NHS for Sale: Myths, Lies & Deception
By Jacky Davis, John Lister, David Wrigley
In 1926 when I was a small lad my sister Marion contracted TB and died in a workhouse infirmary because my dad, who had worked as a miner since the age of twelve, was too poor to provide medical care for his daughter on a working-class salary.
I can even remember as a boy hearing the piercing cries from open windows on our street of people dying from cancer who didn’t have the dosh to buy morphine to ease their passage from life.
The society of my youth believed that only the well-to-do or well-connected deserved medical care.
I am one of the last remaining people that can remember the cruelty of life before the NHS, and I can assure you that it is essential for Britain’s prosperity and social well-being that my past doesn’t become your future. (Harry Smith)
When the then Health and Social Care Bill was passing through parliament I used the pages of the British Medical Journal to ask whether anyone actually understood what the government was hoping to achieve.
It is very difficult to write legislation in clear English when you are trying to conceal what you are really seeking to achieve.
Consequently, despite a convincing argument that what was being proposed actually met all the accepted definitions of privatisation, somehow this word was redefined by ministers to ignore whether health services were delivered by a public or a private provider.
The Act emphatically did not promote privatisation, we were told.
It came as a surprise to many to learn that what they thought were core NHS services were instead being transferred to large international corporations, such as Serco and G4S.
In British politics it is very rare for politicians to be held accountable for their failures.
The combination of austerity, transitional costs, and organisational chaos mean that the NHS is suffering almost unprecedented pressures.
Morale among health workers is at rock bottom after four years of pay freezes and, in some areas, general practice is nearing collapse.
In this new book, Jacky Davis, joined by John Lister and David Wrigley, look at the continuing threats to the NHS and demolish the myths that have been widely promulgated by those who seek to undermine it.
It is not that we cannot afford the NHS. Rather, we cannot afford to do without it.
This book brings together the evidence of how recent policies have undermined the NHS. It concludes with a challenge to us all. (Martin McKee).
It’s hard to believe, but it was not so long ago that the Conservative Party was saying – ‘We’ll cut the deficit, not the NHS’. All of those promises were worthless.
To make matters worse Cameron’s government forced through the biggest top-down reorganisation in the history of the NHS.
Clause 1 of the Act was the key factor in giving away control, abolishing as it did the duty of the Secretary of State to provide universal and comprehensive services in England.
Vital cash from NHS budgets is flowing out of the NHS into private companies seeking profits from health care.
Emergency services and care of the most seriously ill suffer cuts, while managers have to focus their attention on tenders offering the easiest elective and community services to profit-hungry companies.
NHS management time and resources which should be concentrated on patient care are increasingly being squandered on complex contractual arrangements.
What has all this done to our NHS? One of the first casualties has been the accountability of the service.
Vast amounts of money are involved here, £95.6bn in the case of NHS England alone, and it is simply not acceptable that there is no clarity or clear accountability for that kind of public expenditure.
NHS England has also been found in the High Court to have repeatedly departed from the provisions of the HSC Act by imposing changes in primary care services without any mechanism to consult or engage with patients and public in the affected localities.
It’s all getting out of hand, but it’s important to remember that the new drive towards privatisation and fragmentation is not the only aspect of government policy that threatens the future of the NHS.
The fragmentation certainly began under Tony Blair’s Labour government, but it has been vastly accelerated and deepened by the impact of the Health and Social Care Act.
Despite the Tory rhetoric before and since, the election of 2010 brought not only a change of government, but the start of a new era of frozen real terms budgets, which will have risen by a total of just 0.1 per cent above general inflation in five years.
Estimates of the rising cost pressures vary – but it is commonly assumed that increases in spending above inflation of 3-4 per cent each year are needed to maintain and grow services and maintain performance.
The NHS budget had never before been frozen for any sustained length of time. We are in unexplored waters.
The Care Quality Commission is warning that more than three quarters of trusts are failing to deliver adequate safety for patients.
The NHS Confederation has pointed out that one consequence could be reopening the question of charging patients to see GPs or for stays in hospital.
The more right-wing ‘think tanks’ have of course wheeled back out their vintage plans to impose charges for treatment, for a £10 per head annual ‘membership fee’ for the NHS, or to drive those who can afford it towards private health insurance.
Health spending has to go up, or services have to be cut.
Of all the scams pulled by the Conservatives in 18 years of power – and there were plenty – the Private Finance Initiative was perhaps the most blatant…. If ever a piece of ideological baggage cried out to be dumped on day one of a Labour government it was PFI.
By the spring of 1998, PFI had become: ‘A key part of the (Labour) Government’s 10 year modernisation programme for the health service.’
