NHS –not safe in Tory hands
Stephanie Clark explains that both cutbacks and creeping privatisation is threatening the NHS in England and how to stop it.
On 1 April the first Accountable Care Organisations (ACOs) were due to be introduced into England’s NHS. Concerns about the lack of consultation and parliamentary process involved in this radical re-organisation by the non-statutory body NHS England are currently being considered by the House of Commons Health Select Committee. Its Chair, Sarah Woolaston, asked Jeremy Hunt to pause implementation to allow her committee to complete its investigation. He refused, but has been forced to concede a consultation on the new ACO contract first.
At the same time, Judicial Reviews initiated by NHS campaigners are challenging the legalities involved in this process and the national ACO contract and have caused local plans for ACOs and hospital closures to be put on hold. The collapse of Carillion has added to nervousness about proceeding with further extension of private-public partnerships into the heart of the NHS.
The risks and democratic deficit involved in the massive re-organisation of the NHS, alongside draconian cuts in budget are pushing health and social care to breakdown. There is far greater public awareness and concern about cuts, however, than understanding of the complex programme for NHS re-structuring and privatisation.
Dismantling and privatisation of the NHS has been a clandestine 40 year project by those ideologically opposed to a socialised health service. Margaret Thatcher went as far as she could in introducing limited outsourcing but her ambitions were constrained by practicalities. However, the Conservative Party’s privatisation ambition was embodied in Oliver Letwin’s 1988 book, Privatisating the World: A Study of International Privatisation in Theory and Practice (preface by John Redwood). Letwin was David Cameron’s Chief Policy Advisor and got into hot water for his leaked message to a private meeting in 2014 that the “NHS will not exist” within 5 years of a Conservative election victory.
The Blair/Brown Government increased investment with £5bn a year to the NHS, but also extended privatisation. Health Minister Alan Milburn introduced Foundation Trusts & the ‘internal market’, and Gordon Brown energetically embraced the Major Government’s Private Finance Initiative. The NHS was left with £81.6bn to pay off in debts –the cost of privatising hospital construction and outsourcing services via PFI deals – and paving the way to the Carillion disaster.
But privatisation has been accelerating since 2012. The 2012 Health and Social Care Act, drafted by global management consultants, McKinsey & Co, set the NHS up for the purpose. It removed the government’s duty to provide a universal, comprehensive NHS, replaced strategic planning and commissioning with local Clinical Commissioning Groups, handed buildings to NHS Property Services, introduced full marketisation of the NHS imposing competitive tendering of all services, and increased the cap on NHS hospitals’ private patients to 49%. It also left governance in a complete mess.
As at 30 Nov 2017, nearly £10bn of NHS clinical contracts are now held by private companies, and only 34% of contracts tendered last year went to the NHS. Among those with contracts are Care UK, which has links to the Conservative Party. Care UK runs the NHS 111 call centre and, alongside Virgin Care, has seized the opportunities for potentially lucrative community-based health services opening up as the national strategy for moving care out of hospitals into the community is being rolled out.
Virgin Care has won well over £2bn of NHS “business” over the past 7 years – several large contracts in community health, and £1bn of NHS contracts in 2016/17 – over 400 separate NHS contracts. In 2017 Virgin Care won a 7 year £700m contract to run Bath and North East Somerset’s community care and health services. This is the first time a for-profit company will run a council’s adult social care services.
Virgin also exemplifies the vulnerability of the NHS to being sued where companies fail to get the contract they have sought. Virgin Care sued the NHS after it lost out on an £82m contract for children’s services in Surrey. Damages have been kept secret but campaigners have discovered through an NHSE source that they amount to £2m. In a further development this year – and rare success for the public sector – a Lancashire judge has blocked the contract awarded to Virgin to run the Lancashire County Council’s Healthy Child Programme. Virgin is an example of a predatory company ruthless in extracting profit from NHS patient frontline patient care, beginning with loss leading bids to gain foothold in a lucrative future healthcare market. And Virgin, based in a tax haven, pays no tax.
Five years on from the 2012 Health and Social Care Act, there is widespread agreement that it has been a disaster. The fragmentation of services, the destructive effect of competition and shocking contract failures have ostensibly been addressed by Simon Stevens, head of NHS England, the body set up by the Government to run the NHS after the 2012 Act. Stevens’ plan, “Five Year Forward View” (5YFW), published in 2014, to transform the NHS is being implemented through Sustainability and Transformation Plans (STPs). The country has been divided into 44 areas for STP delivery. These have been established as vehicles for cuts of £25bn and privatisation, but are presented as plans for the delivery of improved health outcomes with lower costs. How to achieve this miracle?
Informed commentators have castigated the process dictated by NHSE, the “savings” required to eliminate the deficits within the timescales demanded and with no planned evaluations of pilots and no plan for social care. The national rollout of the STPs in December 2015 was condemned at the time by Julia Simon, until 2016 senior NHS England director, as “ridiculous”, “shameful” and “mad” and the plans full of “lies”.
