In 70 pages this slim volume sets out in 10 chapters the legislative changes and the 30-years history of creeping privatization which are crippling our NHS.
The main points are:
- In the 1980s the NHS internal market was introduced: Primary Care Trusts as "purchasers" and NHS hospitals trusts as "providers". The politicians wanted "competition" despite all medics saying that what you really need in healthcare is collaboration rather than competition.
- At about the same time John Major introduced PFI deals for new hospitals, there which makes the final bill for a new hospital at least 7 times the original cost (and sometimes up to 50 times!) And it comes with strings for expensive "facilities management" (maintenance).
- Corporate takeover:
Primary Care Trusts could commission care from Alternative Providers of Medical Services, shop i.e. companies employing salaried GPs (e.g . United Healthcare, malady Atos and Virgin). Out-of-Hours care contracts were won by Harmoni, Serco and Take Care Now.
- From 2003 hospital trusts could become "Foundation Trusts": this meant that they became financially free-standing, independent businesses. But with that came intense pressure to cut costs, leading to dangerously low staffing levels at Mid Staffs.
- A "Payments by results" - a national tariff of fixed prices - was introduced. Since 2010 the Gov has reduced (by 3% year on year), not increased, the prices paid for each completed treatment despite the increase in population and the average age of the population. Revenue to hospitals could only increase if hospital doctors completed more and more treatments. And of course admin costs soared. Hospitals and doctors were working harder and harder to push more patients through.
- The reduced tariffs and the freeze on all medical salaries for 5 years has produced "efficiency gains" - but at the cost of exhausted and frightened medical and management teams, and dangerously unstable finances (collapse of South London hospitals trust and the near-loss of Lewisham hospital).
- To plug the gaps in staffing hospitals trusts have paid through the nose to agencies for temporary staff.
- What incentive is there for even the most dedicated registrar to stay in a system which is demonstrably financially unstable?
- In an attempt to meet the targets and understand the new environment, hospitals trusts have employed expensive management consultants to guide them - draining even more money out of their budgets.
- In a move related to uncontrolled immigration not to NHS problems, the Home Office is refusing to renew visas of non-EU nurses if they are not earning at least £35K after 3 years. More fees to agencies.....
- It seems very likely that "personal health budgets" for social care will be extended into medical care, and then "co-funding", and then... private medical insurance will be essential to ensure adequate medical care. "Free NHS care at the point of delivery" will have finally gone!!!
- There is ample evidence that Jeremy Hunt, Virginia Bottomley, Stephen Dorrell, Patricia Hewett and many members of present and past Conservative and Labour governments have had or still have financial links to private providers to the NHS. The "revolving door" between a senior cabinet appointment and directorship in the private health sector is active. The present CEO of the NHS, Simon Stevens, is a life-long health manager, but he spent 10 years working in CEO roles for United Health Group companies in the US.
- It also seems very likely that the new and very complex contracts with private companies will provide plenty of opportunities for healthcare fraud at the expense of the patient. Fraud is difficult to detect and expensive to prosecute.