Gordon Brown has fired the starting gun for a race that was already in full flow. In four weeks we will know who has won the 2010 general election. Many angry activists, frustrated at new Labour's adherence to Thatcher's anti-union laws and continuation of her privatisation offensive, have argued that there is "no choice" between the main parties. But one area this is clearly not true is the NHS. While 18 years of Tory rule saw the NHS face cuts, the privatisation of hospital support services, Thatcher's mad, costly and wasteful "internal market" reforms, more cuts, soaring waiting lists and a growing gulf between the quality of British health care and much of Europe, 13 years of Labour rule has brought a real transformation. Huge new resources have been pumped in to the NHS. Spending has risen at the fastest rate in 60 years, with the health budget almost trebled since 1997, with generous above-inflation year-on-year increases since 2001, and the share of national wealth spent on health has increased towards the European average. Waiting times are down and with the 18-week maximum wait they are now among the best in Europe. And staff numbers are up - even if too many of these are managers. There are new hospitals, too, far more than since the late 1960s - although almost all of these have been funded through the controversial private finance initiative, the most expensive possible way to secure the money. PFI is just one of many weaknesses in Labour's record, of which we are all aware.
Another fundamental problem is that instead of sticking to his promise to sweep away Thatcher's costly and wasteful market system, Blair, and now Brown, have hung on to it, made it more complex and bureaucratic and brought in far more private-sector involvement than the Tories ever dreamed of. Overhead costs have mushroomed, while the talk of "efficiency" has never been louder. With the market has come today's indecipherable and pointless jargon of "world-class commissioning," swarms of private-sector management consultants, and the relentless drive to draw in private providers to deliver clinical services and even community and mental health services through the Transforming Community Services policy. With the market has come the establishment of a biased Co-operation and Competition Panel as a platform for whingeing private entrepreneurs to complain at their failure to win contracts, the positioning of Richard Branson's Virgin group and Care UK to exploit the current fad for expensive new "polyclinics" and privatisation of primary care, and the expensive irrelevance of independent-sector treatment centres creaming off the simplest and most profitable elective services at higher cost - and often delivering far fewer than the contracted numbers of operations.
The market system has also brought the "patient's choice" initiative encouraging NHS patients to seek simple elective treatment in private hospitals, leaving their local NHS hospitals facing financial losses and, of course, the costly folly of the billions squandered on a complex computer system that still doesn't work. But while Labour could obviously have spent much of the extra money more wisely - and even now could save billions painlessly by changing course on some of these policies - we know from their previous 18 years in office that the Tories wouldn't have spent the extra money at all. Left to them, the waiting list would still be with us, with tens of thousands of people still waiting 18 months or more for treatment in crumbling and poorly cleaned hospitals. And while Labour has stupidly rolled out the red carpet for private providers, the Tories would be even more eager to please any of their big business friends, like Sir Peter Gershon, who fancy a slice of the NHS £105 billion budget. So let's use the election period to keep the pressure on all the main parties to halt the £20 billion of cuts in the next few years, which threaten to devastate many local services, close hospitals, axe tens of thousands of beds and NHS jobs, and throw more qualified staff on the dole queue. Both parties threaten that, and these cuts must be fought, no matter what the result of the election.
But let's not forget that in 62 years of the NHS only one party has had the courage to pump much-needed resources into health care and create a service that gives us so much to defend. Ignore that difference and we could have years to regret a Cameron government. The pace and scale of planned cutbacks in health care and hospital services has been gathering pace up to the "purdah" period between now and May 6. Top of the cutters seems to be Southampton University Hospital Trust, which is seeking to axe a staggering £100m and 1,400 jobs over four years. Salford Royal - once known quite ironically as Hope Hospital - is to axe 750 jobs over three years, cutting its budget by 15 per cent. The most hurried cuts seem to be in Leicestershire, where the hospitals trust announced plans to cut £58m of spending in just one year with the loss of 700 jobs. But jobs and spending are being hacked back in Oxford, Cambridge, Leeds, Nottingham, Derby, Gateshead, Wirral, Portsmouth, Gloucester, Basildon and Slough. The NHS is Europe's biggest employer. The loss of these jobs, with a knock-on impact on local suppliers and businesses in each area, seems certain to contribute much more to a double-dip recession than Labour's plan to add 1 per cent to national insurance. As soon as "normal" politics resumes on May 7, each of these and many more cuts will need to be challenged by local campaigners and health unions.
Showing posts with label nhs. Show all posts
Showing posts with label nhs. Show all posts
Sunday, 11 April 2010
Friday, 9 April 2010
Blueprint for NHS sell-off
What will the Tories do to the NHS? I am returning to this question because it says a lot about where the two parties stand in the forthcoming election. It tells us Cameron is standing on policies as airbrushed as his face. And Labour is sitting on its hands because a proper punch at Cameron might also biff some of its chums on the chin. Both Labour and the Tories know the NHS is sensitive for Cameron - the Tory leader works hard to shake off popular suspicions that his party is anti-NHS. This is why he plastered up posters promising not to cut the health service. It is why he was desperate to distance himself from MEP Dan Hannan when the latter called the NHS a "mistake." And it is why Labour MPs have highlighted Cameron's pre-Christmas meeting with a group called Nurses for Reform. Nurses for Reform is a hard-right group which argues that the "NHS is no longer a dearly loved British institution. It is a Stalinist nationalised embarrassment that should now be quietly and deftly consigned to the dustbin of history." So Cameron was keen to play down the significance of the time he spent with it. I am going to agree with Cameron - slightly.
Nurses for Reform does not represent his most significant adviser. It is a bit more libertarian than purely Tory and more ultra in the free-market freakiness than he is. But a group called Doctors for Reform is much closer to the Tory centre. It is part of a think tank called Reform which has many strong Conservative connections. Tory shadow minister Ed Vaizey sits on the Reform advisory board. So does Christopher Gent, the ex-Lehman Brothers banker who funds the Tories and sits on Cameron's "recovery committee." Adrian Bull, boss of NHS privatisation firm Carillion Health, also sits on Reform's "advisory council." Doctors for Reform's policies are bound to please the think tank's advisers. They square the circle between "backing" the NHS and wanting to let free-market dogma and private health profiteering run riot in the health service. Doctors for Reform says that if "the founding principles of the NHS are to be preserved the following changes need to be adopted and implemented." Its changes preserve the NHS in the same way a butcher preserves a pig. They include: "Supply competition. Patients should be allowed to exercise real, informed choice about where, how and by whom they are treated." Instead of NHS hospitals treating NHS patients, the health service would dole out cash to private companies like Carillion. The health service would stop being a system of hospitals and clinics and become a big money tap pouring cash into the mouths of contractors.
The second change is "Topping up the basic level of care. The NHS should allow patients to spend their own money on treatment provided by either the independent sector or the NHS, where it might make a charge for treatments not normally available." So posh people could take their NHS money out of the health service, add a bit of their own cash and spend it at luxury hospitals. The third change is "Universal coverage with an insurance element. Our current system provides universal coverage but would benefit from having an insurance element." By raising NHS money through insurance schemes rather than tax, the burden of payment would be shifted away from the better off. This would lay the ground to opening up the NHS to the insurance industry. Now, I have gone to the trouble of looking at Doctors for Reform's proposals to dig out this plan to cut the NHS as a provider and shift it towards a voucher system funding the private health sector. But are these plans really secret? No - most of them are already in or compatible with the Tory draft health manifesto. In his manifesto Cameron promises to "open up the NHS to include new independent and voluntary sector providers." So when his billboards say that he will not cut the NHS, he means that he will.
