Another Attack On The NHS

See this Morning Star report for a terrible example of the disregard for both workers rights and the  well-being of patients, in a newly privatised section of the NHS.


Hat tip - Jon Williams (don't miss his article below this one).

Labour Policy on Health and Care, by Jon Williams.

This is an initial response from Jon Williams to the Labour Party's consultative document on "Health and Care". The consultative document can be found here.

Overall this is a good document for Labour to promote and to take forward into their 2015 election manifesto. It covers a lot of the points of concern which we considered at our Discussion Meeting at Dronfield about the Coalition Government's and Health and Social Care Act moving us further to the privatisation of the NHS. ( See the presentation Jon made to that meeting here . HB).

The consultative document also says that it will use Sir John Oldham’s report  "One Person, One Team, One System"  which can be found here .  Additionally it proposes to make use of Andrew Dilnot’s social care report, see here .

The theme of the integration of  “whole person care”  is pursued to meet physical, mental and social needs. This involves removing inefficient fragmentation and competition to free up money, as long term care needs are increasing every year. It promises to repeal the  2012 Health and Social Care Act.  Yet I have doubts whether this is possible due to the Transatlantic Trade and Investment Partnership and the European and United States US trade agreement – which, however, is yet to be finalised. However, I attended a Chesterfield and North Derbyshire "Save Our NHS" meeting recently where Derbyshire County Councillor David Allen who is Chair of the Health and Well Being Board and Dr Sally Ruane the Deputy Director of Health Policy Research Unit De Montford University, discussed many of these issues. It was thought the NHS could be made an exemption to this agreement.

In the consultative document, Labour proposes to put patients before competition and get rid of the market system in the NHS. It talks about empowering people to use NHS organisations. It supports the principle of the NHS as the preferred provider and of using other providers in partnership. It is good to see the NHS is codified – I assume that incorporates the NHS founding principles. It also states that the local authority remit will be increased using Health and Well Being Boards. Power will be taken away from NHS commissioners and given to an independent body, such as Health and Well Being Board – again I agree with this approach. I hope “Monitor” (see here ) the current economic regulator will be abolished as the market system is reduced / removed. For line 40 of the Consultative Document quotes UNISON as saying  “Labour should use integrated care to break down the market, basing integration on NHS principles...”

By using preventive care / education Labour will reduce the demand on Accident and Emergency Services and will enable better access to local GP services. This is a key theme where funding will reduce over time, for money has been wasted with unnecessary re-organisation - an estimated £3 billion!

Social care funding has been cut with tighter eligibility criteria, which will me mean that hundreds of thousands fewer people get help. Labour is looking to implement Andrew Dilnot’s recommendations, e.g. with caps on care costs. It seems more discussion is required before definite policies are agreed. A key theme is that “older people should be treated with dignity as a top priority”. Keeping people at home to remain healthy, will reduce demand at hospitals. Also carers are central to "whole person care", including providing respite care, proper support and training with new rights. It mentions tackling the abuse of zero hour contracts, but does this mean not abolishing them!?

Part of the theme to help people stay healthy is to provide decent housing and better employment policies. It quotes Marmot’s report on a “Fair Society, Healthy Lives: Health Inequalities in England”  i.e. that large differences in health is dependent on circumstances. I fully agree with these sentiments. See here.

Labour's consultative document "Health and Care" is brief,  but it contains the major issues. What It lacks in detail is (a) how the process of integrated care will be applied, (b) where funding will be raised (taxation), (c) the issue of private involvement in the NHS,  (d) whether existing PFI contracts can be cancelled and (e) what role existing private companies have, if any, in the NHS.

Recently Clause 119 allowing hospital closures without consultation was carried in the Commons whilst probation privatisation went through the House of Lords.  Seemingly there is no limit to the privatisation ideology!

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

Agenda

• 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-
focus/ttip/#what_is_ttip
• http://en.wikipedia.org/wiki/Transatlantic_Tra de_and_Investment_Partnership

The Way Forward: References 2

• http://www.bbc.co.uk/news/health-19674838
•    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://en.wikipedia.org/wiki/NHS_foundation_trust
• 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.sochealth.co.uk/
• 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

JON WILLIAMS 


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.