The white paper Equity and Excellence: Liberating the NHS proposes some of the most devastating changes to the NHS since its creation in 1948.
If the coalition manages to implement these proposals then we will lose the NHS as a publicly owned, universal and comprehensive health service.
Since the 1980s, both Tory and New Labour governments have sought to break up the NHS and sell it off to private business. The Tory-Lib Dem government are now poised to take a massive leap forward. What are their plans?
Every Trust will become a Foundation Trust. FTs are run like commercial businesses. Instead of planning services to meet the needs of the community, FTs compete with each other. Success is measured by financial calculation.
All evidence shows, competition between different FTs increases health inequalities and the postcode lottery. The Foundation Trusts are governed by an independent regulator, Monitor, which, unlike the Department of Health, is exempt from the legal duty to provide comprehensive and equal healthcare for all. In fact, the opposite is the case: Monitor now has a remit to increase competition by pushing privatisation. It is one quango that the Tories wanted to hold on to.
Restrictions are being lifted on how Foundation Trusts can raise funds. Over the last ten years, more and more patient charges have been introduced to the NHS.
Things that used to be free and abundant are now scarce and costly. Patient transport, car-parking, television and telephone all cost money. This is now going to be extended to the care itself.
FTs will be able to offer unlimited private beds for people who can afford to jump the waiting lists. We will see the introduction of various top-up payments where patients can pay extra to get better quality care. We could imagine many tiers of healthcare, where patients are divided by their ability to pay.
This is particularly worrying as the government is also removing the targets for waiting times. Once again our right to life and health will be dependent on our ability to pay.
Private firms will make large profits from auxiliary services in the NHS. The evidence about whether privatisation is cheaper is highly disputed, but if it is, then it is only because it has driven down standards and the pay, terms and conditions of staff. Poor quality food, hospital superbugs and demoralised staff are a result of private firms running these services for maximum profit.
Tory-Lib Dems are proposing “the biggest privatisation in the world” with private firms taking over core healthcare services. The private firms will take all the low risk, most profitable procedures, leaving all the high risk, high cost patients to the NHS.
Abolition of the PCTs and SHAs and replacement with “GP commissioning”. They say they want to cut down on “bureaucracy”. However, the “bureaucracy” is caused by internal markets and privatisation.
Up until 1980, the NHS had no internal market, no commissioning, no privatisation of services. It ran on a basis of block funding and planning to meet needs. It was the most efficient healthcare system in the Western world, with just 5% of the total NHS budget going on adminstration.
Since 1980, as privatisation has accelerated, admin costs have soared to 12% of NHS budget. GPs are not equipped to deal with these extra responsibilities and will need to hire some help. Far from abolishing the “bureaucracy”, GP commissioning will have the effect of privatising the bureaucracy. Multinational corporations like United Healthcare and Serco are expecting to reap enormous profits by providing administrative support to the GPs. We will find private firms both commissioning and providing services.
All of this is taking place with £20 billion of cuts over the next five years. The government want to run the NHS into the ground and then sell it off to private business. They hope to create conditions where better-off patients are looking to subsidise their care. So the most immediate effects are understaffing, pay freeze and attacks on our terms and conditions. We will also be faced with working in a system that cuts against our core principles where patients will be segregated and treated differently on the basis of class.
Fragmentation of our national bargaining power. Foundation Trusts will not have to comply with Agenda for Change and neither will private providers. We may find our ward being sold off to BUPA or Kaiser Permanente and ourselves working the same job but on less pay.
Instead of a united workforce of 500,000 healthworkers that can bring collective pressure on the employer to improve wages, terms and conditions, we will have hospitals where there are many different employers and a fragmented workforce.
What is UNISON doing?
As the biggest public sector union, Unison is the main fighting force that can defeat the White Paper. However, so far the response has been very tame.
Unison has submitted a legal challenge to the White Paper saying that it has not allowed enough time for consultation. At a recent meeting of the Unison executive, the leadership of the union claimed their challenge has sent “an almighty shudder through the Department of Health”. This may be true but a legal challenge alone will only help postpone the plans. Unison needs a bigger response.
The Unison leadership believes that the best way to beat the Tory cuts is to fight a political battle and get Labour elected next time round. Partly this is because the leadership have no connection to or faith in the rank and file to take industrial action.
Unison general secretary Dave Prentis says that “nurses and careworkers will not abandon their service users to go on strike” (Dispatches, Channel 4, 27 September).
But a recent survey in the Nursing Times, 25% of nurses said that they would take strike action if their job was at risk. This figure rose to 40% in intensive care nurses and 50% in mental health services.
It cannot be denied that years of service unionism and social partnership have resulted in a very poorly organised health branches. But we cannot let that cripple us in advance.
A serious leadership should be alerting the public to the dangers facing the health service and rallying support for healthworkers in struggle.
Healthworkers should be packing out union meetings and putting pressure on the leadership to take action.
