“That’s the standard technique of privatization: defund, make sure things don’t work, people get angry, you hand it over to private capital.” Noam Chomsky
This is taken from Your NHS needs you! https://www.yournhsneedsyou.com
Stopping the Health and Care Bill is an immediate goal of our campaign. But it won’t be enough to save the English NHS. That’s why we’re also calling for full renationalisation.
Since the 1980s, our world-class and value-for-money public NHS has been slowly fragmented at enormous cost into a jigsaw puzzle of businesses and quangos. We now have less than half the NHS beds we had when reforms started; many hospital, A&E and GP closures and mergers; a serious shortage of doctors and nurses due to cuts; and a much larger population.
The picture doesn’t make sense, until you realise that some of the pieces are missing — pieces that health policy experts have been trying to warn us about for years: hidden from view, private American insurers have been installed in NHS back rooms and offices ready to make the switch to a privately provided, American-style ‘managed care’ system.
While in government, the Conservatives, Liberal Democrats and New Labour have all diverted a large portion of the NHS budget (paid for with our hard-earned taxes) away from care and into the pockets of private corporations. Our at-a-glance guide tells the story of how this happened. It also explains why the only way to save our NHS is to renationalise it.
The Story of the NHS… made simple
Before the Second World War, doctors’ fees were out of most people’s reach. Few could afford treatment, so a serious diagnosis was often a death sentence. Grandparents who fell ill would sometimes take their own life so as not to become a financial burden on their loved ones. Parents would stand by helplessly as their children died from treatable illnesses.
The war made life even harder but there was a silver lining. It built a strong sense of community and service to others. In 1945, people voted overwhelmingly for Clement Attlee’s Labour government to set up a welfare state and a nation–wide healthcare system funded by the taxpayer, free at the point of delivery and provided as a public service. Everyone would receive the same high quality of care and the whole society would share the cost. In 1948 the NHS was born, and the profit-motive was banished from healthcare! Doctors could now make decisions based on a patient’s health needs alone. Families were finally free from crippling medical bills and heart-breaking, unnecessary loss.
Caring was the beating heart of the NHS, but it was also the most efficient system in the world. Senior doctors ran medical departments often with only a manager and secretary in support. Matrons ran the wards. In the 1980s, admin costs were just 4% of the total NHS budget. No wonder everyone fell in love with the NHS!
Well, everyone apart from the businessmen who had once made fortunes selling medicines and treatments to anyone who could scrape enough pennies together. And the banks who see healthcare as a goldmine. And the politicians who represent Big Business. This powerful clique was itching to get their hands on the NHS. In the early 1980s, the Conservative government under Margaret Thatcher began chipping away at the edges, privatising the bits they thought we wouldn’t notice, like NHS kitchens, porters and cleaners. With cleaning no longer under matron’s control, standards dropped, eventually leading to more hospital-caught infections. The Conservatives also cut back on free NHS optician and dental care, and brought in new charges.
In 1988, privatisation expert Oliver Letwin and Conservative MP John Redwood wrote a manual on how to turn the NHS into Britain’s Biggest Enterprise by gradually and stealthily turning it into a private health insurance system. Thatcher’s government began implementing the plan, setting up an artificial market in the NHS, in which GP surgeries became purchasers and hospitals became providers competing to sell their services. Under John Major, the Conservatives put the next steps in place. Letwin soon became a Conservative MP, advising on the privatisation behind the scenes for the next two decades.
Had doctors got wind of the plot, many would have opposed it. Taking the cash out of care had allowed them to practise truly ethical medicine based on patients’ needs, with no financial conflict of interest. Public health experts tell us that to weaken the influence of doctors, the Thatcher and Major governments hired an army of managers at huge expense to control how NHS care was delivered. From here on, it was drummed into doctors that running the NHS, which they had always done, was a job for non-medical experts. It was extremely difficult and doctors simply didn’t have the right skills — or so they were told!
Thatcher’s government began reducing access to medical care by merging or closing hospitals and A&Es, and massively cutting beds and medical staff. They came up with the idea of private loans at extortionate rates of interest (PFIs), instead of using the normal and much cheaper public option of government borrowing. Major continued the policy.
