The announcements of NHS devolution plans and pilots for Manchester (Devo including NHS), Cornwall, Gloucestershire, North East Combined Authority, Liverpool and London came as a surprise to local residents. The most shocking part is that the plans were all agreed by senior – mainly Labour – politicians negotiating with the most cold-blooded Chancellor of the most ruthless Tory government ever, behind closed doors and without any public consultation.
The models for NHS devolution set out in these proposals actually date back to the 2014 NHS’ Five Year Forward View (5YFV), published by Simon Stevens, Head of NHS England (NHSE). Stevens is no friend of a publicly funded, publicly provided health service. Before becoming Head of NHS England, he worked for over a decade in senior positions at UnitedHealth, the largest single health insurance provider in the US. He was previously an advisor to Tony Blair’s Labour Government where he was an outspoken supporter of NHS market reforms and PFI. With Alan Millburn he co-authored the ‘2000 NHS Plan’ which resulted in significant private sector involvement in the NHS
Local authority and CCG leaders may believe the spin about devolution being an opportunity to end privatisation and provide a route to saving the NHS as well as managing budget crises, but they are wrong on both counts.
Implementing budget cuts
The main reason behind Chancellor Osborne’s enthusiasm for devolved budgets is that local authorities must limit spending and balance their budgets, while the NHS, with its overwhelming national support, has been able to pressurise the government to cover budget overspends.
Britain already has far fewer hospital beds per person than any comparable economy – just 3 per 1,000 people compared, for instance, with 8.3 in Germany, 7.7 in Austria or 7.2 in Hungary. Despite this, Steven’s Five Year Forward View plan to modernize the NHS proposes many fewer beds still, declaring: ‘Out of hospital care needs to become a much larger part of what the NHS does’. Several of the devo schemes are designed to put this into practice.
Budgets for adult social care have been slashed. The Association of Directors of Adult Social Services (ADASS) reported a real-terms reduction of 31% in adult social care budgets between 2010 and 2014, with 400,000 fewer people receiving care services, and most of those still in receipt getting a reduced service. These are massive reductions in service for the most vulnerable of people. Pooled budgets will not increase the money available.
An authoritative commission of inquiry led by experts including Professor John Appleby of the Kings Fund found no evidence whatever that integrating health and care would lead of significant cashable savings either in acute hospitals or across health economies. They described plans to save the NHS by moving care out of hospital as ‘magical thinking’. But mere evidence doesn’t prevent the plans to reduce hospital care featuring in the devolution pilots.
Devolution and the road to privatisation
Far from being able to choose the health (or social care) providers local people want, in practice the NHS Regulator, Monitor, will ensure providers are selected through procurements. NHS procurements are tightly controlled and carefully worded to outlaw any requirements that could be regarded as anti-competitive (for instance limiting profit levels, demanding tax is paid in the UK, or specifying that a hospital must have links to a university).
Private sector involvement is growing strongly in the primary, community and elective care sectors. In the last 3 years, £7bn of new NHS contracts have been awarded to private sector providers.
However, devolution has much bigger prizes in store for multinational healthcare corporations. The size and emerging shape of devolved and integrated health and social care services will make them particularly attractive to giant US healthcare multinational corporations to bid for as an entire integrated health and care service. The prospect of whole areas’ NHS and social care turned over into the hands of these corporate giants is nothing short of terrifying. Yet this is where our NHS devo pilots are headed.
12 Feb 2016