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Friday 24 February 2012

NHS Reforms: Privatisation By Any Other Name

Quite why anyone should be surprised that the Tory’s and their Lib-Dem “lapdogs” are intent on privatising Britain’s last great industrial treasure, England’s National Health Service, is, quite frankly, beyond me. Having ravaged most of the nation’s industrial base, including mining, shipbuilding, utilities, transport and communications, the only great “cash cow” left for private commercial interests to pillage is Britain’s relatively cash rich health industry, which with the help of the Conservatives and their political allies, some of the bigger private health companies now believe is firmly within their grasp.

Rather than being at one with the British electorate over the NHS and the country’s future health needs, increasingly David Cameron, Nick Clegg and their Health Secretary, the chief architect of the planned reforms, Andrew Lansley, find themselves at odds with a majority of the general public, who along with the vast majority of health professionals, are all equally opposed to such sweeping changes in the way our health services are run. Even though the opposition Labour Party are making significant political capital out of the proposed reform, despite having allowed increased levels of commercial involvement in the NHS since 1997, their claim that anything up to 49% of NHS capacity and resources could be given over to the private sector, should be a wake-up call for anyone who believes that the NHS must remain free at the point of delivery for everyone, regardless of their means.

Even though most people recognise that the NHS could do better, the prospect of private healthcare companies being allowed to raid and plunder the vital resources of the English health service, for their shareholders benefit, fills most observers with dread; not least because of the real threat that such providers will not only seek to cherry pick the most profitable areas of the health services for their own corporate benefit, but will also use their newly acquired access to fatally undermine existing NHS institutions, thereby reducing choice to NHS patients. Of course supporters of the proposed health reforms defend the changes by claiming that a newly appointed regulator will be put in place to prevent any widespread “privatisation” or exploitation of health services, suggesting that it will operate in a similar fashion to the likes of OfGen, OfWat and OfCom. However, the only problem with such guarantees, is that although Britain’s electricity generators, water suppliers and telecommunication companies have undoubtedly improved the basic infrastructure of these industries since they were first privatised, all three have done so by imposing huge price increases on the British consumer. Sometimes bordering on being completely unaffordable for the poorest consumers, rampant price increases and excessive profit-taking have been allowed to thrive in these industries, simply because the various regulators don’t have the necessary powers to control these large private corporations, suggesting that any planned health regulator would fare little better, regardless of any government promises to the contrary.

Clearly with an annual budget in excess of £110 billion to spend on English health services, it is perhaps little wonder that numerous private healthcare companies are anxious to gain unlimited access to a market that is currently dominated by the publicly owned and fully accountable National Health Service. However, when one considers that the Cameron-Clegg coalition is currently looking to find savings of 20% from that headline figure then the real health budget figure is probably closer to £88 billion per year. An estimated 20% of that £88 billion is retained by the Department of Health for national services, meaning that the actual amount of money spent within the 150-odd Primary Care Trusts and Strategic Health Authorities is around £70 billion per year, of which an estimated 60% is reportedly spent on staff costs. A further 20% of the £70 billion is said to be spent on drugs and medical supplies, whilst the remaining 20% is thought to be used to cover the costs of buildings, equipment, training, catering, etc.

Interestingly, according to some commentators, the £20 billion worth of “savings” being demanded by the coalition is significant, in that there is a suggestion that this money is being deliberately withdrawn from the national health budget, in a cynical attempt to purposefully “under-resource” the NHS, thereby strengthening the coalition’s case for further private investment, much the same as the previous Tory government’s did in the case of Britain’s former heavy industries. By withholding this £20, 40 or 60 billion worth of “savings”, it has also been suggested that these monies will subsequently be returned to the NHS, but only after the private healthcare companies have begun to involve themselves in England’s seemingly impoverished health service. That way at least, the Conservative Party will be able to publicly repay their political paymasters by offering them access to a multi-billion health fund, which has in effect been stolen from the English taxpayer in the first place, through the much criticised budget cuts.

