NHS privatisation accelerated during the pandemic: a medical ‘shock doctrine’

Instead of rebuilding our decimated public capacity, private providers are being subsidised to the tune of billions to take the place of the NHS.

Proletarian writers

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The NHS’s ever-expanding budget is increasingly being funnelled to private providers, its billions siphoned off to create guaranteed profits for the privateers rather than to provide essential frontline services. Meanwhile, the doctors, nurses and others whose job it is actually to provide those services are working longer hours for less in increasingly stressful environments, answerable not to clinicians but to business managers.

Proletarian writers

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Throughout the Covid pandemic, prime minister Boris Johnson, secretary of state Matt Hancock, and a host of other cabinet ministers held briefings in which they uttered the mantra “Stay home, protect the NHS, and save lives”.

The number of people who died at home rather than accessing care owing to a combination of this advice and overwhelmed ambulance services is not often talked of. The mismanagement of the pandemic in total will have taken in excess of 150,000 lives.

And it seems that the much talked-of “Covid enquiry” will now not happen, or at least not any time soon. Justice delayed is justice denied. But use of the slogan “protect the NHS” is particularly mendacious in view of the accelerated privatisation measures that have been implemented throughout the pandemic.

Chronic under-capacity of acute medical and intensive care beds, staffing and facilities have driven the responses to the pandemic – including the need for lockdowns. Over the last thirty years, the number of NHS beds has halved, such that today there are really only 100,000 overnight stay acute medical beds in the UK – and, as we saw before the pandemic, there are only 6,000 functioning and staffed ITU beds.

Moreover, the pandemic-induced collapse of the NHS had been predicted by Operation Cygnus, an exercise run in 2016 by then health secretary Jeremy Hunt, which found that after just a few short weeks, the NHS would “fall over” due to lack of capacity, lack of ventilators and inadequate PPE.

That report was kicked into the long grass (court proceedings to unearth its findings and recommendations are ongoing) because remedying the situation would have meant a complete reversal of the overall long-term strategy of NHS privatisation – vehemently denied by all government incumbents, but just as assiduously implemented through serial policy decisions all the same.

Systemic underfunding was intensified after 2008

Following the 2008 financial crisis, on the eve of election of the ConDem coalition, politicians of all stripes privately acknowledged that funding to the NHS would be cut. Senior medical leaders openly discussed that rationing of healthcare that would be required, including the closing of beds, services and hospitals, as one way to achieve the required billions in savings.

Inevitably, this austerity has led to an increase in waiting lists and to difficulty in accessing services, both of which growing problems have been further accelerated in the last year. Under the cover of ‘Covid’, we have seen widespread changes in clinical practice, with a huge increase in telephone or virtual consultations, skeleton ‘face to face’ clinics, and the suspension of elective and ‘non-urgent’ appointments and surgical procedures.

Boldened by this situation – the perfect storm of under-capacity and soaring need – the ‘solutions’ being offered are yet more privatisation, as a recent Financial Times article made clear:

“Health chiefs in England are looking to the private sector to help clear a massive backlog of patients whose care was delayed during the pandemic, creating a dilemma for independent providers that can earn more from people who can afford to pay for their own treatment.

“Just over a year ago, the NHS completed an unprecedented deal to buy up virtually the entire capacity of the private sector, pouring in millions of pounds of taxpayer money as part of measures to ensure the health service was not overwhelmed as the Covid-19 crisis escalated. [It was not the NHS that was saved, but the private sector, which would have sustained huge financial losses from the cancellation of its work.]

“Some 4.7 million people are now waiting for treatment in England, including more than 387,000 who have been doing so for more than a year.

“David Hare, chief executive of the Independent Healthcare Providers Network, said: ‘We think this is a long-term, minimum five year, exercise to get on top of the waiting lists and improve access for NHS patients and … that will require a lot of capacity from the private sector.’” (NHS and private sector forge new partnerships to clear patient backlog by Sarah Neville and Gill Plimmer, 25 April 2021, our emphasis)

Of course, having halved capacity in the NHS over the last 30 years, it stands to reason that ‘a lot more capacity’ is needed. The sustainable and efficient way to provide that capacity would be to build back the lost NHS provision. But that is not what is being proposed. On the contrary:

“The deal forged during the early days of the pandemic, which cost an estimated £400m a month, also shored up private health groups that would otherwise have struggled to survive as the NHS staff they use to perform operations were diverted full-time to duties in the taxpayer-funded system.

