By Daniel Margrain
‘Humanitarian crisis’ in NHS hospitals, warns Red Cross (Getty) Royal Sussex County Hospital, UK (Photo by Universal Images Group via Getty Images)
Pictures that emerged last week from the Royal Blackburn hospital that showed mothers and babies being held in corridors for 13 hours and 89 year old Iris Sibley spending more than six months in a hospital bed because a care home place could not be found for her, are the kinds of incidences that are now becoming the norm in the NHS. Figures from the BBC suggest that nine out of 10 hospitals have unsafe numbers on their wards.
Health Secretary Jeremy Hunt’s comment on Friday (February 10) that the treatment of some patients was “completely unacceptable” in response to the worst A&E waiting times on record, was uttered as if he was absolving himself of all responsibility for the chaos. The reason why he gives the impression that he has no intention to do anything about the unfolding crisis enveloping the NHS, is because the chaos is a by-product of government policy.
The government’s objective is to move more healthcare to people’s homes and the community which will involve the merging of NHS and social care budgets that largely have already been privatized. This will lead to contamination and the entry-point for patient charges and co-payments. Given that the overall framework for such a system within the NHS already exists, it’s just a matter of time before such payments and charges are put in place.
Health & Social Care Act
The stated referencing for NHS funding is a deception, as was the assurance in 2010 that there would be no top-down re-organization of the service. The 2012 Health and Social Care Act undermines this assurance since it removes the duty on the Secretary of State for Health to provide a comprehensive health service, while the act requires up to 49 percent of services can be tendered out to “any qualified provider”. Already between a quarter and a half of all community services are now run by Virgin Care.
Since the late 1980s during Margaret Thatcher’s third term in office, whole entities within the public sector have increasingly been outsourced, health and social care services privatized and competition and the business ethos introduced into public services. Following the advice of the then chief executive of Sainsbury’s, Sir Roy Griffiths in 1987, the Thatcher government set about removing the foundations upon which the welfare state had been built. One study suggests that “the privatisation of social care services is arguably the most extensive outsourcing of a public service yet undertaken in the UK”.
The aim is to ensure the domination of the market by a small number of very powerful multinational corporations whose primary concern is not the welfare of the residents in care homes which they own or patients in hospitals, but rather with maximizing profits. In line with Noam Chomsky’s defunding notion, the strategy of successive governments’ over the last three decades has been to shrink the NHS and bring it to the point of collapse as the basis for then claiming the only solution is more privatization.
Britain’s Biggest Enterprise
The retreating from the principle of the universal provision of free at the point of delivery health care, can be pin-pointed to 1988 when Tory politician, Oliver Letwin, wrote a ‘blueprint’ document called ‘Britain’s Biggest Enterprise’ where he set out the stages governments’ would have to go through to achieve a US model of healthcare without the public noticing.
The New Labour government under Tony Blair adopted Letwin’s principles. But prior to the 1997 General Election, Blair had to disguise the strategy by using dissembling language in order to get elected. Once in office, he took several steps towards privatization – for example, breaking up the hospital network into foundation trusts which are essentially separate business entities. He also deliberately saddled hospitals with Private Finance Initiative (PFI) liabilities which involved the government borrowing £11 billion from private banks and financiers in order to justify the sale and breakdown of the NHS further down the line.
This culminated with the New Labour government introducing in 2009 what was termed the “unsustainable provider regime” which is a fake bankruptcy framework to justify closing hospitals. The £11 billion of public money Blair and Brown borrowed from the banks and financiers ostensibly to invest in the NHS through PFI (a sum that has soared to £80 billion which the NHS is duty bound to pay), helps further this eventuality in two ways.
Firstly, financing hospitals through PFI displaces the burden of debt from central government to NHS trusts and with it the responsibility for managing spending controls and planning services, thereby hindering a coherent national strategy. Secondly, the high cost of PFI schemes has presented NHS trusts with an affordability gap. The financing of these legally questionable PFI contracts, which has increased the public’s liability by a massive £69 billion, cannot be examined because they hide behind strict confidentiality rules.
Nevertheless, the Labour party under Jeremy Corbyn appears to be reluctant to raise the issue surrounding the alleged inadmissibility of the contracts despite the high probability that best value and cost effectiveness criteria were unlikely to have been adhered to in this instance.
