Friday, 13 January 2012

Voices from the Occupation - Britain's NHS: Sold to the Highest Bidder


Voices from the Occupation
Britain’s NHS: Sold to the Highest Bidder



British tax payers would be forgiven for thinking that they have a National Health Service.  However, this is a myth.  Recent years have seen the government and private interests bankrupt the NHS then start selling it off to the same people who bankrupted it in the first place.  Today’s article reveals the reality – that Britain’s public services are merely publicly funded private enterprises, and the devastating results on a sleeping population.

Life before the NHS



It is important to remember that Britain hasn’t always had a National Health Service.  In fact, the National Health Service was only successfully implemented on July 5th 1948, within living memory.  The only recognised health system in Britain prior to the NHS was the period from 1911, when the then Chancellor, Lloyd George, established a system of National Health Insurance.  This was paid by working men and their employers at a flat rate, not graduated to account for differing levels of wealth.  Therefore, the Lord and the Layman paid the same fee.  The insurance also failed to cover dependents, therefore wives and children were left unprotected.  There were a patchwork of Voluntary Hospitals where the Poor may receive treatment if they could gain sponsorship or philanthropy.  If all else failed, some Workhouses had their own infirmaries.  In fact, an uninsured person could only gain treatment at a public hospital if they had Tuberculosis.

This meant that access to healthcare was based on ability to pay for it.  Every year, thousands died from treatable diseases – pneumonia, diphtheria, polio, meningitis.  One in twenty children born in the UK died before their first birthday.  Those who could not afford to ‘call the doctor out’ instead endangered themselves with bogus home remedies ranging from the ineffective to the downright poisonous.

Throughout the first half of the century, the 19th century view that Philanthropy could solve the health issues of the British public came under sever challenge.  The 1920 Dawson Report put forward the case for a national service under a single authority.  In 1926, a Royal Commission on National Health Insurance pioneered the idea of a health service funded by the public.  During World War II, the UK government took ownership of the medical service for the first time with the Emergency Medical Service – this catalysed the momentum for a nationalised health service.  In 1941, a government commissioned Independent Inquiry established that there were vast inequalities in healthcare provision across the country and across class. 

The NHS is Born



Finally, the Beveridge Report into social care the following year put forward the National Health Service as one of the three pillars of a workable social security system.  Two White Papers and a substantial US loan later (paid off three years ago), and the NHS was born under a Labour government and Health Secretary Aneurin Bevan on July 5th 1948.  For the first time anywhere in the world, healthcare was based on citizenship, not ability to pay.  This meant any person born in the UK was eligible to entirely free healthcare including GP, hospital treatment, ambulance services, opticians, midwifery, prescribed medicines.  There were queues down whole streets outside GPs, Hospitals, Opticians and other service providers the day the NHS was born and for a while after, as people baffled that it was indeed true.  They could actually get treatment, for free.

Since this point, we have achieved vaccinations for diseases like Polio and Tuberculosis which has virtually eradicated these formerly common killers, life span has extended by over 10 years on average in the UK.  By just 1950-55 infant mortality in the UK had dropped from one in twenty, to three in every hundred…today it stands at 5 in every thousand.  DNA was discovered in the 1950’s.  There are a plethora of achievements in public health and scientific understanding as a result of the National Health Service.

NHS: Sitting on a Goldmine




Despite all this, there is a huge amount of wealth which could be getting made on the back of the sick.  To some, this is a missed opportunity.  In the sixty plus years since its inception, private enterprise has been seeking a way back in.  Private Health Insurance is still available in the UK and those who can afford to generally have it and are eligible to use private hospitals and avoid waiting lists.  However, this is the tip of the iceberg.

The NHS today employs 1.7m people - Only the Chinese People’s Liberation Army, the Wal-Mart supermarket chain and the Indian Railways directly employ more people.  It treats over 3 million people, in England alone, each week.  The NHS budget in its first year was £437m (£9bn in today’s money) for 2011/12 stands at roughly £106bn.

In short, the nation’s sick are a potential gold mine to the private medical industry.  For all our complaints of waiting lists, uncaring nurses, ambivalent doctors and horrible food – Britain loves it’s National Health Service.  It isn’t the best healthcare service in the world.  But it is ours.  If we get sick, we get treated. 