Despite promising to reverse NHS privatisation, Tony Blair’s government got into bed with Big Business. In the 2000s, New Labour used PFIs to borrow over £11 billion, saddling the public with debts of £88 billion during a decade of very low inflation. That’s right, PFIs meant that the NHS would have to pay back 8 times the amount it had borrowed, yet the public won’t even own the hospitals once the money is repaid! PFIs made bankers rich, while threatening to bankrupt the NHS.
Money was being wasted in other ways too. By the mid-2000s, estimates showed that the NHS market had pushed up admin costs from 4% to 14% of the NHS budget. Costs have continued to rise steeply. In the privatised US system that we’re heading towards, admin costs are 36% of the budget. This means that over £10 billion each year is being diverted away from care to move us over to the American system.
New Labour also hired US corporations like McKinsey and UnitedHealth to advise on how to run the NHS along profit-making American lines. Blair’s government paid private companies to carry out operations and procedures at a higher cost than the same care on the NHS. Managers imposed business-style ‘performance targets’, which put a big strain on staff. Doctors and nurses who didn’t meet the targets faced intimidation by bureaucrats. Some dedicated medical staff were forced out of the NHS.
Behind the scenes, McKinsey co-wrote the Conservative/Liberal Democrat coalition’s new 2012 health law, which abolished the government’s legal duty to provide healthcare. The coalition, and later May’s Conservative government, went on to sell off swathes of NHS land and buildings to the private sector. David Cameron & Nick Clegg’s coalition created a new quango: NHS England. In 2014, they put Simon Stevens in charge. The same Simon Stevens who had previously worked for ten years as CEO of the Global Health Division of UnitedHealth: the world’s largest private health insurance corporation.
With Stevens at the helm, privatisation has gone into overdrive. All over England, Stevens has overseen the introduction of software, staff and business practices from his old boss UnitedHealth. Its UK subsidiary Optum has been paid £millions to train NHS and local council leaders in US ‘managed care’, the system exposed by Michael Moore in his film Sicko. More GP surgeries and hospitals have been shut down, employing fewer and less qualified staff. Experts warn that this is designed to push down the wage bill to make the NHS more profitable for corporate take-over. Unfortunately, most health unions have done little to oppose the privatisation. Ongoing cuts are further reducing patient safety. And now, Big Data are poised to swoop in and buy our private medical records.
The English NHS is increasingly unable to give patients all the care they need, as so much of the budget is being wasted. In addition to the cost of the market bureaucracy, in 2020 the NHS paid almost £10 billion on outsourcing care to private companies, and £billions more on PFI debts. Yet we have fewer hospital beds and 25% fewer mental health beds than in 2010. It’s not only a lack of money, but how money is spent that is so damaging to the NHS. Several NHS staff have spoken out about threats to patient safety caused by cuts and re-structuring. They’ve been crushed in costly court cases and left bankrupt, losing their careers and sometimes their homes. The public have been left to foot the legal bill.
The American model of privately provided care is not just extremely expensive, it is also plagued by malpractice, fraud, and fines. It has far worse health outcomes, with medical error in the top three most common causes of death. It costs more than double the price of care per person than in the UK, yet patients have less access to highly qualified medical staff. It is rife with down-skilling and cost-cutting to boost profits; has eye-wateringly expensive drugs; routinely sells wealthy patients operations they don’t need; leaves millions of poorer patients with no access to treatment and is the Number One cause of personal bankruptcy. What’s not to like?
The former CEO of American health insurance corporation, Centene, is now ‘expert adviser for NHS transformation’ to Boris Johnson’s Conservative government. Their Health and Care Bill is one of the last pieces of the privatisation puzzle. It will break the English NHS into 42 easy–to–manage chunks. Initially called Accountable Care Organisations like their American counterparts, which was a bit of give-away, they were quickly renamed Integrated Care Systems or ICSs. Health policy experts warn that ICS boards will operate like commercial entities. Like all UK health law since 1990, the direction of travel of this new Bill is towards an American insurance industry take-over of the NHS. The Bill gives private corporations a bigger than ever stake in the NHS. And, as happens in the US Kaiser Permanente ‘managed care’ model on which NHS privatisation is based, the more they cut and deny care, the bigger the profits they’ll make.