The latest overall figures published on the Treasury website show £11.6bn worth of NHS schemes in England are set to cost almost £80bn over the lifetime of their contracts, averaging seven times the capital cost.
Amersham Hospital, a £45m development, is costing 11.6 times the capital cost: the Trust has already paid almost five times the cost, and still has 15 years left to pay.
From 2012 onwards it became clear that spending on mental health services was actually declining for the first time in over a decade.
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.
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.
We have an NHS to win back – or lose. Which will it be?
For two decades politicians have introduced policies for the NHS that ran against the wishes of the vast majority of voters.
The biggest myth has been that the NHS is expensive and inefficient leading to the useful and inevitable conclusion that ‘it can’t go on like this’.
This part of the book takes the myths one by one and exposes them for what they are – convenient lies to conceal the continued attempts by an alliance of politicians and commercial interests to dismantle the NHS as a publicly funded, publicly provided and publicly accountable service.
Successive governments have lied repeatedly about the NHS and their lies have taken many forms.
Increasingly they hide inconvenient facts behind ‘commercial confidentiality’ or they have just stopped gathering data all together so that they can claim with justification that they don’t have the facts.
When the Labour government left power in 2010 patient satisfaction levels were the highest since surveys began.
Along with the specific lies about outcomes, the coalition has waged a more general campaign against the NHS. They declared the service to be ‘unsustainable’.
But a major international survey showed them to be liars about this too.
Many in the media, led by the Daily Mail, were content to keep repeating government lies in their headlines.
It was notable that the government was quite prepared to see patients suffer while NHS money was returned to the treasury, and that while able to bail out bankers to the tune of billions the government chose not to do the same for the NHS for relatively trivial sums.
‘That’s the standard technique of privatisation: defund, make sure things don’t work, people get angry, you hand it over to private capital.’
Since Thatcher introduced an NHS market – the so-called purchaser/provider split – NHS administration costs have escalated.
The Commons’ Health Select Committee declared it to be a costly failure.
Tendering, billing, accounting, chasing fees, legal costs all use up the precious NHS budget and divert money away from frontline care, and these costs have only been exacerbated by the Health and Social Care Act.
The future of healthcare in England lies in the hands not of politicians and professionals but of competition lawyers.
There seems to be no political will to abandon the English NHS market and use the billions that would be freed up for patient care instead.
Having an NHS market in place is necessary to enable the privatisation of the English NHS.
PFI projects are crippling many hospitals and the debate is now raging about how to reclaim hospitals and the eye watering PFI repayments.
The NHS budget is going to shareholders and tax havens instead of frontline care.
Repeated assertions that it is unsustainable and unaffordable have no foundation.
If we can’t afford the most cost-effective health service in the world what can we afford?
Patient choice is integral to patient dignity and respect and lies at the heart of the doctor-patient relationship.
Politicians have exploited that fact to produce their own version of patient choice, which serves their ideological direction for the NHS rather than the patient.
The Health and Social Care Act has facilitated competition and marketisation of the NHS, always in the name of patient choice. But patients and their doctors have less choice now than they did when the NHS was first founded.
Patient choice is important but only when it is meaningful to patients, not when it is a means of facilitating a political agenda.
From 1948 until 1991 (which saw the creation of the NHS internal market) patient choice was a reality, it was not the sort of choice that served the purposes of right-wing politicians and the private sector.
It did not allow private companies to get a foot in the door of the NHS and their hands on its guaranteed budget. That required the creation of a market.
Thus began the process of marketising the NHS, for which political intervention was required.
Politicians were turning the NHS into a market, with health as its commodity, and open to the private sector who were after their holy grail, the guaranteed funds of the NHS budget.
‘Patient choice’ has been used by successive governments as the Trojan horse and ironically the more politicians have championed it the less of it there has been.
The covert conversion of the NHS into a business started with the Griffiths report in 1983. Then in January 1988 Thatcher used an interview on television to announce that she was going to conduct a ‘review’ of the NHS.
Just over 12 months later the review: a new NHS White Paper ‘Working for Patients’.
So began the 25-year non-evidence-based experiment to turn the NHS into a market-based system, and the emphasis on choice as a justification.
Thatcher’s reforms were pushed through Parliament in 1990 as the National Health Service and Community Care Act.
Choice was not an immediate priority for the new Labour Government when it came to power.
However in 2000 Alan Milburn, as Health Secretary, signed a ‘Concordat’ with private hospitals under which the NHS would pay for the treatment in private wards of waiting list patients.
