Thursday, February 13, 2014
What is the way forward for the NHS now that the dam is broken?
This is the power-point presentation by Jon Williams for his fine talk at our Discussion Meeting on Sunday. Each section was placed in turn on the screen. It opens with a summary of the ground he went on to cover. It should be studied by anyone with a serious interest in the future of the NHS.
PRIVATISATION OF THE NHS
“The Way Forward” by Jon Williams
• Brief History • Introduction “Terminology & Structures” • Current NHS “Where we are now”
• Labour response “Policy Submissions” • Post 2015 “Ideas”
• Discussion • References
The Way Forward: Brief History
• 1945 Labour Government implemented Beveridge Report of 1942
• Report's recommendation to create "comprehensive health and rehabilitation services for prevention and cure of disease” was implemented across the UK by Aneurin Bevan in 1948 and it’s core principles were,
– That it meets the needs of everyone – That it be free at the point of delivery – That it be based on clinical need, not ability to pay.
The Way Forward: Intro 1
• H&SC (Health & Social Care) Act in 2012 is now law
• Yes, the NHS is being privatised as we speak... – BBC recently reported 70% of contracts have been
won by private companies since April 2013 • Privatisation dam has broken!!
The Way Forward: Intro 2
• Which allows:
– Currently up to 49% of any NHS business can be private
– Any “Qualified Provider” can bid for contracts i.e. Competitive Tendering
– NHS budget handed over to the world corporate sector
– Est. H&SC Act reorganisation costs so far £3billion
– Competition lawyers, up to Dec 2013 has cost £5m
The Way Forward: Intro 3
– Shortage of money to finance PFI repayments and become prey for takeovers by private companies
– RCN (Royal College of Nursing) est. 56,000 lost nursing jobs
– Creates a market system based on ability to pay – Opens the door to unlimited charges – Treats patients as customers – Gains privatised and losses socialised
– Harmonises UK and US health systems, re TTIP (Transatlantic Trade & Investment Partnership)
The Way Forward: Intro 4
• H&SCAct2012doesn’t allow, – Health Sec. duty of responsibility health care for all
– Freedom of Information requests of private Co’s
– Differentiate between private & public re NHS logo
– UK Government final say due to harmonisation of EU & US regulations under TTIP (Transatlantic Trade & Investment Partnership) i.e. Repeal of H&SC Act 2012?
– Termination of private company contracts if failing patients – it can sue for loss of earnings under ISDS (Investor State Dispute Settlement) i.e. competition laws
The Way Forward: Intro 5
H&SC Act 2012 doesn’t allow,
– ISDS “means that companies will have the right to sue foreign governments if they don't like the local legislation”...e.g. UK Government
– TTIP / ISDS under negotiation est. made law end 2014
The Way Forward: Current NHS 1
• Independent FT (Foundation Trust hosp. x145) formed in 2004
• Powers to borrow money, enter contracts and diverge from national pay settlements
• H&SC Act 2012 abolished the private patient income cap for FT Hosp.
• FTs will prosper at the expense of other remaining NHS Trusts – a two tier NHS
• FTs operational control is with board of directors, not local / community governors...
• Sec State may close hosp. without consultation – re The Care Bill Clause 118 after Health Sec lost decision to close Lewisham A&E...
The Way Forward: Current NHS 2
• Private Co’s cherry pick profitable services • Private Co’s fail they can walk away • Staff reduced terms and conditions to max profits
• Hinchingbrooke Hosp. sold to a private company Circle Health in Feb 2012 – cost saving plans include job cuts; increasing private patients; changing nurse to bed ratios and streamlining A&E.
• Circle Health made pre-tax loss in 2010 and 2011
• Southern Cross residential care homes went bankrupt unable to pay rent. Local Authorities had to step in...
The Way Forward: Current NHS 3
• PFI - Cost of capital for a typical PFI project is currently over 8%—double the long term government gilt rate of approximately 4%.
• PFI projects are significantly more expensive to fund over the life of a project. This represents a significant cost to taxpayers.
• Already privatised GPs, Dentists, Opticians, Blood Service & Pharmacisits...plus 5% of hospital services
• PCTs (Primary Care Trusts) and SHAs (Strategic Health Authorities) have been abolished
The Way Forward: Current NHS 4
The Way Forward: Current NHS 5
• NHS CB (NHS Commissioning Board) new body to oversee commissioning health services by Health Secretary
• NHS CB delegate responsibility for commissioning to CCGs (Clinical Commissioning Groups) in their local areas
• “Monitor” will regulate private / 3rd sector competition with NHS bodies to ensure it doesn’t affect patient services
• Monitor Exec committee backgrounds: McKinsey, KPMG, PWC, Deloitte & Prime Ministers Office
The Way Forward: Current NHS 6
• CCGs effectively groups of local GP Surgeries
• CCGs role is complex: research, planning legal contracts and monitoring of health needs...
• To improve efficiency separate bodies set up, – CSS (Commissioning Support Services) – Private
Companies eg Virgin Health & Serco – CSU (Commissioning Support Units) – ex NHS
• Health & Well Being Boards, local authority oversight
The Way Forward: Current NHS 7
• Who plans and buys treatment for patients?
The Way Forward: Labour Response 1
• Policy Paper “21st Century NHS & Social Care: Delivering Integration”
• How to integrate / organise a fragmented health and care services – post 2015 Labour win?
