In Part 1, Dr Bob Gill (@DrBobGill) explained the unreported and sinister drive behind the push to change Junior Doctors’ contracts. Part 2 discusses what this means for the future of the NHS, as well as the importance of the current dispute. Reposted with the author’s permission from the Keep Our St Helier Hospital website.
What does the future hold for the NHS?
The blueprint for the final stage of the NHS privatisation and conversion to a private insurance system is to be found in Simon Stevens’ Five Year Forward View. Steven is currently the head of NHS England and was previously the President of private sector giant UnitedHealth.
Proposals that will profoundly alter the NHS in favour of his former employer have largely escaped public exposure and scrutiny.
Like many policy documents before it, the true intent is coded within harmless-sounding text. There is no mention of privatisation, competition, the market or the growing role of commercial insurance in the NHS. Instead, we see code words like ‘innovation’, ‘choice’, ‘modernisation’, ‘integration’, ‘partnership’ and ‘prime contracting’.
The introduction claims a strong commitment to the NHS and then goes on to promote its carve-up. The proposals will replace the last vestiges of the NHS with ‘New Models of Care’ (NMC), which reformat the internal structure of the NHS. The reforms will make it less flexible, with more costly arrangements which better suit the commercial insurers destined to take over the system.
A further £20 billion shortfall in funding is celebrated as ‘efficiency savings’. This masterpiece in spin and deception hides the reality of further hospital closures, GP surgery closures, staff reductions, pay cuts and reduction in qualified staff.
Patients’ medical needs will be met by non-existent community services.
The same con trick was pulled off with mental health services under the ‘care in the community’ narrative in the 1990s. Publicly owned psychiatric institutions were shut down and flogged off with insufficient replacement services to support patients. Access to non-profitable, competent life-saving emergency care will be drastically reduced.
Specialist hospital services will be cut and concentrated in fewer, larger centres. This, according to Stevens “could avoid the need for another 17,000 hospital beds – equivalent to opening 34 extra 500-bedded hospitals over the next five years.” (page 36)
Or put another way, NMC will enable the closure of another 34 district general hospitals:
“More generally….NHS employers and staff and their representatives will need to consider how working patterns and pay and terms and conditions can best evolve to fully reward high performance, support job and service redesign …” (page 31)
Some of the investment required for the NMC will come from the sale of NHS land and assets, and by 2020 the NMC could be put out to tender for international corporations to make ‘productive investment’ – i.e. extract profit.
Junior doctors’ loss of income and increased hours performing routine work in hours previously defined as unsocial will increase profitability for the new players, who will be providing healthcare by sweating the assets.
The ‘modern workforce’ created through the ‘Shape of Training Review‘ for medical students and ‘Shape of Caring review‘ for nurses, as well as the creation of ‘transitional roles’, is designed to produce a workforce that is less qualified and cheaper and quicker to train. We are told that they will be performing new roles ‘across organisational and sector boundaries’. This arguably means staff members doing things they aren’t qualified to do. This represents a wholescale de-skilling of the workforce with nurses and Physicians Assistants doing doctors’ work, health care assistants doing nurses’ work and volunteers doing Healthcare Assistants’ (HCA) work.
No qualifications whatsoever are needed to enter an NHS hospital as a paid HCA, to do work formerly reserved for qualified nurses.
We are starting to be softened up for the ‘HealthForce’ of volunteers. The unskilled workers in line to do nurses’ jobs will not even be paid. Of course, this will become extremely dangerous for patients – and all this is happening just as the monitoring of NHS performance is in the process of being privatised. This provides the essential cloak of commercial confidentiality and exemption from the Freedom of Information Act, as private companies are not subject to FOI requests. This is one of the biggest reasons to fear the march towards a fully privatised health service.
What now for Junior Doctors?
The prospect of a 30% reduction in pay through the restriction of payment for unsocial hours and increased working week has been the prompt for protest and a potential spark for a brain-drain, with thousands preparing documentation to emigrate.
