that the nursing staff were largely unchanged despite the passing of time – and btw the nursing assistants were mostly caucasian while the nurses and seniors nurses were mostly ethnic minority. Being the curious sort, I started to probe why. They liked working there and had resisted being circulated back into the neighbouring NHS district hospital. The nursing work was more satisfying and they could develop better nurse-patient relationships.

From there, I went into convalescence, which I had to pay for. The NHS used to pay routinely, i’m told, but not any longer inspite of limited mobility following hip and knee replacements. That was also an illuminating experience. One guy I met had had both hips replaced in one operation in a private hospital but paid for by the NHS. Rather him than me, I thought. The only credible rationale IMO for having two hips done at one go was to minimise the overall time off work.

Another insight was that many district hospitals across the south of England are doing hip replacements – the number being done nationally was running at over a 100,000 a year and there have been recent reports of rationing. There are known specific risks, usually reckoned at 5 to 10pc and I met some – none had come from Epsom. One lady in convalescence had spent more than a month in hospital recovering from an operation to repair the damage from her original hip replacement operation. There’s something to be gained from the highly specialised skills and care at a unit dedicated to elective orthopaedic surgery.

This was getting to experience something closer to how I think the NHS will come to work in future.

31. Richard Carey

Bob B’s bossing the thread. We could learn a lot from places like Germany and France, if we could move on from sacred cow worship.

31 It is people like you who have the scared cow worship . Namely the obsession with free markets ( which don’t exist)

The neo liberals are the sacred cow fetishists. They are fanatics. Like Maoists. All bow the false gods of the market. We all know how it will go. The rich will get richer, and the poor will be screwed over. That is how it works. Thats how it is meant to work. And a tiny group of elites will own more of society for their own selfish ends.

As usual with the free market brownshirts democracy must be replaced with the market. Why? Because the top 20% of Americans now own 85% of the wealth. That’s your free market for you. It is not being done to improve the lives of the majority. It is being done so the rich can take more for their greedy selves. And thanks to cretins like you it will get worse.

Bob B reads the Mail and had a friend who wasn’t happy with his GP service, so the NHS has to go?

Still a complete fool, raving without understanding.

I’d have to agree with Bob B here. The assumption that state provision is inherently superior surely doesn’t withstand even the most cursory of examinations. What’s more, these “reforms” are merely an extension of what the previous Labour government had already put into place, but suddenly, we’re expected to think the sky’s going to fall in and old ladies are going to be dying in the street? Please.

Irony alert!
Sally @ 32 calls her opponents “fanatics”.

Surely those who find private businesses engaged in healthcare must demonstrate their outrage by refusing to go to their GP, which should help cut waiting lists for hospital treatment.

It gets even worse. All the leading supermarkets are in the business sector. They sell groceries in order to make profit. How unspeakably terrible to sell food for profit. The only appropriate response to this outrage is a national hunger strike – which should, at least, help to resolve the national obesity crisis besetting the NHS.

37. Planeshift

“GP practices are mostly small busineses and have long been so. Privatisation of healthcare services is therefore no very big deal.”

GP practices are also the problem end of the NHS.

– There are shortages of them in deprived areas.
– Opening hours are often inconvenient for people in full time jobs
– It can be difficult to impossible to get an appointment when you need one.
– Out of hours services are a joke in most of the country. This is why A+E departments get over-loaded.

The NHS should not be privatised.

Try obliterated…..

“GP practices are also the problem end of the NHS.”

The obvious solution is to nationalise GP practices, isn’t it? Why do you suppose successive governments haven’t done that?

Britain has too few GPs – as compared with France, for instance – because medical schools weren’t permitted sufficient finance to expand. It’s to Frank Dobson’s eternal credit that medical schools expanded to increase the numbers of graduates.

I certianly don’t accept that GPs are the only NHS problem. How come the hospital that I go to was declared to be the “worst in Britain” in 2001 by the healthcare watchdog at that time? How come the scandal at the Mid Staff Hospital Trust? How come the central NHS administration ignored umpteen complaints?

There are sensible and important concerns about the NHS reforms going through – try the link @15. The mantra about “privatisation” is just silly and blocks out debate over very real issues – such as the consequences of abolishing the Primary Care Trusts and vesting enormous purchasing power in local Clinical Commissioning Groups run by GPs. Who are patients to complain to now about their GP or about the hospital treatment they had that was commissioned by the local CCG of which their GP is a member?

40. Aileen Cheetham

If we allow the NHS to be privatised and don’t get active then we have only ourselves to blame.

