Cameron’s ‘public service reforms’ would mean a privatised but publicly subsidised NHS – without any electoral mandate

Prime Minister David Cameron’s ‘Big Society’ ‘public service reforms’ would be PFI on steroids – the end of free healthcare paid for by taxes and it’s replacement with private healthcare only for those who can afford it, but subsidised by all tax payers and effectively paid for twice by those who can get it – once in taxes and once in charges.

Cameron in his recent speech on ‘public service reform’ and ‘The Big Society’, claimed that ‘Sometimes, a charity or social enterprise trying to come into public services will find strong forces trying to keep them out…vested interests, people who want to stick to the status quo…We need a level playing field so that anyone with a good idea can get involved.’ (1)

Here Cameron pretends that the main bidders for health service contracts will be charities or not-for-profit groups. In fact most bidders will be private healthcare firms such as ‘Assura’ a firm he also referred to in his speech as one which could provide ‘NHS walk in clinic’ services, or privatised GP consortia profit sharing with these firms.’

The Bureau for Investigative Journalism found that ‘At least half the board members of some GP consortia, the new bodies that will take over commissioning, have links with… Assura Medical, majority controlled by Sir Richard Branson’s Virgin Group… Most were GP members of Assura, meaning their practice had formed a joint company with it…. with profits split 50:50 between Assura Medical and member practices.’ (2)

One of Cameron’s principal advisers on healthcare ‘reform’ is Mark Britnell, who is employed in the Healthcare division of accountancy firm KPMG. He has told private healthcare firms that “GPs will have to aggregate purchasing power and there will be a big opportunity for those companies that can facilitate this process” and that “The NHS will be shown no mercy”. (3) – (4)

Britnell also wrote in the Health Service Journal that the NHS’ ‘funding mechanism is no longer resilient’ and that in future patients will be charged for treatment. (5)

The GP who headed the government’s review of it’s ‘healthcare reform’ policy- Professor Steve Field – has said that introducing internal competition into the NHS would be ‘destroy key services’. He’s also said that allowing private sector patients to be treated in NHS hospitals would open up the NHS to EU competition law, potentially allowing private firms the legal right to be allowed to bid for contracts for all NHS activity. (6) – (7)

Cameron also claimed in the speech that “A study published by the London School of Economics found hospitals in areas with more choice had lower death rates.”

This is true – the study was made by Zack Cooper, an LSE researcher, but it is far from undisputed. Professor Allyson Pollock, an expert on NHS funding, found serious problems with the methodology and the data it used . Pollock concluded that based on Cooper’s study ‘the only safe conclusion is that if you live near an NHS hospital or have many NHS hospitals in your area, you may get care quicker and be less likely to die from an acute heart attack. This is hardly a ringing endorsement for competition, or the Department of Health policy of centralisation and hospital closures under the expensive private finance initiative.’ (8) – (9)

Pollock, on the proposed healthcare ‘reforms’ in general writes that ‘The bill, as designed, will allow commissioners (purchasers of healthcare or insurers) to pick and choose patients and services. It abolishes the duty to secure or provide comprehensive care, and permits GP consortiums to recruit members, and introduce charges and private health insurance, as well as enter into joint ventures with private companies. In a market, insurers and commercial providers must be able to limit their risks by carefully selecting members on the basis of ability to pay and predictable costs.’ (10)

In other words it would mean the end of guaranteed free public healthcare and instead returns to a system where people can only get what healthcare they can pay for. Even worse, the private healthcare firms and privatised or ‘mutualised’ GP consortia would be getting huge taxpayer subsidies without any limit on how much they can charge or any requirement for them to treat people who can’t pay what they demand. (This would repeat the disaster of privatised but publicly subsidised railways).

This would not be greater efficiency or greater choice, but the worst kind of privatisation, including a public subsidy for private firms. It’s not reform, but PFI on steroids.

It will also lead to chaos, with many people lacking vital services in their areas due to the government letting hospitals and schools go under if they fail to compete in internal markets. In fact government ministers have been encouraged by their advisers to allow public sector hospitals to fail in order to hasten “reform” and the entry of the private sector (expect budget cuts to public services like the NHS with claims of lack of the money to fund them, followed by greater levels of public funding appearing for private healthcare firms) (11)

If all this goes ahead we’ll see cases like the one of the American man who had no way to get the healthcare he needed, so in desperation staged a bank robbery of one dollar in order to get sent to jail so he could get treatment (12).

Devolution in Scotland could prevent this happening North of the border, assuming the government don’t try to impose it here by cutting funding or making future funding conditional on such ‘reforms'. That might boost support for independence and Cameron and the Conservatives might want to encourage that to remove a lot of Labour MPs from the British parliament. However while many voters in Scotland would like to avoid involvement in more Iraq and Afghanistan wars by independence, just as many may be nervous of independence after the financial crisis brought down RBS, fearing ending up like Iceland. So with independence no certainty the British government's policies on public services may still affect Scotland's.