The most powerful and influential individual currently working in the NHS is former Labour councillor, Simon Stevens, chief executive of NHS England. After having served under the Blair government, Stevens went on to work for the US private health care provider, United Health, where he campaigned against Obama Care. Stevens then argued for the Transatlantic Trade and Investment Partnership (TTIP) to be included within the UK health care remit. Those encouraged by the election of Jeremy Corbyn (myself included) are still waiting to hear something from the shadow health team about this troubling development.
The latest controversy to have emerged from NHS England led by Stevens is the proposed introduction of its ‘Sustainability and Transformation Plans’ which forms part of the annual 2016-17 HHS Planning Guidance. “Sustainability and transformation” is Orwellian-speak for the move towards the total reorganization of the NHS predicated on more privatizations and cuts. As Mike Sivier puts it:
“We’re told the project is about ‘strengthening local relationships’ and building on ‘local energy and enthusiasm’ to achieve ‘genuine and sustainable transformation in patient experience and health outcomes’. But in fact, the Guidance contains some very specific requirements that will test these new collaborations to the limits and usher in a new wave of privatisations and huge cuts.”
Last January, activist Dr Bob Gill from the Save Our NHS Campaign attended a meeting to get some insight into what the position of the Shadow Secretary of State for Health, Heidi Alexander, was in relation to the direction NHS England was moving in under Stevens. What he heard were narratives that fitted into the ongoing privatization agenda. According to Gill, Alexander expressed support for Simon Stevens, despite his appalling track record.
This is deeply concerning for people who see in Corbyn somebody who might be willing to take a man who appears less committed to ethics and patient care than to ensuring medicine is a profit-based ‘conveyor belt’ service, to task. Unfortunately, there is no indication that he is the man who intends to do it. On the contrary, the narrative of the shadow health team appears to be one of support for both Simon Stevens and the existing regime of privatization that he is overseeing.
A year down the line since Dr Bob Gill’s revelation and with no action taken by Corbyn against Stevens, it’s now a matter of urgency that activists exert political pressure on Corbyn’s team to address the rightward direction Stevens, in conjunction with the Tories, is taking the NHS. Prior to the last election, David Cameron promised to “protect the NHS budget and continue to invest more.” This promise has been broken. According to the Nuffield Trust, “government spending on the English NHS is falling as a share of UK GDP – from 6.5 per cent of GDP at the end of the last decade to 6.2 per cent in 2015-16.”
Research by the Kings Fund indicates that the UK is ranked 13th out of 15 original EU members. In Orwellian fashion, health under-funding is portrayed in the media as “unprecedented levels of overspending by hospitals and NHS trusts.”Under-funding has inevitably impacted on staffing levels. The shortage of nurses within the NHS has reached dangerous levels in 90 per cent of UK hospitals, and the amount of doctors per capita is the second lowest among eleven European countries.
Overall, on six out of nine measures of varying sorts – five year survival rates for breast cancer; the same for prostate cancer; the number per capita of MRI scanners, CT scanners, angioplasty operations, hip replacements and knee replacements; waiting times to see a specialist and the OECD assessment of outcomes compared to money spent – Britain did worse than any other advanced country in the world. Under both Stevens and the Tories every aspect of the NHS is under attack.
At the time of writing, Virgin Care is in control of well in excess of 200 contracts across the UK while administration for the new NHS market alone, costs tax payers £1 in every £10 the NHS spends (4.5 billion). The carving open of the service for exploitation by private interests is proceeding at a pace and the government shows no indication of wanting to reverse the process. This is hardly surprising given that 70 MPs have financial links to private healthcare firms while hundreds of private healthcare corporations have donated to Tory coffers.
The erosion of the principle of a free at the point of delivery service also undermines what Sir Michael Marmont refers to as “the optimal allocation of resources.” This, in part, explains why a country like the United States where the marketization of its health care system is long established, is ranked 44th in the world in 2014 in terms of efficiency compared to 10th for the UK. Given these figures, one might reasonably ask why the government appears to be insistent on dismantling something that, despite its faults, essentially works, and then restructuring it in the image of a system that doesn’t?
