NHS for Sale: Myths, Lies & Deception (6 page)

From the end of 2013 into 2014 warnings were beginning to sound over the impact of the continued spending freeze, and CCG plans were becoming even more irresponsible. In the East Midlands 19 CCGs resorted to plans for cuts and closures of existing services in their efforts to cut spending by more than £1bn over the next five years, despite rising populations and even more rapidly growing numbers of older patients with greater health needs.
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In Leicestershire, a massively indebted trust borrowed money to open extra beds and meet targets at the same time as the county’s CCGs drew up plans to close down hundreds more beds and scale down hospital services. In Lincolnshire, plans to save £105m over five years are focused primarily on making huge savings from cuts in A&E, maternity and paediatrics by ‘centralising’ on just one site – regardless of the journey times and problems this would pose patients, parents and their visitors. Taking ‘care closer to home’ to new levels of absurdity, the CCGs regard all of the beds in the homes of the county’s 700,000 population as ‘community’ settings.

In Nottinghamshire, two separate plans aimed for massive cutbacks in hospital treatment, trying to slash not only numbers using A&E but also numbers of emergency admissions, acute hospital bed days, and even to cut referrals
to nursing homes by 25 per cent. In North Derbyshire the CCG wants to cut ‘avoidable emergency admissions’ by 22 per cent – despite the fact that the increase in emergency and elective caseload at nearby hospitals is because patients are being sent there by GPs! In South Derbyshire, where the £300m PFI-burdened Derby Hospitals Trust has been running at a deficit, the CCG plans to save itself money by redirecting patients away from the hospital to ‘the community’ – despite having no concrete plans to establish the services patients would need. In Northamptonshire, (designated as a ‘challenged health economy’ seeking huge ‘savings’ of £276m in health and social care) the Nene CCG is attempting to solve its own financial problems by imposing hefty financial penalties on the struggling Northampton General Hospital Trust for exceeding target numbers for emergency admissions, although the high and rising numbers flow from the CCG’s own failure to put any alternative services in place.

CCGs have also been drawing up irresponsible plans to put other services out to tender, potentially jeopardising local trusts: in Staffordshire, contracts for the control of £1.2bn worth of cancer and end of life care have been put out to tender by several CCGs egged on and funded by Macmillan, the cancer support charity.
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In Cornwall, NHS Kernow has decided to put £75m worth of elective services out to tender – a massive share of the budget of the county’s only acute trust,
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despite the consequences for the Royal Cornwall Hospitals Trust if the contracts are awarded to the private sector.

Utilising another aspect of the HSC Act, some foundation trusts, under severe financial pressures, have cranked up their private work resulting in massive increases of up to 40 per cent in their income from private patients.
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Social care is facing a massive financial squeeze. Between March 2011 and March 2014 £2.68bn will have been ‘saved’ by adult social care in England, equivalent to 20 per cent of the budget, according to forecasts by the Association of Directors of Adult Social Services
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– figures broadly confirmed and underlined by the more recent Age UK report
Care in Crisis.
As a result of the years of cutbacks 87 per cent of councils have so far restricted eligibility for social care to service users with ‘substantial’ or even more severe needs. This means that those who do receive care tend to be relatively more expensive to support: so a 25 per cent reduction in the number of people supported to live at home in the five years to 2012 brought only a 5 per cent reduction in actual spending.

According to the Audit Commission, a reducing share of adult social care spending is now allocated to older patients, with more going instead to those with learning disabilities and mental health problems. Average spending per resident aged 65 and over was 13 per cent lower in 2012 than in 2010. The percentage cut in spending per head appears even higher because budgets are reducing as numbers of older people increase. The 2013 spending round will lead to a further 10 per cent cut in overall council budgets in 2015/16.
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Since the coalition came into power the previous gains made by the NHS have gone into reverse. Growing pressures on the diminishing hospital services result in increasing and underfunded demand on A&E, the return of lengthening waiting times, and more delays in discharging patients from hospital for lack of suitable support in the community. A recent report
in
The Times
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shows the decline:

• Since 2010 there has been an increase of a third in the numbers waiting for operations, now 3.3 million.
  