Payment by Results introduced a fixed tariff payment per case treated and was a further mechanism for diverting NHS money to the private sector.
The Blair government, egged on by Milburn, Stevens and others, was artificially creating a new market in health care.
By the time the Labour Government lost power in 2010, the concept of patient choice in the NHS was firmly established.
In May 2010 the coalition government launched their white paper ‘Liberating the NHS’.
The Health and Social Care Bill (2012) introduced the concept of ‘Any Willing Provider’, which allows private companies and other non-NHS bodies to bid for lucrative NHS contracts.
The term ‘Any Willing Provider’ was quietly changed with no fanfare to ‘Any Qualified Provider’ (AQP) to try and make the process sound more professional.
The cost of imposing competition on the English NHS is high both in terms of the money wasted on running a market (upwards of £5bn a year), and in the deleterious affect it has on the service.
Competition, so destructive and expensive, was never necessary to provide choice, and indeed as the privatisation of the NHS proceeds choices available to patients will reduce.
Andrew Lansley presented the Health and Social Care Bill emphatic that the intention was to hand power and money to GPs.
The reality has proved to be quite different. Few GPs have the enthusiasm, time or expertise to take on the work involved.
Contrary to firm government promises CCGs now have to tender out almost all services, wasting money and clinical time and resulting in an increasing number of contracts going to the private sector.
The majority of GPs now believe that they have been set up to take the blame for rationing health care.
These promises have turned out to be worthless, a deliberate deception of GPs and the public.
Lansley’s promise that GPs would decide whether to tender services has proved to be yet another lie.
Most CCGs believe that almost all services now have to go through the lengthy, tedious, expensive and bureaucratic formal NHS tender process.
Hunt ‘presses ahead Thatcher-like, wilfully ignorant, skipping around every tiresome obstacle, using new tools like Clause 118 to take more power and control away from the people who have paid for the NHS and who need it the most’.
How did GPs in particular and medical professionals in general end up as the victims of legislation that promised so much and delivered so little?
The BMA leaders failed to recognise the dangers inherent in the Lansley Bill and wasted months when they should have been campaigning against it pursuing a policy of ‘critical engagement’.
The BMA’s failures – either to consult their members or to understand the Bill – allowed Lansley to get away with his legislation.
In one 2014 survey, a shocking six out of ten GPs were considering retiring early due to the pressures and to constant denigration of the profession.
One could be forgiven for thinking that the politicians are setting primary care up to fail.
Despite promises to the contrary the Treasury has clawed back about 拢5bn from the NHS budget at a time when care is being rationed and waiting lists are growing.
The Health and Social Care Act has increased bureaucracy and complicated lines of accountability.
In July 2014 the cost of redundancy payments for NHS managers had reached almost £1.6bn as a result of the new legislation.
It has been estimated that it costs an additional £5-10bn a year to run the English NHS as a competitive market.
The minimum estimate of £5bn currently wasted on pointless market activities would fund both the £4bn annual increase in NHS spending with some left over to contribute to free critical social care for everyone who needs it
The coalition government simply turned a blind eye to the additional costs of their expanding market or lied about them.
Regulations impose countless procurement competitions on the NHS, and cause vast resources to move from patient care into administration.
The concern that the HSC Act would lead to a ‘tsunami of bureaucracy’ proved well founded.
The average doctor and nurse spent ten hours a week on bureaucracy, more than a quarter of their working week.
A survey by the RCN found that nurses were ‘drowning in paperwork’ including filing, photocopying and ordering supplies.
Lansley’s promises about reduced bureaucracy and lower costs have proved as empty as the NHS coffers under the coalition government.
Real patient voice has become politically inconvenient as more NHS ‘reforms’ have been pushed through against the wishes of the public.
The more political rhetoric there has been about patient voice the less genuine engagement there has been with the public.
Many people feel that legitimate avenues of enquiry and complaint have been closed to them, leaving little option but to take to the streets in order to be heard.
Campaigners – lacking any regular democratic access to express their views – are obliged to resort to street protests and petitions,
For the past thirty years or more NHS ‘consultations’ have often been seen as little more than a pointless ritual.
The last fifteen years have seen the abolition of the statutory bodies which once gave local people much more influence.
The proliferation of private and confidential contracts and tendering processes has led to increased secrecy due to ‘commercial confidentiality’.
There has seldom been more official rhetoric about ‘engagement’ with patients and the local public and less actual engagement with anything other than supportive views.
The ‘hospital closure clause,’ section 119 of the HSC Act, gives carte blanche for a future TSA to ride roughshod over local communities where they find it politically expedient to do so.