So, no government has ever been able to even moot the idea of privatising health care.  We sold the gas, the coal, the water, the phone service, the postal service, and the railways.  But there has never been anywhere near substantial support for selling the NHS, and moving to a system of privately run healthcare.

With a population stubbornly attached to their publicly funded institution, what were successive neo-liberal governments and private healthcare providers to do?  Privatise by stealth.

If you can’t buy Them, Bankrupt Them



In the name of modernisation and efficiency, large sections of the NHS have been passed into private hands over the last twenty years.  However, the pace accelerated considerably under the New Labour government, with its focus on harnessing the efficiencies of private enterprise to modernise the NHS.

Firstly, there are the much-lauded Private Finance Initiatives.  This is where a private company pays for a state capital project, and the state repays an annual fee over 30 years or so.  The first PFI project was implemented by the Major government in 1992, was highly controversial and attacked vigorously by the Labour opposition
However, by 1997, New Labour was in power and performed a dramatic volte-face on PFI.  Now it was indeed a means of bringing together public and private in a mutually beneficial deal. 

However, PFI spread like topsy before the reality of it had time to sink in.  In the early days, as new colourful modern hospitals replaced withered baby boomer ones, PFI was looked upon mostly favourably and trumpeted in the press and media.  However, for many years since, PFI has been going very wrong.

In reality, PFI is a way of masking debt.  In essence, if a government takes out a loan to raise capital to build a hospital, it goes on the books.  However, PFI debt is (thanks to Gordon Brown) invisible.  Therefore, the private company offers up the capital and a repayment rate to be paid back through the hospital budget, but this is not counted as government debt.

Today, 22 of the 103 NHS trusts to enter PFI are facing difficulty due to the exorbitant repayments required to pay back the so-called NHS Mortgage (paying back the company for building the hospital).  Some hospitals are having to handover a fifth of their annual budget on paying for the PFI deal.  In fact the Department of Health’s own figures reveal the real disaster of PFI.

In return for a capital investment of £11.4bn, once the last scheme set up by New Labour is paid off in 2049, we will have paid £70bn in repayments.  Annual bills are due to rise year on year for the next 18 years, due to the inflation and the structuring of the deals. 
So, in order to keep debt off the books, the government is borrowing at 8% from the PFI deals, when we could be borrowing at 4% on government gilts.  The mutually beneficial nature of these deals is between a government seeking to bribe its electorate by promising something for nothing, and a private sector keen to make a fast buck.  Nowhere in this, do the people funding the deals - you and I, win.  Taxes go up, services are reduced or downgraded to accommodate the financial burden of repayments, and unsurprisingly, some of these hospitals will close as they become ‘financially unviable’.

Speaking of this great NHS rip off before their election, the Conservative and LibDem parties were vocal in their dissent on Labour’s PFI scandal.  Headlines were ‘Tories to Scrap PFI’.  However, their words were far more nuanced than that, and in fact promised merely a new PFI where the private sector didn’t win at the loss of the public sector.  34 new PFI deals have been entered into by the coalition government since taking office in 2010, with £5bn more in the pipeline.  In reality, almost every new hospital built since 1992 has been a PFI deal.
 
This is one effective way of taking money from the public and handing it to the private sector. 

NHS For Rent



From the cleaners, to the maintenance, to the catering; elements of the NHS were contracted out to private companies who somehow, despite a profit motive, were going to give us more for less.  Of course, prices went up and service went down. 

There was a 700% increase in hospital infections between 1993 and 1997 as cleaning was contracted out of the NHS and this figure has doubled since.  Incompetence and understaffing have been identified as critical factors in the spread of infections in hospitals such as MRSA. 

And if we aren’t killing off patients with MRSA we are having a good stab at starving them with poor, un-nutritious food.  A recent survey of 60,000 NHS patients revealed that one in ten rated the food as poor.  The Hospital Caterers Association itself, stated that procurement rules were in part responsible for the lack of quality – managers were responsible for procuring the lowest bidder, regardless of quality.  However, how is the bid even on the tender if provision does not meet patient needs?  Furthermore, many hospitals built under PFI deals, rather conveniently, do not have kitchens which allow for cooking from scratch.  One might consider that rather convenient, considering the same companies that market the PFI deal often offer services such as catering.  It is the equivalent of the White Star Line providing too few lifeboats for the Titanic, only to arrive as it sank with a tanker and charging people for entry.  