He won't cut government spending on health, but he won't give the money to the NHS hospitals and clinics. Instead he will give the cash to his private health firm pals. Cameron's promise not to cut the NHS rests on a division between the NHS as a funder and as a provider. This arbitrary division is quite common in the minds of MPs, ministers, policy wonks and other Westminster folk, even though it is pretty much unknown in the wider world. And this will be done through a great big marketing drive, because Cameron says: "The next step is to create an NHS where patients are in the driving seat. We will give everyone the power to choose any health-care provider that meets NHS standards." So Carillion Health, for example, could grab the NHS cash from as many patients as it could persuade through its doors. It could use advertising drives, loss leaders and other tricks to starve local NHS hospitals. This would open the door to non-NHS health firms taking both NHS "voucher" payments and extra top-up fees for a little luxury. The only element of the Doctors for Reform plan not in Cameron's draft is the top-up insurance funding. So there is a lot of room to attack Cameron as wanting to take cash from the NHS and give it to his business pals. But Labour will not launch this attack because it did it first.
After years of campaigning by unions and activists, Health Secretary Andy Burnham finally stalled the handover of NHS money to private contractors. Because Labour has its own friends in the private health industry you get the feeling that it would want to restart the scheme as soon as possible if it was re-elected anyway. Essentially Labour is slow to attack Cameron's unpopular policies because they are too popular among its own team.
Nurses for Reform does not represent his most significant adviser. It is a bit more libertarian than purely Tory and more ultra in the free-market freakiness than he is. But a group called Doctors for Reform is much closer to the Tory centre. It is part of a think tank called Reform which has many strong Conservative connections. Tory shadow minister Ed Vaizey sits on the Reform advisory board. So does Christopher Gent, the ex-Lehman Brothers banker who funds the Tories and sits on Cameron's "recovery committee." Adrian Bull, boss of NHS privatisation firm Carillion Health, also sits on Reform's "advisory council." Doctors for Reform's policies are bound to please the think tank's advisers. They square the circle between "backing" the NHS and wanting to let free-market dogma and private health profiteering run riot in the health service. Doctors for Reform says that if "the founding principles of the NHS are to be preserved the following changes need to be adopted and implemented." Its changes preserve the NHS in the same way a butcher preserves a pig. They include: "Supply competition. Patients should be allowed to exercise real, informed choice about where, how and by whom they are treated." Instead of NHS hospitals treating NHS patients, the health service would dole out cash to private companies like Carillion. The health service would stop being a system of hospitals and clinics and become a big money tap pouring cash into the mouths of contractors.
The second change is "Topping up the basic level of care. The NHS should allow patients to spend their own money on treatment provided by either the independent sector or the NHS, where it might make a charge for treatments not normally available." So posh people could take their NHS money out of the health service, add a bit of their own cash and spend it at luxury hospitals. The third change is "Universal coverage with an insurance element. Our current system provides universal coverage but would benefit from having an insurance element." By raising NHS money through insurance schemes rather than tax, the burden of payment would be shifted away from the better off. This would lay the ground to opening up the NHS to the insurance industry. Now, I have gone to the trouble of looking at Doctors for Reform's proposals to dig out this plan to cut the NHS as a provider and shift it towards a voucher system funding the private health sector. But are these plans really secret? No - most of them are already in or compatible with the Tory draft health manifesto. In his manifesto Cameron promises to "open up the NHS to include new independent and voluntary sector providers." So when his billboards say that he will not cut the NHS, he means that he will.
He won't cut government spending on health, but he won't give the money to the NHS hospitals and clinics. Instead he will give the cash to his private health firm pals. Cameron's promise not to cut the NHS rests on a division between the NHS as a funder and as a provider. This arbitrary division is quite common in the minds of MPs, ministers, policy wonks and other Westminster folk, even though it is pretty much unknown in the wider world. And this will be done through a great big marketing drive, because Cameron says: "The next step is to create an NHS where patients are in the driving seat. We will give everyone the power to choose any health-care provider that meets NHS standards." So Carillion Health, for example, could grab the NHS cash from as many patients as it could persuade through its doors. It could use advertising drives, loss leaders and other tricks to starve local NHS hospitals. This would open the door to non-NHS health firms taking both NHS "voucher" payments and extra top-up fees for a little luxury. The only element of the Doctors for Reform plan not in Cameron's draft is the top-up insurance funding. So there is a lot of room to attack Cameron as wanting to take cash from the NHS and give it to his business pals. But Labour will not launch this attack because it did it first.
After years of campaigning by unions and activists, Health Secretary Andy Burnham finally stalled the handover of NHS money to private contractors. Because Labour has its own friends in the private health industry you get the feeling that it would want to restart the scheme as soon as possible if it was re-elected anyway. Essentially Labour is slow to attack Cameron's unpopular policies because they are too popular among its own team.
Saturday, 3 April 2010
New decade, old enemies for NHS
Perhaps against the odds, 2009 turned out to be a successful year in which campaigning and pressure forced a significant retreat on controversial policies in the NHS. The pell-mell drive to privatise community and primary care services that had until recently been directly provided by primary care trusts appears to have been slowed, if not halted, although very few people in the wider electorate even knew that it was going on. The change of policy is a result of consistent trade union pressure on health ministers - although sadly not before services in Hull, Bromley and Kingston had been lined up for take-over by "social enterprises." Private and "non-profit" voluntary sector organisations that fancied carving themselves a generous slice of the £11 billion NHS budget for these services, and some of the senior managers lining up to take advantage of Lord Darzi's so-called "right to request" that an NHS unit be hived off as a "social enterprise," have been twitching with anger at Health Secretary Andy Burnham. The so-called co-operation and competition panel, set up as a sounding board for aggrieved private-sector punters to complain they have been treated unfairly, has apparently received complaints from various aggrieved parties bitter at Burnham's October declaration that the NHS should be the "preferred provider" unless all efforts to improve NHS services had failed.
But to his credit Burnham has not only stuck to his guns, apparently having won the support of Gordon Brown - he has even suggested he may review the working of the competition panel itself. NHS managers have been - in some cases reluctantly - dragged into line on the new policy. If only we could look forward to similar successes in this new year. But sadly, the new decade is opening with the NHS facing new and very serious threats. The new danger is the old enemy that the London Health Emergency was formed to fight back against in 1983 - cuts and closures. All the main political parties are agreed that massive cuts should be inflicted on health care, education and other public services - not because these services have failed in any way, but because of a huge private-sector failure. They are cutting health care in a bid to cover the colossal £175 billion costs of bailing out failed and irresponsible bankers. Of course the party leaders won't admit that they plan cuts in the NHS, least of all in the run-up to the general election in May. So each of them claims to be "protecting" front-line services by increasing funding in line with inflation - ignoring the fact that the NHS needs billions more in real terms each year to keep pace with the costs of a growing population, rising numbers of elderly and new drugs and technology. And even if front-line budgets were to be protected, many spending plans for the next few years already assume massive "efficiency" savings of up to 5 per cent a year, without any evidence that unprecedented savings on this scale can be achieved without cuts.