Leaving the NHS for pastures new is an entirely justified response, but will do nothing to defend the NHS for the relatives and friends left behind, who may need to rely on it for care. Those that leave now in the hope of coming back later when the dust has settled may find that the NHS has dwindled to a threadbare remnant in their absence, and the country will be a worse place for it. The destruction of the best healthcare system in the industrialised world and its replacement with a model resembling the very worst is one of the greatest political betrayals of public interest, and we face it collectively.
Medics are highly trusted by the public and could prove a powerful voice against Stevens, Hunt and Letwin. NHS activists have been desperately hoping for more medical leaders to join their ranks and help break the silence and contribute to defending the NHS. No doubt the stakes are high, as serious consideration has to be given to personal and professional damage. Pressure may come from employers and unexpected quarters to stay in the shadows.
It is crucial to understand the scale of the privatisation industry and its broad influence over our politics and media, and the fact that it is now presiding over the discontinuation of the welfare state. Its representatives are well-funded and cunning, but they are lying.
We must educate ourselves and the wider public on the truth of the threat to the NHS to mount a defence. The documentary ‘Sell-Off’ gives a summary of what has happened in England. Michael Moore’s ‘Sicko’ similarly exposes how the American system fails private healthcare insurance policy holders.
The privatisation project is well-planned and effective.
In the UK, it was essential to have New Labour as a controlled opposition to then carry the privatisation baton between 1997 and 2010. Since returning to opposition, Labour has provided tokenistic resistance and diverted genuine grassroots activism, whilst simultaneously promoting the massive corporate power grab in the form of the Transatlantic Trade and Investment Partnership (TTIP).
What shall we do?
Junior doctors have overwhelming public support for industrial action, but they must be vigilant to avoid being impeded in their struggle by hidden traps.
With vast sums of money up for grabs, the privatisation lobby will stop at nothing to permanently and irreversibly break open the NHS for exploitation and profiteering at the expense of patients, staff and the taxpayer. It is essential that techniques successfully deployed by the health insurance industry in America for decades to neutralise attempts to improve healthcare for Americans, including the use of front groups, third party advocates, think tanks and other propaganda channels, are recognised and resisted loudly and publicly.
Join or support local NHS campaigns and network with health activists to learn about the local issues and share your experience. Cross fertilisation of knowledge is vital for maximising impact of future activity.
Clear and simple messaging is important to influence the widest audience.
The treatment of Junior Doctors is inextricably linked to the privatisation agenda. Attempts to separate these issues will squander opportunity to alert the public at large to the major heist that is under way. Advice to uncouple these issues should be rejected.
We must campaign for an end to privatisation and restoration of the NHS through renationalisation. We demand a publicly funded and universally provided health service and reinstatement of the Secretary of State for Health’s legal duty to provide a national health service – removed in the Health and Social Care Act 2012.
It will only be possible to protect patient care and improve terms and conditions for staff in a renationalised, publicly run, not-for-profit system. Anything less will not escape corporate capture through the EU-US so-called ‘trade deal’ – TTIP.
If you work for the NHS, speak out about what is going on in your workplace, taking care not to put your career on the line. That said, there will be fewer career opportunities for doctors in the Five-Year Forward View’s deskilled NHS, unless you are willing to work for a clerk’s wages using computer packages rather than clinical judgement, providing medico-legal cover for the down-skilled colleagues.
Exposing the damage inflicted by frontline services cuts is powerful evidence against privatisation. Spread the word to your friends, family and, if you work in the NHS, to your patients.
Tell trusted journalists in the local and national media. It has never been easier to call, email or tweet journalists with information about what is going on in the NHS.
Use every available platform, from talking to people on the street to broadcast and social media. The greater the public awareness and understanding about what is happening to their health service, the harder the privatisation becomes.
Pleading and petitioning of our politicians has failed to stop privatisation. There remain many already engaged in this approach. Both the Conservative Party and the Labour opposition support Stevens’ final solution for the NHS, the control of which currently remains in the firm grip of the corporate raiders. Doctors, nurses, patients, campaigners and everyone they can get to join in must help build a mass movement to expose what is going on and fight for our NHS.