Writ to your MP sign petitions etc Please do what you can to save the NHS.

“Lucy Reynolds adds that she expects a lot of public providers to go bust, as public providers that get passed over for contracts are shut down because a private provider has slightly undercut them.”

So you do want the NHS to pay over the odds for services? And that means that we the taxpayer pay more than we need to the state for it to waste it on expensive services.

“And what happens if it turns out that the private provider offers you a worse service?”

And what’s the difference between a private provider offering a crap service and a public one offering a crap service. At least with a private provider, another one will jump at the chance of offering a solution. With the public service, there is no alternative. You are stuck with the crap service, plus loads of enquiries as people try and cover their arse and pass the buck.


“Britain has too few GPs – as compared with France, for instance – because medical schools weren’t permitted sufficient finance to expand”

I you sure about that Bob? Couldn’t be that they were one of only two powerful trade unions not attacked by Thatcher (the other of course being the airline pilots union headed at one point by a certain N. Tebbit)could it?

43. Planeshift

“The obvious solution is to nationalise GP practices, isn’t it?”

No, just improve the standards each practice has to abide by and enforce the gms contract. Plus use other health professionals to replace the stuff that GP’s shouldn’t be wasting their time doing eg nurse prescribing (worth noting here that the BMA has been the main obstacle to this happening). Also have directly salaried GP centres in areas of deprivation to counter inverse care law, existing alongside the existing set. In other words tackle the problems I mentioned without resorting to simplistic dogma about private/public sectors.

“? How come the scandal at the Mid Staff Hospital Trust? ”

been dealt with millions of times. However one of the key sets of recommendations from francis was around transparency. Good luck with getting that once numerous providers start inserting confidentially clauses and collecting data in different ways so you can’t even check performance.

Also, poor quality out of hours care leads to A+E being overwhelmed, which isn’t an insignificant part of the problem in mid staffs and elsewhere.

“There are sensible and important concerns about the NHS reforms going through”

Totally, but pretending that this is straight private sector provision = good, public = bad is barmy and doesn’t help the debate. There are major problems in provision of primary care despite over 60 years of relying mainly on private sector provision here.

Worth just asking ourselves here – what exactly is the problem the government is attempting to solve with it’s AQP policy?

44. Mediastinum

@Aileen and everyone of like mind.

I have a Tory MP in my constituency, he hasn’t responded as yet to my emails. In the end I doubt he will as I am against the reforms. Signed pretty much every petition too. Is there anything else people can advise I do? The only thing I am not inclined to do is protest as my graduate medicine course has repeated warned that students would be kicked off the course if they discredit the profession or university. It’s probably a bit of paranoia on my part but I don’t want to risk being on the six o’clock news and described in derogatory ways or be part of a group arrest through no fault of my own. The only thing I can think of is working my way into a CCG and making sure It isn’t being used to prop up other GP’s private interests, unfortunately that is a very long way off.

Also I’m not going to vote for the national health action party, don’t want to waste my vote.

45. Planeshift

“Is there anything else people can advise I do”

Once you qualify, work in one of the devolved nations that haven’t gone down this route.

If England starts having recruitment problems not being experienced by the other nations then the tories will have no choice but to reverse matters.

@Bob B: On the Mid Staffs. issue, the report into it found that a key problem were cuts initiated to gain Foundation Hospital status. It wasn’t a failure of the classical NHS, but a failure of right-wing market experimentation.

41 what utter clap trap. The American private health care system is the most expensive in the world and its performance outside of patients with unlimited budgets is very average. Even honest tories ( and they are a rarity these days) have admitted the NHS cost effectiveness has been far greater than most private systems of health.

State monopoly become private monopoly. Cherry picking will become rife and the private sector will concentrate where the biggest areas of profit can be had. The private sector will squeeze out the public sector, and having destroyed it will then raise it’s prices to the tax payer. Just as in banking and everything else private cartels will emerge, using state handouts to enrich themselves and no doubt pay donations to their tame tory mps to continue the giant con

Today private hospitals drop anything that becomes un profitable and quickly pass it on to the NHs hospitals. But under your dream system there wont be any nhs hospitals left to pass on the complications too.

I really hope people like you develop painful, unprofitable conditions that cause you hours of agony and grief. You will deserve it for what you have done to others.

Sally – thank you for the Gypsy Petulengro act but your crystal ball seems to be a little faulty. Do you really think centrally administered state health care is going to be in a position to cope on its own with the change in demographics, the rise in chronic conditions like dementia and with what seems like an endless tide of new technology? It seems already to be creaking; what happens if the whole edifice falls down?

