STPs: Secretly Transmitted Privatisation

While councils in Greater Manchester collaborate with the plans to privatise our NHS, two councils at the other end of the country are refusing to cooperate as John Furse explains ….
Hammersmith & Fulham Clinical Commissioning Group (CCG) called it a ‘public engagement’. But their October 3rd event at St Paul’s Church, Hammersmith proved to be more military than matrimonial in connotation. Angry Save Our NHS campaigners overrode the CCG’s agenda with repeated demands for information on NHS England’s Sustainability & Transformation Plans (STP). The STPs update NHS England’s 5-Year Forward View blueprint for restructuring the NHS and reducing its deficits. They involve major cuts, a drastic reconfiguration of health provision and making patients and their communities increasingly responsible for their own healthcare. The plans are seen by campaigners as the coup de grace in the dismantling of the NHS and handing over its profitable parts in marketable entities to the private sector.
In West London alone this would mean the axing of Charing Cross and Ealing Hospitals’ A & E departments, the loss of over 500 beds at Charing Cross, the sell-off of buildings and land for luxury flats development and its conversion to a modest clinic. A ‘gold rush’ for planned asset sell-offs at St Mary’s Paddington is anticipated. But much of NHS England’s plans remain shrouded in obfuscation and uncertainty.
Councils, along with CCGs and hospital trusts like North West London’s Imperial NHS Trust, have been made responsible for enacting the plans. But LBH&F and Ealing Councils are refusing to collaborate with the STP cuts. So far they’re the only two councils in England to do so. The councils’ refusal follows their commissioning of Michael Mansfield QC’s damning report on the 5-Year Plans for NW London. These demand the cut of a projected £1.3 billion deficit by 2020, the largest cut of any NHS ‘footprint’ in England, and the creation of a £55 million surplus, City-speak for making a business attractive to bidders. The STPs are being rushed through to complete this massive turnaround in only 4 years, without any clear assessment of the risks involved, who will be responsible for what, or plans for funding of services, critics say. That the NW London plans are costing the taxpayer £1.3 billion to implement, much of it for business consultants like US behemoth McKinsey, doesn’t enhance their standing. Meanwhile, by withholding adequate funding, the Government continues to fragment and weaken the NHS as a public service, with chronically overstretched A & E services, a beds crisis accentuated by the privatisation of hospital wards and care homes, and lengthy waiting lists.  
The STPs do contain some reasonable sounding proposals for modernising the NHS – the use of new technologies, service rationalisations and efficiency savings. But as a well-established local GP says; “All this could be done by the (non-privatised) NHS”. Like many GPs he sees privatisation, with all its financial incentivisation and division of doctors, staff, services and units into competitive entities, as detrimental to his patients’ interests. How can patients trust doctors who are being forced to work as business people driven by market imperatives? Human relationships and collaboration between medical practitioners, GPs and their patients have always been key to the NHS’ exceptional public esteem. “Competition has no place in public healthcare. And the idea of asking for a credit card is repugnant”, the local GP states.
Privately provided services, with shareholder dividends, costly bank loans, large add-on ‘management’ fees and high executives’ rewards, are also a lot more expensive than publicly funded ones, as the saddling of the NHS with over £80 billion in repayments on private sector hospital investments (PFIs) of £11.6 billion has proved. International studies show that the admin costs of private sector marketing – tendering, consultants, lawyers, billing, accountants, auditors – double, even triple, public sector admin costs. NHS admin has soared since privatisation. The £200 million costs of ‘health tourism’ pale in comparison to the estimated £5-10 billion or more that privatisation is costing taxpayers every year. That’s where waste really lies.
How our healthcare costs will be met, if not by inexpensive State investment and modest tax increases on the best off, is also obfuscated. At a Parliamentary Health Enquiry in May Health Secretary Jeremy Hunt invoked the USA’s private health insurance-based model. Apart from being the most expensive in the world this privatised system is notorious for putting corporate profits before patients’ needs. Those that are seen as risky – smokers, drinkers, the ageing, those with a medical or mental history – face hefty premiums or can be denied insurance cover. Claims by ‘customers’ who they do accept can be whittled down to leave patients footing outstanding bills. Unsurprisngly healthcare costs are the leading cause of personal bankruptcy in the US.
When confronted by local Save Our Hospitals campaigners at Imperial Trust’s AGM on September 14th Board Chairman Sir Richard Sykes, GlaxoSmithKline’s former chair, invoked European models of public healthcare. But none of these systems, with combinations of health insurance and patients’ payments, are as cost-effective as our old tax-funded and publicly provided NHS, as international studies have shown. Where once our nationalised NHS was a world leader a recent OECD report placed the now part-privatised NHS 28th out of 30 for healthcare resources, with fewer doctors, nurses, beds and medical scanners than most wealthy countries. We have only 2.7 beds per 1000 compared to 6.3 in France, 8.2 in Germany and 13.3 in Japan.
Hammersmith & Fulham CCG abandoned its event’s scheduled round-table confabs with local residents on executing the plans as campaigners tore into the lack of proper public consultation and the STP’s lack of a clear strategy or business plan. “You have a responsibility to defend the health of local residents!” said one local campaigner. “We have a responsibility to work within our budget” responded the CCG’s supremo Clare Parker. The budget has indeed been imposed on them by NHS England. Its CEO Simon Stevens, a former senior executive of US private healthcare and insurance giant United Health, is seen by campaigners as the Government’s hatchet man. He has the same Nuremberg defence as the CCGs – ultimate responsibility for public spending lies with the politicians. And the Government appears bent on privatising as much of the NHS as it can by 2020.
In 1977 Thatcher pin-up Nicholas Ridley declared to the Conservatives’ Economic Reconstruction Group “Denationalisation should not be attempted by frontal attack, but by a policy of preparation for return to the private sector by stealth. We should first pass fresh legislation to destroy the public sector monopolies. We might also need to take power to sell assets. Secondly, we should fragment the industries as far as possible; and set up the units as separate profit centres.” The STPs are bringing to a head over 30 years of this stealthy NHS privatisation under both Labour and Tory administrations. “Only the public can save the NHS” says East End GP and NHS campaigner Dr Youssef El-Gingihy. That’s you, dear reader.    

This article was kindly provided by John Furse