Cameron also claimed that New Orleans since Hurricane Katrina provides a model for British public services.

What’s actually happened in New Orleans since Katrina is that people have been forced out of much public housing which was never flooded by armed private mercenary companies like Blackwater and the properties sold off to private developers to build luxury flats to rent. This resulted in mass protests against the enforced evictions and homelessness. To stop this and to stop them trying to return to homes many of them had lived in for decades, many have been sent to trailer parks, surrounded by razor wire fences and guards, effectively imprisoned and not allowed to leave (13) – (16).

That is not a good model to follow. It certainly provides profits for some, but as with Cameron’s plans, at the expense of the majority and especially the poorest. The same goes for government plans for ‘mutualised’ and ‘for profit’ ambulance and fire fighting services (17)

Cameron and the Coalition have no electoral mandate whatsoever for their plan for a privatised, publicly subsidised healthcare system. The plan did not appear in his election campaign or his party’s manifesto – in fact he made election pledges to end the endless and disruptive reorganisation of the NHS (18). A YouGov poll in January showed only 34% support the ‘reforms’ and only 5% ‘strongly’, while 37% oppose them (16% strongly opposing them). The other 30% didn’t know (19)

The more people hear of the details of the ‘reforms’ the more people who supported them are becoming "don't knows" and the more ‘don’t knows’ are becoming opposed. A Comres poll in June found 49% of people thought the NHS reforms should be scrapped, with only 19% supporting them and 32% unsure (20). Only 27% of British voters support allowing private companies to provide NHS services (21). If Cameron goes ahead and attempts privatisation he is virtually certain to be a single term Prime Minister – if he even survives that long.

Finally, Cameron repeatedly made bizarre comparisons to buying mundane services or goods from private firms – for instance ‘You wouldn’t pay for a gym membership and then get told you’re only allowed to use the running machine or only allowed to come in on a Tuesday’ and ‘Imagine you’re buying a mobile phone. You go to the shop – only one shop – and there they’re selling one model of phone. You can guarantee the service wouldn’t be what you’d expect, the quality wouldn’t be great.’

He also claimed that ‘choice’ and ‘competition’ in healthcare will ‘get real value for money’

Cameron ignores the incompatibility of motives between maximising profit by treating only those patients who can pay and those illnesses that are profitable to treat (the primary and often sole aim of private firms) and providing good healthcare, education or social care based on providing it to everyone equally according to need.

Heart operations or cancer treatment or fire-fighting or ambulances are not mobile phones or gym memberships, nor are they comparable to them. Mobile phones are incredibly cheap compared to healthcare and no-one selling mobile phones needs to have had many years of training and experience to sell a mobile phone to someone without endangering their health or life by recommending the wrong phone. A gym membership can affect your health over the longer term, but you won’t die if you can’t afford the gym membership you want. You will die if you can’t afford health care and have a serious illness. Choosing whether to use a running machine does not require years of training, education and experience to avoid someone dying. Healthcare does. As a result private health care will always be more expensive than public sector healthcare as private firms have to make a profit. It also follows that the more share of the healthcare provision market is given to private healthcare firms, the more costs will rise, especially as public services will end up short of fully qualified and trained doctors and nurses.

(1) = 10 Downing Street Press Office 11 Jul 2011 ‘Speech on Open Public Services’,http://www.number10.gov.uk/news/speech-on-open-public-services/

(2) = Bureau of Investigative Journalism 15 Jun 2011 ‘Conflict of interest fears in NHS shakeup plans’ by Emma Slater and Sophie Clayton-Payne , http://thebureauinvestigates.com/2011/06/15/half-on-some-consortia-have-links-to-virgin-group/  ; ‘At least half the board members of some GP consortia, the new bodies that will take over commissioning, have links with a single private healthcare company, an investigation by Bureau of Investigative Journalism, published in the Independent and Pulse Magazine can reveal.

Assura Medical, majority controlled by Sir Richard Branson’s Virgin Group, has links with 50 per cent or more of the board members at three of the 52 first-wave GP pathfinders… More than 60% of those with private links were associated with Assura Medical. Most were GP members of Assura, meaning their practice had formed a joint company with it…. with profits split 50:50 between Assura Medical and member practices….At the Sutton Consortium in Surrey, 19 out of 25 board members are linked to Assura Medical. In the South Reading Consortium, three out of five board members are GP members of Assura, and two are employees of an Assura member practice. At the Calleva Consortium in Basingstoke, Hampshire, six out of 11 voting members on the consortium board have links with Assura, as does the non-voting board secretary..’

