Not safe in New Labour hands NHS NATIONAL HEALTH SERVICE Cause of der PRIVATISATION • ir Nigel Crisp's abrupt and result of his failure to deliver the complex and contradictory Blairite agenda of privatisation and marketising, to Britain's biggest and most popular public service. His failure to deliver financial balance across dozens of crisis-ridden NHS hospital Trusts and Primary Care Trusts (PCTs) is not simply the result of his shortcomings as an individual, but flows from a systems failure of New Labour policies - a failure that also threatens to drag down his immediate and medium term successors. 6 Trusts and PCTs in England are variously estimated to be anything upwards of £790 million in the red, and headed not towards financial balance but ever deeper into the red. Many have already cut jobs, hacked back on axed beds, mental health and elderly care services which do not feature in the government's published list of 'priorities', and begun to defer treatment and lengthen waiting lists as they attempt to wrestle their finances back into line. Stepping in to Crisp's still warm hush puppies will be Sir lan Carruthers, described by the media as a 'hugely experienced' NHS manager, who has held various posts since joining the NHS in 1969, but whose most recent appointments have been as Chief Executive of TWO adjacent Strategic Health Authorities, Dorset and Somerset and Hampshire and isle of Wight. The resignation in March of the National Health Service Chief Executive Sir Nigel Crisp, and his 'early retirement' - at age 54 - to a seat in the House of Lords, marks a crisis point and highlights New Labour's neo-liberal strategy for the NHS. Here.John Lister, Information Director, London Health Emergency, exposes Blair's attempts to privatise much of the NHS. THE NHS reputedly committed to Carruthers is forcing through the privatisation of all NHS suppliers - but first of all he will be the hit-man charged with balancing the books, and wiping out the existing level of overspending. These huge sums of money cannot be cut from NHS spending without absolutely massive cutbacks and closures, which in many cases will have to be imposed from above. Already there is talk of pressing through a 'failure regime' that will facilitate the fast-track closure of a growing number of NHS hospitals which are seen as 'surplus' to the plans for a 'modernised' NHS that will no longer provide care itself but effectively act as an insurance fund commissioning care from a range of providers. The Financial Times summing up the situation after Crisp's departure from the
helm of the NHS, described how his former £600m commissioning budget to a private with results to be announced in the Job is now likely to be divided along the lines of the 'purchaser provider split' of a new market in health care, 'Sir Nigel's job will be split. Hugh Taylor, 55, a career civil servant ... Will become acting permanent secretary, with Sir lan Carruthers ... becoming acting chief executive." The permanent secretary post is seen withering away, along with the direct services provided by the NHS as a public '... as head of provider organisations [the permanent secretary] is likely to be responsible for the dwindling number of NHS-run organisations. Other NHS bodies Will have become foundation trusts or independently contracted run by the staff, with remaining provision coming from the private and voluntary Commissioning or delivering? Crisp's main role over the last nine months has been to drive forward the separation of NHS services between 'commissioning' (purchasing) and the provision of services. His highly controversial circular to the NHS in England on July 28 last year, laughably entitled Commissioning a patient-led NHS called upon Primary Care Trusts to divest themselves of their role in directly providing a range of community health care, therapy and primary care services, and instead to merge to form fewer, bigger 'commissioning' bodies. But Crisp 250,000 PCT-employed staff, and many others who use or support the services they deliver, by failing to make clear who was supposed to take over the PCTs' role in delivering key services to The lack of any clear steer on who was expected to step into the breach, left staff wondering if they were about to be privatised, PCT managers eagerly seeking new jobs, and angry campaigners braced to fight the privatisation of the most lucrative of the PCT services. It also left the prospect that other less profitable services, which the private sector do not want would face cuts, closures, or amalgamation into existing NHS Trusts. Despite a storm of unexpectedly vociferous opposition, Crisp stuck to his guns and refused to clarify the end objective of his proposals: but ministers under pressure from angry MPs were forced to step in and insist that - despite the clear implication of the Crisp circular - there was no immediate requirement for PCTS to cease providing services by 2008. It was also left to ministers to squash another perceived threat, when it became clear that Thames Valley Strategic Health Authority was proposing to interpret the Crisp circular as a brief to merge the five PCTs in Oxfordshire into a single PCT - and hand the control of the combined company, United Health Europe (UHE). The role of United Health Europe United's chair is Simon Stevens, who as a former advisor to Tony Blair, was the architect behind the controversial "modernisation' of the NHS, and has a clear view of the most promising and profitable targets for UHE's activities. Not surprisingly, UHE has not even bothered trying to replicate its role in private health insurance, which is a mainstay of its highly profitable US parent company - whose annual turnover is almost £16 billion. The existence of the NHS with its universal health cover has left private medical insurance as a relatively marginal activity in Britain, covering just 12 percent of the population. Instead, like a shark scenting fresh blood, UHE has zeroed in on much bigger prey: the juicy prospect of controlling hundreds of millions of pounds in the 'commissioning budgets' of Primary Every patient transferred to the private sector will represent a cash cut for their local NHS Trust A storm of local opposition to this unparalleled privatisation of the function commissioning united all political parties at council and MP level in Oxfordshire, and forced ministers again to step in, and declare that the Health Authority had jumped the gun, and that the privatisation would not proceed... for the time being. However the companies may not have long to wait. On February 16 Tony Blair told a back-slapping gathering of eleven private sector companies coining in contracts with the NHS that they were now part of an NHS family, and that, 'by 2008 we could have as much as 40 percent of acute operations done in the private sector being done under the NHS banner'. Ministers had already announced plans to switch as much as 15 percent of the NHS elective caseload to the private sector - equivalent to 450,000 operations a year - by 2008. Many of these are to be carried out in new 'Independent Sector Treatment Centres' (ISTCs), a second wave of which, with a projected spend of over £3 billion over four years, is currently out to tender, summer. The reality is that many of these private, for-profit units are already destabilising local NHS hospitals, and that this problem will become even more serious after April, when NHS hospitals will only be paid on the basis of a fixed fee for each item of treatment they deliver. This means that every patient transferred to the private sector will represent a cash cut for their local NHS Trust. Untried and untested Under New Labour's plans, staff, too will follow the cash and the patients out of the NHS - leaving the mainstream, depleted NHS to cope with a costly mix of emergencies, complex term cases which the private sector does not want to bother with. Nobody knows how this will work: the model is untried and untested, with only negative experiences in evidence from market- style experimental policies in health care around the world. To make matters worse, a new White Paper published earlier this year outlines plans that would make it possible to force a PCT to put publicly- provided services out to tender - while offering no corresponding right for those unhappy with privatised services to force moves to bring them back in house. As the privatisation bandwagon gathers pace there is a growing sense of foreboding that it will be applied to a series of popular local hospitals which lose out to unfair competition from private providers in this new cut-throat health care market. But underneath it all a political fact remains, stubborn and ever-present: for ministers to create the economic space to enable their new era of 'contestability' (read competition) between the NHS and a 'sustainable' private sector - they will have to wield the axe and close down hospitals that enjoy widespread popular support. While unelected career bureaucrats like Sir lan may happily slash away, secure from the voters' wrath, it is not so clear that ministers and backbench Labour MPs feel so safe. A large part of the cash deficits that heralded Crisp's demise arose because local health chiefs had been given a nod and a wink not to cut services to balance the books in the run- up to the 2005 general election. We have yet to see whether ministers will have the political courage to ram through the biggest and most unpopular cuts since the NHS was founded in order to secure a new, marketised system that few, if any, among the electorate have said they really want. 1. Nick Timmins, Financial Times, 8 March 2006 7