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Day of shame on NHS

We were told by an airbrushed David Cameron in a Tory election poster just 8 months ago: “I’ll cut the deficit, not the NHS”. We now know there will be £15-20bn cuts within 4 years. He also pledged repeatedly “to stop the top-down reorganisation of the NHS”. Just 2 months after the election we were presented with by far the biggest, most risky and destructinve reorganisation in the NHS’ history, with no consultation on the principles whatever, only on how they would be implemented. Following tuition fees, abolishing universal child benefit and hiking VAT, this is the worst example yet of this Government’s calculated dishonesty.

Today’s NHS and Social Care Bill has no electoral mandate, consultative justification or evidence base. Forcing through so much change in the very short time-frame proposed is bound to produce instability. Cuts of 45% in management costs mean fewer managers will be expected to deliver major structural change with far less money and a deeply unsettled workforce. As Sarah Wollaston, ex-GP and now a new Tory MP, so evocatively put it recently, it’s like throwing a ‘grenade’ into the system. And the re0rganisation itself will cost at least £2-3bn, at a time of unprecedented fiscal austerity.

The requirement on the new GPs’ consortia to commission services from “any willing provider”, as opposed to currently the NHS as “the preferred provider”, opens the way for the full-scale privatisation of the NHS. Because most GPs have neither the inclination nor the skills to undertake the highly complex and time-consuming commissioning role, many will transfer responsibility to the private sector – to the likes of Bupa, Capita or Virgin and US multi-national healthcare corporations like Humana, United Healthcare or McKinsey. That will create a conflict of interest as the same private companies become both purchaser and provider.

But the most pernicious aspect of today’s Bill is opening up the NHS to competition law. That means consortia, if they are to avoid legal action by private companies, cannot treat the NHS as ‘preferred provider’ and must put all contracts out to tender. And to whittle down the role of the public service further, the new NHS operating framework allows providers to offer services “at less than the published mandatory tariff price”. That gives the private sector the opening to offer temporary loss leaders, undercutting the NHS. The danger is, against the background of the enormous cuts demanded, that will force GPs to prioritise cost over quality.

There are other serious concerns too in this Bill about a declining quality of care for NHS patients. The Government’s lifting the cap on hospitals’ private earnings means NHS patients could well find themselves pushed to the back of the queue. The weight of evidence is that private markets in health bring ex0rbitant administrative costs – a tripling from 6% to probably 20% by 2014, lead to cherry-picking of more profitable patients, increase inequity and the postcode lottery gap, generate conflicts of interest, are unaccountable, and intensify pressure for top-up payments and ‘care package’ limits.

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