The Clinical Commissioning Groups (CCGs) that will control the NHS budget under the Tories’ new system have to serve just 75% of the population in their given geographical area. CCGs will attempt to use this flexibility to dump the most expensive, high risk patients.
A recent investigation by a local Primary Care Trust found that a GP practice formerly run by Dr Charles Alessi, the new chair of the National Association of Primary Care (the pro-Health and Social Care Act lobby group), de-registered 48 elderly patients because “their demand for GP time and other resources was high”.
The investigation found that they were motivated purely by financial reasons. When the PCTs are disbanded next year, who will police the GPs who want to dump expensive patients?
The cuts and privatisation will take their toll on waiting times. To give a few examples:
* In November 2011, MP Margaret Hodge revealed that over 50% of stroke victims were denied scans within 24 hours of their stroke because of staff shortages and a lack of equipment.
* The Health Service Ombudsman recently accused the NHS of failing to meet “even the basic standards of care” for the over-65s.
* A King’s Fund report says elderly patients are more likely to wait longer in A&E and less likely to get access to intensive care wards or receive surgery after traumatic injuries.
Those who can afford to will increasingly choose to pay privately. Now NHS hospitals can treat up to 49% of patients as private. The specialist cancer hospital, the Royal Marsden, currently has around one third of its beds occupied by private patients. The private medical insurance market sector report shows that this sector is growing at 7.8% a year.
As private patients skip the queue for treatment, the waiting times will increase for the less well off.
Some treatments are being denied outright on the NHS. In April 2011 the Federation of Surgical Specialisms Association raised concerns that elective surgery was being routinely denied due to cutbacks.
Such surgery includes types of hip, spinal, ENT [ear, nose and throat], dental, bariatric [obesity] and even some cancer surgery.
The surgery being denied is largely for painful and debilitating but non-life-threatening conditions.
These cutbacks coincide with the “fat and fags” policies that are being adopted by NHS Trusts where patients are denied access to fertility procedures, knee and hip operations, fat-loss surgery and breast reductions if they are overweight or smoke. “Lifestyle rationing” is supported by 54% of GPs.
This logic may well extend into addictions. This reactionary approach stresses individual responsibility for what are in reality social problem
Our society is built upon sado-masochistic principles where the most ruthless psychopathic personalities are rewarded with great wealth and power. It is hardly a surprise if the rest of us engage in our own low level sado-masochism by eating, smoking or drinking ourselves into an early grave.
A socialist society may have fewer fat people, fewer smokers and fewer drug addicts, but it will not end our innate sado-masochistic tendencies to indulge in unhealthy pleasures. Health services should be the social safety net to provide help when things have got out of hand and people look for help.
“It appears, therefore, that there is a certain quantitatively defined social need on the demand side, which requires for its fulfilment a definite quantity of an article on the market. In fact, however, the quantitative determination of this need is completely elastic and fluctuating.” Karl Marx, Capital Vol.3
Marx’s stark warning describes the capitalist tendency, driven by the profit motive to commodify more and more areas of human life. Everything will be bought and sold at the market place. At the same time, as Marx explains, the market distorts real social need.
Every worker knows it — you spend what you earn. If workers win decent pay rises then they spend more on luxuries. When times are tight we shop more at the pound store and cut back. But our real needs are never known, we are buying and selling machines. If they opened the doors to the world’s department stores and allowed us to shop for free, then we would get a sense of our real social need.
For the last 63 years the NHS has been such a “free department store” for healthcare services. Although the NHS has often suffered from underfunding, the healthcare needs of the population have been served with world-beating efficiency.
The privatisation and commodification of healthcare under the Health and Social Care Act, driven on by cuts in the healthcare budget, will increase inefficiency as private individuals line their pockets with a diminishing supply of NHS money. It will also distort the real demand for healthcare.
Patients will be under-treated — and some over-treated — depending on the play of market forces.
Bizarrely the market also distorts demand so that some patients are over-treated. The technical term for this is “Health Related Group drift” (HRG-drift).
The HRGs are complexes of conditions (e.g. 80 year-old woman with schizophrenia and diabetes who needs treatment for a broken leg) which are given a price tag (tariff) paid under the “payment by results” system from the PCT/CCG to the health provider. The problem is that the provider is responsible for carrying out the assessment and selecting the HRG for the particular case.
This introduces a conflict of interest. Clinicians with an eye on the budget tend to bump a patient up and try to get the higher tariff. Health economist Alyson Pollock claims that this is universal practice in the USA.
Anecdotal evidence from healthworkers who have written into AWL health bulletin Red Pill suggests HRG-drift is rife when dealing with overspill from acute mental health inpatient wards into private sector beds. Private sector providers often place a patient in a higher risk category in order to justify treatment in a high-cost secure ward.
As well as the additional cost of treatment, patients who enter the system via this route often need to step down to an open ward before they are discharged, thus extending their stay in hospital.
The problem is made more complicated by the huge conflict of interest that is now involved in the commissioning process. The TUC’s False Economy research group has discovered that in 22 CCGs over half of the GPs were shareholders or had other financial interests in private health firms and other non-NHS health providers. In 10 CCGs a majority of the doctors are directly profiting from services that they commissioned to an organisation that they themselves run in partnership with Virgin Care.
Increasingly it will be difficult to tell whether our doctors are giving us the care that we need or the care that will bring them most money.
Despite the supine attitude of the union leaders in failing to organise effective strikes over pensions, there are signs that workers’ organisation in the NHS is growing.
The doctors’ strike on 21 June may be the spark to get national action back on the agenda of the unions that organise in the NHS — Unison, GMB, RCN and Unite. If the government tries to do a deal with the doctors then union leaders will be put in a very difficult position — not least because the zero increase in contributions for low members is made up by increased contributions by doctors and management.
Workers in the health service must show their solidarity with the doctors and prevent the government from splitting the movement. But to make solidarity more of a reality our union leaders need to call more strikes.
Meanwhile a number of disputes are brewing, largely in outsourced companies.
* Cleaning and catering staff employed by Serco in the Derriford Hospital, Plymouth, are being asked to take a huge cut in hours, resulting in losses of up to £7000.
* Cleaning and catering staff at Great Western Hospital in Swindon have been on strike for weeks over bullying, victimisation and harassment of staff.
* Surgeons at the Robert Jones and Agnes Hunt Orthopeadic Hospital in Shropshire are working-to-rule and have imposed an overtime ban after arbitrary closure of a ward.
* Action at Addenbrookes Hospital in Cambridge continues. Compass cleaners and caterers have been served with a change in shift patterns and consequently an up-to-21% pay cut. These workers are calling for their union, Unison, to release an industrial ballot.
We can expect campaign groups to spring up to oppose ward and hospital closures. The Keep Our NHS Public conference on 23 June offers us an opportunity to discuss building a national campaign network that can link up the struggles of workers within the NHS with the community campaigns that exist to protect the NHS.
We need a united, open, democratic, dynamic campaign that can link up all these struggles if we are to reverse the Tories drive to a US-style health system and re-establish the principle of comprehensive, state-of-the-art healthcare free at the point of need.
The alternative is that the bodies of the sick and vulnerable will be plundered for private profit as the market runs amok through our health and wellbeing.