If the two–tier American system is imposed on England, standards will take a nose–dive. People who can afford it will (understandably) get scared and take out costly private health insurance for privately provided care, not realising that three quarters of people bankrupted by healthcare in the USA had health insurance. Those who can’t afford health insurance will be left with a run-down, privately provided, skeleton NHS funded by our taxes—the same failing system operating in the USA. Of course, until the last piece is in place and the 40-year demolition of England’s NHS is done and dusted, smooth-talking politicians will keep repeating that worn-out old lie, “The NHS is safe in our hands!”
And this is how the story will end, unless you and I and all of us take a stand and write a different ending by calling for a complete renationalisation of the NHS to restore it to its former glory. This means bringing back a publicly funded, publicly run service, managed by medical staff who deliver high quality care to all. To do so, we need to reverse four decades of health and care law; kick out private providers; cancel PFI debt; bring back social, dental and optician care; and get rid of the hugely wasteful internal market and the highly paid bureaucrats who run it.
Put simply, renationalisation means handing the NHS back to the nation.
1948 Clement Attlee (Labour) sets up the National Health Service, a publicly financed, publicly provided healthcare system for all, including optician and dental care.
1983 Margaret Thatcher (Conservative) introduces competitive tendering to outsource ancillary services including cleaning, porters and kitchens to private companies. In the 1990s, levels of hospital-acquired infections increase. Access to NHS optician and dental care is reduced and charges are brought in.
1988 Oliver Letwin, a privatisation expert at NM Rothschild Bank, and Conservative MP John Redwood write Britain’s Biggest Enterprise, a manual on how to privatise the NHS through the gradual introduction of trusts, private companies, charges, profits, and health insurance. The Adam Smith Institute, a neoliberal think tank, flesh out this manual in The Health of Nations, Pirie & Butler.
1991 John Major (Conservative) brings in the NHS and Community Care Act introducing an Internal Market to the NHS with a ‘purchaser-provider’ split, de-centralising the service by forming NHS trusts, adding a corporate management structure and the principle of competition. Analyses of NHS marketisation show costs escalating. By 2005, the cost of NHS bureaucracy is estimated to have increased by 10% (Bloor Report).
1992 The Conservatives introduce Private Finance Initiatives (PFIs), an unnecessary and expensive method of borrowing money for new hospitals designed to deliver attractive, risk-free returns for private investors, drain money out of the NHS, lock the taxpayer into long-term debt and justify hospital closures.
1997 Tony Blair (New Labour) dump Labour’s tradition of support for public service and opt for privatisation and deregulation, funding 100 new NHS hospitals with PFIs. In total, approximately £11 billion is borrowed, with repayments reaching approximately £88 billion. Even when fully repaid, the public won’t own the hospitals. PFIs enable a covert bed closure program to shrink NHS capacity, and a future land grab. As the costs of paying off debts rise, NHS trusts will be forced to sell assets. Letwin becomes a Conservative MP.
2000 New Labour’s NHS Plan introduces private provision of medical services into the NHS for the first time to ‘modernise’ and ‘reform’ its practices. Routine planned surgery, diagnostic tests and procedures are contracted out to private sector treatment centres at greater cost than the same care on the NHS.
2003 New Labour allows NHS trusts to apply to become Foundation Trusts (FTs), arms-length business entities independent of government control. This further embeds commercial priorities and leadership into the system.
2004 New Labour brings in Payment by Results. Providers are paid a fixed price per unit of completed health care. This helps the private sector to cherry-pick the easiest, most profitable treatments.
2009 Gordon Brown (New Labour) brings in the Unsustainable Provider Regime, the framework for using the PFI hospital debt burden to close and sell off publicly-owned NHS land and property.
2012 David Cameron & Nick Clegg’s (Conservative / LibDem coalition) Health and Social Care Act (HSCA) abolishes the legal foundation of the NHS, removes the Secretary of State for Health’s legal duty to provide healthcare for all, hands responsibility to a series of quangos – most notably NHS England – and opens all major NHS contracts to the private sector. This accelerates private involvement in the NHS and increases administration costs substantially.
