The NHS and ‘Privatisation by Stealth’ – Part Two

In Part Two of ‘Privatisation by Stealth’, Will Stent assesses the Conservative’s secrecy and deliberate continuous suppression of information in their efforts to privatise the NHS.

The case detailed at the outset of Part One – Alliance Medical’s 10-year, 80 million contract – not only exemplifies the Conservative’s agenda of privatisation, but also the way in which this government implements this agenda. Despite the NHS being ranked number one in a survey of the world’s top healthcare systems – and despite the fact the NHS ranked second lowest in expenditure – the Conservatives have long trumpeted the current nature of the NHS as unsustainable. Though both academic and public opinion do not support the Conservatives’ view, the government has not been dissuaded from stripping down and selling-off the NHS, and doing so without proper public awareness.

In Part One we briefly touched on how opening up NHS services and contracts to a fully competitive market meant that public trusts were now being forced to compete for these very contracts. This constructed competitive market is arguably the single biggest force working to undermine the NHS, both financially and practically. This market is established and maintained by Conservative policy and represents the focal point of the Conservatives’ reforms. Finally, its establishment has been one that is deliberately shrouded as much as possible from full public scrutiny.

The government has not released a figure as to how much actually running and maintaining this marketplace is costing. This is either because they genuinely do not know, or because they are suppressing it. Current estimations vary; the National Health Action party put the cost at £10 billion; the Centre for Health and the Public Interest have put it conservatively at £4.5 billion. Under the current strains of cuts, the NHS must make the avoidance of waste and unnecessary expenditure an imperative; this ‘market’ is a major source of waste, especially when the ‘start-up’ costs attached to each phase of this competitive market have further spiralled without check into the billions.

Statements on this market have further come from inside Westminster. A Health Select Committee revealed that the costs of running the NHS as a competitive market equated to 14% of its total yearly budget, with specific dramatic increases in transaction management and administration costs. Four of the Department of Health’s most senior civil servants, interviewed in the Committee’s proceedings, could not give accurate figures for staffing levels and administration and commissioning costs regarding the internal market arrangement.

There are some fundamental factors that must be remembered in this. First, this emphasis on competition has not led to any actual or tangible improvements in the delivery of patient care. Second, the agenda of privatisation being pushed by the Conservatives has forced important resources and finances away from patient care and toward costly and ultimately unnecessary bidding processes. Third, none of these costs or arrangements have communicated appropriately to the public, nor have they been presented for necessary parliamentary scrutiny and analysis.


 

The construction and empowering of this internal competitive market is the clearest example of the Conservatives implementing a privatised structure across a public service, and doing it with stealth and without proper scrutiny. But it is certainly not the only example.

Prime Minister David Cameron has personally quietly promoted the idea of paying upfront for the NHS, as a means of addressing its apparent-but-unsubstantiated ‘unsustainable’ nature. This cost would be through additional charges and insurance, not through an increase in tax. An enquiry into bringing this about was launched, not through party leadership, but through the recently-appointed – and barely-visible – Under Secretary of State for NHS Productivity, Lord David Prior. These discussions were downplayed and given fractional coverage, considering the potential consequence of such a policy. Not only does such a policy contradict the fundamental founding principles on which the NHS was established, but the idea of a pay-for-use NHS has already been discussed and subsequently dismissed by a number of top think tanks[8]. Nevertheless, the fact that those Tory Peers who did discuss this concept moved for an enquiry demonstrates the willingness to push forward with an unpopular and unsupported agenda purely out of an ideological commitment to competition and profit.


 

The three founding principles of the NHS, as laid out by its founder Aneurin Bevan on July 5th 1948, were broad yet simple: it would meet the needs of everyone; it would be free on the point of delivery; and it would be based on need, not ability to pay. Tied into this and repeated since its inception was a commitment that this health institution belonged to the public. It was a right.

In a short space of time government policy has moved the NHS to a place distant from these founding ideas. If the public decided such a move should happen, or at least gave the vaguest nod of approval at such decisions, the direction of current government policy could claim some justification. But it simply can’t. Opinion polls since 2000 have consistently shown the public’s overwhelming rejection of any privatising or corporatising of NHS services9. The subsequent secrecy and deliberate shrouding of decisions made by this government show that they are aware of this, but have chosen to ignore and disregard. It seems clear that the current Conservative government will continue such a policy of stealth until the NHS resembles the organism they want. It will be an entity the public neither wants nor deserves, and though the title of ‘NHS’ will still be used, it will not resemble or share anything of the NHS established and admired in 1948.

 

 

 

References

Denis Campbell & Nicholas Watt, ‘NHS comes top in healthcare survey’, the Guardian (17 June 2014).

‘Government is failing in its ethical duty to prevent NHS waste’, NHA (6 November 2014): http://nhap.org/if-you-push-too-hard-nhs-efficiencies-become-inefficiencies/

Calum Patton, ‘At what cost? Paying the price for the market in the English NHS’, Centre for Health and the Public Interest (February 2014): http://www.chpi.org.uk/wp-content/uploads/2014/02/At-what-cost-paying-the-price-for-the-market-in-the-English-NHS-by-Calum-Paton.pdf

Vincent Moss & Nicola Fifield, ‘Savage Tory cuts and privatization have left NHS in critical condition’, The Mirror (3 May 2015): http://www.mirror.co.uk/news/uk-news/savage-tory-cuts-privatisation-left-5626911

Richard Grimes, ‘Government proposes inquiry into moving to a ‘pay NHS”, openDemocracy (15 July 2015): https://www.opendemocracy.net/ournhs/richard-grimes/government-moves-to-consider-nhs-user-charges

Colin Leys & Stewart Player, ‘The Plot Against the NHS’, Renewal: http://www.renewal.org.uk/articles/the-plot-against-the-nhs/

The NHS and ‘Privatisation by Stealth’ – Part Two

The NHS and ‘Privatisation by Stealth’ – Part One

The Conservative government recently awarded an 10-year, eighty million pound NHS hospital scanning contract to private firm Alliance Medical – despite a competing bid being offered by an NHS trust that was £7 million cheaper.

