On 5 February 2021, Health Policy Insight published a leaked draft of a white paper outlining plans for an overhaul of the National Health Service.
The proposals, supposedly emanating from needs highlighted by the Covid-19 pandemic, promised to remove bureaucracy from the NHS, to integrate healthcare with social care, and to give local authorities more control over provision in their area. Subsequently, on 11 February, health minister Matt Hancock introduced the white paper in the House of Commons.
The initial announcement gave rise to belief that the draft bill was being proposed to dismantle the ‘internal market’ system introduced in 1997 as a vehicle for gradual privatisation of the service, with the relatively slow start having been accelerated by David Cameron’s Health and Social Care Act 2012.
With the introduction of the internal market came a whole new level of bureaucracy, since the NHS was divided into ‘providers’ and ‘consumers’ so that internal competition could be introduced. Funds were allocated to one section of the NHS so that it could ‘purchase’ services from another, while a range of ‘lesser’ but nonetheless essential services such as cleaning and catering were farmed out to the private sector.
All this required competitive tendering – a layer of time-consuming bureaucracy necessitating the expensive employment of large numbers of additional ‘managers’, and accountancy, requiring the equally expensive employment of a large number of additional bean counters – all out of taxpayer money that was supposed to be used for the treatment of patients.
The 2012 act brought in the requirement that private concerns should be allowed to tender to supply clinical services, with the expectation that those offering them at the lowest prices would get the contracts – which the privateers were all too often able do because they were free to employ people at rock-bottom wages and generally to cut costs in a myriad other ways liable seriously to affect the quality of the service, while hammering the working conditions of their staff.
So when health secretary Matt Hancock announced that NHS bureaucracy was to be reduced, it was all too easy to rejoice on the assumption that he meant to do away with the internal market. Not a bit of it, however! Much less did he intend to sweep away the privateers fattening themselves out of the public purse on the pretext of providing services to the NHS. Tout au contraire, mon ami!
“The NHS campaign group We Own It has stated its opposition to the restructuring, saying it would leave the NHS even more vulnerable to privatisation than before.
“The group criticised the ability the white paper would give for private companies to sit on NHS boards, as well as the provision allowing the government to hand out contracts without competition. It added that the reforms opened the door to privatisation by offering patients more choice from private providers.” (The reasons why Matt Hancock’s proposed NHS reforms should worry us all by Jasmine Norden, The Canary, 16 February 2021)
Professors Peter Roderick and Allyson Pollock, who have always stressed that market norms cannot but starkly conflict with patient interests, have written in the BMJ in great detail about the government’s nefarious plans to expand the process of piecemeal selling off the NHS. (A new bill to reform the NHS in England: the wrong proposals at the wrong time, 11 February 2021)
They stress, among others, the following points:
1. No material change
“The core elements of the disastrous [2012] reforms remain in place: no duty on the government to provide key services throughout England to everybody; entitlement to services dependent on membership, now of clinical commissioning groups (CCGs), in the future of ‘Integrated Care System (ICS) NHS bodies’, though abolition of CCGs is implied, not expressed; commercial contracts and the purchaser-provider split still the basis for delivering services; foundation trusts still able to receive 49 percent of their income from outside the NHS; and public health functions and communicable disease control remain outside the NHS.”
2. The end of compulsory competitive tendering
While on the face of it this removes an unnecessary layer of bureaucracy, it at the same time removes the only protection the NHS has from cronyism in the award of contracts for the provision of services:
“transparently competing for contracts is the check against corruption and cronyism within a market model. Contracts worth £10.5bn were awarded directly without any competition during the pandemic to the end of July 2020; this will now become the norm.”
And it is now notorious that not a few of these contracts were awarded to private entities with no previous experience in the field. The New York Times, for instance, reported:
“When the pandemic exploded in March, British officials embarked on a desperate scramble to procure the personal protective equipment, ventilators, coronavirus tests and other supplies critical to containing the surge. In the months following those fevered days, the government handed out thousands of contracts to fight the virus, some of them in a secretive ‘VIP lane’ to a select few companies with connections to the governing Conservative party.
“To shine a light on one of the greatest spending sprees in Britain’s postwar era, The New York Times analysed a large segment of it, the roughly 1,200 central government contracts that have been made public, together worth nearly $22bn. Of that, about $11bn went to companies either run by friends and associates of politicians in the Conservative party, or with no prior experience or a history of controversy. Meanwhile, smaller firms without political clout got nowhere.” (Waste, negligence and cronyism: Inside Britain’s pandemic spending by Jane Bradley, Selam Gebrekidan and Allison McCann, 17 December 2020)
And further: “a wealthy former investment banker and Conservative party grandee, Paul Deighton, who sits in the House of Lords, was later tapped to act as the government’s tsar for personal protective equipment.
“Eight months on, Lord Deighton has helped the government award billions of dollars in contracts – including hundreds of millions to several companies where he has financial interests or personal connections.
“The contracts that have been made public are only a part of the total. Citing the urgency of the pandemic, the government cast aside the usual transparency rules and awarded contracts worth billions of dollars without competitive bidding. To date, just over half of all of the contracts awarded in the first seven months remain concealed from the public, according to the National Audit Office, a watchdog agency.”
And, to add insult to injury: “In the government’s rush to hand out contracts, officials ignored or missed many red flags. Dozens of companies that won a total of $3.6bn in contracts had poor credit, and several had declared assets of just $2 or $3 each. Others had histories of fraud, human rights abuses, tax evasion or other serious controversies. A few were set up on the spur of the moment or had no relevant experience – and still won contracts.”
