Paul Hobday on another NHS reorganisation

Paul HobdayThis is about the 13th reorganisation I’ve seen in my 3 decades as a GP. Up until now I’ve put it all down to the fact that politicians can’t resist “fiddling,” and if we called all managers administrators instead, they’d administer rather than think they too have to introduce change for change’s sake or to prop up their egos. However, this “reorganisation” is far more sinister as the label “NHS” will not be in any way applicable afterwards.

This white paper represents the Coalition Government’s proposals for legislation to privatise the NHS. It is the next logical step in the seamless acceleration of the policies of the last Government. Tony Blair was elected in 1997 on a platform of abolishing the NHS market, but a few years later reversed this without a mandate from the electorate. The present Secretary of State gave a pre-election pledge that there would be no more major reorganisations in the NHS. And why wasn’t the NHS a “hot topic” in the election campaign? Because all three main parties are in agreement that commercialisation is the way forward. Those believing in the founding principles of the 1948 NHS were disenfranchised.

The main aim of the white paper that Mr Lansley has introduced is to hand over the provision of NHS care to private companies. This policy is called “ patient choice.” To enforce this change, commissioning in England is to be privatised.

GPs have no choice but to amalgamate into consortia (GPCC) which have the task of commissioning the bulk of the NHS care under the control of a National Commissioning Board (NCB).

The GPCCs and the NCB are open to be largely run by private interests. The appointed NCB would contain figures from large health corporations. GPCCs in some areas are at risk of being dominated by a clique which would turn to the private sector to do the commissioning for them. There is a real danger of damaging conflicts of interests when GPs are both service providers and service purchasers.

The present commissioners, the Primary Care Trusts and Strategic Health Authorities are a publicly run bureaucracy and would get in the way so they are to be abolished by 2013. This plan to privatise commissioning is skilfully hidden by saying that GPs will be in control of 80% of the NHS commissioning budget, through GPCCs. But these GPCCs would take over the debts of the PCTs and then have to ration care on a massive scale as they would be held responsible for cutting the NHS budget by £20bn (a fifth of the NHS budget).

The nominally responsible GPs would then be blamed for the withdrawal of care and treatments and for closing hospitals.

The publicly owned infrastructure of the NHS is continuing to be closed down, sold off, and privatised as the cuts proceed and the private companies such as BUPA and the US company UnitedHealth move in ( e.g. PFI and LIFT buildings, privatisation of NHS procurement, IT contracts, privatisation of ambulance and pathology services, ISTCs etc.). The new commissioners are instructed to carry out “patient choice,” by ending the present position of the NHS as preferred provider and changing to an “any willing provider” policy.

The new “market” of competing providers would be regulated by MONITOR, which would also introduce price competition by abolishing national tariffs, and deciding best practice tariffs.

The new commissioners are instructed to continue the reconfiguration of NHS care by driving down GP referrals of patients to hospital, and removing hospital care.

The consequences for NHS staff are the loss of thousands of posts through cuts, and the forcible transfer of employment to private companies with removal of national terms and conditions and NHS pensions.

The consequence for patients is the rapid and drastic removal of care provided; fewer hospitals miles from home, and the withdrawal of all types of treatments and care. The white paper demands increased individual patient budgets, which together with provision by private companies, paves the way for charges and private insurance.

The vision of the future is one in which corporate interests will be given incentives to select patients, time-limit care, sell top-up insurance, and introduce charges for some elements of care no longer provided by the NHS. The Government will then want to see the development of practices competing against one another for members (patients), just like US health insurers.

That’s a chilling prospect for the elderly, those with chronic illness, and people with mental illness and long-term needs, who are often of no commercial interest to corporations because of their high healthcare costs.

The white paper proposals will inevitably lead to the end of the NHS as a publicly owned and provided system of healthcare funded by taxation, with the right of every citizen to have access to comprehensive, high quality healthcare, free at the point of need. “NHS” will be nothing more than a title. Just as the USA is waking up to the inefficient, unfair, corrupt and discriminatory health care system they have, we are being driven in that direction— for ideological reasons.

The danger is that without careful and informed debate one of the best-loved and most
successful public institutions of the last 60 years will go down undefended.

Paul Hobday is a GP in Kent.

  • Ravinder

    There is much written about the dangers of GP commissioning- however look at the number of GPs who have already volunteered to take this forward.
    As with the last `new contract' we are given no real choice to vote against any of this.
    Honestly the day job is taking more of my time than ever -I really do not have the time to read the reams being written to `help'me take on commissioning.
    Should we support Stephen Dorrell who is speaking against this reorganisation?

