I am writing this to make people aware of what is happening to our NHS under this present Govt. The article is intended to be politically neutral, and is hopefully going to provoke a lot of thought.
At present a piece of legislation called S75 is going through Parliament. This set of NHS regulations forces the new GP commissioners to outsource everything. It stops GP's choosing what to use & where. There is provision for integration to be in there, being fair, but is this a good idea?
The theory is that competition improves things. So if you're unhappy about how the trains now cost a fortune for the same old service, or how your gas bill has sky-rocketed since Privatisation, or why these Care Homes we are reliant on only pay minimum wage whilst expecting to attract skilled dedicated staff, then this should ring alarm bells that will hopefully force you to stop & think. It is your NHS after all. And you only get one.
Now I am not going to deny that 'jobs for life' culture has damaged our Public Sector. 'Jobs for life' culture is the belief that you can be lazy and/ or incompetent and you'll just be let off. I trained a whole floor in the UKBA, and I saw staff trying to slope off. But, and this is really important to remember, they were a minority. Many many Public Sector staff are top quality and really do put the effort in. I flag up problem staff now in my current roles, and it is still only a minority that mess things up. But... It's obvious The Public Sector still needs some work.
So, should we outsource all of our NHS?
Our Croydon IAPT service was outsourced under New Labour. Think of it as an NHS Counselling Service in simple terms. This was one of New Labour's experiments to see if small amounts of Private Sector involvement could help improve The NHS. In Croydon the contract went to The Priory.
After 4-odd years of providing this service The Priory decided to pull out, and an interim NHS Service was set up to cover people until a new provider could be found. And that is when the stories I documented as the minute-taker in certain meetings came out. Waiting times so high people had given up ever getting help. They thought they'd been forgotten by The NHS. And there were LOADS of them. A massive backlog had developed. From a Service User perspective the service had collapsed.
The Priory told no-one of this huge problem before just walking away. It was a total surprise to the NHS Interim Service when they took over. In the end the backlog was seriously reduced by The NHS working with local Charities to get the job done. Those Charities & our NHS are currently 'not-for-profit', where-as The Priory is a 'for-profit' provider. This is important to remember.
In recent news it came out that Virgin Care ( a for-profit provider ) take about 5% of what they earn and set it aside for the Shareholders & profits. So if you give them £100 to run a service they'll only spend £95 on that service. Where as a 'not-for-profit' will spend all£100 on said service.
So, if all our Services are outsourced will The NHS 'not-for-profit' crowd win the bidding competition? Not according to what happened with NHS Surrey.
When NHS Surrey decided to outsource pretty-much everything out-patient the local old Public Sector NHS decided to bid. They did not want to lose their jobs, so they formed a Social Enterprise for the £500m contract being offered.
When bidding one of the things you are judged on is your ability to borrow cash should an emergency happen requiring investment. Under the old system an NHS provider simply used The Govt to borrow the cash, so could borrow huge amounts of money at very cheap prices should the need arise.
The Social Enterprise formed by ex-NHS Surrey staff lost to Virgin Care. Virgin Care who could borrow far more, as was later shown. The Social Enterprise, considered so good even David Cameron gave it a Big Society Award, could not cover the borrowing factor. And it is believed that is why they lost. The Charities face a similar problem you'll find.
And this is what happens when you sever the link between Govt & NHS. It all goes Private, and so far the old Public Sector has not been able to keep up.
Now add to this how Cherry-picking is now allowed ( even though it means that Private Providers can choose the easy jobs leaving the hard jobs for The NHS ) and, well, I would hope it obvious someone is stacking the deck so that the old Public Sector NHS providers cannot win. The old Public Sector NHS providers are being left with the hardest jobs and also can't borrow what they used to be able to. Under how the NHS pays a hard hip-replacement is paid at the same amount as an easy one. Even though the hard hip-replacement will cost more to actually do. This is called the Tariff. So this perceived competition is not fair. It's stacked against the old Public Providers ( even if they are REALLY good ). Some people are seeing it as sabotage.
So let's go back to this S75 regulation. Our new NHS set-up is that a bunch of GP's get to decide where the money is spent. That sounds ok until you realise they have to outsource everything under this new regulation. What if the current NHS set-up is actually really good? If the current NHS set-up becomes a Social Enterprise will it win the bidding war? Will you be able to keep the great team you once had? Old NHS Surrey didn't after all. It's all Virgin Care down that way now. And that means that, unless Virgin Care is a miracle worker ( being fair ), less money is getting to the actual Service. The Tax-payer is now subsidising Shareholders AS WELL AS paying for NHS Services. Can we honestly afford this?
