Tuesday 11 January sees yet another Tory bill being debated in the House of Lords. This time it’s Sajid Javid’s disgraceful Health and Care Bill. If it passes, we will see a healthcare system with further privatisation of the NHS, giving companies dangerous sway over how our health system is run.
The key change, once the bill becomes law, will be the increasing power of Integrated Health Care Systems (ICSs) and the boards that will run them. According to the NHS, the role of ICSs is to coordinate:
partnerships between the NHS, local authorities, and a range of stakeholders to improve services and the health of people within their area.
A push towards privatisation
By April 2021, 42 ICSs were already in place across England. The NHS says that the boards are organisations “with responsibility [for] NHS functions and budgets”. According to The Canary’s Curtis Daly:
The important part to look for is who’s represented on these Care Boards. It will range from charities, councils… and private health firms.
What insight do private health providers bring to the table? Nothing except profitability over the quality of care. The aim is not to provide patients with the best services but to serve shareholders.
That is the whole point of these structural changes – to move public wealth into private hands.
The NHS has already designated who will be chair of the majority of the boards, even though the bill hasn’t yet passed.
And the NHS was already dealt a huge blow when the Health and Social Care Act was passed in 2012. Daly says:
The Health and Social Care Act was a significant move to privatisation. Before the legislation was brought in, hospitals were restricted to only making 2% of their income from the private sector. This dramatically increased to 49%.
The bill will also hand a huge amount of power to the government to control what happens at a local level in the NHS. According to Keep Our NHS Public:
the Secretary of State for Health will assume decision making power to impose local service reconfigurations
the right and power of scrutiny by local authorities of significant health changes will be weakened or abolished
the right of access by the public to board meetings and papers may also be threatened.
Is this our last chance to save the NHS from complete destruction?
As the public urges the House of Lords to step up to save our health care system, SOS NHS – a coalition of campaign groups – has called a public emergency. At a time when coronavirus (Covid-19) deaths have exceeded 175,000, SOS NHS argues that:
There has also been a total failure of government during the pandemic. Public health measures have been undermined and far too many have been allowed to die, especially among vulnerable groups.
Billions have been wasted on failed, privatised test and trace and useless PPE: we need investment to expand our NHS, not line the pockets of private shareholders. But the Health and Care Bill going through parliament won’t stop privatisation. Instead it strengthens central powers and further reduces any local control or accountability.
A core demand of the campaign is to “invest in a fully publicly-owned NHS & guarantee free healthcare for future generations”. But as the bill passes through the Lords, it’s highly unlikely that parliament will put the public before profit.
We already live in a desperately unequal society, divided by both class, race, and migration status. We mustn’t stand by and watch the last remnants of our public healthcare be crushed by the rich and their powerful corporate friends. After all, it’s society’s most vulnerable that will suffer the most from the changes to the NHS. As the Tories pass bill after draconian bill, we must continue to shout out our resistance.
With the new Health and Care Bill, and funding cuts pushing the NHS to breaking point, Curtis Daly explains exactly how the Tories are setting the scene to privatise the NHS.
Video transcript
NYE Bevan:
“Now, the National Health Service had two main principles underlying it. One, that the medical arts of science and healing should be made available to people when they needed them, irrespective of whether they could afford to pay for them or not. The second, was that this should be done not at the expense of the poorer members of the community, but of the well to do. In short, I refuse to accept the insurance principle.”
The government’s Health and Care Bill aims to remodel NHS England, and not in a good way. Currently, the NHS does have private provision, despite any form of privatisation being massively unpopular. This particular bill goes much further by expanding private companies to have a say on how it is run.
Clinical Commissioning Groups, made up of GPs, are in charge of local services and how they operate. The Health and Care Bill will scrap over 100 of them, and replace them with ‘Integrated Care Systems’ which will span over 42 regions.
The ICSs are made up of Integrated Care Partnerships, that consist of Integrated Care Boards…. Confused yet?
The important part to look for is who’s represented on these Care Boards. It will range from charities, councils… and private health firms.