  • Narny

    I work in the NHS as a senior manager whose role is to strive to collect good clinical information to support payment by results (PbR). I totally agree with Dr Hobday and do think this should be a public debate. GPCC reminds me of the GP fundholding days that “crashed and burned” as they did not work. What does worry me is that the hospitals are the end provider and if the money runs out and GPCC cannot afford to pay how will the hospitals be able to manage their bills? Who will step in to help? Why does the gevernment think that privatising will help? There is a wealth of informed people who work tirelessly in the NHS who could be put into a “task force” to be used to guide policy and change and keep the NHS free at point of use. The NHS is unique and cannot be put into a business without consequence to certain groups of public – especially the diasabled, elderly and those on low income or benefits. My father and grandfather fought in the wars to keep us safe and have freedom of speech. Just after WWII the NHS was born. Will we be a nation that remembers the deceased war heroes at the cenotaph along with the deceased NHS? I cerainly hope not unless we fight for our NHS.

  • PublicHealthWoman

    How come more GPs don’t have the clear vision of Dr Hobday? Oh, sorry, I forgot, greed. Too few Dr Hobdays and too many who are sitting in their offices trying to figure out how to pay themselves twice for one procedure.

  • Clive Peedell

    I fully agree with Paul's analysis.
    These reforms are ideologically driven with the main aim of reducing the public sector workforce, reducing public sector pensions, removing national T+Cs, and transfering public money to the private corporate sector. This allows Government to keep taxation low and control inflation in order to suit the needs of the City of London, investors, and the International Bond markets. This is why all 3 political parties support the idea of marketisation and privatisation of our public servicies. This has happened all around the world because of the deregulation of the financial markets and the potentially grave consquences of “capital flight” i.e unless the domestic polices of Governments suit the needs of the financial sector, investors will flee to other countries. Nations have lost sovereignty to the demands of global financialisation. This is neoliberalism in action and this explains why Labour became “New Labour”. Blair famoulsy said in a speech in Chicago:
    “Every day about $1 trillion moves across the foreign exchanges, most of it in London. Any government that thinks it can go it alone is wrong. If the markets don’t like your polices, they will punish you.’
    Two Labour MPs, Jon Cruddas and Jon Tricket, summed up this up will in the 'New Statesman' in 2007: ‘After years in opposition and with the political and economic dominance of neoliberalism, New Labour essentially raised the white flag and inverted the principle of social democracy. Society was no longer to be master of the market, but its servant.’

    I would add that the “Big Society” is also a key part of the neoliberal agenda. The aim is to reduce public expenditure by replacing public sector jobs with the voluntary sector. This is known as “Social Capital”. When FTs become Social Enterprises, all employees will belong to the biggest “Social Enterprise” sector in the world. New employees will not be protected by TUPE legislation and will not be entitled to NHS pensions and national T+Cs. SEs will set their own local T+Cs.

    I congratulate Paul on his excellent piece. The sooner that the profession wakes up to this impending destruction of the NHS, the better

    Dr Clive Peedell,
    Consultant Clinical Oncologist
    Co-Chair NHSCA

  • Drrenjukc

    Evolution tells us that the best hunters in the wild are the ones that hunt in packs and that they can bring down prey bigger their size.
    It still applies today, to see the GP take down consultants,all because they hunt in packs.An advise to all hospital senior staff time to wake up and evolve.

  • 75 year old retired teacher

    Type your comment here.
    I read your article with interest and agree with all that was written, and that of Clive Peedell in later articles.
    A very frightening prospect for all people using the NHS and for the future health of all children and grandchildren. A letter sent to Andrew Lansley via my MP on the very frightening aspects of the changes proposed by this government has illicited a very negative response of no hope for my/our concerns. – Earl Howe Minister responsible for this policy area.'
    It was obviously a standard letter, and did not address any of my concerns.
    Where I expressed the concern over the pace of changes the reply was 'Bold proposals.' Where I expressed my view that GP's were not wanting or experienced in the type of work that was being forced onto them the reply was 'Commissioning by GP consortia will ensure that commissioning decisions are underpinned by clinical insight and knowledge of local healthcare neeeds. It will enable consortia to work closely with secondary care, other health and care professionals and with community partners to design joined up, high quality services that make sense to patients and the public. Effective healthcare is a partnership including not just doctors and patients but everyone involved in healthcare.'
    This kind of answer does not inspire confidence that they, the government do not understand what the public needs and capabilities are. .