To make matters worse, much of the 5 per cent of the NHS which is not seen as "front line" - and therefore not protected - includes training and research budgets which are likely to be slashed. Even NHS chief executive David Nicholson admits that the coming cuts are "tougher than the NHS has ever had, through its history. And it's for a sustained period." The squeeze will hit hospital services hardest of all - with a four-year freeze on the "payment by results" tariff which determines hospital budgets, and a massive 70 per cent cut in funding for any additional A&E patients treated in excess of the 2008-9 caseload. A Health Service Journal analysis argues that by 2014 "savings on this scale could entail perhaps half a dozen general hospitals going to the wall in each Strategic Health Authority." Hardest hit will be hospitals with large fixed overhead costs - in particular those funded through the private finance initiative. But primary care trusts and strategic health authorities are also required to cut their management costs by 30 per cent - some might say not before time. They are even looking to cut the massive amount they are wasting each year on hiring costly private-sector management consultants. While NHS chiefs are already discussing these issues in secret, the plans are only beginning to emerge. NHS London is leading the charge, with cuts - based on a secret briefing by US-based private management consultants McKinsey - aimed at slashing up to £5 billion from the capital's £13 billion primary care trust budget by 2017.
NHS London has said quite openly that it wants primary care trusts to chop A&E caseloads by 60 per cent - diverting almost 2 million patients a year to unproven or as yet non-existent primary care "polysystems." This seems especially bizarre in the context of this winter of snow and swine flu, in which all of the existing A&E units are full to bursting and running well above target. NHS London also wants primary care trusts to cut hospital outpatient attendances by 55 per cent - diverting upwards of five million appointments to other "settings" such as polyclinics and health centres, where highly paid consultants would have to travel to see a fraction of the number they could see in a properly equipped hospital. Even on Lord Darzi's inadequate and outdated figures in 2007, these two changes would mean cutting well over £1 billion from London hospital budgets, forcing a drastic round of service cuts and closures. But primary care and mental health face cutbacks too. GPs have been caught up in the new cash squeeze and required for the first time ever to deliver efficiency savings, but NHS London also wants to slash staffing in "non-acute" services by 66 per cent - and even cut GP appointment times by 33 per cent. The list goes on and on. NHS London is frogmarching the capital's primary care trusts deep into unknown territory. Nobody anywhere has changed an established health-care system on this scale before, let alone at the breakneck speed it proposes, with virtually none of the alternative services that would be required even planned, let alone in place.
All of these potentially devastating cutbacks are based on the assumptions and assertions in the secret McKinsey document. In other words, there is absolutely no published evidence that these changes could even be achieved, or that they would save money, enhance efficiency or deliver acceptable levels of patient care. The few Darzi-style health centres that have been established so far are not only much more expensive than the average primary care but they have generally failed to sign up their "drop-in" patients to regular lists.
The NHS London plan seems to be guesswork hatched up by management consultants from the US, the land of the world's most costly, exclusive, wasteful and hugely inefficient health-care system. And if the guesses go wrong, the health care of millions will be put at risk. Let's stop them before it's too late.
But to his credit Burnham has not only stuck to his guns, apparently having won the support of Gordon Brown - he has even suggested he may review the working of the competition panel itself. NHS managers have been - in some cases reluctantly - dragged into line on the new policy. If only we could look forward to similar successes in this new year. But sadly, the new decade is opening with the NHS facing new and very serious threats. The new danger is the old enemy that the London Health Emergency was formed to fight back against in 1983 - cuts and closures. All the main political parties are agreed that massive cuts should be inflicted on health care, education and other public services - not because these services have failed in any way, but because of a huge private-sector failure. They are cutting health care in a bid to cover the colossal £175 billion costs of bailing out failed and irresponsible bankers. Of course the party leaders won't admit that they plan cuts in the NHS, least of all in the run-up to the general election in May. So each of them claims to be "protecting" front-line services by increasing funding in line with inflation - ignoring the fact that the NHS needs billions more in real terms each year to keep pace with the costs of a growing population, rising numbers of elderly and new drugs and technology. And even if front-line budgets were to be protected, many spending plans for the next few years already assume massive "efficiency" savings of up to 5 per cent a year, without any evidence that unprecedented savings on this scale can be achieved without cuts.
To make matters worse, much of the 5 per cent of the NHS which is not seen as "front line" - and therefore not protected - includes training and research budgets which are likely to be slashed. Even NHS chief executive David Nicholson admits that the coming cuts are "tougher than the NHS has ever had, through its history. And it's for a sustained period." The squeeze will hit hospital services hardest of all - with a four-year freeze on the "payment by results" tariff which determines hospital budgets, and a massive 70 per cent cut in funding for any additional A&E patients treated in excess of the 2008-9 caseload. A Health Service Journal analysis argues that by 2014 "savings on this scale could entail perhaps half a dozen general hospitals going to the wall in each Strategic Health Authority." Hardest hit will be hospitals with large fixed overhead costs - in particular those funded through the private finance initiative. But primary care trusts and strategic health authorities are also required to cut their management costs by 30 per cent - some might say not before time. They are even looking to cut the massive amount they are wasting each year on hiring costly private-sector management consultants. While NHS chiefs are already discussing these issues in secret, the plans are only beginning to emerge. NHS London is leading the charge, with cuts - based on a secret briefing by US-based private management consultants McKinsey - aimed at slashing up to £5 billion from the capital's £13 billion primary care trust budget by 2017.
NHS London has said quite openly that it wants primary care trusts to chop A&E caseloads by 60 per cent - diverting almost 2 million patients a year to unproven or as yet non-existent primary care "polysystems." This seems especially bizarre in the context of this winter of snow and swine flu, in which all of the existing A&E units are full to bursting and running well above target. NHS London also wants primary care trusts to cut hospital outpatient attendances by 55 per cent - diverting upwards of five million appointments to other "settings" such as polyclinics and health centres, where highly paid consultants would have to travel to see a fraction of the number they could see in a properly equipped hospital. Even on Lord Darzi's inadequate and outdated figures in 2007, these two changes would mean cutting well over £1 billion from London hospital budgets, forcing a drastic round of service cuts and closures. But primary care and mental health face cutbacks too. GPs have been caught up in the new cash squeeze and required for the first time ever to deliver efficiency savings, but NHS London also wants to slash staffing in "non-acute" services by 66 per cent - and even cut GP appointment times by 33 per cent. The list goes on and on. NHS London is frogmarching the capital's primary care trusts deep into unknown territory. Nobody anywhere has changed an established health-care system on this scale before, let alone at the breakneck speed it proposes, with virtually none of the alternative services that would be required even planned, let alone in place.
All of these potentially devastating cutbacks are based on the assumptions and assertions in the secret McKinsey document. In other words, there is absolutely no published evidence that these changes could even be achieved, or that they would save money, enhance efficiency or deliver acceptable levels of patient care. The few Darzi-style health centres that have been established so far are not only much more expensive than the average primary care but they have generally failed to sign up their "drop-in" patients to regular lists.
The NHS London plan seems to be guesswork hatched up by management consultants from the US, the land of the world's most costly, exclusive, wasteful and hugely inefficient health-care system. And if the guesses go wrong, the health care of millions will be put at risk. Let's stop them before it's too late.