The plans require co-operation between the NHS and local authorities at a time when both NHS and social care are in crisis due to underfunding. But, both CCGs and, in many cases, local authorities are being sidelined as the new organisational structures are being set up. It is NHSE’s intention that a multiplicity of interim arrangements will over time evolve into ACOs.
So what are ACOs? And where do they come from?
Simon Stevens’ 5YFV plan for the NHS mirrors the blueprint developed over 2012 and 2013 at the World Economic Forum at Davos. Simon Stevens was leading that project team in his then role as President of Global Health Division at the US health corporation UnitedHealth. (Previous to that, Simon Stevens was health policy advisor to Tony Blair.)
The WEF group commissioned two reports from McKinsey & Co to develop a global template for transforming “socialised” health systems. The reports’ recommendations, now being implemented through the STPs, are to:
- Lower costs with new payment systems
- Reduce capacity in costly settings like hospitals
- Promote ‘self care’
- Redefine ‘health industry’ to allow global corporations to take over more public services
- Introduce new ways to deliver ‘integrated’ or ‘accountable’ care based on models like Kaiser Permanente in the US, and the Alzira model in Spain and called Accountable Care Organisations, or ‘ACOs’.
An ACO requires a corporate entity to be set up: a commercial – non-NHS body, though NHS providers may be included among its constituent members. There is nothing currently to prevent a private company, including a global corporation, from taking over the contract as a whole. (The “accountability” of ACOs relates to financial accountability to partners, not to the public.)
Jeremy Hunt referenced Kaiser Permanente and Alzira as his two models for restructuring the NHS in addressing the Health Select Committee on 9.5.16.
Kaiser Permanente in the US is a company running its own hospitals and primary care, with its own health insurance plan. Its business model is based on saving money on treatments and denial of care.
The Alzira model appears, however, to be the preferred option of Simon Stevens. This model (named after the town Alzira in Spain where it was piloted) functioned in part like a UK PFI for a new hospital (the first privatised hospital in Spain) but also included providing the actual health care. The Alzira model was credited with bringing down costs and was extended to other regions but became mired in scandal over strikes, allegations of premature deaths and banking corruption and in 2017 the Valencian government passed new legislation to return the Alzira health concession to direct public management.
Centene is a partner in the Greater Nottingham ICS, has its UK base in the Kings Fund premises in London and has recently appointed Alan Milburn to its Board. Centene’s role in Nottingham is as a “Care Integrator” – a key new role in ICSs with particular potential for the private sector and critical to the evolution into ACOs.
Optimum UK, the UK arm of UnitedHealth, is another example of a company in pole position to benefit from the evolution of ACOs. It already has NHSE contracts for commissioning support as well as community services. Optimum declare they are: “One of the few companies in the world that provides fully integrated solutions to deliver NMC [New Models of Care] requirements, from back-office transactional support to front-line delivery”.
In July 2017, NHSE announced 8 areas that would become ACSs (now ICSs), working towards becoming ACOs, originally intended from April 2018.
In this 70th anniversary year of the NHS, we have reached the end game of a long project to destroy it.
We cannot stand by and let this happen.
What can you do?
Support the Judicial Reviews, which are the best current hope for frustrating the privatisation and the cuts. National challenges:
#JR4NHS, was supported by Stephen Hawking among the 5 campaigners
To be heard 23-24 May 2018
#Comprehensive healthcare for all, challenging the legality of the new draft ACO contract due to be heard on 24 April in Leeds
Local legal challenges in South Yorkshire, Huddersfield, Barnsley and Rotherham stroke services, Dorset and Forest of Dean and South Tyneside.
Sign the online petitions:
Stop Privatisation of NHS Services – to be debated in the House of Commons on 23 April
- And ask your MP to attend
STOP the new plans to dismantle our NHS
Build support for the NHS Reinstatement Bill.
This is being tabled for the third time as a 10 Minute Bill on 11 July
Join the demonstrations planned for the NHS 70th anniversary on 30 June
Work within the Labour Party to gain understanding of what is happening to the NHS, get discussion informed by the health campaigns to embed the 2017 national Conference NHS policy to oppose ACOs and work for the reinstatement of the NHS.
If you have a Labour Council, do what you can to ensure it is adopting national conference policy and opposes the ACOs and cuts to health and social care.
Support the local campaign in your area. Consider joining Keep Our NHS Public
This article has drawn particularly on the work of my fellow campaigners in Tower Hamlets Keep Our NHS Public, the Public Matters website http://publicmatters.org.uk and the many contributors to Keep Our NHS Public and Health Campaigns Together
Member Keep Our NHS Public and local health campaigns, and Tower Hamlets CLP