(3) = Health Service Journal 11 Jan 2009 ‘Mark Britnell quits NHS for private sector’,http://www.hsj.co.uk/news/policy/mark-britnell-quits-nhs-for-private-sector/5002713.article

(4) = guardian.co.uk 14 May 2011 ‘David Cameron's adviser says health reform is a chance to make big profits’,http://www.guardian.co.uk/politics/2011/may/14/david-cameron-adviser-health-reform

(5) = Health Service Journal 11 May 2011 ‘Mark Britnell: the NHS funding model is no longer 'resilient'’,http://www.hsj.co.uk/comment/opinion/mark-britnell-the-nhs-funding-model-is-no-longer-resilient/5029675.article

(6) = guardian.co.uk 13 May 2011 ‘Andrew Lansley's NHS reforms are unworkable, says review chief’,http://www.guardian.co.uk/society/2011/may/13/andrew-lansley-nhs-reforms-unworkable ; ‘Prof Steve Field, chairman of the NHS Future Forum – set up last month to undertake the coalition's "listening exercise" – flatly rejects the health secretary's plan to compel hospitals to compete for patients and income, which he says could "destroy key services". The proposal, contained in Andrew Lansley's health and social care bill, has led key medical organisations to warn that it will lead to the breakup of the NHS and betray the service's founding principles.’

In an interview with the Guardian, Field says Lansley's plan to make the NHS regulator Monitor's primary duty to enforce competition between healthcare providers should be scrapped. Instead it should be obliged to do the opposite, by promoting co-operation and collaboration and the integration of health services.

(7) = guardian.co.uk 28 Jun 2011 ‘NHS forum GP admits private patient doubts’,http://www.guardian.co.uk/society/2011/jun/28/nhs-private-patients-doubts ; ‘The government is facing renewed pressure over its health bill after the GP who led its "listening exercise"…Steve Field acknowledged that the government would leave hospitals vulnerable to European Union competition law due to the presence of private patients in NHS hospitals.’

(8) = London School of Economics working health paper No.16  Does Hospital Competition Save Lives? Evidence from the English NHS Patient Choice Reforms’,  by Zack Cooper http://www2.lse.ac.uk/LSEHealthAndSocialCare/LSEHealth/pdf/Workingpapers/WP16.pdf

(9) = guardian.co.uk 16 Jun 2011 ‘A return to pre-NHS fear’, by Professor Allyson Pollock,http://www.guardian.co.uk/commentisfree/2011/jun/16/nhs-fear-tory-reforms-competition

(10) = See (9) above

(11) = Guardian 11 Jul 2011 ‘Ministers urged to let schools and hospitals fail to hasten reforms’,http://www.guardian.co.uk/society/2011/jul/11/nhs-health

(12) = guardian.co.uk 21 Jun 2011 ‘US man stages $1 bank robbery to get state healthcare’,http://www.guardian.co.uk/world/2011/jun/21/verone-one-dollar-robbery-healthcare

(13) = Klein, Naomi (2007), 'The Shock Doctrine' , Penguin , London, 2007, Chapter 20

(14) = Greg Palast 29 Aug 2007 ‘“They wanted them poor niggers out of there.” – New Orleans Two years after’, http://www.gregpalast.com/%E2%80%9Cthey-wanted-them-poor-niggers-out-of-there%E2%80%9D/

(15) = Mail & Guardian (South Africa) 21 Dec 2007, 'Housing protests grip New Orleans', http://mg.co.za/article/2007-12-21-housing-protests-grip-new-orleans

(16) = Greg Palast 24 Aug 2010 ‘Five Years and Still Drowning - The New Orleans CNN Would Never Show You’,http://www.gregpalast.com/five-years-and-still-drowning-the-new-orleans-cnn-would-never-show-you/

(17) = guardian.co.uk 09 Nov 2010 ‘Ambulance drivers and firefighters could break away from national service under new plans’,http://www.guardian.co.uk/society/2010/nov/09/ambulance-firefighters-mutualise-plans ; ‘Ambulance drivers, paramedics and firefighters could be given the right to breakaway from the national rescue service to form for-profit groups and run their services themselves, the Cabinet Office minister Francis Maude has said.

The government is to unveil a white paper that will give nearly all public sector workers a right to "mutualise" services, along the lines of a John Lewis model whereby employees own the service they work for, and can profit if it makes money.

Maude said that almost all public services – bar the police and the armed forces – could be mutualised. One ambulance service had already expressed an interest and he would also look at options for the fire service, he said.’

(18) = New Statesman blog 14 Apr 2011 ‘Video: Cameron slams “pointless reorganisation” of the NHS - The Prime Minister – then in opposition – addresses the Royal College of Nursing conference in 2009’, http://www.newstatesman.com/blogs/the-staggers/2011/04/royal-college-opposition

(19) = YouGov 20 Jan 2011 – Politics – The National Health,http://today.yougov.co.uk/politics/national-health

(20) = Comres 13 Jun 2011,http://www.comres.co.uk/systems/file_download.aspx?pg=796&ver=2

(21) = guardian.co.uk 21 Jan 2011 ‘Poll reveals widespread suspicion of NHS reforms’, http://www.guardian.co.uk/politics/2011/jan/29/nhs-private-companies-yougov-poll