NHS for Sale: Myths, Lies & Deception (24 page)

It is incumbent on the cheerleaders for outsourcing the NHS to prove their case that the private sector delivers better cheaper health care and they have simply failed to do so. In fact all the evidence is to the contrary – not only are the private sector more expensive and less efficient but they may come with unacceptable baggage – lack of accountability and antisocial behaviour including fraud and corruption. They take no responsibility for training medical staff and increasingly their activities destabilise local NHS services. So why does privatisation via outsourcing continue?

In their 2007 paper Woolhandler and Himmelstein asked: ‘What’s driving privatisation?’ Since ‘the evidence
is remarkably consistent; public funding of private care yields poor results’ they reasonably concluded that ‘only a dunce could believe that market-based reform will improve efficiency and effectiveness’. One could be forgiven for concluding that our elected leaders are all dunces.

_____________

*
See Chapter 7 for more detail on transparency.

*
Recently rebranded in the UK as Optum to escape the reputation of its parent company in the US.

*
The European Commission, which calls them ‘services of general interest’, officially defines them in the following way: Services of general economic interest (SGEI) are economic activities that public authorities identify as being of particular importance to citizens and that would not be supplied (or would be supplied under different conditions) if there were no public intervention.

*
As for screening, in the private sector the sky is the limit. The author’s then twenty-year-old son received an invitation from Life Line Screening to have an ultrasound scan to exclude arterial disease including abdominal aortic aneurysm. The letter promised ‘You’re in safe hands with Life Line Screening’ – unless that is you are invited to pay £149 to screen for conditions you are extremely unlikely to be suffering from until late middle age.

The NHS is not for sale, there will be no privatisation.
¹

Andrew Lansley

There is no privatisation agenda … my party doesn’t want that.
²

Jeremy Hunt

You told us you were worried about privatisation through the back door. So we have made that impossible.
³

Nick Clegg

Privatisation of public services takes place when the government either outsources those services to the private sector or transfers ownership of those services to the private sector. The coalition government is doing both of these. The fact that thus far it remains free at the point of use is irrelevant. Contrary to politicians’ denials they are privatising the NHS.

The insidious process of privatisation began some years ago but has accelerated under the present coalition government. This is because their 2012 Health and Social Care Act was explicitly designed to hasten the process. The government is pushing ahead with the privatisation of the NHS via a number of different mechanisms. These include:

• The outsourcing of services to the private sector through ‘commissioning’ or buying care from companies (Any Qualified Providers) such as Circle, Serco or Virgin Care.
  
• Sale of services to the private sector (e.g. pathology, plasma services).
  
• The use of Private Finance Initiatives (PFIs) that use private money to build new buildings and infrastructure for which the state has to pay at inflated prices for thirty years or more.
  
• The creation of foundation trusts that are run much more like private businesses and have the ability to raise funding from expanding private beds and services.
  
• Allowing services to become ‘not for profit’ organisations such as social enterprises, cooperatives or mutuals and no longer part of the NHS and thus vulnerable to corporate takeover.
  
• Limiting access to certain services previously provided by the NHS.
  
• The creation of market mechanisms for the distribution of funding within the NHS (e.g. commissioning, payment by results mechanisms, the purchaser-provider split and so called patient choice policies).
  
• The reduction of the role of government in regulating health provision.
  

* * *

The NHS has become part of our national life. No political party would survive that tried to destroy it.
⁴

Aneurin Bevan

Politicians know very well that the NHS is the UK’s best loved institution, more popular even than the royal family.
⁵
Nigel Lawson may have scornfully described it as ‘the closest thing the English have to a religion’ but another Tory MP was more accurate when he told
Newsnight:
‘We are all socialists in a funny way when it comes to the NHS.’
⁶
Whether they approve or disapprove of the public’s love affair with the NHS all politicians recognise the truth of Bevan’s observation that no political party can afford to be associated with its destruction.

No accusation is more toxic or potentially damaging than that of an intention to privatise the NHS, which is why the changes that have been introduced by successive governments over the last twenty or so years have been dressed up with language meant to disguise their true agenda. Politicians are most anxious to deny any move towards privatisation and David Cameron, Jeremy Hunt, Andrew Lansley and Nick Clegg have all denied that the Health and Social Care Act would result in privatising the service.
⁷

In July 2014 even the Department of Health felt it necessary to respond to an accusation from Unite that the government was privatising English health care.
⁸
They recycled the usual justifications for the reforms – that they were ‘necessary for patients’ and that they placed ‘the financial power to change health services in the hands of those NHS professionals whom the public trust most, and (put) clinicians, rather than politicians, in control of healthcare’. The claims rang hollow, particularly as by this time the reforms had little support
beyond Westminster and tens of thousands of patients, along with the same trusted professionals and clinicians, had taken to the streets to protest against what the government was doing to the NHS.
⁹

But these denials are pointless when the Tories have a record that speaks for itself. As early as 1982 Tory grandees John Redwood and Oliver Letwin wrote a pamphlet (which Redwood subsequently disowned),
¹⁰
in which they advocated privatising the NHS. Letwin
*
has long had a central role in developing Tory policy and was described as ‘the Gandalf of the process’ in the period leading up to the 2010 general election.
¹¹
He rather gave the game away in 1988 when he wrote a book with the not too subtle title of
Privatising the World, a Study of International Privatisation in Theory and Practice.
He also (in)famously told a private meeting in 2004 that the NHS would not exist within five years of a Tory victory.
¹²
In 2008 Jeremy Hunt,
¹³
the current secretary of State for health, co-authored a book
(Direct Democracy: an Agenda for a New Model Party)
which contained the following statement: ‘Our ambition should be to break down the barriers between private and public provision, in effect denationalising the provision of healthcare in Britain.’
¹⁴