What insight do private health providers bring to the table? Nothing except profitability over the quality of care. The aim is not to provide patients with the best services but to serve shareholders.
That is the whole point of these structural changes – to move public wealth into private hands.
PFI gave private companies huge contracts to build public infrastructure such as hospitals.
What was great for companies was the terms of the contracts. Instead of the government simply using traditional spending methods for investment, PFI meant that we borrowed from the private sector. The repayments involved very favourable terms for those companies, costing us more.
According to the IPPR think tank, NHS England owed debts of £55bn to private companies in 2019. £13bn worth of borrowing will end up costing NHS England £80bn when contracts come to an end in 2050.
On the face of it, it’s clearly a scam. Why would we choose to pay more for investment when we could just make it ourselves? When successive governments are in bed with business, it all makes sense.
PFI has been used by both Conservative and Labour governments.
Between 2010 and 2015, the private sector was awarded 86% of pharmacy contracts, 83% of patient transport contracts, 76% of diagnostics, 69% of GP out of hours, 45% of community health contracts including children and adults with learning disabilities, and 25% of mental health contracts.
COVID
The National Audit Office has investigated the government on Covid contracts producing two reports:an investigation into the supply of personal protective equipment and another into government procurement during the Covid-19 pandemic.
The reports expose that £17.3bn Covid related contracts were awarded, £10.5bn of it was given to companies with no competitive tendering.
This can then lead to scenarios such as Matt Hancock’s ex neighbour bagging a £30m contract to produce plastic vials for testing kits… through a WhatsApp message.
This doesn’t indicate that decisions were based on quality of outcome but for business interests.
Labour and especially Tory governments have usually denied privatisation, but nobody is falling for it. In 2005, a book was published named Direct Democracy: A New Agenda For a New Model Party.
This book, calls for the NHS to be ‘denationalised’. One of the co-authors of the book was former health secretary Jeremy Hunt.
The Conservatives record on the NHS has been appalling. The NHS is on the edge of what could be its worst winter crisis ever. The waiting times in A&E are at its worst since records began. Response times are three times longer than the target of 18 minutes, and 30% of admitted A&E patients are waiting more than four hours to get a bed.
It’s easy to see why when the levels of spending were well below the average for a decade. The annual increase of spending has been just under 4% since its creation, with record spending of 6% between 1997 and 2010. The coalition government dramatically cut its funding to around 1% with a marginal increase just before 2019.
This is the Tories oldest trick in the book. Systematically underfunding a service and bringing it to breaking point – paving the way for private contracts and ultimately full privatisation. They can then make the case for a US style health care system where care isn’t rationed on need but on the size of one’s wallet.
Examples of a US style system include a woman named Anne Soloviev who had to pay $1,500 a month for toenail cream that… didn’t work. Janet Winston was charged $48,000 for skin testing and a BuzzFeed user claimed they were charged 2.2 million dollars for their NICU baby who was born at 28 weeks.
The National Health Service is Britain’s finest creation. After the bloody second world war, a new consensus was forged, that of community and collective effort. The health service showed the best of this nation, taking care of everybody regardless of financial worth.
For decades that has been slowly dismantled, and this Health and Care Bill is the biggest risk to the principle of health care free at the point of use in history.
The NHS will only survive if there are those who are willing to fight for it; we must protect it at all costs.
In October 2020 and March 2021, The Canary reported on an attempted right-wing takeover of the Socialist Health Association (SHA) which would silence Labour opposition to NHS privatisation. The SHA was instrumental in establishing the NHS in 1948.
This week, the Tory-sponsored Health and Care Billpassed its second reading in parliament. A bill that, if enacted, could downgrade the NHS to more closely reflect the profit-driven US healthcare system. Meanwhile, as the threat of NHS privatisation has become imminent, Labour seems to be dragging its heels.
If people care about the NHS, now is the time to get active. Because if not, this latest Tory assault will be another nail in the coffin of a public health service that was once the envy of the world.
