This is part three of Cold Comfort, a regular series covering the NHS winter crisis from within A&E.
Is the NHS for sale? Despite the false assurances of its chief executive and the health minister, the answer is a resounding yes. Tactical under-funding under the guise of austerity is leading to ill-conceived sell offs by NHS trusts and ministers trying to make quick savings – as if the lessons from private finance initiatives (PFIs) weren’t evident enough.
Working on the front line, I see the consequences of austerity daily. A growing number of people are ending up in hospital due to community service cuts; mental health patients deteriorate waiting for appointments, elderly patients unable to cope are admitted due to cuts in social support; patients with chronic lung conditions unable to afford heating come in with pneumonia. As NHS services feel the pressure, they turn to outsourcing in an attempt to cut bills by making so-called efficiency savings.
Since the Health and Social Care Act of 2012, which brought in legislation that if a contract could be run by a non-NHS organisation then it had to be put out to tender, there has been an increasing number of contracts going to non-NHS firms. The increase in private contracts has seen an increase in failures to go along with it.
The most recent of these was the collapse of Carillion – a crisis that showed how public and private interests cannot be reconciled, as Carillion continued to make a profit despite failures. Since the collapse, Serco have stepped in to take over many of the contracts. Serco is a company that cancelled its GP out-of-hours contract in 2013 after staff falsified performance data, and more recently caused cleaning staff at Barts Health Trust to strike. Its first move after securing the £600m deal at Barts was to take paid breaks away from cleaners. The contract was supposed to provide efficiency savings for the trust, which is struggling with PFI repayments of over £200m a week. Is this is kind of company you want running a health service?
As well as causing the NHS to lose out on all the potential profits they make, many of these companies, such as Virgin Health (who have won £1bn worth of NHS contracts) and Malling Health (who run GP practices in the West Midlands), hold off-shore accounts so they pay no tax on these profits. This means the taxpayer is losing out twice. This waste of money in an already struggling system boggles the mind.
The number of patients seen in A&E with psychiatric problems has been rising since the coalition government came to power. With GPs over-stretched, referrals for talking therapies in the community can include waits of over six months. I can only apologise to the parents I met whose daughter is on the brink of psychosis after suffering a slow deterioration from depression. They turned up in A&E as a last resort after her refusal to eat and delusions of celebrity took hold. As with the majority of cuts and changes, it is those most vulnerable and least able to take care of themselves that suffer first. 25% of mental health services contracts were awarded to non-NHS providers in 2015, including in York, where a panel member’s husband worked for the body that won the £190m contract.
Recent research by the Kings Fund has shown that the public is fully against NHS privatisation, with headlines such as ‘NHS privatisation would be political suicide’ frequently in the press. This is why politicians, most notably the health secretary Jeremy Hunt, and the chief executive of the NHS Simon Stevens, continue to deny it’s taking place. Privatisation is happening via the back door, and staff and patients are being blinded to it. Non-NHS companies are able to use the NHS logo, without their own, masking the extent of privatisation to the public. Just last week the prime minister refused to deny that the NHS would not be on the table for an post-Brexit trade agreement with the US.
One of the major concerns around the changes to junior doctors’ contracts in 2016 was that they were pursued partly with the intention of making doctors’ contracts more lucrative to private companies. By driving down staff costs, and disenfranchising the workforce, profit margins can be increased, easing the transition to private companies stepping in. As Noam Chomsky stated: “That’s the standard technique of privatization: defund, make sure things don’t work, people get angry, you hand it over to private capital”.
Sound familiar? Last year health trusts across England were accused of taking support staff off NHS contracts by creating non-NHS subsidiary bodies that don’t pay VAT – another short-term saving, without thinking about the long-term consequences. Future employees won’t have access to NHS pensions or to pay schemes, and the company can then be sold on with a more lucrative profit margin. Most recently the controversial sale of NHS professionals, a highly lucrative part of the NHS, was blocked; a small victory in a sea of losses. With a wealth of documented links between politicians and private health companies, no wonder ministers tried to push the sale through behind closed doors. It’s nothing short of corruption. For instance Andrew Lansley, the Conservative health secretary who brought in the 2012 changes, has links to Care UK, that in 2016/17 won £596m worth of NHS contracts. Care UK, who in Severn have been circulating lists of procedures for GPs to pedal to patients – procedures that should be available for free. This is just another example of how private health care in the UK continues to expand due to underfunding and lack of alternative choices for patients and staff.
The latest top-down restructuring of the NHS comes in the form of ‘accountable care organisations’ (ACOs), a term borrowed from the American health system (need I say more?). These changes, being brought in without appropriate consultation or legislation, could pave the way for private companies to become responsible for the health of an entire cohort of the population, from public health and GPs to social care. Concerns have been raised by leading health professionals around lack of accountability, increases in health inequalities and patients requiring proof of eligibility amongst others. The #Justice4NHS campaign, along with Professor Stephen Hawking, are taking NHS England and Jeremy Hunt to court over the changes, but despite both this and calls for a delay by the health select committee, ACOs are set to go live in April 2018.
Caught up with the day-to-day pressures of seeing patients, it’s hard to find time to keep track of the changes happening in the NHS. But I have no doubt that the ultimate objective of austerity is, as Hunt put it, to “break down the barriers between public and private provision”. With a budget of over £100bn, and so many interested parties, I wonder how long we’ll be able to hold out against market forces.
Dr J is a medical doctor working in A&E in one of London’s major trauma centres.