Can we afford this? It's a VERY big question. Our Country is £1.4t in debt. There is no way on earth we can pay this off without increasing Taxes, making some cuts, and wasting NOTHING. Don't believe the anti-cuts crowd on this one. If the Deficit was £157b in 2010/11, and Tax Avoidance costs us a predicted £90b per year then where does the other £70b come from ( assuming you can stop ALL Tax Avoidance, which is a VERY big if )? And that's just to stop borrowing. We need to be able to repay as well, and that's another £30b per year at a guess. We're £100b per year short assuming we can stop ALL Tax Avoidance.
Only about 10% of The Rich can leave sure ( a Barclays analysis checked this ), but even so. Is it not obvious someone has to pay more Tax AND lazy types need to be got rid of? So you have to decide what goes where. So can we afford to start giving about 5% of the NHS budget to a bunch of Shareholders?
Shareholders are often called investors. What people often miss is that a Shareholder is not like a Bank Loan. With a Bank Loan you borrow a lump of cash, and then pay off over a fixed number of years. With a Shareholder they give you a lump of cash, and then you pay them off for the next, well, forever in theory. Shareholders are a loan that cannot be paid off.
This is why your Care Homes are now so skint, why your Gas& Electricity bills are now so high, why your trains are so expensive for the same old service, and why your phone line is so old it usually can't support modern Internet packages ( I can't even get ADSL2+ on mine. That won't help the TechCity initiative ) unless you live right next to the exchange. It's all where so much money goes to Shareholders, and then never comes back. It's like using a bucket with a hole in the bottom to get water for your family.
So can we afford this?
The Conservatives claimed it was all about 'more choice'. And this is true. Under 'Any Qualified Provider' you, the end user, will be able to choose where you go to get help & treatment. Under something called 'Choose & Book'. It sounds great until you realise that as people move away from the old Public NHS Providers they ( the old Public Providers ) will get more and more run down. And will eventually collapse. Yes, NHS Hospitals will go out of business. All you'll have left is Private Providers. It's a nightmare to find a Dentist that accepts NHS patients these days after all. They were broken up ages ago as well.
Which is why I mentioned what has happened to The Trains, your Gas bill, The Care Homes... They have not improved with time. They're actually REALLY expensive now.
The Trains are a really good example here. In the old British Rail system our trains ran at a loss. To keep fares cheap. And the Govt then topped them up to break even to keep them trading. A Taxpayer subsidy to keep your rail fares cheap. British Aerospace actually turned a profit for the Taxpayer, so helped pay for this ( & our NHS ). British Aerospace profits now go to Shareholders. But back to The Trains...
Under the new system they still run at a loss, but the Govt tops them up into profit. We should be paying about £3b per year to The Trains to make sure they break even. We actually pay nearly £4b. Why? Because these firms need to make a profit to keep their Shareholders happy. So we do pay more, both as Taxpayers & users, to get the same old train service we always had. A higher Taxpayer subsidy AND much higher fares. All due to Shareholders leaching money away.
Can we afford that when this country is £1.4t in debt and will be paying off for the next 40 years? Remember, those Shareholders won't invest any more now. They've bought their chunk. They just want to be given money to spend on holidays & fast cars.
We'll know by the end of this month whether Section 75 is to become law or not. And if it does become law we'll have 2 years of outsourcing, with this unfair bias against the old Public Sector 'not-for-profit' NHS crowd, before we can get to an election and get a party in that will repeal these changes. How much of our NHS will be left by then? And how much will be in the hands of the Shareholders?
Section 75 is currently being opposed by pretty much every major Doctors group, The Labour Party, & The Greens.
Section 75 is wanted by The Conservatives.
The Lib-Dems are expected to once again roll over and let The Conservatives privatise another system. Like how they have now Privatised the Universities by trebling Tuition Fees and removing a huge chunk of Taxpayer subsidy.
I hope you understand why you need to know this now.
Christian Wilcox is the Chair of the Croydon Mental Health Forum ( politically neutral ), an NHS Executive ( Advisory ) for the South London & Maudsley ( politically neutral ), and works for the Labour Party privately.