NHS for Sale: Myths, Lies & Deception (35 page)

A final broad brush suggestion for getting better results from the NHS is an experiment conducted many years ago by a Dutch teaching hospital in Maastricht in an attempt to improve referrals to the hospital. They wrote new guidelines for referring patients for imaging and pathology, and circulated them to the local GPs, who were at the same time given an identifying number. The hospital then fed back anonymised data to the GPs which showed how well they had done in adhering to the guidelines. They could only identify their own number in the data, which allowed then to see how well they had done in relation to others, but to remain anonymous to others.

The interesting result was that everyone’s referral behaviour improved. There was no financial incentive, no naming and shaming, only professional pride to motivate the doctors to improve their performance, and they did. Once they knew via the feedback how they were doing in comparison with their peers they were motivated to improve, although no one else knew how well or badly they had done.

Professionals by and large are not interested in competing on a financial basis but are easily motivated by professional pride. Nobody sets out in the morning to do a bad day’s work but the NHS has never exploited the natural pride that health professionals have in doing a good job. This is something that has been largely overlooked by management consultants, politicians and others who speak endlessly of ‘incentivising’ professionals, usually with non-clinical incentives such as targets-with-menaces. We would like to suggest that the
appropriate bodies look at this as a matter of urgency, as it offers a benign way of encouraging healthy competition that would benefit both staff and patients and save money at the same time.
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As the book goes to press we are weeks away from the 2015 general election. The outcome is less than clear but whatever the result the next government will inherit an NHS in genuine crisis. As we hope we have shown in the book, there was no need for this, as the NHS was doing very well until the advent of the coalition government, and its current problems can largely be traced to misjudged political interference and inadequate funding.

Many would like to vote for a party that will commit to an NHS that is not artificially divided into buyers and sellers of care, and where collaboration replaces competition, but that is still not a real possibility. All three major parties are still committed to the purchaser-provider split and with that come greater or lesser degrees of competition and outsourcing, depending on the particular party.

Labour, of course, have said they will reverse much of the legislation and promote the NHS to the status of ‘preferred provider’ which would be a step in the right direction. But one of the authors was recently told by a senior Labour official that it was necessary to maintain the purchaser-provider split because competition was ‘good for the NHS’. It was alarming to hear that such a belief is still held by highly placed people in the Labour party, but old attitudes are deeply entrenched.
Labour unfortunately built the bridge across which the Tories have stormed the NHS and there are still too many at the heart of the party who don’t think they did anything wrong when they destabilised the service by vigorously promoting its marketisation.

The Greens have adopted a very progressive health policy
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which includes calling for the scrapping of the Health and Social Care Act, and opposing the whole of the US-EU Transatlantic Trade and Investment Partnership treaty.

The National Health Action Party, much more recently arrived on the scene, have drawn up an ambitious policy framework,
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starting from the need to combat austerity and neoliberalism, and putting the fight for repeal of the Health and Social Care Act and scrapping the competitive market in the NHS in this context. The National Health Action Party supports the Pollock-Roderick NHS Reinstatement Bill,
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calls for significant increases in NHS funding, and is consistently opposed to PFI and all forms of privatisation.

With the spark of political resistance and alternative policies on offer from these and other progressive critics of Labour’s official line, the chances of campaigners fighting back long after the general election are greatly increased. It’s only by understanding what is happening and fighting tooth and nail against each attack as it comes that our NHS can be defended, reinstated and developed to fulfil its role as our most popular and universal public service, free to all at point of need, offering a full range of treatment, run for patients, not for profit, and funded from taxation.

As this chapter is completed the latest casualty of the push to privatisation is Hinchingbrooke Hospital, whose takeover
by the private firm Circle is described in
Chapter 1
. Circle, who had promised unrealistic levels of savings in order to win the contract, have announced that they are pulling out after only three years of their ten-year term. They have said their continuing involvement was ‘unsustainable’, blaming funding cuts, social care shortages and a surge in demand for A&E services – conditions which the NHS faces every day and is expected to deal with, not having the private sector’s option of walking away. As angry tweeters remarked – when the going gets tough, the private sector gets going. It was no coincidence that on the day Circle announced their decision they received a damning report from the Care Quality Commission, of which they had been previously notified. It revealed a catalogue of serious failings and resulted in Hinchingbrooke being the first hospital ever found to be ‘inadequate’ in how it cares for patients. Circle blamed anybody and everybody and their shares fell by 25 per cent. An unseemly political row broke out over who had awarded the contract in the first place. The NHS was as usual left to sort out the mess.
³³