Now various CCGs have been seeking costly legal advice on how NOT to consult local people on substantial changes knowing that there will be no popular support for their proposals.
So what of the bodies that we might expect to represent the views of local people? Healthwatch, which is organised at local and national level, was established under the HSC Act.
The new bodies were designed from the outset to be toothless, with a limited frame of reference, primarily offering advice, and with no independent role.
Healthwatch in its current form is unlikely to deliver an effective voice for local communities.
The invisibility and impotence of Healthwatch is rivalled by Health & Wellbeing Boards, which were also established under the HSC Act.
The whole sorry history of the erosion of the public voice since the late 1990s has been accelerated dramatically by the HSC Act and the cash pressures of the freeze on spending.
The proliferation of commercial secrecy, from the very top right down to local commissioners and competing NHS trusts, means local people are even less likely to be aware of issues on which they might expect a say.
This is incompatible with democratic accountability and a strong independent voice for the public in influencing decisions.
There was an early indication of Lansley’s real attitude to transparency when he refused to publish the risk register despite having been ordered to do so by the Information Commissioner.
A Secretary of State for health can criticise the NHS without offering solutions or acknowledging responsibility for problems arising from government policy.
New bodies created by the Act do not have to meet in public or publish their minutes. Information about their costs, profits and outcomes is unavailable.
The NHS is now considerably less transparent and accountable than it was before the HSC Act came into force.
The ‘voice of the public’ has never been more marginalised than it has been since the HSC Act took effect. The public would have no chance to hold commissioners or providers to account either.
Clause 1 of the HSC Act ended the duty of the Secretary of State to secure or provide a universal and comprehensive health service in England. This responsibility was transferred to the body now known as NHS England.
The HSC Act can be seen as a way of ‘liberating’ ministers – to attack it whenever they feel it politic to do so.
Tory bosses have forced through legislation that puts all of the financial control in the hands of commissioners.
However not one of these bodies, which are supposed to be the vehicle for accountability and transparency, is either accountable or transparent.
The HSC Act has put the entire NHS at arm’s length from any democratic accountability.
All this is set to get worse if more contracts are awarded to private providers under the HSC Act section 75.
There is no evidence that the private sector is cheaper or more cost effective when it delivers public health care.
A blind faith in the power of the market to work its wonders is no substitute for evidence of benefit and there is none. Indeed the reverse is the case.
Private companies take the profits while society underwrites the risks.
One of the great strengths of the NHS is that until relatively recently it has been largely publicly delivered. The importance of public delivery cannot be overstated.
This means that taxpayers’ money goes back into the public purse to be spent on the NHS rather than being diverted to shareholders’ profits and tax havens.
Evidence of the inherent superiority of the private sector in delivering public services is non-existent. Indeed the available evidence points to quite the reverse.
But such hard facts have never been allowed to dent ideological commitment to the private sector and to the market.
Commercial confidentiality continues to trump every other interest including that of the patients.
We are left guessing as to whether the horror stories that surface give us the whole picture or are just the tip of an iceberg that the government, despite their calls for openness and transparency, would rather keep submerged.
The potential for fraud and corruption in the NHS has traditionally been low. That is set to change after the HSC Act.
Adequate oversight of the increasingly fragmented system is nigh on impossible. For the first time a culture has been created in which fraud and corruption are possible.
Many of the companies moving in on the NHS have already been successfully indicted in the US.
Private companies have only one legal requirement and that is to make a profit for their shareholders.
The other unanswered question is whether the private sector can ever make a profit by taking over the running of a cost-effective health service without it resulting in deterioration in clinical services. The answer at the moment would appear to be not.
PFI has proved to be a costly disaster for the NHS with the financial problems of a number of trusts being traced to their crippling PFI debts.
‘as many as 270 PFI projects were based offshore avoiding millions in tax. These involve more than 70 NHS projects.’
It means that when taxpayers fund these NHS PFI projects the money is not recycled back into the UK economy but instead goes to tax havens abroad as well as into shareholders pockets.
Complaining that the private sector maximises profits at the expense of public services is tantamount to complaining that cats kill birds.
No one would leave their cat in charge of the canary. Equally private companies cannot be trusted to behave well when delivering public services.
Few people have any idea of the suffering that many endured from untreated illness before the advent of the NHS, nor is there a collective memory of the fear that people once had of the financial consequences of illness.
The first duty of the private sector is to its shareholders and it shows.
The malign effects of privatisation on those who provide health care are insidious as the corruption of the ‘industry’ in the USA demonstrates.
By 2013 outsourcing scandals were becoming commonplace.
