Link to this page: https://www.socialistparty.org.uk/issue/705/13820
Private hands off our NHS!
On the 'Save the NHS' march, 3 November 2007 , photo Paul Mattsson
Case studies: risks of privatisation
East Midlands Ambulances
Non-emergency ambulance services - known as Patient Transport Services (PTS) - include transferring vulnerable patients to and from their hospital, day care and outpatient appointments, as well as ferrying vital equipment and patient records across different hospital sites.
In many areas of England, PTS services are being put out to tender. Where the contracts have been won by the private sector there have been problems. For example, some patients have been left waiting for up to nine hours. There are some reports of hospital staff having to report patients as being more ill than they are in order to secure transport.
The latest ambulance service to be affected is the East Midlands Ambulance Service (EMAS). Contracts for Derbyshire, Leicestershire, Rutland, Northamptonshire, Nottinghamshire and almost all of Lincolnshire have been awarded to NSL Ltd, who describe themselves as an "expert outsourced service provider", and the bus company, Arriva Passenger Services.
The contracts were worth £20 million a year to the ambulance service. The total value of the contracts over five years is estimated to be about £130 million.
Will these companies understand that these people are not passengers? They are patients with illnesses and disabilities and complex needs, they are not simply to be picked up and dropped off.
Over 600 staff currently employed by EMAS face an uncertain future following the decision to privatise their jobs. EMAS Unison condemned the decision as one that put financial savings ahead of the quality of service.
Alarmingly, the contracts were based on a 35% reduction in patient journeys that will be achieved through using new stringent eligibility criteria. Currently transport is booked by the hospital or GP surgery according to patient need, whereas the new contracts will be based on patients making their own booking direct with the private company who will apply the criteria.
This means 35% of patients currently receiving specialist care transport will no longer be eligible. This has particularly worrying consequences, not only for these patients but also for what remains of the EMAS - the Accident and Emergency (A&E) fleet. What is almost certainly going to happen is private companies seeking to offload their difficult and costly patients onto the A&E fleet.
Denying, not providing, is the natural logic of the private sector; as it must manage the financial risk associated with providing health care. Furthermore, the PTS fleet provides a vital function in the event of a major incident or large scale emergency. For example when dealing with multi-casualty road traffic collisions the PTS are often called upon to transport patients who need to be taken to A&E but have non-serious injuries. The ambulance service will no longer have the same access to this vital back-up role.
The exclusion of the private sector from health and social care in 1948 was not a mistake; it was done by design. Bitter experiences meant that private enterprise needed limiting. Don't we learn anything from history?
We must act now to defend our NHS. The Socialist Party calls for a socialist NHS to meet everyone's health needs, free at the point of use and under democratic control. Kick out the private contractors!
Steve Wells, NHS worker
Whipps Cross hospital
Privatisation in the NHS is a policy aimed at the reversal of every gain secured by the strength and organisation of health workers and the wider working class over the last 30 years. The experience of workers at Whipps Cross hospital who provide vital support services such as cleaning and portering attest to this.
The profit motive and shareholder dividend payments conflict daily with the need to provide a service based on the real needs of human beings. Successive governments have used 'outsourcing' to further cut taxes for the rich while directly transferring public money and assets into the bank accounts of their rich backers.
'Domestics', cleaning workers, have described what privatisation has meant for their job. Previously 'deep-cleaning' had been done by a specialised team. Now general cleaning staff must incorporate this into their routine, including moving heavy furniture, turning beds and so on. This represents an enormous cut in the cleaning service. Workers have suffered back injuries as a result too. They are expected to do a specialised job without training or increased pay.
The workers also reported that they felt they were punished for going on holiday - no training was given to those who covered their areas while they were away meaning that on their return everything had to be cleaned more to make up for a bad job done. This, of course, has massive implications for the health service.
Privatisation is a big concern for workers at Whipps in a pending merger of the hospital with Bart's and the Royal London where there exists possibly the biggest Private Finance Initiative scheme in the country. PFI or Profit From Illness in reality is a huge money maker for capitalists with guaranteed profit year on year for up to 35 years and more and paid for often by workers through cutbacks, down bandings job and service cuts.
The Whipps Cross workers have fought to preserve union organisation as the only sure way of resisting low pay and worsening conditions of working. They have learned in struggle the value of this and have acted in unity, serving as an example to other workers, of the benefits of what being in a trade union can bring.
A Whipps Cross worker
A brief history of privatisation in the NHS
- 1948 - Creation of the NHS - but private practice and private hospitals remain
- 1952 - Charges introduced for prescriptions, glasses and dental treatment
- 1983 - Thatcher starts privatisation of ancillary services (such as cleaning and catering)
- 1990 - NHS and Community Care Act introduces an "internal market"
- 1992 - PFI introduced in the UK for the first time
- 1997 - Blair elected with the promise to remove the internal market. He quickly reverses this position and PFI in the NHS is expanded massively
- 2002 - Foundation hospitals launched
- 2011 - Con-Dems' Health and Social Care Bill proposes further moves towards privatisation
Scrap the health bill
"Patients could find themselves at the centre of an advertising war for hospital treatment. The private health care partnership, Circle, has launched an advertising campaign to woo Leicestershire patients over the border to the Nottingham NHS treatment centre." (Leicester Mercury 10.2.12)
The NHS never used to spend money on advertising except for health education. Now the 'efficiency' of competition and free markets is pouring in, millions are being wasted on marketing. The Con-Dems' health bill will make this 100 times worse, with more advertising, so less health care.
