NHS for Sale: Myths, Lies & Deception (14 page)

Another area where costs have risen despite reassurances to the contrary from Andrew Lansley is the money lavished on management consultants. After the election Lansley claimed to be ‘staggered by the scale of the expenditure on management consultants’, which stood at £313m in 2010, and promised to slash it. But after four years of coalition government the costs had doubled to £640m a year, almost £1.8m per day and enough to hire an extra 20,000 nurses or run three medium sized hospitals.
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David Oliver, formerly of the DoH, blamed the health reforms for this explosion, pointing out that racketeers profit in times of chaos. Rumours circulated that senior management consultants were being paid £4,000 per day and that Monitor (largely staffed by ex-employees of management consultants) was spending an eye watering £32m on management consultancy firms (Oliver noted that only seven of Monitor’s 337 employees had any frontline clinical experience). The
BMJ
article is worth reading as an example of profligate spending by people who claim that we can’t afford the NHS.
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One thing is sure – the public would rather see their taxes spent on medical not management consultants. Once again they aren’t being given the choice.

The concern of the NHS Confederation that the HSC Act would lead to a ‘tsunami of bureaucracy’ proved well founded.
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The Act has resulted in a worse bureaucratic
tangle, with more layers of management resulting in increased spending on administration. In 2013 Jeremy Hunt called on the NHS Confederation to review the problem of bureaucracy, thus tacitly admitting that the HSC Act had not delivered on its promise. Their review found that 40 per cent of clinicians and NHS managers spent between one and three hours a day collecting and recording information, with 75 per cent feeling that certain information they were asked to provide was irrelevant. It reported that the average doctor and nurse spent ten hours a week on bureaucracy, more than a quarter of their working week and a truly shocking statistic when there is a chronic shortage of frontline staff to care for patients. And tellingly the review suggested that the blame lay at least in part with Lansley’s reorganisation of the NHS, with ‘a lack of clarity of roles and responsibilities resulting in duplicated requests’ for information and data.
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At the same time a survey by the RCN found that nurses were ‘drowning in paperwork’ including filing, photocopying and ordering supplies.
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It is difficult to avoid the conclusion that if Lansley had paid more attention to helping clinical staff do the work they were trained to do rather than requiring them to write bids for their own services and fill in forms then the NHS and its patients would be in much better shape today.

Lansley’s ‘reforms’ have incurred further costs associated with an expanding commercial market for the English NHS. Lansley’s promises about reduced bureaucracy and lower costs have proved as empty as the NHS coffers under the coalition government.

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Another broken promise. It is estimated that the Treasury has clawed back over £5bn from the NHS under the coalition. The NHS has currently 6,000 fewer nurses than when the coalition came to power.

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It is well worth watching their short animation (
http://vimeo.com/69224754
) on the Byzantine structure of Lansley’s new ‘streamlined’ NHS, illustrating as it does the very ‘alphabeti spaghetti’ that Cameron promised he would get rid of in a pre-election speech to the RCN (See
https://www.youtube.com/watch?v=nH2EmVGowCk
.).

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The figures showed that in 2013-14 a total of 6,330 ‘exit packages’ were agreed for NHS staff, at a cost of £197m. This took the total since 2010-11, when the government launched its reform plans, to 38,419 packages totalling £1.588bn. In 2013, 237 managers received payoffs of between £100,000 and £150,000, 83 of between £150,000 and £200,000, and 40 of over £200,000.

There will be no decision about you without you.
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One of the things we are intending to do is create much greater opportunities for patients’ voices to be heard.
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Andrew Lansley

Andrew Lansley and David Cameron repeatedly promised that the Health and Social Care Act would give greater powers to patients and a louder voice to local communities when it came to health matters. The reality is that the patient voice is fainter than ever as the organisations representing patients become weaker, ‘consultations’ become more of a sham and NHS bodies become more secretive.

The patient voice was strongest when represented by Community Health Councils (CHCs). CHCs could and did visit and report on local NHS services, organise local campaigns and hold NHS bureaucrats to account. They were abolished by Alan Milburn in 2003, and replaced by a succession of weak bodies culminating in Healthwatch, established by the HSC Act.

Real patient voice has become politically inconvenient as more NHS ‘reforms’ have been pushed through against the wishes of the public. ‘Consultations’ are held at short notice
or not at all, and any findings are likely to be misrepresented or shelved if unhelpful. The public and the press have more difficulty finding out what is being done in their name as new NHS bodies hold meetings out of the public eye and are not obliged to publish minutes. The private sector is able to hide its profits and outcomes behind commercial confidentiality.

The more political rhetoric there has been about patient voice the less genuine engagement there has been with the public. The proliferation of local NHS campaigns and action groups is an indication of the fact that many people feel that legitimate avenues of enquiry and complaint have been closed to them, leaving little option but to take to the streets in order to be heard.

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In the run-up to the 2010 general election, David Cameron and his shadow health secretary Andrew Lansley repeatedly promised to protect the NHS from local cutbacks and reconfiguration, but also to give increased public voice and control over local services.
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As soon as he had taken office, Lansley repeated similar pledges. At the 2010 conference of the NHS employers’ body the NHS Confederation Lansley insisted:

As we set out in the coalition agreement, for the first time the voice of the public will be heard across commissioning, the public health service and social care. In these straitened financial times this accountability for how we use taxpayers’ money is even more important.
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However, this commitment, like the promise to halt closures of A&E and maternity units and deliver a real terms increase in NHS spending each year, proved to be worthless.