• Average waits for treatment have lengthened by over 10 per cent.
  
• There has been a 25 per cent increase in the numbers waiting over 18 weeks and over 26 weeks for outpatient appointments and treatment.
  
• Cancer treatment targets have been missed for two successive quarters.
  
• For well over a year A&E departments have been failing to hit targets for treatment within four hours.
  
• Trolley waits for a bed have almost trebled in the last three years.
  
• Last minute cancellation of operations last year hit the highest level for nine years.
  
• Delayed discharge of patients fit enough to leave hospital have hit a new record level.
  
• 60 per cent of patients have to wait more than 48 hours to see a GP.
  

In the summer of 2014, the Tory-led coalition revived yet another policy initiative that had been first developed by New Labour from 2005 – the promotion of ‘social enterprises’ or ‘mutuals’ as a business model for what had formerly been NHS providers – the so-called ‘John Lewis’ model.

By bizarre coincidence the renewed campaign kicked off at the very point when the most prominent self-proclaimed ‘mutual’, the private hospital chain Circle, which had famously won a ten-year contract to manage Hinchingbrooke Hospital, wound up the ‘partnership’ that had appeared to give staff
‘shares’ equivalent to almost 50 per cent of the company. These Circle shares were always very strange: they paid no dividend, gave no control, and could not be sold. Now they have been scrapped, Circle is simply a Jersey-based company almost entirely owned by hedge fund and city interests, while new shares, equivalent to less than 10 per cent of the company, have been issued on an unclear basis to staff, who still have no real control.

A report by health union UNISON
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also showed that despite the rhetoric, there is and was NO partnership working at Hinchingbrooke. Circle has refused even to meet the trade unions representing staff at the hospital, and a disastrous NHS staff survey showed relationships between management and staff at Hinchingbrooke are worse than the average for the whole NHS. Out of 28 key findings, Hinchingbrooke came out worse than the NHS average on two thirds (19), and in the lowest 20 per cent of trusts in almost half.
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Nonetheless in July 2014 Tory grandee Francis Maude joined with LibDem health minister Norman Lamb and former Blairite minister Hazel Blears to launch a campaign to persuade hard-pressed foundation trusts to float off FTs as mutual/social enterprises.
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Interestingly the government definition of a public service mutual, according to the literature for the new Pathfinder Programme, is an organisation that ‘has spun out of the public sector’.
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The truth is that mutuals are no longer part of the NHS: they are non-profit businesses, and their staff are guaranteed none of the benefits of NHS terms and conditions, training schemes, or pensions. These are among the reasons why Labour encountered such stubborn resistance from staff when they attempted to push Community Health Services towards mutual status.
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Few staff other than the most senior managers driving the process accepted the absurd claim (recently echoed by Chris Ham of the King’s Fund
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) that mutuals would increase staff engagement, empower them to improve services, or in any way benefit them or their patients. In the few instances where ballots were allowed before frog-marching unwilling staff into these ‘partnerships’ the votes against were 80-90 per cent or higher. Back in 2006 the first social enterprise to win a substantial contract, Central Surrey Health, had pressed ahead with the bid in the teeth of opposition from 84 per cent of their staff.
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The coalition plan to promote mutuals involves putting £1m up front to subsidise the costs of 10 ‘pathfinder’ foundation or NHS trusts in paying for ‘bespoke technical, legal and consultancy support’ – giving an early foretaste of the increased bureaucratic costs involved if they press ahead and launch as mutuals. It’s unlikely to stop at that point. Francis Maude in particular is already looking to mutuals and charities as a less politically damaging way to break up the NHS and other public services.
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It’s clear that even those mutuals that manage to survive will struggle to retain their contracts against predatory private sector bids when they next come up for tender. Mutuals are both a step outside the public sector and a big step on the road to full privatisation.