“While that original deal has expired, more than 90 providers – virtually the entire independent healthcare market – have signed up to another four-year deal with NHS England, worth up to £10bn, which began [without much fanfare] in March.

“This includes two of the biggest, publicly listed Spire Healthcare and privately owned Circle Healthcare.” (Ibid)

[Circle, it will be recalled, attempted and failed to run Hinchingbrooke hospital privately, having found that the only way to turn a profit was to dramatically reduce the pay and conditions of its healthcare professionals. This in turn has led to the attacks on the junior doctors’ contract and moves towards localised employment contracts, as well as to the removal of whistleblowing protection for medical staff. All this took place under the watch of Jeremy Hunt, but continues unabated in his absence.]

Subsidising and nurturing the private market in healthcare services

This siphoning off of this huge tranche of NHS funding by private healthcare companies is portrayed by our corporate media as being both logical and sensible under the circumstances of pandemic – a welcome measure by which to address NHS shortcomings.

The reality is the reverse. The shortfall in capacity has been carefully engineered in the public health system, and is now being used as a cover under which to further erode what remains of our NHS. The fact that private services are offered to us under the badge of the NHS should not fool us, for when a certain point of no return has been reached, that form too will be jettisoned as “no longer viable”, and the necessity for personal private funding or health insurance will become clear.

The same FT article continues:

“We don’t want to fill our hospitals with too much NHS work,” an executive at one provider, who declined to be named, told the Financial Times. “The margins from private payers are much higher so we want to do self-pay and private insurance work.

“However, he added that private hospitals were seeking to extend their working hours by taking on more cases in the evenings and on Saturdays, indicating that their company would try to maintain income from both NHS and private patients. One option for the NHS to reduce its backlog would be to raise fee rates paid to private hospitals but budgetary pressures, which have only worsened during the pandemic, will make that difficult.

“Tony Veverka, chief executive of Transform Hospital Group, a cosmetic surgery specialist that worked with the NHS during the pandemic, said the Covid-19 crisis had seen a ‘groundbreaking partnership’ between independent providers and the NHS.”

It should not be forgotten that the overwhelming majority of medical staff who provide private healthcare, were trained in and are also employed in the NHS. Bringing in the private sector very often does not increase capacity; it simply increases costs by providing profits to the private health corporations. But if NHS capacity is reduced enough, the pressure to access care will inevitably mean an increase in private referrals:

“Although Spire Healthcare grew its NHS revenues by more than 50 per cent in 2020 compared with the previous year, it believes long waiting lists will encourage people to convert to self-pay, the fastest growing segment of the healthcare market.

“In early March it said its inquiries from private patients were up 29 percent on the previous year. ‘People will be choosing to pay for their own treatment [if adequate access to care was easily available locally within the NHS, of course, few if any would make this ‘choice’] and they have discretionary cash,’ said Justin Ash, Spire chief executive. At the same time, he anticipated working more closely with the NHS. ‘It will be a different world and there will be a more collaborative approach between trusts, commissioners and independent sector providers.’

“The IHPN’s Hare said there were ‘emerging signs that more people will want to pay for their own care directly and through private medical insurance’, but he suggested the public and private sectors could forge new kinds of partnerships. Investment by independent providers in diagnostic imaging equipment such as scanners, for example, [!] would benefit both self-pay and NHS patients, as the health service grapples with a shortage of the machines.”

Again we must ask, how much diagnostic imaging equipment could have been purchased with the £10bn that is being casually passed to the private sector in this perverse and unscrutinised deal? Or, indeed, with the £45bn gifted to the private sector for the totally ineffectual ‘track, trace and isolate’ system overseen by former TalkTalk chief executive and Tory grandee Dido Harding?

‘Scanners’ (CT, MRI, ultrasound and PET scanners, along with the staff to run, use, interpret and maintain them), can be bought, accessed and operated full-time within the NHS at a fraction of the price per scan of hiring such services from private firms.