Under constant attack
Aneurin Bevan, former Labour minister for health who’s credited with establishing the NHS, is reported as saying:
The NHS will last as long as there are folk left with the faith to fight for it.
There’s hardly been a more appropriate time for that statement to be re-aired. Even in the 1940s, Bevan must have been aware of how precarious the NHS’s position was. After all, the British Medical Association (BMA) lobbied GPs not to sign up to it.
The intensification of this opposition took hold during the Thatcher years, before she’d even entered No. 10. Then Tony Blair’s ‘New Labour’, as well as successive Tory governments, continued to attack the NHS. So for the last 40 plus years, the NHS as a publicly run health service has been under attack.
If it’s not stopped in its tracks, health secretary Sajid Javid’s bill could see the NHS become little more than a poor relation of the unenviable US healthcare system.
Should it become law, and the numbers in parliament suggest it might, the health and lives of British people are in danger. However, there are still sufficient numbers to make the kind of noise that could block it. So people need to organise to stop further privatisation and return the NHS to full public ownership.
The fight back has already begun
The Canary has already been investigating NHS privatisation and has spoken to anti-privatisation campaigners. Additionally, NHS doctor and campaigner Dr Bob Gill, who’s at the forefront of the fight to protect the NHS, spoke to The Canary. Gill said the NHS has suffered from four decades of “stealth privatisation”. And because the NHS is:
so treasured by the British public, successive governments have had to do this [secretly]
Indebting the NHS to the private sector
Gill explained how the government started by outsourcing “non-clinical services like cleaning and catering” in the 1980s. They then introduced:
the internal market, supposedly bringing pre-market discipline into the NHS and driving up efficiency. Well we know that’s a total scam.
This allowed the government to transform the NHS from “a public service ethos” to a business-friendly one. The Blair government then “doubled down on the internal market” and started outsourcing clinical services like elective surgery.
The Blair years also saw the private sector being allowed to “to saddle the NHS estate, land, and buildings with PFI [Private Finance Initiatives] debt”. According to Gill, PFI debt:
was a deliberate saddling of the NHS with private debt, which would get more onerous over time, and then be used as an excuse to flog off land
And PFI:
also handed over ownership to the private sector. So you had the assets being privatised.
From Dr Bob Gill’s documentary The Great NHS Heist
NHS capacity
Then in 2012, the Health and Social Care Act became law and austerity followed. According to Gill, the NHS’s capacity, that is “the number of beds per head of population, has more than halved since the 1970s”. He explains:
We have the lowest bed capacity per head of population compared to all other OECD countries of similar economic status. We have the fewest number of doctors per head in Europe. And by the time we entered the pandemic, we’d suffered a historic freeze of annual increase in the budget of around 1% on average over the decade, where since 1948 it’s averaged about 4%.
defunded, repurposed, marketised NHS with a huge hole in the workforce – 10,000 vacancies in doctors, 40,000 nurse vacancies – and then we were hit with a pandemic. So this was a disaster waiting to happen.
In his documentary The Great NHS Heist, Gill laid out the timeline of NHS privatisation from the early 1980s until 2014:
Integrated care systems (ICS)
According to Gill, one of the biggest changes proposed in Javid’s bill is the creation of Integrated Care Systems (ICS). But instead of integrating or improving healthcare, these ICSs will integrate budgets which could be controlled by large private corporations.
based on the US Medicare, Medicaid system – which is dominated by big private insurance companies like United Health, the world’s biggest private insurer – where the government, the taxpayer, puts in the money, but the management of that money is with a private insurer. And they are allowed to make profit…out of the ICS budget.
The US healthcare system and the denial of care
Gill says the number three cause of death for hospitalised patients in the US is medical error. He believes the hiring of less qualified medical staff, and breaking medical tasks up into “smaller, more straightforward tasks”, causes this. And no matter how efficient that may seem, it can increase the chances of error and patient harm.