Allowing "any willing provider" to run different parts of the health service in England will destroy it, leaving a mess of competing businesses. Competition means losers as well as winners. Patients and health workers will be losers. Profit-making companies will win the public money spent on the NHS.
The NHS was set up to be nationally planned and provide equal access to all who needed it. No government ever invested enough to achieve this. But a huge advance was made compared to life before the NHS.
Until 1948, those with money (and some 'charity' patients) could get treated in the best hospitals, in large cities. Many could neither get to these hospitals nor afford them. General practice was very unevenly spread. Poor working class areas could not attract doctors, as they couldn't offer the income earned in more prosperous places.
Private practice and private hospitals remained after the NHS was formed. But it was Margaret Thatcher's 'internal market' (implemented by her successor John Major) that started to expose parts of the NHS to privatisation. She wanted full privatisation but had to hold back. Her cabinet feared the reaction to it would force the labour and trade union movement to resist.
However, the Labour Party leaders Tony Blair and Gordon Brown forced open the cracks in the NHS, allowing business with its need for profit to flood in. Now Tories Cameron and Lansley are following in their footsteps, detonating an explosion of profiteering that will destroy what remains of a national service. They know Labour's opposition is hot air.
The Con-Dems are determined to go ahead with the health and social care bill despite huge opposition from health workers' organisations and the public. This is because they believe it will allow their friends in big business even more opportunity to make profit from our health service. The bill will pave the way for a decimation of wages and conditions of health workers in the future. And it is part of the Tories' wider agenda of cutting the welfare state to the bone - making ordinary people pay for the economic crisis.
This is also because of the dilemma which confronts 'modern' capitalism, of restricted opportunities to invest profitably in Britain's depleted manufacturing sector.
They therefore look hungrily to invest in privatised industries - not just health, but other sections as well. Even if this means a more expensive, less efficient, worse service - which it will - nevertheless it could be a profitable outlet for the billions of pounds presently locked up in the vaults of big business.
Nobody believes government claims that GPs will be able to decide what local health services they commission for their patients. The bill gives Clinical Commissioning Groups (CCGs) control of 80% of the NHS budget. They are already being set up even though the bill has not yet become law. Huge corporations like KPMG and McKinsey are 'advising' many of them. It's clear these 'advisers' will direct CCGs to spend more money with private health companies.
Kill the bill
Patients will wonder if they have been referred to a particular clinic because it is best for them or because their GP stands to gain financially. GPs, their budgets set by government, will become messengers for the cuts, having to explain why they do not have money to provide particular treatments.
Seeing the overwhelming hostility to the bill among health professionals, including GPs, Labour leader Ed Miliband has finally become more vocal. But his plan is "for people of all parties and of none, the professions, the patients and now peers in the House of Lords to work together to try to stop this bill." This strategy is like treating pneumonia with a spoonful of cough linctus and a get-well-soon card.
Labour could kill the bill with one announcement - that a future Labour government would take back into public ownership all privatised health services without compensation, except where there is proven need. That would stop the profit-seeking sharks in their current plans. As there's no prospect that Labour will do this, the reliance of many trade union leaders on a future Labour government to stop the bill is dangerously misleading their members.
Lansley's Bill can be stopped by a mass movement uniting health workers, trade unions and community campaigns, with a national Saturday demonstration to fire the signal that the battle has started.
The splits emerging within the cabinet can be widened and the government itself could fall if strikes of health workers develop as well as plans for further action to defend public sector pensions and against the cuts. A strong and determined lead from the unions is needed. A political alternative must be built to the three parties representing the interests of private health care and big business.
The Socialist Party demands:
- No to cuts. For a publicly funded service, free at the point of use, to provide for everyone's health needs
- End big business profiteering from the NHS! Scrap the costly Private Finance Intitative (PFI) schemes. No to private polyclinics and GP consortiums. Scrap the bill
- End 'payment by results'. Take all health services and buildings back from big business and place them under public ownership. Publicly fund and integrate them with the rest of the NHS
- Nationalise the pharmaceutical and medical supply industries and private health providers, with compensation only on the basis of proven need. Bring them under working class control and management
- Abolish Foundation Trusts. For democratic control of local health services by elected health workers and community representatives as well as elected representatives from local and national government
- End NHS job losses and low pay
- For a massive trade union led struggle to defend the NHS
- For a new mass workers' party to fight for the NHS and against cuts and privatisation. For socialist policies and a planned economy to end poverty, bad housing, unemployment, pollution and inequality - the biggest killers and causes of ill-health.
In The Socialist 15 February 2012:
Fighting the cuts
International socialist news and analysis
Socialist Party review
Socialist Party news and analysis
Socialist Party workplace news
Socialist Party reports and campaigns