The Tories’ overriding commitment to ‘austerity’ policies
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to address the immense hole in government finances created by the multi-billion bail-out of the banks. This meant that local policies have, since 2010, had to be shaped not around the ‘voice of the public’ but around the drive for cost-cutting ‘reconfiguration’ of hospital and other services – driving through unpopular cuts regardless of local opinion.

As a result even the limited avenues for local communities to register their concerns on local schemes and plans have
been further restricted or closed off. New, even less forceful and representative local bodies have been set up by Lansley’s Health and Social Care Act – bodies that have played little or no role in defending any of the threatened hospitals and services, and which few people even know exist.

The result has been a serious and growing problem in which not only the public’s views but also their legitimate concerns over the viability of proposals and the knock-on impact they are likely to have on other services are effectively excluded from final decision-making and from any later review of decisions that have been made. Campaigners – lacking any regular democratic access to express their views – are obliged to resort to street protests and petitions, or to judicial review in which only the legal process itself is ever scrutinised, not the merits of the proposals that have been put forward.

The report of the People’s Inquiry into London’s NHS also sums up the situation in many other parts of the country, when it points out:

In every part of London we have heard an overwhelming sense of frustration at the lack, or inadequacy, of channels for public engagement with many commissioners and provider trusts. We have seen little evidence of public or professional confidence in the official box-ticking consultation processes. There is equally little evidence that commissioners or providers give serious consideration or in some cases respond at all to issues and doubts raised during consultation exercises.
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The problem is worse than ever, but not new. For the past thirty years or more NHS ‘consultations’ have often been seen as little more than a pointless ritual, designed to blow off steam while eventually allowing unelected NHS managers to force through most of the changes they want regardless of local community views and wishes. Any real power was not in the consultation process itself, but in the various mechanisms through which the public could get information on what was being proposed, and organisations representing the public could intervene to delay or even stop some of the most controversial changes.

But more recently even these standby mechanisms have been undermined – while governments, health bosses and civil servants give empty promises to enhance the voice of local people. The last fifteen years have seen the abolition of the statutory bodies which once gave local people much more influence – and the ability to halt controversial changes pending a ministerial decision. Since 2000 the proliferation of private and confidential contracts and tendering processes has led to increased secrecy due to ‘commercial confidentiality’. This has reduced the public’s right even to know what is being proposed by local health commissioners – and to develop a coherent critique and response to plans which many would oppose if they knew of them.

Some of the most contested policies arising from Labour’s 2000 NHS Plan were negotiated by Department of Health officials at national level, and then imposed on local commissioners whether they liked it or not – most notably the early contracts for Independent Sector Treatment Centres and diagnostic services.
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Other plans were hatched up in the early 2000s by the newly-created Commercial Directorate,
charged with creating a new competitive market in elective care behind the closed doors of Whitehall and away from any public scrutiny.
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An even more authoritarian approach has developed recently taking advantage of the Unsustainable Provider Regime established by New Labour. This sets out the precise and rigid timetable for the intervention of a government-appointed Trust Special Administrator with draconian powers to intervene where a trust or foundation trust is seen as ‘failing’.
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This has been followed in the last two years by the Tory-led coalition taking extraordinary steps to add a new Clause 119 to the HSC Act that gives even more sweeping powers to close hospitals, where necessary against the wishes of local people, even when the hospitals under the axe are not the ones in financial difficulties.
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There has seldom been more official rhetoric about ‘engagement’ with patients and the local public and less actual engagement with anything other than supportive views. This rhetoric stands in stark contrast to those Clinical Commissioning Groups (CCGs) – such as Bedfordshire, Cambridgeshire and several in Staffordshire – who have been taking legal advice on how best to phrase their refusal to consult local people on controversial changes, or publish even basic documents and general information on what they are doing or the contracts they are asking NHS and private sector providers to bid for.

The biggest blow against any public voice on major change in the NHS was the abolition of Community Health Councils (CHCs). Up until then, especially in the final few years of John Major’s government and the first few years of Tony Blair’s
New Labour, some of the best and most proactive Community Health Councils had been at the peak of their effectiveness.

CHCs had been set up in 1974 as statutory bodies, independently funded through regional health authorities, with a brief to represent patients and the local public. Most CHCs included an elected component representing local communities, charities and other organisations. With full time staff, the best CHCs developed a body of expertise, and a group of local activists and experts who knew the structure and working of local services, could champion patient complaints and give voice to their concerns, and were empowered to visit hospital wards and clinics.
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They were able to report and register their views through representation on the boards of health authorities. A strong CHC could strike fear into the hearts of many NHS bureaucrats and senior staff – and could also rally local public support when a more substantial issue arose.

Beginning from an initiative in Southwark monitoring the A&E at King’s College Hospital, a network of over 150 CHCs in England (and Wales prior to devolution in 1999) developed, and conducted regular coordinated monitoring of delays and issues in A&E departments, publishing devastating reports which grabbed press headlines.
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Some local campaigns were very powerful. In North London, Barnet CHC was a was willing throughout to support one of the most massive and wide-reaching campaigns, which from 1995 fought to stop the closure of Edgware Hospital, whose catchment straddled three boroughs, Barnet, Brent and Harrow – and included a number of marginal constituencies. The Edgware Hospital campaign held huge meetings, lobbies, demonstrations – and won support from almost every organisation in the area, from the Brent Cross
traders and local businesses through every religious and ethnic community.