When a less qualified member of staff deals with an atypical patient, there’s a risk of harm. So, despite the US spending twice as much on health per head of population as the UK, it has worse outcomes. He says:
They don’t live as long; more of their children die in young age; more of their mothers die in pregnancy. These are hard endpoints that show how well a health system is functioning. That is not a model any rational person, ethical person would follow. Yet our consecutive governments have been following them.
So the managed care system is a way that the American profit hungry corporations… collude to deny care to sick patients
What’s particularly worrying is Gill’s claim that the US healthcare system denies care to people with the greatest need. And it does so because providing such care is costly. This system uses patients’:
medical notes and various other algorithms and computer software. You identify the people who are undeserving, in your eyes, because you want to maximise profit… and you block their access to expensive hospital care.
And how do you do that? Well you set up an algorithm that blocks their access, you close services, you take away their GP surgeries, you present them with less qualified people, and you shut their A&Es. So there’s nowhere for these people to go. And you know the outcome is obvious. So people will be dying of serious illnesses before they get to hospital.
Renationalise the NHS
We need to renationalise the NHS. This puts it back in the hands of British people. However, until such time as that happens, Gill believes section 75 of the 2012 health act must stay. Section 75 allows private providers “in as minority participants in the NHS market to be paid from the NHS budget”. But it does at least require there to be a tendering process, and therefore there’s some transparency.
While this isn’t at all ideal, Gill believes section 75 means there’s some scrutiny of the tendering process, thereby making challenging it possible.
the emergency legislation that the government used to outsource the whole pandemic response in multi-billion pound crony deals… There has been blatant corruption. … if you had connections to the Conservative Party, you were 10 times more likely to get a contract.
Do we really want that system for the marketised NHS? I don’t want a marketised NHS, but if we have a marketised NHS, until we renationalise it, we must not repeal section 75. Because that will allow secretive deals to be made. And it will also enable, this is the more worrying thing, it will enable the private sector monopoly within the NHS.
Where’s the opposition?
Gill was scathing of the Labour party’s opposition to the bill. He pointed out that:
they sabotaged their own electoral chances on two occasions. So a significant proportion of the Labour Party… were gunning for their own leader, who refreshingly dared to mention the ‘P’ word when it came to NHS. He mentioned privatisation. He mentioned the threat of a US trade deal, and he paid a very heavy political price. But the current shadow frontbench, from what I have heard, I hear nothing that reassures me that they are genuinely interested in defending the NHS
Similarly Gill was scathing of medical professional bodies and one trade union who he said were:
disconnected from the interests of their members, as we see in many organisations in this country. The BMA, the Royal Colleges, the RCN, and I believe Unison, all rubber stamp the white paper on which this bill is standing.
And he didn’t stop there. Gill has criticised groups that are calling for a repeal of section 75. Additionally, the BMA released a statement in opposition to the bill, but it endorses the creation of ICSs. And it’s arguing for greater representation on ICS boards. So, according to Gill:
They’re arguing for a snout in the trough. That’s what they’re arguing for. They should be calling for a total rejection and renationalisation, and they’re not doing that
The Canary also contacted the Department of Health and Social Care. A spokesperson said:
The NHS is not and never will be for sale.
Our Health and Care Bill builds on the NHS’ own proposals for reform and will ensure a health system that is less bureaucratic, more accountable, and more integrated in the wake of the pandemic.
Our proposals will give the NHS more power, not less, and maintain the NHS’s clinical and operational independence while ensuring the Secretary of State has appropriate oversight and accountability.
What can we do?
Despite the lack of real opposition and the difficulty of defeating this bill, Gill is still hopeful. He says we must:
make it clear to [the public] what is at stake, and who is after our NHS – it is American corporations, who will be extracting wealth from this country – it will be costing us all a lot more in financial terms either through taxation or topping up private insurance to replace what is gone from the NHS.
On an individual level, it will cost us more financially, it will cost us security, it will cost us – on a human level – mass preventable harm and death of patients, our loved ones, our family members, our friends. And this is what our government is doing.
So if the public wants to protect the NHS, it needs to get active now.