49. James O'Connell

There is a lot of Tory propaganda in this blog.
Have you noticed that the wonderful NHS is now being portrayed as absolutely terrible.
There have been problems at some hospitals, probably caused by gross understaffing but the great majority are excellent.
It is a well known Tory ploy to seek out some scandals and blow them out of proportion.
How many people remember the ‘groundnuts scheme’? Not many probably. This was a great scheme to grow groundnuts in Africa, just the sort of thing that was needed but it was pilloried day after day by the tabloid rags that pass for newspapers in this country.
They are now trying to do the same thing with the NHS.
Can the new Act be reversed? Certainly, it can be repealed by Labour on day one. Additionally, if surgeons and consultants were forbidden to ‘moonlight’ outside their NHS contracts, private hospitals would be finished. Simple.

@Bob B – That is the point isn’t it? GP practices are ripping the tax payer off hand over fist. If we nationalised them, we would be paying GPs far less money as employed doctors than as business owners. This would bring millions back into the NHS, force the many who work part time to go full time, thereby increasing the supply of GPs.

The problems at Mid Staffs were caused by the hospital focusing on making profits within the shadow “internal” market which already wastes loads of our taxes. Introducing full marketisation will only exacerbate the problem. We need infact to abolish the internal market and put the millions saved back into Doctors etc instead of wasting it on accountants and lawyers.

51. Mediastinum

@ Planeshift

If I am forced into helping privatise the service I might just do that. God knows where I would go as this seems to be happening everywhere. At least I could say I did not have a hand in the process if I disappeared for a few years.

I have watched the interview with Lucy R in full and I realise that even on a CCG I will be controlled by monitor so it looks like even altruistic GPs will be forced to give private companies public funding. How depressing.

I have shared the video with the rest of the students on my course, my friends and family so hopefully that will help spread the message a bit.


“On the Mid Staffs. issue, the report into it found that a key problem were cuts initiated to gain Foundation Hospital status. It wasn’t a failure of the classical NHS, but a failure of right-wing market experimentation.”

By law, all hospitals must achieve “Foundation Trust” status by near the end of 2014. Basically, that means they must be “financially viable” so that projected costs are covered by projected revenues from serving NHS patients, charging private patients and aliens, from donations and from other income sources – charging extortionate car parking charges to visitors and out-patients is a favourite wheeze.

If “balancing the books” is “right-wing market experimentation”, I’ll have to take your word on that although I’d rather put it in terms of the editorial in the British Medical Journal on 21 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. . . ”

The local hospital I go to has a projected deficit for 2012/13 of just under £20m. On top of that, the hospital trust has just been fined £4.8m by the NHS for failing to meet targets for the control of C Difficile infection rates. A silly question: How is the hospital going to pay down the running deficit, discharge this fine and make Foundation Trust status by autumn next year?

I’ve benefited from healthcare services at the hospital since end July 2004 – over eight years ago – starting with intensive care following a heart attack – if ever I lapse into feeling sorry for myself, I only need remind myself of the far more daunting medical histories of friends and people I know of around the same age: heart bypass operations, heart pace makers, strokes, macular degeneration of retina, cataracts etc beside the relatively tame stuff of diabetes, arthritis and hip replacements.

During those 8 years, the hospital has periodically checked on my birth certificate and proof of residence – I regularly pay the full community charge to the local council. All this, presumably, to establish whether I’m an alien and therefore liable to pay for the NHS healthcare I’ve had. In January this year, I had a very friendly call from the one remaining clinic I haven’t been discharged from to check on “your ethnicity” – and that despite previous sight of my birth certificate etc. I confirmed to the caller that I looked “white”, in the official jargon, and had been born in London before WW2. I should have added “in Lambeth” and that both parents were British citizens but he accepted my word.

The problems of this hospital – btw John Major was born in it – are all too apparent. I’ve been discharged from two clinics and it has been very noticeable that the status of the consultants at clinics has been successively downgraded to relatively junior staff or to visiting “GP consultants”.

It is therefore demonstrable nonsense to claim that the quality of NHS hospital healthcare depends on “clinical needs”, not on costs.

I relate all this in some detail not to parade my personal medical history but to provide a realistic insight into what actually happens to elderly patients in the NHS – and I stress again that my predicament is far less daunting than that of others I know of around the same age.