The tin lid has been supplied by the recent revelation that a contract for the supply of vaccination vials went to one of the health secretary’s neighbours: “The former publican and neighbour of Matt Hancock who secured lucrative work producing millions of vials for NHS covid tests is under investigation by the UK’s medicine agency, the Guardian can reveal.
“Alex Bourne, who used to run the Cock Inn near the health secretary’s old constituency home in Thurlow, won about £30m of work producing the test tubes despite having no prior experience in the medical devices industry.
“Prior to the pandemic, his company, Hinpack, made plastic cups and takeaway boxes for the catering industry. Now it supplies tens of millions of vials from its production site on an industrial potato farm complex in Cambridgeshire.” (Matt Hancock’s ex-neighbour under investigation by UK’s medicine agency by Felicity Lawrence, The Guardian, 21 February 2021)
If this level of graft on the part of the government itself is not bad enough, the future will only extend these opportunities.
3. Private companies will be involved in the body that doles out contracts to provide services to the NHS
The clinical commissioning groups that now give out the various contracts will be replaced by a new ‘representative’ body with wider powers: “A statutory ‘ICS NHS body’ … will receive a ‘single pot budget’ which will merge the budgets for general practice with acute and other services …
“Its board will include representatives of NHS trusts, local authorities and general practice ‘and others determined locally’. General practices taken over by US corporations would be included. No controls are proposed over whom the other board members may be.
“They could therefore include, for example, private hospital groups, nursing home chains and the 67 companies awarded a £10bn contract last November for NHS inpatient, day case, pathology and imaging services, urgent elective care, cancer treatment, and diagnostic services …
“The opportunity, for example, for private companies to be either or both members of the ICS NHS body, and commissioned to provide services, is obvious.”
Moreover, if in spite of all this the ‘ICS NHS body’ should favour bids from the NHS, in the belief that they are likely to prove more reliable even if marginally more costly on the face of it, then any disappointed privateer will be able to sue: “Private health companies unhappy at being shut out of health service contracts will also be told to take the NHS to court under reforms to outsourcing due this week as part of new legislation.” (op cit“>NHS shake-up offers patients more private choice by Chris Smyth, The Times, 10 February 2021)
4. And yet: there is a dearth of provision for transparency or accountability
5. The power of local communities to influence decisions is less than ever
6. The right of the government to issue instructions to the NHS bodies, ‘taking back control’, carries a demonstrable risk of being misused
This has been the case during the pandemic. If Lord Deighton, multiple Tory party donors and Matt Hancock’s publican were richly rewarded during the pandemic, how many others had to be disappointed because of NHS ‘bureaucracy’ that the government lacked the power to overcome?
Apart from all else, it has come to light that Matt Hancock has been receiving generous handouts to the tune of £32,000 from the Institute of Economic Affairs, a thinktank that is campaigning for the NHS to be replaced by a privatised healthcare system. This worthy organisation has “criticised the NHS as ‘nothing special’ and unworthy of the ‘adulation’ it has received during the pandemic”. (Matt Hancock took cash from ‘anti-NHS’ Institute of Economic Affairs by Eleni Courea, The Times, 10 February 2021)
Greater ‘patient choice’ – a cover for more comprehensive privatisation
So why are we not surprised to hear that “Patients will be promised greater rights to choose private treatment and have it paid for by the NHS …
“People waiting for routine care will be able to choose treatment from any company that meets NHS standards and prices as the health service struggles to reduce waiting lists that have grown sharply during the pandemic.” (Chris Smyth, op cit)
The NHS has already suffered greatly as a result of underfunding and the accelerating rate of privatisation, a fact that has been brought into high relief as a result of the pandemic. That the NHS didn’t collapse in 2020 or before is more to do with the tenacity of the dwindling number of doctors, nurses and support staff within its ever-shrinking number of hospitals.
When people praise the NHS and hold it up as something dear to them, it is those hospital doctors, nurses and support staff that they are thinking of, not the cost and staff-cutting managerial elites sitting on health authority boards, CCGs and NHS England directing bodies.
Had the NHS been better funded, with a truly national organisation spreading the wealth equally and with all parts working in harmony rather than vying against one another, and without the atrocious haemorrhaging of cash straight into private pockets through so many gaping holes – the greatest of which is the private ownership of drug and medicines production, followed not far behind by outrageous super rents courtesy of the Labour party’s PFI schemes – its staff would not have been pressed beyond endurance during the pandemic.
Had the staffing been kept at anything like a proper level, then, when those Nightingale hospitals were made and equipped in 2020 (once more by throwing money at private companies), they could have been used to capacity instead of sitting, shiny and mostly empty, because we had no staff to run them. Even at the beginning of this year, when numbers in hospital climbed above those of 2020, those Nightingale hospitals were still not being used because we continue to lack the necessary staff in the public sector.
There are very few, if any, hospitals that are fully staffed as far as doctors, nurses and support staff levels are concerned. This means that, to cover the shortfall, staff have to work even harder while private companies are paid to send in ‘bank’ staff (qualified people employed by private companies, often on a daily basis) who must try to slot in on any ward and who cost the hospital around three times what they are paying for in-house staff. Such are the joys of privatisation.
There is every reason to think that an irresistible resistance will be put up to the new proposals, and that resistance must be given every support and encouragement. If we, the people, do not rise up as one to defend our NHS, we are certain to lose it altogether in the not too distant future.
It is not enough merely to applaud our NHS heroes; we need to defend them tooth and nail. It cannot be doubted that the fight will be severe, for the fat cats will not give up what they see as their ‘right’ to make billions at the expense of the health of the masses of people without deploying all the vicious and dirty means at their disposal.