In fact, one Nottingham Hospital proved this by using its 105 year old kitchen to make 8000 meals per week from scratch for its patients, seeing an increase in nutrition, contentment and a decrease in cost.  In fact it is estimated that working this way could save the NHS £200m per year.

Private Sector Saves the Day



As the impact of PFI and contracted services kicks in, the story has been spun that the disorganisation and bureaucracy of the NHS is responsible – as if, in and of itself, the NHS is a fiscal black hole impossible of delivering the services we require. As the hospitals, crippled with debt, start to show signs of the wear and tear – along comes a new phenomenon ‘the failing hospital’.  The failing hospital needed one thing to make it right – the innovation and efficiency of the private sector.

Not complete with mortgaging the buildings and contracting out the ‘non medical’ services to the private sector – the government is now moving towards outsourcing the NHS to private companies.  In recent years, this has been limited to polyclinics.

However, GPs are now almost exclusively private businesses contracted to the NHS for frankly, exorbitant fees.  Furthermore, private medical providers are now being put in charge of NHS hospitals.
Freedom of information requests revealed last year that German provider Helios, was in talks with the UK government to take over a string of NHS hospitals.
Then, at the end of last year, Hinchingbrooke Hospital in Cambridgeshire became the first UK hospital given over to be run by a private company.  Hinchingbrooke, a PFI victim, could not pay its £40m debt, so Circle, a private healthcare provider will be running the hospital from February this year for a decade.  Circle says that it can pay off the £40m debts, and make a profit, and raise quality and performance at the hospital.  When asked how, the only answer coming back from Circle chief Ali Parsa is greater involvement of doctors and nurses in problem solving.  Perhaps this refers to the possibility of a stripped back medical staff working out how on earth to keep patients alive while cooking their dinners, sweeping the floors and changing the light bulbs?

The Saga Continues…



The Circle takeover has been barely touched upon by the corporate media, and no one appears to have seized on the arguments put forward by the government in response to the decision that a further 20 NHS hospitals could go the same way.  This is the same number which have been bankrupted by PFI.  The hospitals aren’t failing in the sense that they have bad doctors, or evil nurses.  They are failing commercially.  They are failing to be able to balance their books, books buggered by PFI scandal.

So, having decimated the NHS with botched PFI schemes which saw tax payer money siphoned away from services and into repaying loans to private companies – the government then invited those same companies to save these failing hospitals.  Somehow, these companies will raise standards, pay off debts, and maintain current NHS costs for doing so, and all whilst making a decent profit for the shareholders.  It is simply cloud cuckoo land nonsense of the highest order.  No doubt, in a decade or less, the chickens will come home to roost and we the tax payers will be bailing out private health care providers as we bailed out banks – while in the intervening years executives at the companies make vast sums and fees on the takeovers.

The Sleeping Giant


The more people interrogate they see it is not just our NHS, but our Education system, our local services, our whole state structure has been re-engineered to serve interests that are not ours.  The media attempts to spin those interests until many people believe that economic interest and personal interest are the same thing – when they are patently not. 

The British public are the great sleeping giant in all of this.  The ideas of PFI, contactor services and takeovers is simply too involved for a lot of people to get into.  If an MP said ‘I want to privatise the NHS’, there would very well be outrage and marches and protest.  However, the death by a thousand cuts approach is working perfectly, with most people simply unaware or unable to connect the dots.  So, share this story.  It is important, and certainly part of why I occupy that before we change the world – we see it as it is.  None of these things; the sell offs, the rentals, any of it is inevitable or irreversible. 

But someone has to resist it; someone has to have the tide turn another way.  Someone has to throw themselves in front of the paradigmatic train.  This is what the Occupy Movement is doing.  This is what every single person all over the world, in a tent, at their place of work, on their blog, at local community meetings, on the streets, is doing when they say ‘We are the 99%’.

It is not some false dichotomy, them versus us stuff.  They are saying ‘Look, we exist, we are awake, the sleeping giant has arisen and we are not standing for this nonsense anymore’.

What you can do

You don’t have to just get angry when you read this article, you can get involved.  These are just a couple of ways that you can take action today, to stand for a public NHS safe from the hands of private interests:

Get down to your local Occupation, and see what you can do to support.

Sign the 38 Degrees Petition to Save the NHS – make your feelings known.

Support the Keep Our NHS Public and the Save our NHS campaigns.

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