Thursday, 25 March 2010
When efficiency means health service cuts
Health minister Mike O'Brien has said he believes health bosses such as NHS London should keep a veil of secrecy over their discussions on how to impose wholesale changes to the service's operation. If information leaked out, he told MPs this week, opponents of the plans could "attack them over their lack of evidence." What a telling admission. Not only are paranoid levels of secrecy now official government policy, but ministers are actively encouraging health chiefs to hatch up plans for which there is no evidence - while opposing those of us who point out that these policies are potentially dangerous. The three remaining strategic health authorities that have so far kept a stony silence on their plans are expected to reveal how they intend to generate their share of a £20 billion financial "gap" in the service in the new financial year. Their policy changes, as called for by NHS boss Sir David Nicholson, are unlikely to contain many surprises. Across the country the same rhetoric is being wheeled out to justify proposals for astronomical increases in "efficiency" and "productivity" which will wind up as cuts. Buzz-words such as "reinventing care pathways" (dumping patients out of hospital A&Es onto untested, supposedly cheaper alternatives in primary care such as "polysystems" - see below) "working smarter" and "innovation" crop up again and again.
But so do more obvious, unambiguous phrases such as "affordability analysis," "decommissioning," "savings," and "tariff reductions" - in other words cutting the amount paid to NHS trusts for each episode of treatment.
Perhaps the most blunt statement about the real driving force behind the various new policies comes from NHS Southwark, which declares openly that its proposals are cash-driven. "Our financial modelling shows that the primary care trust's (PCT's) current profile of expenditure is unaffordable over the next five years. "The affordability analysis requires £18m of savings in 2010/2011. Our commissioning strategy is driven by the need to achieve a system of healthcare which is financially sustainable." (Strategic Plan 2010/11 to 2016/17)." But this highlights a major question. Can the proposals outlined by health bosses actually work, delivering services to patients while saving a large amount of money? Central to the guidelines laid down by NHS London for cutting £5 billion from its PCTs' spending by 2017 is an assumption that 60 per cent of people who currently attend A&E units with relatively minor problems could be treated satisfactorily in primary care.
On this basis NHS London wants to divert around 2 million people annually away from hospitals and into a new, expensive network of "polysystems" - controversial centralised super-facilities which were originally designated "polyclinics" in Lord Darzi's 2007 suggestions for reform. Similar assumptions have also been made elsewhere and A&E has been a major focus for redesigning "pathways." I have consistently challenged these assumptions, which have become more and more extravagant since the early 1990s, and pointed to the failure of previous attempts to divert smaller numbers patients from A&E to "minor injury units." These turned out to treat mere handfuls of patients at high costs, while queues at A&Es were undiminished. But now we also know for a fact that NHS London's 60 per cent assumption is wrong. A recently released Primary Care Foundation report commissioned by the Department of Health found that less than half the A&E patients included in that figure were suitable for treatment only by GPs. Their figure showed that in some cases as few as 10 per cent, and a maximum of 30 per cent of people in A&E had no need of any form of hospital care. Since we now have fresh and reliable evidence that the 60 per cent figure was wrong, one obvious question is where such a false assumption came from.
It appears to flow from the top-secret document produced for NHS London by US-based management consultants McKinsey's. But where did McKinsey's get the number? Is it based on anything substantial, or just made up to drive forward the reorganisation of hospital care? Another question arises: would it save any money to deliver minor A&E services in polyclinics? Again the answer seems to be No. Lord Darzi's 2007 report on London, which argued A&E patients should be switched to polyclinics, estimated that the cost would be £66 per visit to a polyclinic compared with £81 at a hospital. However transferring the patients brings the added cost of building or renting the new polyclinic and running it day by day. Darzi-style health centres that are already running on a much smaller scale than the London plans are "jaw-droppingly" expensive compared with existing primary care services - with costs ranging from three to seven times more per patient. It seems most improbable that a new network of polyclinics in London will come in any cheaper, especially since private-sector providers such as Richard Branson's Virgin group now see them as an attractive future profit stream. Health chiefs have also been keen to switch a large volume of outpatient treatment - up to half, equivalent to 5 million appointments a year in London - away from hospitals and into polyclinics.
Yet even according to Lord Darzi's projections this would save no money at all. Instead it would massively inflate the costs of providing and running the polyclinic. It would also of course make running hospital services less efficient if consultants and staff have to spend hours at a time trekking round to small-scale clinics instead of working from a central base. The Audit Commission at the end of last year highlighted another reason to doubt the viability of these plans. Their report More For Less pointed out that while hospital unit costs were falling and productivity improving, there had been "no shift from hospitals to care closer to home in the community; either in terms of investment or activity." Nor, argues the Audit Commission, had PCTs succeeded in "dampening demand" for hospital care, despite years of promises. In fact the most recent figures show another substantial increase in numbers of patients referred to hospitals by GPs for inpatient care. These are not "inappropriate attenders" in A&E, but people whose condition requires treatment that primary care and community services cannot provide.
Flying in the face of all this hard evidence of rising demand, and offering no explanation on how it might be achieved, NHS London has said it wants to cut the number of hospital beds in the capital by a third. Even if they only focus on front-line acute beds that would mean a staggering 5,700 beds to go - equivalent to around 12 district general hospitals. This might save money - but only if the services are not replaced by any alternative. None of these proposals seems to have any basis in evidence in this country or elsewhere. Nor do they seem to fit with experience on the ground. Doctors are increasingly required to demonstrate the "evidence base" for the treatment they deliver.
But it appears that the most senior levels of NHS management feel no equivalent obligation to show that their plans are evidence-based, organisationally viable or likely to yield the promised cuts in costs. If the plans go wrong patients and NHS staff lose out either way. If they prove to save little or nothing, these policies will widen the gap they are supposed to help close and force another round of even bigger cuts. On the other hand short-sighted closures and excessive reduction in staff numbers can result in local collapse in service and the quality of care. Lurking in the background is the grim example of Mid Staffordshire hospitals, where the quest for just £10m of cuts resulted in the loss of 150 clinical posts and a total collapse in care, with dozens or hundreds losing their lives as a result. Managers who fail to learn from existing evidence could be doomed to repeat this type of failure.
But so do more obvious, unambiguous phrases such as "affordability analysis," "decommissioning," "savings," and "tariff reductions" - in other words cutting the amount paid to NHS trusts for each episode of treatment.
Perhaps the most blunt statement about the real driving force behind the various new policies comes from NHS Southwark, which declares openly that its proposals are cash-driven. "Our financial modelling shows that the primary care trust's (PCT's) current profile of expenditure is unaffordable over the next five years. "The affordability analysis requires £18m of savings in 2010/2011. Our commissioning strategy is driven by the need to achieve a system of healthcare which is financially sustainable." (Strategic Plan 2010/11 to 2016/17)." But this highlights a major question. Can the proposals outlined by health bosses actually work, delivering services to patients while saving a large amount of money? Central to the guidelines laid down by NHS London for cutting £5 billion from its PCTs' spending by 2017 is an assumption that 60 per cent of people who currently attend A&E units with relatively minor problems could be treated satisfactorily in primary care.
On this basis NHS London wants to divert around 2 million people annually away from hospitals and into a new, expensive network of "polysystems" - controversial centralised super-facilities which were originally designated "polyclinics" in Lord Darzi's 2007 suggestions for reform. Similar assumptions have also been made elsewhere and A&E has been a major focus for redesigning "pathways." I have consistently challenged these assumptions, which have become more and more extravagant since the early 1990s, and pointed to the failure of previous attempts to divert smaller numbers patients from A&E to "minor injury units." These turned out to treat mere handfuls of patients at high costs, while queues at A&Es were undiminished. But now we also know for a fact that NHS London's 60 per cent assumption is wrong. A recently released Primary Care Foundation report commissioned by the Department of Health found that less than half the A&E patients included in that figure were suitable for treatment only by GPs. Their figure showed that in some cases as few as 10 per cent, and a maximum of 30 per cent of people in A&E had no need of any form of hospital care. Since we now have fresh and reliable evidence that the 60 per cent figure was wrong, one obvious question is where such a false assumption came from.