However, this roundabout route to privatisation is another useful reminder that the private sector have not had it all their own way despite the framework of legislation that has been put in place by a privatising, neoliberal government committed to creating a competitive market in health care.

In October 2014 it was announced that the biggest contract
yet put out to tender, the £800m, five-year contract for Older People’s services in Cambridgeshire and Peterborough, had been won by the NHS bid, led by Cambridge University Hospitals Trust. However this came only after a costly
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and protracted tendering process which consumed large amounts of NHS management time, and after the local community health services trust, (Cambridgeshire Community Services, CCS) had been twice rebuffed in its attempt to win the contract. CCS now has to make hundreds of staff redundant, while the successful NHS bidders are faced with a complex and confusing contract which offered so little prospect of profit that several shortlisted private consortia pulled out before the decision was made.

Nevertheless the Cambridgeshire decision was an important reminder that putting services out to tender does not have to mean that they are privatised. Indeed, while most contracts since the Health and Social Care Act have gone to private bids, a stock-take shows that despite years of erosion and contracting-out since New Labour first devised its Concordat with private hospitals and the Independent Sector Treatment Centres, the majority of NHS-funded care is still delivered by NHS providers and NHS foundation trusts.

A Department of Health spokesman said in September 2014: ‘Use of the private sector in the NHS represents only 6 per cent of the total NHS budget – an increase of just 1 per cent since May 2010.’
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6 per cent of the English NHS budget is £6.3bn.
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This is more significant than it appears because much of the budget for patient care consists of services that the private sector
does not (and does not wish to) provide, so privatisation is concentrated in a few areas of health care.

The Institute for Fiscal Studies concluded from its analysis of figures up to 2012 that: ‘Despite large growth in the role of private providers in the delivery of some procedures, the vast majority of care is still provided by NHS hospitals.’
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The private sector is interested in elective care, community health services and mental health, so the £6.3bn needs to be seen as a share not of the
total
spend, but as a proportion of the
relevant
spending in the NHS. That is equivalent to 13.2 per cent of the £48bn of the NHS budget for primary care, mental health, community and elective services. Even here, the remaining, crucial 86.8 per cent is still in the public sector – including virtually all of the other clinical services, and 100 per cent of the costly, complex and emergency caseload. There is still plenty of NHS left for us to defend.

The long run up to the 2015 election has already begun to put the brakes on some plans to put services out to tender and has made it much harder for ministers to press through highly controversial plans for reconfiguration, cuts and closures in acute hospital services. Regardless of efforts to persuade them otherwise, local communities affected by these schemes have proved utterly resistant to arguments seeking to win their acceptance or acquiescence, putting local MPs of all main parties on the spot if they wish to be re-elected. Panicked by the impending crisis, Jeremy Hunt has suddenly released hundreds of millions of pounds of extra funding to prop up flagging A&E services over the winter in the hopes of minimising angry headlines which may stick in voters’ minds as polling day approaches.

In October and November 2014 the government faced the first national action by trade unions on NHS pay since 1982 – further evidence of the unstable political footing of the coalition in its plans for a decade of austerity, cuts and privatisation in the NHS. This included the first-ever strike action by the Royal College of Midwives. Even the proportion of the one million NHS workforce who were not on strike, and those who have meekly put up with the hefty cuts in real terms pay since 2009, are unlikely to warm to parties that insist their pay and conditions have to be sacrificed indefinitely in order to balance the books.

Shortly after his arrival in office Simon Stevens, the NHS England Chief Executive (a man fresh from a decade near the top of the giant US private medical giant UnitedHealth) published the
Five Year Forward View.
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It effectively declared its intention to undermine key elements of the Health and Social Care Act, making no reference at all to competition and setting out new proposals to integrate services that have been pushed apart by the Act. Stevens also put the question of NHS finances firmly on the table, demanding an additional 1.5 per cent per year (£8bn) above inflation for the five years from 2015, to come alongside a hugely optimistic, unprecedented £22bn which he hopes to generate through ‘efficiency savings’.