However, the privatisation of the NHS that the Conservative party so earnestly sought behind closed doors could never have been achieved by the traditional methods that were employed for other services such as railways and energy, that is by the mass sale of shares to investors and private companies who would then own and make a profit from the NHS. No political party has ever dared to flout public opinion
openly in that way, knowing that the majority of voters (84 per cent in one YouGov poll)
¹⁵
oppose privatisation of the NHS. Instead the process has spanned more than one government and has been insidious, achieving its ends by a number of means.
¹⁶

There is no doubt that the primary intention of the Health and Social Care Act was the accelerated privatisation of the NHS, an outcome elegantly predicted by Dr Clive Peedell in his article for the
BMJ:
‘Further privatisation is inevitable under the proposed NHS reforms.’
¹⁷
In the article Peedell debunks the government mantra that privatisation cannot be happening as long as ‘care remains free at the point of delivery’. Although politicians consistently suggest otherwise, care free at the point of delivery and privatisation of the public service are by no means mutually exclusive.

Peedell quotes the WHO definition of privatisation of health care, which is straightforward and describes accurately what has happened since the passage of the HSC Act: ‘a process in which non-governmental actors become increasingly involved in the financing and/or provision of healthcare.’
¹⁸

His article then cites five further criteria for defining privatisation of public services:

• Divestiture or outright sale of public sector assets in which the state divests itself of public assets to private owners.
  
• Franchising or contracting out to private, for profit, or
  not for profit providers.
  
• Self-management, wherein providers are given autonomy to generate and spend resources.
  
• Market liberalisation or deregulation to actively promote growth of the private health sector through various incentive mechanisms.
  
• Withdrawal from state provision, wherein the private sector grows rapidly as a result of the failure on the part of the government to meet the healthcare demands of the people.
  

Peedell goes on to explain how every one of these criteria would be fulfilled under the proposals in what was then the Health and Social Care Bill and demonstrates how the HSC Act was drawn up to contain all the levers needed to enable and hasten the privatisation of the NHS. Despite the coalition’s earnest denials this is exactly what has happened.

The HSC Act was passed in March 2012 but the final piece of the privatisation jigsaw was put in place in early 2013 with the passage of the infamous section 75 (see
Chapter 4
). This piece of secondary or ‘enabling’ legislation in effect requires all NHS contracts to be put out to tender and thus flies in the face of firm promises made previously by coalition ministers, MPs and peers. In March 2012, for example, the emollient health minister Earl Howe promised that commissioners would ‘be under no legal obligation to create new markets’ and would ‘be free to commission services in the way they consider best’. Andrew Lansley himself had written to all GPs to reassure them that Monitor ‘would not have the power to force you to put services out to competition’.
¹⁹
With the passage into law of Section 75 it was clear that their promises were worthless and GPs began to wake up to the
extent of the betrayal. Critics claimed this would produce a ‘major extension of market principles in the NHS’, in which view they were supported by legal advice that competition would become ‘the norm for placing NHS contracts’.
²⁰
GPs themselves understood the implications of the legislation only too well and the vast majority were soon predicting that the NHS would be privatised within the next five to ten years.
²¹

Is this view overly pessimistic? It has been difficult to track the rate of privatisation of the NHS since the passage of the HSC Act as the government is naturally keen to hide the figures, and for all Cameron’s promises of transparency and accountability there is no central record of the number of outsourced contracts. It has been up to campaigning organisations and others to monitor these, with Unite, the NHS Support Federation and the
BMJ
all producing figures. The campaign group The People’s NHS has set up a site with an ‘NHS privatisation counter’ showing how much of the NHS the government has sold off since the HSC Act came into force.
²²
In October 2014 they managed to project an image of the counter onto the roof of the Tory Conference, a brilliant coup which was widely celebrated on social media if not by their mainstream brethren.

In May 2014 the NHS Support Federation estimated that in the two years since the Act was passed there had been a 30 per cent rise in the number of NHS contracts put out to competitive tender with their value increasing more than three times to total £13.5bn.
²³

Even more worrying was that the majority of these contracts were being awarded to the private sector. Already in 2013,
just one year after the enactment of the legislation, the
BMJ
reported that only two of sixteen contracts awarded since the government’s section 75 regulations came into force had gone to NHS providers, with the remaining fourteen going to private companies.
²⁴

By 2014 the NHS Support Federation reported that 70 per cent of contracts awarded through competitive tendering were going to private firms.
²⁵
In the light of this figure Unite denounced the ‘explosion’ of contracts going to the private sector and demanded ‘an inquiry into the impact of the government’s changes, looking at the cost to the NHS of the new contract culture in terms of the bidding process and associated costs, as well as service and staff cuts as companies put profits before patient care’.
²⁶
The government did not oblige with any figures about the additional costs incurred by the new tendering rules, indeed almost certainly did not even have the information, the possession of which might prove very inconvenient. It is much easier to deny what’s going on if you’re not keeping track of it.

In December 2014 the
BMJ
obtained up-to-date figures via Freedom of Information requests, which showed that between April 2013 and August 2014 a third of all contracts had gone to the private sector.
²⁷
The government claimed that this showed there was no cause for concern but campaigners disagreed. They pointed out that the private sector don’t want most NHS contracts, as big contracts for acute care are not profitable. Private companies were actually winning a much higher percentage of contracts in the areas in which they were interested e.g. elective care (they are now responsible for 15-20 per cent of elective surgery, a cause for concern, including for those responsible for training junior doctors).
²⁸