It appears to flow from the top-secret document produced for NHS London by US-based management consultants McKinsey's. But where did McKinsey's get the number? Is it based on anything substantial, or just made up to drive forward the reorganisation of hospital care? Another question arises: would it save any money to deliver minor A&E services in polyclinics? Again the answer seems to be No. Lord Darzi's 2007 report on London, which argued A&E patients should be switched to polyclinics, estimated that the cost would be £66 per visit to a polyclinic compared with £81 at a hospital. However transferring the patients brings the added cost of building or renting the new polyclinic and running it day by day. Darzi-style health centres that are already running on a much smaller scale than the London plans are "jaw-droppingly" expensive compared with existing primary care services - with costs ranging from three to seven times more per patient. It seems most improbable that a new network of polyclinics in London will come in any cheaper, especially since private-sector providers such as Richard Branson's Virgin group now see them as an attractive future profit stream. Health chiefs have also been keen to switch a large volume of outpatient treatment - up to half, equivalent to 5 million appointments a year in London - away from hospitals and into polyclinics.
Yet even according to Lord Darzi's projections this would save no money at all. Instead it would massively inflate the costs of providing and running the polyclinic. It would also of course make running hospital services less efficient if consultants and staff have to spend hours at a time trekking round to small-scale clinics instead of working from a central base. The Audit Commission at the end of last year highlighted another reason to doubt the viability of these plans. Their report More For Less pointed out that while hospital unit costs were falling and productivity improving, there had been "no shift from hospitals to care closer to home in the community; either in terms of investment or activity." Nor, argues the Audit Commission, had PCTs succeeded in "dampening demand" for hospital care, despite years of promises. In fact the most recent figures show another substantial increase in numbers of patients referred to hospitals by GPs for inpatient care. These are not "inappropriate attenders" in A&E, but people whose condition requires treatment that primary care and community services cannot provide.
Flying in the face of all this hard evidence of rising demand, and offering no explanation on how it might be achieved, NHS London has said it wants to cut the number of hospital beds in the capital by a third. Even if they only focus on front-line acute beds that would mean a staggering 5,700 beds to go - equivalent to around 12 district general hospitals. This might save money - but only if the services are not replaced by any alternative. None of these proposals seems to have any basis in evidence in this country or elsewhere. Nor do they seem to fit with experience on the ground. Doctors are increasingly required to demonstrate the "evidence base" for the treatment they deliver.
But it appears that the most senior levels of NHS management feel no equivalent obligation to show that their plans are evidence-based, organisationally viable or likely to yield the promised cuts in costs. If the plans go wrong patients and NHS staff lose out either way. If they prove to save little or nothing, these policies will widen the gap they are supposed to help close and force another round of even bigger cuts. On the other hand short-sighted closures and excessive reduction in staff numbers can result in local collapse in service and the quality of care. Lurking in the background is the grim example of Mid Staffordshire hospitals, where the quest for just £10m of cuts resulted in the loss of 150 clinical posts and a total collapse in care, with dozens or hundreds losing their lives as a result. Managers who fail to learn from existing evidence could be doomed to repeat this type of failure.
Monday, 15 March 2010
NHS bomb is set to explode
It may not yet look like it on the surface, but behind the scenes NHS bosses are cooking up a really massive programme of cuts, beginning next year. NHS London is projecting upwards of £5 billion in cuts by 2017 - almost 40 per cent of its £13bn budget this year. NHS Oxfordshire has just stunned local people by unveiling plans to slash £240 million over the next five years - 30 per cent of its £800m budget, with proposals to cut up to £80m a year from 2011. Other strategic health authorities and primary care trusts will be working on similar figures, even if they have not yet been published; of course the government's spending figures do not show an actual reduction in NHS budget next year. But after eight successive years of large above-inflation increases, 2010 will see the rate of growth slashed right back. And from 2011 NHS budgets are set to stand still in real terms - rising by just the rate of inflation - while demand for health care, especially from an increasingly aged population, is expected to continue its upward spiral, creating an ever-increasing spending gap.
How big is the gap? What are the calculations based on? It appears that these huge spending cuts flow from projections by US-based management consultants McKinsey's. It is all over the NHS like a rash, scooping up tens of millions in consultancy fees for suggesting improbable and unpopular policies to deliver colossal cuts, although there is little or no evidence that many of the changes it's proposing will save the amounts it is predicting. We can see some of these policies emerging now in the guidance for strategic planning issued by NHS London and the discussions of primary care trusts, all of which are clearly working to a common "one-size-fits-all" blueprint - but we are not allowed to see the full figures. Information is being grudgingly produced in local dribs and drabs, ensuring local people and front-line NHS staff are the last to know what is happening. NHS London has refused a freedom of information request to release the McKinsey report it commissioned in the summer and which it has now circulated in secret to primary care trust bosses across the capital.
To ensure that they do not let local opinion or opposition get in the way, London's primary care trusts themselves have been largely relieved of power. Instead six new "sectors" have been established, covering groups of trusts in different areas of the capital. These sectors meet in secret and only reveal their proposals at the last minute, to the surprise of the individual primary care trusts, local councils and MPs. One example of this was the plan to axe A&E and other services at King George Hospital in Ilford, discussed in last month's column. This triggered an immediate and angry reaction from MPs and councillors from all parties and has now led to lobbies and protests as campaigners begin a rearguard campaign to defend the hospital. It turns out that the rundown of King George is part of a plan to reduce hospital services across the whole of north-east London, with major acute hospitals in just two places - the Royal London Hospital in Whitechapel and Queen's Hospital in Romford. Both of these are expensive private finance initiative hospitals facing three decades of index-linked payments.
Other hospitals - Newham General, Homerton and Whipps Cross - would be reduced to "local hospitals." The suggestions flowing from McKinsey are the NHS equivalent of a neutron bomb which is supposed to destroy life but leave property intact. All of the cuts are aimed at the front-line trusts, while the primary care trusts are encouraged to keep on expanding their layers of bureaucracy and their spending on management consultants. No questions are raised over the value for money of the billions now being pumped out of the NHS to pay private-sector providers and PFI schemes. The plans outlined in guidance from NHS London are brutal: A 66 per cent cut in staff working in non-acute services. A 33 per cent reduction in GP appointment times from 12 to eight minutes. A 10-15 per cent cut in prescribing costs. 55 per cent per cent of outpatient services and 60 per cent of accident and emergency activity to shift to "polysystems" A reduction in emergency admissions by 30 per cent for "non-complex long-term conditions" and 10 per cent for complex long-term conditions.
"Decommissioning" of 7 per cent of elective procedures, 30 per cent of out-patient appointments, 10 per cent of A&E activity and 10-15 per cent of diagnostic tests. A squeezing down of the "tariff" - the rate paid to hospital trusts for each patient treated - by 3-4 per cent each year, which will have the most drastic impact on PFI hospitals with high, inflexible overheads. These proposals only scratch the surface of the cuts because many of the plans to switch services out of hospitals will inevitably mean the trusts facing hefty loss of income, calling into question their longer-term financial viability. According to figures by former health minister Lord Darzi back in 2007, just switching 60 per cent of A&E attendances away from hospitals - even if this unlikely result could be achieved - would slash more than £500m a year from London's hospital budgets and trigger fresh cuts and panic mergers. Nor is there any real indication of how primary care and other services are supposed to handle the huge numbers of patients that would be diverted.
