NHS for Sale: Myths, Lies & Deception (33 page)

The lies have been necessary to conceal the true privatising agenda from the voting public, since as Portillo pointed out no one would have voted for it.
*
They have also been necessary to draw a veil over the vested interests looking to profit from the break-up of the NHS, and to cover up the damage done by the financial cuts (which they also lied about) and by Lansley’s ill-conceived legislation. Egregious lies had to be
told about the NHS itself, and how it couldn’t go on like this (see
Chapter 2
), lies necessary to justify their assault on the service.

We are now so inured to financial impropriety that we are apt to turn the page on yet another story about shady connections between politicians and the private sector. We are so accustomed to a diet of lies that we are hardly surprised when national institutions have to point out to our politicians that they are being economical with the facts. The UK Statistics Authority had to write to Jeremy Hunt pointing out that Tory claims of increased spending on the NHS were not true
⁴⁶
but they went on lying anyway, with Cameron making further false claims about NHS spending.
⁴⁷
Hunt (who had parliamentary form of course) was accused of repeated lying about various aspects of NHS performance.
⁴⁸
As Leys and Player pointed out,
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even the culture within the DoH itself changed from one of accountability and fidelity to one of misrepresentation and spin, which the authors attributed to the arrival of more private sector personnel in the department.

The biggest lie of all (and there are some serious contenders) was Cameron’s pre-election promise that ‘the NHS will be safe in my hands’. Far from being safe in Tory hands the NHS and its patients are now the victims of lies, profiteering, contracts for donors, jobs for the boys, the sale of confidential data and secret meetings run by a US multinational who is the ex-employer of the NHS CEO. No wonder they are so anxious that we don’t know the facts about what is happening to the NHS.

One of the most serious aspects of the lies and cover ups is
that the voting public does not have anywhere near the full facts to make up its mind about the political agenda for the NHS, which would allow them to call politicians account. The three major political parties have espoused the neoliberal ideology which demands marketisation of the NHS and as a result successive governments have ignored evidence and manipulated statistics to suggest that the NHS market is beneficial.

As Professor Calum Paton points out in his closely argued case against the marketisation of the NHS,
⁵⁰
there has for example been no attempt to monitor the cost of the market reforms, allowing pro-marketeers to claim minor benefits while ignoring the expense incurred, which has been considerable. He calculates that the benefit-cost ratio of market reforms is likely to be very low at best and at worst a double negative i.e. high costs incurred in doing harm rather than in creating benefit. If politicians had been truthful about this we would long ago have recognised the English NHS market to be a failed experiment that has cost a great deal and delivered little. Based on the evidence, withheld from the public, it should have been abandoned years ago. Therein lies the real damage done by political lies, dishonesty and obfuscation.

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*
The Plot against the NHS
(Leys and Player) is an essential read for anyone who wants to know more about the relentless political manoeuvring against the NHS.

*
One person who had been expected to apply for Stevens’ new job at NHS England was the former NHS Director General of Commissioning Mark Britnell, who quit his senior post in 2009 to become a partner and Head of Healthcare in Europe & UK for KPMG.

*
He was was paid £285,000 a year by the NHS in 2006 – the highest paid civil servant in the country at that time. Even his mother was shocked when she heard of his new role. ‘I can’t believe that my son is running the IT modernisation programme for the whole of the NHS’ she is quoted as saying, having told a newspaper he failed his computer studies course when he was at Bristol University. Mrs Granger was at that time campaigning to save services in her local hospital in Halifax and went on to say ‘some of the money going into Connecting for Health could be saving my local services’ (
http://www.theguardian.com/society/2006/nov/12/epublic.technology
).

*
A 2013 Yougov poll showed 84 per cent of the public would prefer to see the NHS run as a not-for-profit public service, while only 7 per cent favoured privatisation.

NHS reforms our worst mistake, Tories admit.
¹

The Times,
October 2014

We have set out in this book to chart the effects on the NHS of the Health and Social Care Act and of the cuts required by the Tory ten year plan to freeze NHS spending in real terms and reduce it as a share of GDP by 2020.
²
We have challenged the lies politicians have told us in order to push through their programme for marketising and privatising the NHS and to buttress their false claims that they have protected the NHS from funding cuts. From the preceding chapters it is clear that whoever wins the general election in May 2015 will face an NHS in serious crisis.

As this book has been drafted the scale of this crisis has grown and the pace of events has increased. We have massive and unsustainable pressure on secondary care while at the same time commissioners throughout England are drawing up plans to cut back hospital services, with ambitious hopes of diverting an ever-increasing number of patients away from hospitals and ‘into the community’. Perhaps the most notable phenomenon has been the extension of so-called ‘winter pressures’ into all year round pressure on A&E and ambulance services, largely attributable to the near-collapse of social care
after year-on-year reductions in local government spending.
*
GPs and primary care services are also struggling, faced with a funding reduced in real terms and as a share of total NHS spending, while the tasks dumped onto GPs and primary care continue to increase with each new plan drawn up by Clinical Commissioning Groups (CCGs). The serious shortage of GPs to maintain services during the day and out of hours is matched by shortages of district nurses, other nursing staff and other health professionals.
³

Short-sighted government and Department of Health decisions to run down training programmes for new health professionals are bearing bitter fruit. The problem is now compounded by the fact that the Health and Social Care Act carved up the responsibility for the education and training of health professionals into a myriad fragmented ‘Local Education Training Boards’,
⁴
just one example of the bureaucratic nightmare that Lansley’s ‘reforms’ have unleashed on the NHS. Reports now suggest that up to 6,000 overseas nurses from other EU countries have been recruited in the year to date in attempts to plug the gaps created in the NHS workforce.
⁵