It emerged that neither the Cabinet Office nor any other department knew how much public money was being spent on outsourcing
The record of the private sector delivering NHS care is not a happy one.
There is no doubt that the primary intention of the Health and Social Care Act was the accelerated privatisation of the NHS.
The HSC Act was passed in March 2012 but the final piece of the privatisation jigsaw was put in place in early 2013 with the passage of the infamous section 75.
This piece of secondary or ‘enabling’ legislation in effect requires all NHS contracts to be put out to tender.
For a long time traditional primary care presented a solid face against the private sector but a number of factors have combined to change that.
It will be impossible to avoid a situation where the private sector is buying care from itself. The privatisation of the NHS will have come full circle, and Dracula will be in charge of the blood bank.
Bed numbers have been cut, and in April 2014 an OECD study reported that only Sweden had fewer hospital beds per capita than the UK.
Once again the private sector was being proposed as the solution to NHS woes resulting from government mismanagement.
Those who can pay will either queue jump through buying access to the service or will get treatments that aren’t available to those who can’t pay, or both.
Patients who can’t afford to pay to bypass the system will find themselves in the queue behind those who can.
This shows there is no limit to the willingness of the government to replace NHS services with those from profit-driven companies.’
The process of privatisation has also been helped along by the outsourcing of NHS policy decisions to private companies.
One the most alarming and insidious encroachments of the private sector into the NHS has been via the ‘privatisation of policy making’
The public has never voted for privatisation of the NHS and certainly doesn’t want it.
According to a 2013 YouGov poll, 84 per cent of the public would prefer to see the NHS run as a not-for-profit public service, whilst just 7 per cent favour privatisation.
Hundreds of GP surgeries are now owned by private companies and billions of pounds worth of contracts have been awarded to the likes of Serco and Virgin.
Privatisation is proceeding apace and will do irreparable damage to the NHS and our patients.
No closure plans are ever honestly presented as cuts: they are painted up as ‘reconfigurations’ to centralise services in other hospitals, and treat patients ‘closer to home’.
The passing of their Health and Social Care Act and the imposition of massive financial cuts have had a very damaging effect on the NHS.
Legislation has also opened up opportunities for big profits to be made and political favours to be called in.
It really does not suit them for the voters to know the truth about what is being done to the NHS.
The Conservative manifesto made no mention of the assault on the NHS that had been planned for many years by Tory politicians.
The HSC Act was a stark betrayal of Cameron’s clear promise that he would not reorganise the NHS but, worse than that, it was a betrayal of the NHS itself. A reflection of the ‘tragic reality’ of current politics.
Some 225 parliamentarians had recent or current financial interests in private health care. 145 peers had recent or present financial connections to companies or individuals.
The conflicts of interest constitute a running sore in a country with pretensions to democracy.
Lord Popat donated over £320,000 to the Conservative party and was subsequently made a peer. Lord Popat’s wife now owns the company which has won contracts worth £4.43m since the HSC Act was passed.
Private companies with financial links to 24 Tory MPs and peers had won NHS contracts worth £1.5bn under the new legislation.
Type ‘politicians lies NHS’ into Google and pages of links come up. Successive governments have lied and lied again about the NHS and their intentions for it; they have had to.
The lies have been necessary to conceal the true privatising agenda from the voting public.
The biggest lie of all was Cameron’s pre-election promise that ‘the NHS will be safe in my hands’.
One of the most serious aspects of the lies and cover ups is that the voting public does not have anywhere near the full facts.
Successive governments have ignored evidence and manipulated statistics to suggest that the NHS market is beneficial. Based on the evidence, withheld from the public, it should have been abandoned years ago.
- The Secretary of State should take back responsibility for the NHS.
- There is no place for a competitive market in delivering health care.
- The NHS must be adequately funded.
- The bulk of the cost should flow from collecting the £120bn of unpaid tax each year.
There needs to be proper investment in NHS staff and their training.
- The main job of managers should be to facilitate clinical activity and not to chase political targets.
- The NHS was doing very well and its current problems can largely be traced to misjudged political interference and inadequate funding.
- Labour unfortunately built the bridge across which the Tories have stormed the NHS and there are still too many at the heart of the party who don’t think they did anything wrong.
- The billions wasted on marketising the NHS could and should have been spent on patient care.
- The result is money squandered, opportunities lost and harm to the system which we all rely on.
- It’s time to end the failed market experiment and return to an NHS which is publicly funded, publicly provided and publicly accountable.
- That’s the standard technique of privatisation: defund, make sure things don’t work, people get angry, you hand it over to private capital.
- It’s our job to make sure they don’t get away with it.