On last year's figures, 1.86 million A&E attenders alone could be diverted from hospitals and descend onto ill-prepared "polysystems," few of which are yet up and running. This would require enormous allocations of staff and management resources, on top of the strain of dealing with millions of out-patient consultations, and the cost and complexity of hospital consultants travelling to outlying clinics. There is no evidence at all that this would be cheaper, more efficient or in any way more desirable than the present system. Polyclinic-style health centres elsewhere in the country have been described as "eye-wateringly expensive" compared with existing primary care services. Health workers, and in some cases the NHS trusts which deliver services, are deliberately kept in the dark on plans being hatched up by primary care trusts. The secrecy demonstrates beyond doubt that the strategic health authorities and the primary care trusts know that they can expect no popular support for their plans from the wider public. They therefore conduct as much business as possible behind locked doors.
In Oxfordshire, health workers have been quick to respond to the threat of cuts, the UNISON branch demanding the primary care trust publish "a detailed case in plain English" so local people can examine the funding assumptions. Health workers in London and elsewhere will need to be equally swift and determined in challenging the furtive plans being hatched by secretive quangos that threaten the health care of millions. Anyone concerned to avoid a Tory victory in next year's general election needs to fight these damaging proposals, which threaten further to discredit Gordon Brown's government as more unpopular plans emerge and go to public consultation in the first few months of next year. It doesn't have to happen. The cuts are not driven by overspending in the NHS or other public services but by massive failure in the private sector.
Chancellor Alistair Darling is attempting to balance the Treasury books after squandering hundreds of billions of taxpayers' money on propping up the banks. Ask any voter whether they want taxpayers' money given to bankers or to employ nurses and doctors and you will get a unanimous and clear answer.
Darling and other ministers must be told to make their economies elsewhere. If there is a spending gap, it should be plugged by raising the taxes on the high-rolling scroungers who got us into this mess in the first place and are now gleefully sharing out new bonuses as primary care trusts work out their share of NHS cuts. Brown recently floated the idea of a "Tobin tax" on City transactions that could raise billions. He should be told to get on with that - and get his government's hands off our NHS.
How big is the gap? What are the calculations based on? It appears that these huge spending cuts flow from projections by US-based management consultants McKinsey's. It is all over the NHS like a rash, scooping up tens of millions in consultancy fees for suggesting improbable and unpopular policies to deliver colossal cuts, although there is little or no evidence that many of the changes it's proposing will save the amounts it is predicting. We can see some of these policies emerging now in the guidance for strategic planning issued by NHS London and the discussions of primary care trusts, all of which are clearly working to a common "one-size-fits-all" blueprint - but we are not allowed to see the full figures. Information is being grudgingly produced in local dribs and drabs, ensuring local people and front-line NHS staff are the last to know what is happening. NHS London has refused a freedom of information request to release the McKinsey report it commissioned in the summer and which it has now circulated in secret to primary care trust bosses across the capital.
To ensure that they do not let local opinion or opposition get in the way, London's primary care trusts themselves have been largely relieved of power. Instead six new "sectors" have been established, covering groups of trusts in different areas of the capital. These sectors meet in secret and only reveal their proposals at the last minute, to the surprise of the individual primary care trusts, local councils and MPs. One example of this was the plan to axe A&E and other services at King George Hospital in Ilford, discussed in last month's column. This triggered an immediate and angry reaction from MPs and councillors from all parties and has now led to lobbies and protests as campaigners begin a rearguard campaign to defend the hospital. It turns out that the rundown of King George is part of a plan to reduce hospital services across the whole of north-east London, with major acute hospitals in just two places - the Royal London Hospital in Whitechapel and Queen's Hospital in Romford. Both of these are expensive private finance initiative hospitals facing three decades of index-linked payments.
Other hospitals - Newham General, Homerton and Whipps Cross - would be reduced to "local hospitals." The suggestions flowing from McKinsey are the NHS equivalent of a neutron bomb which is supposed to destroy life but leave property intact. All of the cuts are aimed at the front-line trusts, while the primary care trusts are encouraged to keep on expanding their layers of bureaucracy and their spending on management consultants. No questions are raised over the value for money of the billions now being pumped out of the NHS to pay private-sector providers and PFI schemes. The plans outlined in guidance from NHS London are brutal: A 66 per cent cut in staff working in non-acute services. A 33 per cent reduction in GP appointment times from 12 to eight minutes. A 10-15 per cent cut in prescribing costs. 55 per cent per cent of outpatient services and 60 per cent of accident and emergency activity to shift to "polysystems" A reduction in emergency admissions by 30 per cent for "non-complex long-term conditions" and 10 per cent for complex long-term conditions.
"Decommissioning" of 7 per cent of elective procedures, 30 per cent of out-patient appointments, 10 per cent of A&E activity and 10-15 per cent of diagnostic tests. A squeezing down of the "tariff" - the rate paid to hospital trusts for each patient treated - by 3-4 per cent each year, which will have the most drastic impact on PFI hospitals with high, inflexible overheads. These proposals only scratch the surface of the cuts because many of the plans to switch services out of hospitals will inevitably mean the trusts facing hefty loss of income, calling into question their longer-term financial viability. According to figures by former health minister Lord Darzi back in 2007, just switching 60 per cent of A&E attendances away from hospitals - even if this unlikely result could be achieved - would slash more than £500m a year from London's hospital budgets and trigger fresh cuts and panic mergers. Nor is there any real indication of how primary care and other services are supposed to handle the huge numbers of patients that would be diverted.
On last year's figures, 1.86 million A&E attenders alone could be diverted from hospitals and descend onto ill-prepared "polysystems," few of which are yet up and running. This would require enormous allocations of staff and management resources, on top of the strain of dealing with millions of out-patient consultations, and the cost and complexity of hospital consultants travelling to outlying clinics. There is no evidence at all that this would be cheaper, more efficient or in any way more desirable than the present system. Polyclinic-style health centres elsewhere in the country have been described as "eye-wateringly expensive" compared with existing primary care services. Health workers, and in some cases the NHS trusts which deliver services, are deliberately kept in the dark on plans being hatched up by primary care trusts. The secrecy demonstrates beyond doubt that the strategic health authorities and the primary care trusts know that they can expect no popular support for their plans from the wider public. They therefore conduct as much business as possible behind locked doors.
In Oxfordshire, health workers have been quick to respond to the threat of cuts, the UNISON branch demanding the primary care trust publish "a detailed case in plain English" so local people can examine the funding assumptions. Health workers in London and elsewhere will need to be equally swift and determined in challenging the furtive plans being hatched by secretive quangos that threaten the health care of millions. Anyone concerned to avoid a Tory victory in next year's general election needs to fight these damaging proposals, which threaten further to discredit Gordon Brown's government as more unpopular plans emerge and go to public consultation in the first few months of next year. It doesn't have to happen. The cuts are not driven by overspending in the NHS or other public services but by massive failure in the private sector.
Chancellor Alistair Darling is attempting to balance the Treasury books after squandering hundreds of billions of taxpayers' money on propping up the banks. Ask any voter whether they want taxpayers' money given to bankers or to employ nurses and doctors and you will get a unanimous and clear answer.
Darling and other ministers must be told to make their economies elsewhere. If there is a spending gap, it should be plugged by raising the taxes on the high-rolling scroungers who got us into this mess in the first place and are now gleefully sharing out new bonuses as primary care trusts work out their share of NHS cuts. Brown recently floated the idea of a "Tobin tax" on City transactions that could raise billions. He should be told to get on with that - and get his government's hands off our NHS.