The strains on acute services and primary care are matched by those afflicting mental health services, which despite increasing rhetoric from ministers have suffered years of disproportionately higher cuts than acute services, with loss of beds in hospitals alongside severe pressure on the replacement services in the community. Shortages
of inpatient services
*
for child and adolescent mental health have hit the headlines,
⁶
while a less acknowledged bed shortage is also affecting the ability to deliver a full range of adult mental health services. Already the future of some specialist mental health care has been put at risk by incompetent commissioning from NHS England.
⁷

Integrally linked into this mounting chaos has been the draconian 27 per cent cutback in local government funding over the five years to 2015,
⁸
which has necessarily impacted on social care, making it impossible in many areas to discharge patients from hospital, or to support vulnerable older people in their own homes. In many areas in England ‘eligibility criteria’ have been tightened to exclude almost all but the most serious and desperate cases from any support from social care. With council spending still falling and NHS budgets static in real terms, the illusion that services can somehow be ‘integrated’ by top slicing £3.5bn from NHS budgets to spend jointly with local authorities through the so-called ‘Better Care Fund’ has become even more far-fetched.

The
Health Service Journal
has warned that the ambitious targets set for the Better Care Fund are hopelessly unrealistic,
⁹
as the evidence accumulates to show that the obsessive focus on reducing attendances at A&E and emergency admissions is unlikely to yield significant results. So why do the plans for economies through reconfiguration of services focus so consistently on emergency services, which are relatively cheap to provide and consume such a relatively small share of the budget? When McKinsey produced their report for NHS London in 2009,
¹⁰
outlining savings proposals, their figures showed that spending on A&E (seeing 3.8 million patients)
was just £300m out of £11.3bn – just 2.6 per cent of London’s health budget.

As we have seen in
Chapter 10
, when an A&E closes, it is the first step to the run-down and closure of the whole hospital, since so many other services are linked with A&E. The rationalisation of hospitals, to leave fewer and fewer emergency centres, also means that these remaining NHS hospitals will increasingly be dominated by emergency work, allowing the private sector to pick up yet more contracts to deliver the elective services which it finds most profitable.

Another major problem in many areas is that dozens of trusts are facing a legacy of unaffordable contractual payments on costly PFI-funded hospitals. Deals which were unrealistic and barely affordable in the 2000s (when NHS spending grew year by year) are now proving to be major liabilities, consuming a large and growing proportion of the revenue of the parent trust. At the same time all acute hospitals face crippling financial challenges. These include annual cuts in the tariff of payments they receive for treatment, loss of income as CCGs attempt to reduce the numbers of patients referred to hospital, and competitive tenders which allow the private sector to take over significant amounts of elective care.

None of the main parties has offered any solution to the problems of hospitals burdened by Private Finance Initiative (PFI) repayments. The Tories enjoy pointing the finger of blame at Labour (at the same time as they are signing new PFI deals) while Ed Miliband continues to defend PFI and the disastrous decisions that were taken by Labour in the last decade.
¹¹

Debate continues among campaigners about how to tackle
the problem of PFI. Many campaigners instinctively reject any scheme that does not penalise the private consortia for having used their powerful position as ‘the only game in town’ to press-gang the NHS (which needed to build new hospitals) into signing overpriced contracts. But it’s clear that the private sector lawyers have nailed down fairly watertight contracts, which are not easy to override without potentially costly legal challenges.
¹²

It’s also clear that even if it might save some money in the long term, most PFI contracts are too costly to be simply bought out, along the lines of a recent buyout for a small PFI in the north-east, where a local council was able to lend much of the money.
¹³
The discussion continues on a more substantial solution to the problem, but in the meantime action has to be taken to prevent PFI-driven financial pressures resulting in cuts in frontline services that harm patients. Public campaigns against PFI must start from the need to protect and maintain local services.

The process of educating the public, health workers, and even politicians about the inflated costs of many PFI schemes could start by demanding that all substantial PFI contracts be opened up to public scrutiny. This would happen alongside a process of renegotiation on the basis of fair value, which should in many cases result in reducing the outgoings year by year, and even the return of excessive payments to the NHS. Where cases can be proved, those responsible for misrepresenting facts and mis-selling PFI deals should face legal action.
¹⁴

The Health and Social Care Act has deepened the division between commissioners (largely dominated by primary
care) and providers such as hospitals which are increasingly excluded from decision-making but obliged to cope with the consequences of decisions made elsewhere.

A snapshot survey of acute trusts and Clinical Commissioning Groups in London at the end of 2014 reveals the CCGs projecting an overall surplus of over £150m by April 2015 (despite some individual CCGs facing substantial deficits) while the acute trusts are projecting an overall deficit of more than £150m.
¹⁵
Some CCGs, confident of making a surplus, are nevertheless demanding penalty payments from local hospitals for exceeding contracted numbers of A&E patients and emergency admissions, while the CCGs themselves do nothing to reduce the pressures on these emergency services. This is a prime example of the so called beggar-my-neighbour behaviour which results in one section of the NHS trying to profit to the detriment of another and is a travesty of the traditional co-operation which used to characterise the NHS to the benefit of patients.

In apparent contrast to the fragmentation and competition created by the Health and Social Care Act, Simon Stevens, the chief executive of NHS England, has published his ‘vision’ for the development of the English NHS over the next five years, which makes no reference to competition or to the private sector, but talks repeatedly about integration of services.
¹⁶
The Five Year Forward View
has been welcomed by all three main political parties, each of which claims that it reflects their aspirations for the English NHS.