NHS: "Transforming Community Services"

Another stepping stone towards health privatisation

UNITE UNION reps from across the north-west gathered in Wigan recently to consider how best to fight the latest government proposal to break up the NHS - "Transforming Community Services" (TCS).

Andy Ford, North and East Manchester NHS Unite branch member

Under TCS, NHS Primary Care Trusts (PCTs) have to split themselves into two halves - a commissioning arm, which buys health care and a provider arm which contains all the services and staff - health visitors, speech therapists, mental health teams, etc. Not only that, but they are then to be compelled to put most of their services up for a form of 'market testing'.

A quick scan through the back pages of Health Service Journal will find all sorts of services - from Diabetic Services and Chlamydia Screening to Cardiac Rehabilitation and Mental Health Services - all put up for tender, with "bids invited". It would appear that anyone can bid to run these services - charities, other NHS bodies, private companies, or the government's latest idea to break up the NHS by stealth - 'Social Enterprises'.

Social Enterprises will be a form of staff partnership - NHS staff will be encouraged to opt out of the 'shackles of the NHS' to offer services directly themselves. They will be guaranteed the contract for three years.

But at the end of the three years these mini-enterprises will be easy pickings for the giant health multinationals - Kaiser Permanente, United Healthcare, Netcare UK or even BUPA. They will be minnows in a pool of sharks.

Even in the first three years, staff who opt for a social enterprise will also find they have opted out of the NHS pension. But even worse, if they are 'sold off' or transferred to a private business or a charity they will soon find just how illusory the protection afforded by the TUPE legislation really is - the new employers can change or cut the pay or terms of employment provided they can show a 'technical reason' for doing so.

Disquiet is growing amongst NHS primary care staff as they see the nightmare the government has prepared for them. Morale is already low as it is only a few years since the government's previous reorganisation of PCTs.

The new regulations do give PCTs a choice. They can opt to commission services from their own staff, and they can merge with other NHS organisations to become stronger. So, campaigning work by the NHS trade unions can force PCTs away from the most damaging choices.

In the north-west we have made a start by lobbying the board of the Rochdale PCT, which seemed to be in the vanguard of outsourcing services. A lively lobby of a dozen trade unionists evoked universal support from PCT employees, passers-by and also a lot of Rochdale council staff.

All expressed contempt and opposition for privatisation, outsourcing and constant re-organisations. Many said they were "glad to see the unions doing something".

Without a fightback staff may very well find themselves waking up in a new organisation, out of the NHS pension and with threats of pay cuts, downgrading or outright privatisation hanging over their heads. One government paper boasts of possibly transferring 250,000 staff out of the NHS.

Unite has a good national campaign running - Health B4 Profit - and the other unions are beginning to act. And local campaigns can help tip the balance.