Remarkably, England’s National Health Service is reported to employ around 1.4 million people, making NHS (England) one of the world’s largest single employers; and similar in scale to the likes of the Walmart Supermarket Group in the United States, the Indian National Railways and the Chinese People’s Army in terms of manpower. In England alone, the health service is thought to employ some 410,000 qualified nurses, 150,000 scientific, therapeutic and technical staff, 52,000 doctors in training, 40,000 General Practitioners, 37,000 Hospital Consultants, 24,000 Midwives, and 375,000 other medical support staff, as well as a further 200,000 infrastructure staff, who include managers, administrators, secretaries, etc. A significant number of these health workers will be almost certainly be part-time employees, although taken all in all, it is reported that these 1.4 million personnel help to look after the health and welfare of England’s 52 million citizens, with one million patients being treated by the NHS every 36 hours..

One particularly interesting factor, when looking at the various figures relating to the running and associated costs of the English NHS, is to see exactly where the money for staff wages or salaries is being spent each year. Significantly, some of the most avid supporters of the coalition’s proposed health reforms are thought to be an assortment of GP “commissioning” groups from around the country, who are the very same people that under Andrew Lansley’s reforms would have direct control over their own share of the £80 billion health budget, which is currently allocated to the various PCT’s and SHA’s, that will all be abolished under the planned changes.

According to a number of sources, many of these same GP Partnerships (those running their own private practices within the NHS) currently earn an average of around £100,000 per year, for an average of a 44 hour week, only 60% of which is thought to involve direct patient contact. It has also been reported that many of these same doctors can and do undertake additional out-of-hours work (formerly part of their standard contractual obligations), sometimes at a rate of anything up to £200 per hour. Additionally, on BBC Panorama programme, screened on Monday 20th September 2010, it was widely reported that there were in excess of 6,500 GP’s, currently being paid more than, the £142,000 a year, David Cameron earns in his role as British Prime Minister. Panorama also discovered that at least one General Practitioner, reportedly employed by the Heart of Birmingham NHS Trust was said to be earning an annual income of £475,000, another one £375,000 per year, while two others General Practitioner’s were said to be earning around £325,000 per year from their NHS contracts. An OECD report also found that British GP’s are paid twice the salary of their French counterparts, even though both nations spend equivalent percentages of their GDP on health services, which perhaps in part explains the parlous state of the NHS finances in England. Surprisingly enough, this situation has little if anything to do with the present coalition government that we now find ourselves saddled with, but is entirely as a result of the previous Labour government’s renegotiation of GP’s contracts in 2004, which not only saw a 30% increase in most GP’s salaries, but also a significant reduction in their hours of work, notably the out-of-hours they had previously been obliged to undertake as part of their contracts.

Yet another piece of research undertaken by the BBC was said to have found that seven of NHS England’s highest paid employees, were in fact GP’s. Although many might argue that GP Partnerships are in a sense private businesses, in that they employ their own staff, manage their own costs, etc, when one considers that a salaried GP (a doctor not within one of these private commercial partnerships) works an average of 39.5 hours per week, but only receives a basic salary of £58,000 per year, it seems to put Partner GP’s seemingly outlandish remunerations into some sort of context. Also, the argument that GP Partnerships have the added expense of staff, buildings, etc. would undoubtedly be a major factor in the hugely different wage scales, were it not for the fact that in most cases such private partnerships often involve a number of GP’s sharing such overheads, so such expenses are often minimised for the individual doctor. The very fact that a small number of GP’s are managing to operate more than one practice at the same time, by using locums, agency staff and salaried GP’s to help maximise the particular “owner’s” income from the NHS might well give an indication of just what the coalition’s new reformed health service will begin to look like in the future. That said of course, the fact that GP’s are more likely to be the core voter for the Conservative or Lib-Dem parties might well suggest that as much as anything, Cameron, Clegg, Lansley, et al, are in fact playing to the gallery with regard to the proposed health changes, believing that personal avarice will allow them to gain support amongst the GP lobby, most of whom will undoubtedly benefit from the new so-called commissioning groups. On this point it is worth considering a recent report, which indicates that anything up to 2.5 million patients are registered as being on various GP’s panels, even though they don’t actually exist, despite the fact that each of these individual surgeries are thought to be receiving a fee of £65 for each of these non-existent patients, at a direct cost of millions of pounds to NHS England.