• Submission of ideas to, – Local Party / Your Britain website / CLP
• Which feeds into, – Health Policy Commission – NPF (National Policy Forum) / NEC (dates)??
The Way Forward: Labour Response 2
• Ref Policy Paper “21st Century NHS & Social Care: Delivering Integration”
• “Beyond this point, submissions will continue to inform our work as we move towards the publication of a final year policy document in early 2014. Please make you submissions on this and other policy documents at yourbritain.org.uk.”
The Way Forward: Post 2015 (1)
• How to achieve NHS fit for purpose & funding
• Integrating physical/mental health & social care
• Changing demands on NHS services – Deeply fragmented
– H&SC Act costly top down reorganisation – People are living longer – Long term conditions, chronic diseases – Mental health problems
– Cost of new medicines and treatments
The Way Forward: Post 2015 (2)
• IDEAS- • Unison • “The next Labour government should ensure there-establishment of a national integrated health service, in which cooperation and collaboration are reinstated as the guiding principles – in place of competition and fragmentation.”
• Socialist Health Association • “The NHS locally may choose to use competent private sector clinical skills in clearly defined circumstances, for example where these offer novel services otherwise unavailable, to remedy persisting inadequate standards, or to meet peak service pressures when NHS capacity is not immediately available”
The Way Forward: Post 2015 (3)
• Difficult to go back pre H&SC Act “privatisation dam has been broken”
• Now until Election – set up wide ranging NHS review • Day one post 2015 – Halt to all changes & implement findings of NHS review
• Repeal / amend H&SC Act 2012 to enshrine original NHS ethos
• Co-operation between public/private/3rdsectorto achieve integration
• Accept some private co’s expertise as long as they are transparent and accountable to NHS
• Tackle fragmentation a move to “whole person care”
The Way Forward: Post 2015 (4)
• New legislation to make NHS “preferred provider” and protection from competition law
• NHS become a preventive, not only reactive – we need to stay fit and healthy
• Training / education centred on patient first
• More quality housing / independent living
• LocalGovernmentinvolvement–increasedremit to commission...Council / Health & Well Being Board work with CCGs?
The Way Forward: Post 2015 (5)
• Social care budget has been cut & care costs rising – how to fund? – suggested voluntary or all in approach ref Policy Paper page 8
• Andrew Dilnot review to protect savings
– Capping lifetime individual contributions to £35k (care at home & residential care, not board and lodging costs)
– Raising the means-test threshold for savings below which people become eligible for state-funded residential care from £23k to £100k
– Cross over ideas NHS & Social care e.g. prevention and early intervention
The Way Forward: Post 2015 (6)
• Funding ideas,
– Rebrand NI (National Insurance) as NHSI (NHS Insurance) i.e. A true hypothecated tax with a corresponding 1% increase in basic rate of income tax to cover NI losses?
– And a state run health insurance similar to stake holder pensions with low admin costs for social care costs?
– PFI hosp. contracts cancelled and compensation calculated on gilt rates, not market / capital rates?
The Way Forward End
Thank you for listening - Discussion...
The Way Forward: References 1
• http://en.wikipedia.org/wiki/National_Health _Service
• http://www.nhs.uk/NHSEngland/thenhs/abou t/Pages/nhscoreprinciples.aspx
• http://www.bbc.co.uk/news/health-25660555 • http://ec.europa.eu/trade/policy/in-
• http://en.wikipedia.org/wiki/Transatlantic_Tra de_and_Investment_Partnership
The Way Forward: References 2
• Above web link shows before / after structures
• http://www.theguardian.com/politics/2013/dec/30/nh s-reform-competition-lawyer-fees-labour
• http://www.monitor-nhsft.gov.uk/about-monitor/who- we-are/executive-team
• http://drphilhammond.com/blog/2014/01/29/private- eye/medicine-balls-private-eye-issue-1357/
• http://www.blog.rippedoffbritons.com/2013/11/liebra ry-national-audit-office- report.html?utm_source=buffer&utm_campaign=Buffe r&utm_content=buffer9bd15&utm_medium=twitter
The Way Forward: References 3
• http://www.hsj.co.uk/hsj-local/local-briefing/analysed- one-year-of-circle-at- hinchingbrooke/5055018.article#.Uu_4TVVFCmc
• http://www.theguardian.com/society/2004/mar/31/nh s2000.medicineandhealth
• http://www.communitycare.co.uk/dilnot-adult-social- care-funding-reform/
• http://www.unitetheunion.org/how-we-help/list-of- sectors/healthsector/healthsectorcampaigns/unite4ou rnhs/the-care-bill--clause-118/
The Way Forward: References 4
• http://www.theguardian.com/commentisfree/ 2013/nov/06/david-cameron-eu-us-trade- deal-investor-state-dispute-settlement
Andy Burnham must have been listening,
"Complementing the establishment of “whole-person care”, his other main pledge is to repeal the coalition’s NHS reforms and halt the privatisation of services. He is troubled by how the proposed EU-US free trade agreement could give permanent legal backing to the new, market-led regime and reveals that he will soon travel to Brussels to lobby the European Commission over the matter. “It means being absolutely explicit that we carry over the designation for health in the Treaty of Rome, so that we can exempt it from competition law,” he tells me. “The market is not the answer to 21st-century health care. The demands of 21st-century care require integration. Markets deliver fragmentation." Click here.