Dr John Lister, London Health Emergency reports:
Apparently strangely immune from criticisms even from within his own party and the Cabinet, Andrew Lansley is set to press home his plans for the fragmentation and privatisation of the NHS in a new Bill published on 19th January.
His proposals have triggered a growing storm of protest from the medical profession, and even some otherwise conservative and pro-market academics and “think tanks” – but remain largely unknown to most of the public, including most of the one million health workers in England who face the prospect of being employed by a variety of non-NHS organisations by the end of this Government’s term of office.
This is partly down to the limited awareness, competence and energy of the local and national media in teasing out many of the details of Lansley’s July White Paper, leaving the false impression that it is simply about a transfer of decision making from unpopular Primary Care Trusts and arrogant Strategic Health Authorities to local consortia of GPs.
However, it is also very substantially down to the muted – in fact largely mute – response from Labour politicians (some of whom have recognised that Lansley’s reactionary plans are an extension of their own reactionary policies since 2000 to remodel the NHS as a National Health Market) and trade union leaders, few of whom have been brave enough to say as much as boo to a goose for the last ten years or more.
On paper and in various forums both have declared their opposition to Lansley’s “reforms”: the TUC voted unanimously to oppose it, and Shadow Health Secretary John Healey has even made some powerful criticisms (on a blog!). However, they have not, as a party or as unions, organised a campaign to resist the plans or to explain the significant issues to their members or to the wider public.
With no big campaign to report, no popular agitation against the White Paper and ministers happily perpetuating the view that there is really nothing more to the reforms than empowering patients and GPs, it’s hardly surprising that the story vanished swiftly from news headlines last summer, only to return when occasional high profile critics have broken cover.
The silence also meant that Lansley’s tokenistic “consultation” on his hugely controversial proposals attracted minimal responses, and within hours of the close of consultation he felt safe to insist that the basic plan would remain unchanged, regardless of what objections had been raised and by whom.
However, the surreptitious hijack of the NHS is now running into one of the key problems inherent in Lansley’s White Paper: he proposed not only to hand £80 billion of commissioning budgets over to groups of GPs, but to do so under conditions of a four year freeze on NHS spending, requiring £20 billion of “efficiency savings” simply to maintain levels of service in the face of rising cost pressures and demands from a growing elderly population.
As even Stephen Dorrell – the former Tory Health Secretary who now chairs the Commons Health Committee – has pointed out, this requires the NHS to make real-terms efficiency savings of 4% per year for four successive years – a feat never even nearly achieved here or anywhere in the world.
This will also mean that if Lansley’s Bill does pass through the Commons, local GP consortia will be reduced to little more than rationing committees, working out which groups of patients to exclude and which hospitals and departments should close down to balance the books.
Already this is the main preoccupation of the outgoing Primary Care Trusts, where managers who have not yet managed to find themselves jobs elsewhere before the PCTs are abolished, are hell-bent on a scorched-earth policy of cuts and rationing.
South West Essex leads the charge so far in the number of treatments and services excluded from the local NHS – with a list of 213, including some hip and knee replacements. Many PCTs are following along similar lines, branding various elective procedures as low priority or of limited effectiveness, and leaving local patients the “choice” of going without or going private.
SW Essex also leads the way in axing not only IVF treatment (for all but recovering cancer patients) but also spending on AIDS drugs which keep people alive, despite stark warnings of the consequences from a consultant. Also in the £52 million, two year package of cuts in SW Essex were a month-long pause in any elective operations or outpatient appointments – saving money for the PCT by postponing care to the next financial year, but dumping a new financial problem onto the local Basildon & Thurrock Hospitals Trust.
As the PCTs slash spending, most of their “savings” are at the expense of NHS and Foundation Trusts – and the last two months has begun to see a growing tide of jobs to be cut and services slashed back by Trusts with no other way to make any of the savings or avoid runaway deficits themselves.
Over 3,000 job losses were announced in the second week of January alone, with many more to come as gloomy Trust bosses do the sums. In North Staffordshire, the local Hospital Trust is sending patients back to their GPs for treatment and deferring treatment for months to help cut their deficit – having warned in November that cuts would cause “shock and distress”.
Now a chorus of analysts are warning of the scale of the financial crisis faced by the NHS in the new financial year, when Osborne’s cuts mean that it will see growth in funding cut from 6% a year to just 0.4% over four years.
The projected shortfall on the “efficiency savings” is at least £10 billion by 2014, and even achieving this level of savings will mean unprecedented cuts in our most popular public service.
Academics, columnists and think tanks from the King’s Fund to the Nuffield Institute, including the pro-market Civitas, have all warned that the finances look bleak – and that Lansley’s reforms will actually make things worse, squandering £3 billion or so on changes that nobody but him seems to support.
In the BMA, whose National Council unwisely opted last summer for a policy of “critical engagement” with the White Paper, those calling for outright rejection have gathered support at regional and local level and could yet secure a recall conference on the issue.
With the Government exposed, the servile Cleggies locked in to their deadly embrace with Cameron’s overtly Thatcherite and increasingly unpopular Government, and anyone who knows anything about the NHS warning what will happen next… why don’t Labour and the unions seize the moment and mount a campaign?
The answer seems to be the old one: they lack any real alternative approach, and they are more frightened of the prospect of a mass challenge to the Government succeeding than they are of the impact of Lansley’s policies. Labour is ahead in the opinion polls, and Miliband and the union leaders are convinced that if they carry on with the present tight-lipped approach they can gain support and can more easily win the next election. However, if they win, they will once again be back on the same old New Labour tack – because they have forgotten any other politics.
They prefer to sit tight and watch the NHS being systematically trashed than to lead a campaign to save it. They hate us more than they hate the Tories.
For those of us looking to defend the NHS, fight the cuts and resist its transformation into a competitive market, in which taxpayers’ money is funnelled out to a variety of private for-profit and non-profit providers, the challenge is to follow the lead of the students. If the cuts have not yet been unveiled near you, they will be soon. Link up, stand up – and fight back.