“Every penny spent on privatisation and outsourcing is a penny less spent on patient care. Labour will end and reverse privatisation in the next parliament” – It’s Time for Real Change, the 2019 Labour manifesto.
The 2019 Labour manifesto’s promise of a joined-up, publicly owned National Social Care Service – to work alongside a renationalised health service – would have saved the NHS. And it would have brought social care up to the same standard. Tragically, these policies, which are essential for our continued right to healthcare free at the point of need, are now further from becoming reality than they ever have been.
Integrated Care Systems
The Conservatives’ upcoming Health and Care Bill threatens to introduce Integrated Care Systems (ICS) to the NHS. Integrated Care Systems will ensure that NHS England will share the responsibility of health service provision with councils and, most worryingly, private companies. The legislation will also further dilute our legal right to healthcare. It will do this by removing the NHS’s “statutory duty” to arrange hospital medical services.
According to Dr Bob Gill, NHS general practitioner and producer of The Great NHS Heist:
The private insurance industry is taking of control of NHS budgets. American insurance giant UnitedHealth/Optum are in prime position to control the money, replicating their dominance of public funded Medicare/Medicaid in America. UnitedHealth have been embedded with NHS structure for over a decade already and leadership in the form of Simon Stevens since 2014 until this year when he was elevated to the House of Lords, no doubt to ensure smooth passage of his legislative goal.
ICSs are modelled on US Kaiser Permanente ‘managed care’. They have been maturing and operational in shadow form for some years previous called Accountable Care and Sustainable Transformation Plans. The name change does not signal a change of heart. Managed care business model is profit maximisation through the denial of care.
ICS boards [ICBs] will be dominated by corporate interests [through] proxy membership as NHS employees recruited from the private sector. Prime example of a corporate proxy is Simon Stevens himself.
ICBs will have fixed budgets and autonomy to create ‘value’ and ‘efficiency’, or in other words profit. The profit will be made through the denial of care either on ICS level (3million population) or individual level using insurance industry risk stratification tools and algorithms to replace medical assessment. Your GP or consultant effectively side lined from the decision on your care especially if it’s expensive.
The NHS has been gutted of its original ethos and purpose leave behind a logo and a budget for private corporations to control for their own ends. We are at a point of no return.
The disastrous social care model
As a result of these changes, the Health and Care Bill will level down our NHS so that it comes to resemble the disastrous social care model that’s presently failing our most vulnerable populations. Social care is a mess in the UK. Management of care budgets is farmed out to cash-strapped councils who contract private providers to do the work on their behalf.
Social care has essentially been turned into a funding stream used for funnelling public funds into the pockets of private companies. It’s resulted in a chaotic system and a postcode lottery – meaning the availability of care is dependent on where you live. And the Conservatives’ socially regressive national insurance hike will now see the least well off disproportionately affected, having to bear the brunt of propping up a broken system. A system that’s in dire need of wholesale reconstruction through nationalisation.
No real opposition
Nevertheless, the proposals are arguably less awful than Labour’s contribution under Keir Starmer. Labour has made only vague commitments to services provided in the community. And it no longer seems committed to providing joined up care through a National Social Care service. Even worse, shadow health and social care secretary Jonathan Ashworth has confirmed that Labour’s plans will be funded by “savings”: the David Cameron government’s favourite euphemism for cuts. It seems Labour has retreated into accepting the existing system, while tinkering with – and likely reducing – the availability of existing services.
Adding insult to injury, it appears that Labour is no longer even committed to the basic principle of public ownership of the NHS. In response to the Conservatives’ Health and Care Bill proposals, Ashworth has said “allowing further privatisation with no oversight will be resisted strongly by Labour”. Of course, this statement implies that existing privatisation is fine, as is future asset stripping, so long as there’s “oversight”.
Labour leadership abandoning the NHS
This was underscored by Starmer in his conference speech. He suggested that, if elected, Labour would countenance cuts to service provision. Regurgitating the false argument that it’s not possible to forever guarantee NHS funding increases in line with need, Starmer claimed:
There is no doubt that the NHS needs more money. And a Labour government will always fund the NHS properly. But the future of the NHS can’t just be about chasing extra demand with more money. And neither can it be about re-shuffling the furniture in yet another pointless re-organisation.
He added:
The number of people aged 65 and over in this country is growing three times faster than the number aged under 65. This is both a wonderful achievement and the biggest test in the history of the NHS.
He also said:
We would shift the priority in the NHS away from emergency care, towards prevention.
This is a significant moment for Labour. Opposing another “pointless re-organisation” signals the decision by the party’s leadership to drop the 2019 manifesto commitment to end and reverse NHS privatisation. To reverse privatisation would require primary legislation and a reorganisation to remove the structures of outsourcing and asset stripping already in place.
And while Starmer suggests that “a Labour Government will always fund the NHS properly,” this is premised on a policy of reducing costs through “prevention” and community care. If this sounds anodyne, it’s worth remembering that the Health & Care act is set to remove the duty on NHS organisations to provide hospital care. In other words, an NHS that’s no longer required by law to provide hospital care will not ‘need’ as much money. This is a situation that incentivises ever more “savings” through service reductions, which the law now allows. Starmer’s speech confirms that, under his leadership, Labour has broken with the NHS’s founding principle: comprehensive care, free at the point of need.
The ‘NHS Abolition Act’
The existing system for managing NHS privatisation, which Starmer’s Labour seems so keen to retain, has quickly become a disaster much like social care policy. Frighteningly, the fragmentation, outsourcing, privatisation, and reduction of essential healthcare services is already well under way. And the NHS is on course to becoming, like social care, a funding stream administered to the benefit of big business.
Nearly a decade ago, the Conservative and Lib Dem government’s 2012 Health and Social Care Act removed the secretary of state’s legal duty to provide comprehensive healthcare free at the point of need to all people in England. The “reform” was, in effect, the NHS Abolition Act.
It introduced privatisation via competitive tendering and the outsourcing of vital healthcare services to private corporations. It set up regional Clinical Commissioning Groups (CCGs) to manage the diversion of public money into the hands of private healthcare providers. Nationally, NHS England was established to oversee the asset-stripping process. It allowed the government to keep its hands out of the dirty work by outsourcing responsibility for the many failures to NHS England. Simon Stevens – former corporate executive VP and president of private health giant UnitedHealthcare – was appointed chief executive of NHS England.
At the same time, austerity meant that NHS budgets did not rise in line with need. And large amounts of money were wasted on implementing the overcomplicated reforms.
The NHS is disappearing
Now, the NHS is ‘self-privatising’. The NHS, as a bricks and mortar institution, is disappearing. The new Health and Care Bill will simply add to the existing feeding frenzy. The latest Conservative ‘reforms’ will phase out CCGs only to replace them with a more streamlined system for stripping NHS assets. They are therefore not the beginning of the process of NHS privatisation but its completion.
Saving the NHS by ending and reversing privatisation, and establishing a working social care system, cannot now be achieved simply through voting. We – ordinary people – are going to have to fight for it ourselves. But there’s hope, because socialist campaigning group COSMOS has a plan for doing this.
Under the new legislation, local authorities will share responsibility for the delivery of health services with NHS organisations. In some areas, they are already aiding the asset stripping process by buying up land sold by the NHS for use in housing development schemes. COSMOS has written a model motion that can be submitted to local councils across the country. It urges councils to commit to opposing any action that aids NHS privatisation. It also urges them to commit to ending the use of PFI deals in the construction of facilities serving patients who rely on publicly funded social care services.
You can find it by following this link to the COSMOS website.
Featured image via Flickr/Garry Knight