The US model we are moving towards
During his recent trip to America following Trump’s inauguration, it is likely that UK Health Secretary, Jeremy Hunt, took the opportunity to discuss with US financiers further moves to carve up the NHS in order to bring it closer to the US insurance-based model. The requirement of the US Affordable Care Act (which was signed into law in March 2010 but is actually unaffordable for large swaths of the US population), is that people are forced to buy private health care insurance if they fail to qualify for public health programmes, namely Medicare and Medicaid. However, the insurers have created plans that restrict the number of doctors in hospitals.
These “ultra narrow networks” have resulted in the reduction of at least 70 per cent of health facilities within communities throughout the US, thereby restricting access to care for people with serious health problems. This means that increasingly Americans are paying higher premiums but are not getting sufficient access to services they need. They are, therefore, having to find the money upfront, largely because their insurance policies do not provide adequate cover for their injuries or illnesses.
So America is still seeing high rates of people who are either delaying, avoiding getting access to the care they need, or are being confronted with medical debts. Research shows that tax-funded expenditures account for 64.3 percent of US health spending, with public spending exceeding total spending in most countries with universal care. Yet, 33 million people in the US do not have access to health insurance cover.
When Obama came into office in January 2009 there were approximately 15 per cent of American’s who had been uninsured for at least a year which meant that unless they had access to a significant amount of money, they could not go to a doctor when they or their children fell ill. During this period, surveys showed that two-thirds of all Americans favoured a single payer health plan (ie a publicly financed system of universal health care provision free at the point of delivery for all, similar to the NHS) but Obama rejected it outright. This was despite the fact that war veterans and senior citizens have a variation of publicly/privately delivered and funded arrangements already in place within the existing system.
These limited single payer systems have also proven to be cost effective with good outcomes. In addition, Obama was riding high on a wave of popular support following his election victory. Not only did the Democrats control the White House and Senate but they also commanded a majority in the House of Representatives. It would appear that the $20 million Obama received from private health care companies during his election campaign helped sway his decision not to introduce the single payer system across the board despite the fact that nearly 80 per cent of Democrat voters support the introduction of such a system.
Obama, in other words, had the democratic mandate to introduce the extremely popular single payer system universally but instead he turned his back on the people who elected him into power. The conflicting interests that American presidents like Obama face relates to the close relationship they have to members of Congress who need to get reelected. If Congress speak out against the interests who are funding their campaigns, they’re not going to get that funding. Commenting on a report from the National Journal, Ashlie Rodriguez wrote:
“Health care interests have given $46.6 million in campaign donations since 2005 to [the] 21 lawmakers” at the bipartisan healthcare summit, including Senator Max Baucus, Senate Minority Leader Mitch McConnell, House Minority Whip Eric Cantor, and to the summit’s host, President Obama.”
And Citizens for Responsibility and Ethics in Washington found that:
“health professionals, political action committees, hospitals and nursing homes, pharmaceutical and health product companies, health services firms, HMOs and accident insurers have given heavily to all summit attendees.”
Tiny efforts to try and patch together what is clearly a dysfunctional system is further undermined in as much as that patchwork involves another obvious paradox. This is highlighted by the origin of the Obama Care Plan which has its roots in the Heritage Foundation, a conservative Think Tank, which came up with the model of forcing people to buy private insurance and to use public tax dollars to subsidize the purchase of this insurance. In other words, as a result of a process of publicly funded corporate welfare, billions of funds are shifted into the hands of private insurance companies.
Nevertheless, this was passed into law in Massachusetts under governor Mitt Romney who was Obama’s Republican opponent in the race for the White House. Almost exactly the same plan was passed by Obama at the national level. This led to the insane situation in which the Democrats were essentially championing a Republican plan in which the latter subsequently distanced themselves from. Instead, the Republican policy under Trump is for everybody to pay privately with no public provision and no safety net of any kind in place.
America’s health care costs are the highest per capita of any country in the world with some of the worst outcomes. Attempts to reform the US system are undermined by the insurance companies whose only function is to be middlemen between the patients and the health professionals.The U.S government’s treatment of health care as a commodity instead of a public good is out of sync with the rest of the developed world and illustrates the extent to which, more broadly, the giant corporations have usurped democracy in the United States.
As things currently stand, the US is the only industrialized nation on the planet that has used a market-based model for healthcare. Alarmingly, whether people want to admit it or not, this is the direction of travel both the Tories and NHS England under Simon Stevens are taking the system of UK healthcare provision. In other words, we are heading for a potential nightmare.
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