The hospital’s A&E Department have been transmuted to an “Urgent Care” facility to cut staff cover and costs. One consequence is that around the time of the transformation, a woman friend with a malfunctioning heart pacemaker went to the A&E department on a Saturday evening to be told by a junior doctor to go and see her GP on Monday morning. She returned home and phoned her GP at his home on his private number which she has because of her condition. Fortunately, he was at home and ordered an ambulance to take her directly to St George’s Hospital in Tooting – the very hospital mentioned in the link @5.

Those are the stark realities of NHS care. In all that, the privatisation issue really isn’t very significant. The fundamentals about the quality of healthcare are what matter.

53. Caroline emery

THis is what we the unions have been fighting on for the last 2 years. THe public are completely in the dark. Move out NHS move in Richard Branson. The NHS is 65 this year and it will die at 65. Get the gold cards at the ready. If you want healthcare you will have to pay or go without and THAT is reality.

“If you want healthcare you will have to pay or go without and THAT is reality.”

By the findings of independent, international surveys, other W European countries have pretty good national healthcare systems without having verging-on state monopoly providers.

According to this survey the NHS ranked as rather mediocre compared with healthcare services in other W European countries:

“More than 5,700 patients in England died or suffered serious harm due to errors latest figures for a six-month period show. The National Patient Safety Agency said there were 459,500 safety incidents from October 2008 to March 2009 – the highest rate since records began. Patient accidents were the most common problem, followed by mistakes made during treatment and with medication.” [BBC website 2009]

It matters very much whether the providers of our healthcare system are public or private. Once the NHS is the hands of private contractors, there is always the danger that profit supersedes the best medical decisions. Once privatised it will be next to impossible to return to public hands.

“Once the NHS is the hands of private contractors, there is always the danger that profit supersedes the best medical decisions. Once privatised it will be next to impossible to return to public hands.”

Another silly comment. Judging by independent, international surveys, they manage healthcare in other W European countries pretty well without having a verging-on state monopoly provider which is the largest employer in W Europe.

This could be one explanation as to why healthcare indicators in Britain compare unfavourably with indicators in other W European countries for all the money spent on the NHS:

British GPs are the best paid in Europe according to a study by the Netherlands Institute of Health Services Research and Maastricht University.

The survey of earnings in 2005 found UK GPs on top at £108,680 per annum compared to lowest paid GPs in Belgium with £21,270. German GPs were the second highest paid at £72,170 with the French on £45,200.

Let’s have evidence-based policy, not silly sloganising. From the history, Bismarck in Germany dserves the credit for introducing social insurance to cover health care costs back in the 1880s. Britain took to 1948 to introduce a nation-wide, iniversal system of healthcare insurance. I think we can learn from how others have tackled the issues of providing healthcare and stop assuming we must have the best system going, thereby entrenching vested interests.


Lloyd George introduced the first National Insurance Act in 1911, the 1948 Act introduced free healthcare at the point of delivery.

For those who believe that a business model would be more financially efficient than the current NHS model, I assume that the value of the large army of NHS volunteers has been factored-in. I doubt if any of those voulunteers would be as enthusiastic about giving their time and service free to a plc, and that includes most of the blood utilized within the NHS.

They aren’t ignoring it. They are burying it, because they support it. The media, like the rest of the middle class, sold out long ago. They want the goodies the free market offers those with money. For the rest of us, we can just get lost. We are history’s collateral damage, in the way and about to be swept aside, as far as the neoliberal elite and their fellow travellers are concerned.

By many accounts, they have good healthcare in other W European countries without having a state-owned, near monopoly provider. Most GP practices in the NHS are privately run businesses and I doubt most folk would object to being treated in private hospitals if the NHS pays. What matters is the quality of care they get.

60. MarkAustin

@36. Bob B

In response to your point about supermarkets. I have no problems with a free market there. I can make rational choices. I can do comparisons. I can’t do that with health. No patient will ever have enough information to make a rational choice. To take just one example. If a unit has a high death rate is it because it is bad at its job or because it takes a high proportion of high risk cases? In this case a free market cannot be established: we must establish independent excperts and trust them. Can I trust a GP who owns shares in a private clinic. already 30+ percent of doctors on the commissioning boards have a fuinancial interest in private health care. At the moment, I would be more inclined than not to trust the doctors, but what happens if a GP service falls into the hands of a private firm and ends up run by managers rather than doctors—there is already a tendency for GP practices to employ doctors rather than offer them partnerships.

Free markets can only exist with symmetrical free and open information. Absent that, they must be regulated.

The media can’t touch this story it is an unfolding disaster that seems to be beyond comprehension. In the USA people have no problem understanding what private medicine really means, in Britain we are only beginning to get a taste, a spoonful of sugar to disguise the poison.

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