Thursday, 25 February 2010
NHS not safe in mainstream hands
"You call this cuts - I'm not scared to say cuts... The amount of money available to the NHS is decided by the government. We will have less money to meet rising demands... There are hard decisions to be made. I have to balance the books." That was the £140,000 a year chief executive of North Central London NHS (NCL) trying to explain to 350 people at a protest meeting why NCL were discussing seven different "scenarios" to cut £560 million from its £2.27 billion budget by 2016-17. These NHS bureaucrats, who blame the "global recession", plan to cut services at local hospitals, particularly closing some Accident and Emergency (A&E) departments. Highly paid NHS officials put a positive spin on this, proposing to set up enlarged neighbourhood health centres ("Urgent Care Centres") outside hospital entrances and saying that long-term treatment for conditions like asthma and diabetes should move to new 'polyclinics'.But, whatever the merits of polyclinics in an integrated health system, they are being promoted now as a way both of cutting spending and providing further opportunities to effectively privatise health services.
There is widespread opposition to these cuts - one north London hospital, the Whittington, treats 80,000 A&E patients annually. With a general election and London borough elections pending, all the local political parties have been protesting, but none gets to the root of the crisis in NHS spending. Some election candidates just say: no cuts in 'my' borough. This helps NHS bureaucrats play a 'divide and rule' game. So while Labour leaders insist that the National Health Service is safe, proposed cuts in services countrywide threaten to hit the NHS hard. Campaigns against the local NHS cuts and closures need to be linked to the wider battle. The economy's decline and the huge amounts spent bailing out the banks have brought mounting pressure for cuts in working peoples' living standards and services. Determined local campaigns with protest rallies, meetings, lobbies and demonstrations can save particular NHS facilities, and such victories are welcome.
But as national cuts are being prepared, we also need a generalised nationwide campaign that challenges the government's policies; otherwise repeated anti-cuts campaigns will be unavoidable. The Tories will probably be worse than Labour on the NHS, but this is no reason to go soft on the Labour government's plans. Unfortunately this is what many trade union leaders and backbench Labour MPs have done. Alongside local campaigns, the longer term battle to save and improve the NHS needs a real socialist alternative to the Labour, Tory and LibDem parties' pro-capitalist policies. In the coming election, candidates from the Trade Unionist and Socialist Coalition (TUSC) can vitally help link together different local campaigns. This should be part of a drive to build a national movement to resist the bosses' efforts to make working people pay for the economic crisis.
There is widespread opposition to these cuts - one north London hospital, the Whittington, treats 80,000 A&E patients annually. With a general election and London borough elections pending, all the local political parties have been protesting, but none gets to the root of the crisis in NHS spending. Some election candidates just say: no cuts in 'my' borough. This helps NHS bureaucrats play a 'divide and rule' game. So while Labour leaders insist that the National Health Service is safe, proposed cuts in services countrywide threaten to hit the NHS hard. Campaigns against the local NHS cuts and closures need to be linked to the wider battle. The economy's decline and the huge amounts spent bailing out the banks have brought mounting pressure for cuts in working peoples' living standards and services. Determined local campaigns with protest rallies, meetings, lobbies and demonstrations can save particular NHS facilities, and such victories are welcome.
But as national cuts are being prepared, we also need a generalised nationwide campaign that challenges the government's policies; otherwise repeated anti-cuts campaigns will be unavoidable. The Tories will probably be worse than Labour on the NHS, but this is no reason to go soft on the Labour government's plans. Unfortunately this is what many trade union leaders and backbench Labour MPs have done. Alongside local campaigns, the longer term battle to save and improve the NHS needs a real socialist alternative to the Labour, Tory and LibDem parties' pro-capitalist policies. In the coming election, candidates from the Trade Unionist and Socialist Coalition (TUSC) can vitally help link together different local campaigns. This should be part of a drive to build a national movement to resist the bosses' efforts to make working people pay for the economic crisis.
Sunday, 21 February 2010
The great class divide widens
"In England, people living in the poorest neighbourhoods, will, on average, die seven years earlier than people in the richest neighbourhoods. Even more disturbing, the average difference in disability-free life expectancy is 17 years. So, people in poorer areas not only die sooner they will also spend more of their shorter lives with a disability." The report, Fair Society, Healthy Lives, was commissioned because the government has a target of reducing the gap by 10% but they are going to miss it. The gap in the rate of infant mortality, for example, will rise to 25% by 2011. "Put simply, the higher one's social position, the better one's health is likely to be". And the gap is getting wider. For men in poor areas the gap has widened by 2% and for women by 11%. There are regional differences but there are stark differences also even within a region. For example, men in parts of Kensington and Chelsea, the wealthiest area in London, have a life expectancy of 88. A few miles away in Tottenham Green, one of the poorest areas in London, male life expectancy is 71. It also notes that the poor pay 38% tax on their income compared to 35% for the richest.
The government is moving towards retirement at 68. However, "more than three quarters of the population do not have a disability-free life expectancy as far as the age of 68. In England, the many people who are currently dying prematurely each year as a result of health inequalities would otherwise have enjoyed, in total, between 1.3 million and 2.5 million extra years of life. Many diverse and wide-reaching proposals are developed. Good quality nurseries, apprenticeships, greater security and flexibility of employment, a "minimum income for healthy living", reducing social isolation, investing in health prevention and a whole list of others. Socialists would warmly welcome the many and varied ideas in the report. However, its limitations are revealed: "There will be those that say that our recommendations cannot be afforded, particularly in the present economic climate... we need courage and imagination to rise to the challenge..." And there's the rub. Even the modest target of increasing the lifetime of a poor person by three years in the next decade is unobtainable under the present system.
What the report brutally reveals is that we are living in a vicious, class divided society. Unfairness and inequalities are emphasised and underlined over and over again in facts, figures, charts and graphs but no hint as to why this is the case. Of course, it is naïve in the extreme to expect a well meaning scholarly review by academics to change anything fundamentally. Nevertheless, it makes you boil with rage. The bosses work us to death so that they can live longer and healthier. They get rich on our broken corpses. To see the ideas in this review (and much more), fully implemented, capitalist society will have to be removed first.
The government is moving towards retirement at 68. However, "more than three quarters of the population do not have a disability-free life expectancy as far as the age of 68. In England, the many people who are currently dying prematurely each year as a result of health inequalities would otherwise have enjoyed, in total, between 1.3 million and 2.5 million extra years of life. Many diverse and wide-reaching proposals are developed. Good quality nurseries, apprenticeships, greater security and flexibility of employment, a "minimum income for healthy living", reducing social isolation, investing in health prevention and a whole list of others. Socialists would warmly welcome the many and varied ideas in the report. However, its limitations are revealed: "There will be those that say that our recommendations cannot be afforded, particularly in the present economic climate... we need courage and imagination to rise to the challenge..." And there's the rub. Even the modest target of increasing the lifetime of a poor person by three years in the next decade is unobtainable under the present system.
What the report brutally reveals is that we are living in a vicious, class divided society. Unfairness and inequalities are emphasised and underlined over and over again in facts, figures, charts and graphs but no hint as to why this is the case. Of course, it is naïve in the extreme to expect a well meaning scholarly review by academics to change anything fundamentally. Nevertheless, it makes you boil with rage. The bosses work us to death so that they can live longer and healthier. They get rich on our broken corpses. To see the ideas in this review (and much more), fully implemented, capitalist society will have to be removed first.