The bid entered by the NHS Trust of Royal Stoke Hospital, Staffordshire was rejected in favour of Alliance Medical by health service’s head office, despite the private company charging £7 million more for the contract. Alliance Medical’s board members include Conservative MP Malcolm Rifkind, who earns £60,000 by sitting on the panel.

Neither the government nor the private firm itself have said as to why the contract was awarded at a greater expense, or what the extra expenditure will bring. Negotiations and reasoning behind the decision have been kept secret.

Ian Syme, the coordinator of North Staffordshire Healthwatch, uncovered the public health services’ cheaper bid and its subsequent denial only by ‘digging through 150 board papers’.

‘There’s little or no openness or transparency in these tendering processes, no public debate, no meaningful public scrutiny… The evidence is stacking up that NHS England have a privatisation agenda… [they] are at the moment privatizing the NHS by stealth’ 1.

 


 

This Conservative government’s agenda for the NHS can be aptly summarized in Mr. Syme’s own words; ‘privatisation by stealth.’

The government is steadily building on its agenda of privatization for the NHS, without proper public scrutiny, without appropriate critical assessment, and without the necessary public profile.

This agenda of privatisation should not come as a surprise, and neither should the government’s actions to ensure such an agenda is implemented with as little noise as possible. After all, what better way for the government to implement a policy – motivated by ideology, in contradiction with their initial promises, and against public opinion – than by stealth…?

David Cameron, in the run-up to the 2010 general elections, promised that under a Conservative government there would no cuts to front-line services and, most infamously, “no more of the tiresome, meddlesome, top-down re-structures” of the NHS.
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On the wider issue of public transparency in government affairs, Cameron had previously stated politicians would have to “let go of the information that we’ve guarded so jealously.

These promises have long been brushed aside; the Tories have even engaged in a furious quest to erase these statements – as well as all pre-May 2010 press releases and speeches – from the internet. The Conservative government has and continues to demonstrate a complete abandonment of these election promises, and an actual commitment to a policy program for the NHS based on creating profit. This program truly only serves private interests and themselves.

 


 

The Conservative’s disregard of its promises to protect the NHS and the subsequent implementation of its privatised agenda have been seemingly continuous since the party’s success in the 2010 election. A month after promising to stop any wasteful reorganisation, Andrew Lansley put forward a proposal for the biggest reorganization of the NHS, based on years of extensive development. This formed the basis of arguably the crowning achievement in the party’s first term in office; the 2012 Health and Social Care Act.

Representing the single greatest action in changing the NHS since its inception in 1946, the Act removed any barrier to – and actively encouraged – the breaking-up and selling-off of the NHS and its various limbs. It lifted the cap on how much trusts could earn from PPI – Private Patient Income – from 2% to a staggering 49%, effectively establishing a two-tier NHS and encouraging the perception and identity of the public health service as a potentially-profitable institution.

The Conservative’s hefty reforms of the NHS have subsequently opened the public service to competitive markets. Again, these have been implemented by a government that promised the following: first, that no reforms would be even be introduced; and second, that any wider privatisation would be minimal, and that the NHS would be largely insulated from full economic competition.

The practical effects of the 2012 Health and Social Care Act have already been felt. The NHS Support Federation showed that private firms were awarded £3.54 billion of an available £9.63 billion of NHS contracts in England in 2014, a 36.8% win rate. The 3.54 billion worth of healthcare contracts is five times the value of contracts that were awarded to private firms in 2013.

Similarly, a report on GP-led clinical commissioning groups (CCGs) revealed that private firms won 40% of the medical contracts these CCGs have put out to tender, worth £2.3 billion.

The clear commitment the Conservatives have to extending the role of private companies in the NHS – and the Tory leadership’s emphasis on competition over contracts – has added to the already extensive financial difficulties faced by many individual NHS trusts. By extending the role of private services and ultimately increasing the total number of bidding processes and arrangements, publically-funded NHS trusts are having to spend valuable resources on bidding and competing for contracts, many of which they have already been fulfilling. Private companies do not also face the same public scrutiny and checks on the services they provide. And because they are private, the are only accountable to their board members and investors, whose majority interest is in making a profit. Such an business ideology and focus may work in some sectors, but not in a public service, whose ultimate priority is patients and their health – not profits.

This first post has covered exactly what direction the Conservatives have taken and are currently following in regards to privatizing the NHS. The practical ramifications detailed above of the Conservatives’ reforms is just one side of the coin; the level of secrecy, the hidden costs of this policy, and the deliberate suppression of information with which this has been done together form the other side.

”Privatisation by Stealth’ – Part Two’ deals with this second side to the Conservative’s program of NHS privatization.

The NHS and ‘Privatisation by Stealth’ – Part One