Matt Hancock’s new ‘white paper’ on health

This is precisely the meaning of Matt Hancock’s recent white paper on health, which supplements and bolsters the privateers’ charter that was the Health and Social Care Act 2012. On the one hand, it will end the ‘free-market efficiencies’ alleged to derive from the tendering process and allow government to simply award deals – as Boris Johnson and co have so enjoyed doing under the provision of the emergency powers granted to themselves under the 2020 Covid act.

Even more significantly, the proposed measures will change the structure of health administration and funding by merging the clinical commissioning groups (CCGs) of GP fundholders with social care budgets and private providers under corporate-style board management overseen by private insurance contractors. These will be termed ‘integrated care networks’ in local jargon, but are essentially the health management organisations introduced in the USA by healthcare giant Kaiser Permanante and Richard Nixon in the 1970s that have led to the disastrous situation of today, whereby some 70 million unemployed and impoverished US citizens have no access to medical care.

“Chris Hopson, chief executive of NHS Providers [another health Quango, ostensibly a ‘member’ organisation, composed of all NHS trusts, set up to facilitate the transformation of our NHS hospitals into entities that function as separate business units], which represents health leaders across the country [!], said the NHS was ‘going to have to treat people differently and more productively [a euphemism] and that would suggest there is an opportunity for new ways of doing things that could involve the private sector more’.

“Take up of private sector provision by the NHS even at the height of the pandemic was inconsistent – overall about two-thirds of their capacity went unused and some hospitals furloughed administrative staff.”

Once again, here is an admission that far from using resources ‘more productively’, money was given to the private sector without receiving anything in return. Of course the dual use of terms such as ‘productive’ and ‘efficient’ is precisely the point. They are code for ‘profitable’, but misinterpreted by health professionals and the public as meaning ‘generating better health outcomes’, which downgrading the NHS most assuredly does not.

“Hopson pointed to University Hospitals Plymouth trust in the west country which, at the height of the pandemic, temporarily transferred its oncology department to a hospital run by Nuffield Health in order to release NHS resources. ‘It just feels, when you talk to chief executives, there is a recognition that, given how big the task ahead is, getting as much help as possible, wherever it comes from, is really important.’”

Hopson further stated that “collaborations” (an appropriate term) with the private sector had proved “beneficial and helpful, particularly when it became clear that the local NHS controlled the way private sector capacity was used. If there were suspicions or concerns, I think the experience over the period of the pandemic has helped to overcome them.”

So this further gift of £10bn to the private sector, we are being told, is the much-needed ‘efficiency’ that will get the NHS out of its present dire situation (with five million British citizens waiting for vital operations and procedures), allegedly created ‘by the pandemic’, but in reality created by the past 40 years of incremental underfunding, engineered under-capacity, outsourcing and privatisation.

In reality, this ‘new’ policy is a hair of the dog. More of the same toxic ‘medicine’ that has put the NHS in such dire financial and organisational straights in the first place.

This, then, is the medical ‘shock doctrine’ being applied to the NHS: Generate a crisis by planned under-capacity – by rationing, in fact. Allow the public, the working class, to thrash around in pain, and express their desire for help: “Why can’t we access the services we need? Something must change! Why can’t we get help, on demand, free at the point of use as promised, from the cradle to the grave? Is that not the mark of a decent civilised health system and society?”

And then in steps the Conservative administration – Hancock, Johnson, Harding, Sir Simon Stevens et al – mired in corruption and conflicts of interest, to give away tens and hundreds of billions of taxpayers’ money to their friends in the private health and insurance industry, promising that by such measures the situation will get better, and in the process forcing those who are able to pay into the welcoming arms of the private sector.

A strong campaign against privatisation and for renationalisation of the NHS has never been more needed. And the ability of the main parties – Tory, Liberal and Labour – to mount one is zero. They are all leading the charge to dismantle our much loved and maltreated NHS, at the behest of their monopolist masters and for the sake of the mouthwatering profits and bribes that this course offers them.

When workers wake up to the scale of their betrayal, there will be a huge price to pay.