Supporters of Circle’s role at Hinchingbrooke weren’t slow to comment on the turn of events. Jeremy Hunt tweeted ‘This [government] makes no apology for seeking solutions for failing hospitals. We won’t be deterred from tackling poor care and driving up standards.’
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Not even by the biggest private sector flop to date it seems. The
Daily Mail
predictably sprang to Circle’s defence. It had been a staunch champion of the takeover, claiming that Circle had turned the hospital from a ‘basket case’ to best in country for patient care.
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They explained away its failure to live up to their headlines by suggesting that the hospital was the victim of a ‘stitch up’ by opponents of private enterprise in the NHS and scooped the
fact that one of the 35-strong Care Quality Commission team was possibly a member of the campaign group Keep Our NHS Public, a sure sign of skulduggery.
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Critics of NHS privatisation were quick to claim that Circle’s failure sounded the death knell for the private sector in the NHS, but although it is too early to be sure the lesson is almost certainly a different one. Private companies will want even less to do with the risky and unprofitable end of the NHS, including District General Hospitals, and will gravitate ever more to the profitable activity, including administrative and policy support for the unnecessary market, leaving the complex expensive work
³⁷
for the NHS to pick up.
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The story of Hinchingbrooke, outsourced to and then badly failed by the private sector, seems a suitable place to rest our case. We hope that this book, with its evidence against competition, the NHS market and all the trappings that go with it, will finally kill the NHS market zombie. The NHS will always need to evolve and improve, but the direction of travel that all three major parties have adopted for it over the last twenty years has been an expensive failure in terms of actual money wasted and in terms of high opportunity costs. The billions wasted on marketising the NHS could and should have been spent on patient care.
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The deleterious effects of the policies pushed through to enforce a market extend far beyond the contracts awarded to the private sector and the money diverted to them. They
have a profound effect on the core of the NHS (which will always be required to deliver the services of no interest to the private sector), undermining services, destabilising NHS trusts as elective care is lost to the private sector and diverting scarce clinical time and resources away from patient care into dealing with the demands of compulsory competitive tendering and unbridled competition. The result is money squandered, opportunities lost and harm to the system which we all rely on.

The NHS needs stability and adequate funding, which would allow it to address the real problems it faces – tackling health inequalities, improving clinical standards, training enough staff, determining the appropriate distribution of care between hospitals and the community. The NHS market is a costly distraction for which there is no evidence, an ideological luxury which we cannot afford, above all in a time of ‘austerity’. It’s time to end the failed market experiment and return to an NHS which is publicly funded, publicly provided and publicly accountable.

For the last word we return to Noam Chomsky, who neatly identified how politicians and big business collude to put popular public services like the NHS ‘up for sale’

That’s the standard technique of privatisation: defund, make sure things don’t work, people get angry, you hand it over to private capital.
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It’s our job to make sure they don’t get away with it.

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As the book goes to press NHS Providers, representing 94 per cent of NHS hospitals, have dug their heels in and declared that enough is enough. They have refused to sign off their annual budget, claiming their members could no longer ‘achieve the impossible’ and that a fifth successive year of cuts would mean they could no longer guarantee the safe care of patients.
http://www.theguardian.com/society/2015/jan/29/englands-biggest-hospitals-refuse-nhs-budget-patient-safety-fears
.

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There have even been incidents of mentally unstable children locked up police cells overnight due to the shortage of adolescent beds. http:/
www.theguardian.com/society/2014/aug/17/mentally-ill-children-police-cells
.

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The privatisation of hospital cleaning and other support services back in the 1980s has become almost universally recognised as a disastrous race to the bottom on quality of services. It wasn’t until Tony Blair’s government took office that serious attempts were made to hand NHS clinical services to the private sector.

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One of the authors was part of an application for a grant to carry out the same experiment at a London teaching hospital, which was turned down. How different things might have been if that lesson had been taken on board for the English NHS.

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It would be an irony if the clinical market – meant to give patients choice – were to be increasingly abandoned by the private sector in order to concentrate on running the self-same market in which they are by and large no longer interested.

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Those who want a full analysis of the truly shocking amount of money wasted on the NHS market in England are referred to Calum Paton’s excellent paper for CHPI ‘At what cost? Paying the price for the market in the English NHS’ from
http://chpi.org.uk/
.

In the run up to the general election of 2010, David Cameron made a pitch to the electorate that spoke directly to voter frustration with our broken political system. Lobbying, he said, specifically ‘secret corporate lobbying … goes to the heart of why people are so fed up with politics.’
¹
He pointed to public ‘fears and suspicions’ about how our political system works, with ‘money buying power, power fishing for money and a cosy club at the top making decisions in their own interest’. ‘We all know how it works,’ he confidently assumed.

When it comes to the sell-off of the NHS, our fears and suspicions are well-founded. The views of the public towards the NHS have been sidelined as something to be managed by government rather than actively considered. Public opinion has largely been replaced in policy debates by corporate wish lists.

How the private healthcare lobby won the ear of government, however, goes well beyond Cameron’s gentle vision of lobbying: ‘the lunches, the hospitality, the quiet word in your ear’. The lobbying assault on the NHS by private healthcare interests has been a well-resourced effort over successive governments, involving multiple, overlapping strategies. It has included the financing of political parties, think tanks and very many lobby groups; the manipulation of public debate through the press; the ‘revolving door’ and the capture of whole government institutions by pro-market players; as well as the old-fashioned, behind-closed-doors schmoozing as
described by Cameron.

Let us initially concentrate on the lobbying efforts of just one corporation by way of an illustration (or at least the lobbying that is known to us). UnitedHealth Group is a giant in American healthcare. As well as being one of the largest private health insurers in the US, it has a fast growing business in technology-driven health services. It is involved in the commissioning (or buying) of health services, in outsourcing, and in the promotion of ‘wellbeing’ services to consumers, including through wearable technology.
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Revenue for the group in 2013 hit $122bn.
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The company is not without its critics in the US where it has faced accusations of overcharging and malpractice.
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Every year it spends millions of dollars on political donations and Washington lobbyists.
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Its ambitions, though, extend across the pond and, in the past decade, the firm has secured multiple NHS contracts. It is now in the running for what is thought to be the biggest outsourcing deal in NHS history, the £1.2bn contract to run cancer and end-of-life services across Staffordshire.
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