As an addendum to this, it is also worth considering that a hospital consultant can earn anything between £75,000 and £100,000 per year from the NHS, depending on their grade and specialisation, in addition to any fees that they can earn through their own private practices. These same Consultants are also reported to be able to earn awards or bonuses ranging from £3,000 to £30,000 per year, suggesting that top performing specialists might earn anything up to £130,000 per annum from the NHS, not including their private practice earnings.

Although you don’t need to be a genius, or indeed a Member of Parliament, to recognise that the modern day NHS is struggling to cope with an ageing population, instead of managing budgets, so that this vital resource can then be exploited by those commercial enterprises allied to the various political parties, perhaps governments, regardless of their ideology should be managing peoples and patients expectations. Bearing in mind that the average life expectancy in 1901, just over a century ago, was 45 years for men and 49 years for women, one begins to see the basis for our much reported ageing population, along with the financial difficulties that such changes inevitably create. The major factors in determining our modern day longevity are increased infant mortality, lifestyle, housing, elimination of disease and advances made in medicine generally. Unfortunately, along with living longer, society has begun to see the associated downsides of people living into their late 70’ and early 80’s, with dementia, cataracts, hip replacements, knee replacements being some of the most common health ailments suffered on an almost daily basis.

Our lifestyles too are putting an increasing amount of pressure on our country’s limited financial resources, with obesity, alcoholism and smoking all causing a multitude of associated diseases and symptoms, which at one time would simply have been regarded as a personal lifestyle choice that individuals chose to pursue; and die from, but which now the NHS increasingly finds itself burdened by. Even though it has been calculated that NHS England budgets around £1900 for each member of the population, in reality the vast majority of ordinary people cost our health services absolutely nothing, as they never visit their GP or indeed a hospital, from one year to the next. Instead, an increasing proportion of the country’s escalating health budget is now being spent on maintaining patients that 50 or 60 years ago would almost certainly have died from their conditions, be that a heart attack, obesity, smoking, drinking, etc, but whose lives society now seems duty bound to prolong, at a substantial cost to the national exchequer and to the health service particularly.

Ever since the National Health Service was first conceived, governments of all persuasions have promised to make the service clinically driven, putting doctors and nurses at the heart of medical provision, something that all have parties have singularly failed to do. Instead of more doctors, nurses, carers and hospital beds, successive political administrations have simply tinkered with its management, adding layer upon layer of bureaucracy, which has done little to improve clinical performance, yet at the same time managing to fragment what after all is supposed to be a “national” health service. For all of the thousands of managers, administrators, executives, secretaries and bureaucrats who populate the 150 plus health bodies, even today millions, if not billions of pounds is wasted, simply because it seems beyond their wit to establish and run a centralised supply system, which perhaps explains why the NHS works so badly on a day-to-day basis. Maybe if central government and the Department of Health were to make a start in addressing their own organisational disasters and mistakes, there would be far less need to begin looking for substantial savings at the clinical end of the organisation.

Unfortunately, for a coalition government marked by its own political and economic ineptitude, most commentators believe that Cameron, Clegg and Lansley have invested too much of their own personal reputations to admit that their planned health reforms will be catastrophic, not only to the health service itself, but also to their own long-term political futures. However, given that they owe some of their limited electoral success to the funds provided by many of the private healthcare companies, which even now are lining up to raid a reformed NHS, it seems highly unlikely that Cameron, Clegg and Lansley will put basic morality and a duty of care for the English electorate, before the indebtedness they feel towards their political paymasters. Perhaps instead of trying to convince the general public that they are proposing these changes for the good of the people, Cameron, Clegg and Co should just be honest and call this new Health and Social Care Bill exactly what it is, the Privatisation of the English National Health Service.

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