Deep cuts operation threatens NHS

The sneaking privatisation of the NHS will lead to the closure of hospitals and the loss of jobs, write Susanna Mitchell and Roy Trevelion

Friday, 1st March 2019

Theresa May and health secretary Matt Hancock far right with from left GP partner Dr Jonathan Levy and Simon Stevens

Prime minister Theresa May and health secretary Matt Hancock (far right) during a visit to Kentish Town Health Centre last year. Below: Susanna Mitchell and Roy Trevelion

THIS government’s soundbites about the NHS must be taken with a large pinch of salt. For example, the health secretary, Matt Hancock, could simply be speaking about the past. For he says: “The NHS and the principle of a healthcare system that is free at the point of delivery is one of our country’s greatest achievements.”

It is also unwise to ­listen to Simon Stevens, who is currently head of NHS England, for he is ex-CEO of a huge multinational US health insurance for-profit corporation. Surprisingly Stevens says: “At its best our National Health Service is the practical expression of a shared commitment by the British people – there when we need it, at the most profound moments in our lives.”
Instead let’s examine what is really happening under these “champions of healthcare”. What exactly will be left “free at the point of delivery” once NHS England follows policy right to the bitter end?

Under the Health and Social Care Act of 2012, public health services were transferred to social services and local author­ities (LAs). These included vital services for children, mental health, dental health, immunisa­tion, screening, sexual and reproductive health, and health protection programmes. All these services must now be paid for by our LAs.

Appallingly, and in what seems like an act of spite, the government is not providing funding for them. In fact, devastating – and ongoing – cuts are being made to public health budgets.
Between 2013/14 and 2017/18 the public health grant to local authorities decreased by 8 per cent in real terms from £2.7bn to £2.4bn. The government has now confirmed a 2.6 per cent cut for 2019/20.

The outcome is that social services simply cannot cope. For instance, funding for sexual/ reproductive health services has been slashed by 35 per cent. In November 2017 a snap-shot pilot survey in sexual health clinics in three inner SE London boroughs reported that over 1,000 people (that is almost 1 in 8 people) had been turned away. Shockingly 40 per cent were 24 or younger, and only 11 per cent were symptom free.

It is worrying that there have been such deep cuts in spending when gonorrhoea and syphilis are on the rise. Inevitably more sexually transmitted infections and unplanned pregnancies will follow.

Other services routinely managed by GPs are also being further restricted. In March 2018 NHS England announced that 17 clinical interventions would no longer be provided without a successful individual funding request. These interventions include operations for piles, tonsil removal, varicose veins, grommets for glue ear and the removal of skin blemishes. This is all part of the sneaking privatisation of the NHS.

Already, the shortage of beds and staff means that tens of thousands of routine operations are transferred to the private sector. By last year, for example, a third of knee replacements and 20 per cent of hip replacements were funded by the NHS. But these were carried out by private healthcare providers for profit, drawing resources and staff away from our public services.

In spite of Hancock’s and Stevens’ words, this privatisation is driven by NHS England’s own Sustainability Trans­forma­tion Plans and the establishment of Accountable Care Organisations, recently renamed Integrated Care Providers (ICPs). Their aim is to save £22billion by 2020, and it is estima­ted that the arrangements will lead to the closure of 19 hospitals, including 5 acute ones, and the loss of nearly 3,000 jobs due to plans for a more “agile” workforce. NHS spending on care provided by private companies had jumped from £700m to £3.1bn by the end of 2017, with non-NHS firms winning almost 70 per cent of tendered contracts in England that year.

The ACOs/ICPs are highly controversial, and their legality remains contested. The public supported and crowd-funded legal reviews of the ACOs/ICPs. Final judgments are still awaited. However, the new 10-year plan just released by NHS England proposes legislative changes that will completely legitimate these arrangements. Its contracts will be open to bids from giant US healthcare providers. Promises of increased funding alone are not enough in the face of these challenges.

If we wish to preserve a system that fully supports comprehensive healthcare “free at the point of delivery”, we need to fight the deliberate and systematic privatisation of our NHS, and promote action to nationalise our social services.

• Susanna Mitchell and Roy Trevelion are members of the Socialist Health Association.

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