Wednesday, 9 December 2009
Health privatisation is truly sick
A damning report into hospitals last week claimed many were so sub-standard that over 5,000 patients had died in their care, despite being admitted with low-risk conditions. But the report, by the Dr Foster quality inspectors, is more than an indictment of the hospitals named as failing. It also calls into question the government’s strategy of privatisation and part-privatisation of the NHS. Four out of 12 hospitals deemed to be failing to meet basic standards of patient care are “flagship” NHS foundation trusts; under a scheme brought in by New Labour in 2002, bosses at these trusts are exempted from many normal health service rules, and are free to run their hospitals like independent businesses. Foundation trust status was supposed to be a reward for those hospitals that were deemed to be providing “excellent” patient care and financial management.
The report also deals a blow to the government’s Care Quality Commission (CQC) watchdog, set up this year to take over the monitoring of hospitals - the commission was supposed to be a new broom after the scandal of excess deaths at South Staffordshire NHS trust. This revealed that “self-regulation” of hospitals by their own managers had failed to identify even the most basic failings. Despite this, the majority of hospitals deemed by the Dr Foster organisation to be the “worst 12” were praised by the CQC in its annual health check last month. Among those rated “good” was Basildon and Thurrock University Hospitals NHS Foundation Trust. This manages a hospital that was condemned by Dr Foster inspectors who found “blood-spattered” walls and filthy conditions.
Accident and emergency units at a number of London hospitals are again under threat as the government plans to “rationalise” services. The department of health is rehashing plans to replace emergency services at four London hospitals with services provided by semi-privatised polyclinics. The scheme would involve downgrading the King George’s hospital in Essex, the North Middlesex hospital in Edmonton, and Whittington hospital in Archway. It has already been decided that Chase Farm hospital in Enfield will lose its emergency and maternity units. A huge public outcry greeted similar plans three years ago. Marches, many several thousand strong, forced the government to retreat. Ministers said that in future they would consult more fully. Local Keep Our NHS Public groups must be reformed and rejuvenated in order to force the government to backtrack on these proposals.
The report also deals a blow to the government’s Care Quality Commission (CQC) watchdog, set up this year to take over the monitoring of hospitals - the commission was supposed to be a new broom after the scandal of excess deaths at South Staffordshire NHS trust. This revealed that “self-regulation” of hospitals by their own managers had failed to identify even the most basic failings. Despite this, the majority of hospitals deemed by the Dr Foster organisation to be the “worst 12” were praised by the CQC in its annual health check last month. Among those rated “good” was Basildon and Thurrock University Hospitals NHS Foundation Trust. This manages a hospital that was condemned by Dr Foster inspectors who found “blood-spattered” walls and filthy conditions.
Accident and emergency units at a number of London hospitals are again under threat as the government plans to “rationalise” services. The department of health is rehashing plans to replace emergency services at four London hospitals with services provided by semi-privatised polyclinics. The scheme would involve downgrading the King George’s hospital in Essex, the North Middlesex hospital in Edmonton, and Whittington hospital in Archway. It has already been decided that Chase Farm hospital in Enfield will lose its emergency and maternity units. A huge public outcry greeted similar plans three years ago. Marches, many several thousand strong, forced the government to retreat. Ministers said that in future they would consult more fully. Local Keep Our NHS Public groups must be reformed and rejuvenated in order to force the government to backtrack on these proposals.
Saturday, 5 December 2009
Privatisation is sick, not the NHS
THE LATEST report on safety standards in our hospitals lays bare some shocking examples of safety failures in some NHS hospital trusts. The Hospital Guide, compiled by a joint private/public body known as "Dr Foster", highlights 12 trusts that underperform on patient safety measures. The report highlights foreign bodies being left in patients after surgery, operating on the wrong body part and 5,024 patients with low risk conditions dying in hospital. Predictably the media headlines blame the national health service, trying to weaken support for the NHS and its hard working staff. But these problems are mainly caused by the privatisation and cuts to our NHS that New Labour has instigated. Many of the hospitals in deepest crisis were Foundation Trusts, initiated by Labour Health secretary Alan Milburn in 2002.The criteria for hospitals to become Foundation trusts included getting their finances in order and meeting targets, regardless of the consequences.
Foundation hospitals represent a further move towards privatisation as they have more financial autonomy than other hospitals (though patient care is not always a priority).They are supposed to involve the local community but the real decisions are made at the top. Before privatisation and PFI there was at least some local accountability for health services through the community health councils. We now need local health services that are run and planned by democratic committees with representatives of NHS workers and the local community. One big incentive for hospital chiefs to obtain foundation status is to secure a fat pay rise. The salary of the chief executive of Blackpool, Fylde and Wyre NHS Trust rose 32% from £125,000 to £165,000 on gaining foundation status. The Royal College of Surgeons' President explained that: "Too many hospitals are too concerned with meeting financial targets at the expense of clinical standards, and we are seeing patients suffering as a consequence."
Unison (the largest trade union in the health service) calls for Basildon and Thurrock Foundation Hospital to be taken back under NHS control, and calls for a public enquiry into patient care at the hospital.They explain that the hospital's privatised cleaning contract has been inadequate for many years with too few cleaners and not enough training. This is the direct consequence of private companies inside our hospitals ensuring fat profits at the expense of patient care and of staff wages and conditions. Public money fills the pockets of companies who make huge profits from building hospitals under the Private Finance Initiative (PFI). As interest rates for private borrowers are rising, it now costs £6.3 million more to finance a £100 million deal than it did two years ago. And it costs £23 million more to fund such a deal through PFI than using money borrowed from the government. In consequence, less money is available for patient care. While supporting Unison's demands on bringing hospitals back into NHS control, the health unions should also call for an end to all privatisation and cuts in the NHS. And they should stop paying huge amounts of their members' money to the Labour Party who are responsible for the cuts and privatisation of our health service.
Foundation hospitals represent a further move towards privatisation as they have more financial autonomy than other hospitals (though patient care is not always a priority).They are supposed to involve the local community but the real decisions are made at the top. Before privatisation and PFI there was at least some local accountability for health services through the community health councils. We now need local health services that are run and planned by democratic committees with representatives of NHS workers and the local community. One big incentive for hospital chiefs to obtain foundation status is to secure a fat pay rise. The salary of the chief executive of Blackpool, Fylde and Wyre NHS Trust rose 32% from £125,000 to £165,000 on gaining foundation status. The Royal College of Surgeons' President explained that: "Too many hospitals are too concerned with meeting financial targets at the expense of clinical standards, and we are seeing patients suffering as a consequence."
Unison (the largest trade union in the health service) calls for Basildon and Thurrock Foundation Hospital to be taken back under NHS control, and calls for a public enquiry into patient care at the hospital.They explain that the hospital's privatised cleaning contract has been inadequate for many years with too few cleaners and not enough training. This is the direct consequence of private companies inside our hospitals ensuring fat profits at the expense of patient care and of staff wages and conditions. Public money fills the pockets of companies who make huge profits from building hospitals under the Private Finance Initiative (PFI). As interest rates for private borrowers are rising, it now costs £6.3 million more to finance a £100 million deal than it did two years ago. And it costs £23 million more to fund such a deal through PFI than using money borrowed from the government. In consequence, less money is available for patient care. While supporting Unison's demands on bringing hospitals back into NHS control, the health unions should also call for an end to all privatisation and cuts in the NHS. And they should stop paying huge amounts of their members' money to the Labour Party who are responsible for the cuts and privatisation of our health service.
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