2013 The Conservative / LibDem coalition replaces Primary Care Trusts (PCTs) with new, GP-run Clinical Commissioning Groups (CCGs), transitional state-owned-and-run insurance pools based on American private Health Maintenance Organisations. 60% of NHS budgets flow through CCGs.
2014 The Conservative / LibDem coalition appoints Simon Stevens, former head of the global division of the American health insurance company UnitedHealth, as Chief Executive of NHS England to manage the final stage of privatisation; the coalition continue to support his efforts. Stevens spends £millions embedding UnitedHealth’s UK subsidiary Optum and US ‘managed care’ in England. He oversees the introduction of Optum software, algorithms, personnel, business practices, and the training of local council leaders to replicate American Medicare, which will reduce England’s NHS to a funding stream and a logo.
Stevens publishes his Five Year Forward View (FYFV) introducing Sustainability and Transformation Plans (STPs) and New Models of Care, creating the impression that these are NHS sanctioned policy. The narrative of ‘integration’ points to a move to Accountable Care Organisations (ACOs), based on the American private insurance industry-devised model. The plan is to:
- Reduce the number of full A&E hospitals from 140 (in 2013) to between 70 and 40
- Reduce the number of GP surgeries from 7500 to 1500 “superhubs”
- Close smaller hospitals to produce economies of scale and cut future private sector costs
- Shrink provision of expensive, high risk, unprofitable healthcare to the sickest patients
- Consolidate lower risk routine planned healthcare ahead of outsourcing
2015-17 Stevens rolls out STPs, dividing NHS England into 44 regions or Footprints to be run by ACOs (now re-named Integrated Care Systems – ICSs).
2016 Exercise Alice, a dry-run of how the NHS would respond to a coronavirus-like pandemic, identifies the need for more trained NHS personnel, beds and Personal Protective Equipment (PPE) as well as the need to maintain contact tracing and patient isolation capacity. Both Theresa May’s government (Conservative) and Simon Stevens fail to implement these recommendations.
2017 The Naylor Review report by global accounting consultant Deloitte & Sir Robert Naylor for the Conservative Secretary of State for Health, and Project Phoenix, create incentives for Trusts to sell land and assets as the only option to raise funds to buy, improve and maintain hospitals, equipment and NHS properties.
2018 The Commissioning Capabilities Programme run by UnitedHealth/Optum in partnership with global accounting consultant Price Waterhouse Cooper (PwC), is an exercise setting out the curriculum and all the design functions for both advanced and aspiring ICSs.
2019 A major new contract for GPs means they are grouped together to form Primary Care Networks (PCNs), which form the foundation of American-style Integrated Care. Managers and computer software (rather than doctors) determine ‘care pathways’ for patients and decide on treatments. The British Medical Association (BMA), the doctors’ union, wave through the contract binding GPs in to PCNs, with hardly any debate and no vote of GPs.
2020 Under Boris Johnson (Conservative), NHS privatisation, the decision by May’s government and Stevens not to prepare for pandemics, and Covid19 create a perfect storm. Hospitals become emergency Covid treatment centres. GPs are instructed by NHS England (NHSE) to replace face-to-face appointments with phone consultations, making it almost impossible to see your GP—a taste of what’s to come under American ‘managed care’. More than 1,500 health and care staff die from Covid due to the lack of PPE, the unofficial Tory ‘herd immunity’ policy, delayed lockdowns etc. The Tories pay two corporations without any expertise in public health—global accounting consultant Deloitte and outsourcing giant Serco—£37 billion to set up Test & Trace, which makes ‘no measurable difference’. Sir David King, former government Chief Scientific Officer, estimates that more than 100,000 UK Covid deaths could have been avoided.
2021 The Conservative’s Health and Care Bill revises the number of ICSs to 42 and puts them on a legal footing. Each ICS board will serve private corporate interests, control all spending and decide what treatments to allow patients in their region. As with US ‘managed care’, the more private corporations cut and deny care, the more profit they’ll make. The Bill removes Section 75 of HSCA, which will allow private companies to be awarded £multi-billion contracts behind closed doors without competition, normalising what went on during the pandemic with PPE and Test & Trace. The Bill will mark the end of the English NHS.