Nurses for Reform Blog

I would like to take this opportunity to wish all our readers a Merry Christmas. NFR will be back blogging on 28 December 2006.

Predictably, the trade union Unison (not to mention the Royal College of Nursing), has signed up to the Trade Union Congress’s ‘NHS Together’ campaign which opposes further NHS private sector partnerships and privatisation.

Yet, while Unison’s chief comrade, Dave Prentis, tells NHS staff that they “they deserve more than the failed privatisation policies of the past” guess who is simultaneously offering great deals on various forms of independent healthcare?

Perhaps in recognition of the millions of people who signed up to trade unions during the late 1800s when they offered services via friendly societies (and stopped doing so when they resorted to beer and sandwiches at No.10 while defending failed nationalisations) Unison today has a partnership with the private health cash benefits company Medicash. Like BUPA, Nuffield Hospitals and WPA, Medicash is an independent not for profit healthcare organisation. As such, it “pays back over 80 per cent of contributory income every year to members in cash benefits.

What is so good about this is that while in 1948 the government promised that the NHS will “provide all medical, dental and nursing care” free of charge – today the Unison scheme points out that it will help to cover the private costs of:

“expenses incurred for everyday healthcare such as for Optical, Dental and Physiotherapy…”

For an application and more details, call 0845 600 0151 and just ask for the UNISON plan!

The government funded quango the Healthcare Commission is in the business of monitoring healthcare providers against a uniformity of centralised standards and targets. Assessing healthcare services in such areas as waiting times, cleanliness and safety they are to English healthcare what Gosplan used to be to the former Soviet Union. They monitor performance against a uniformity of rules and in so doing will actually help to stifle innovation and genuine consumer led competition.

That said, they are also in the business of getting their political pay masters off the hook of past promises. Whereas British politicians once foolishly promised that all tax funded healthcare would only be provided in nationalised hospitals, the Healthcare Commission clearly accepts that this is no longer viable: a bridge has to be built to an increasingly privatised future.

In this context the Healthcare Commission’s new website allowing patients to see how independent sector hospitals and health providers are performing is to be welcomed. Accepting the meaninglessness of much of the data presented – the garbage in garbage out axiom is clearly at play here – it is nevertheless good that patients are being given information which will encourage more people to accept private healthcare as being part of the consensual mainstream.

This story in today’s Daily Mail concerning a U-turn on electronic patient records is another piece of spin from the government. For while patients will now be able to view and amend their electronic records they will only have a limited say in how their personal information is – or is not – shared with professionals across the NHS.Away from the all the weasel words the government is still on track to holding vast amounts of data on citizens and making it available to a host of government departments across Whitehall.

I don’t mind electronic patient records in the private sector – providing no one in government can access them. But I do mind such a scheme in the state sector.

The Tax Payers’ Alliance (TPA) has just published the UK’s public sector rich list for 2006 .

While the 12 most highly paid people in the NHS earned more than £183,000 each, the research also points out that the starting salary for an NHS nurse is around £19,000.

On average, the 170 public sector rich surveyed had a pay rise of 8.4 per cent between 2005 and 2006. This is double average earnings growth (including bonuses) across the country – which was 4.2 per cent over the same period.

The average total pay of the 170 people on the list is £259,701 per annum – or just under £5,000 a week!

While I have no problem with people in the private sector reaping the rewards of success I despise the public sector fat cats who parasitically spout their egalitarian waffle but then absorb vast amounts of money which we have to pay at the barrel of a gun – i.e. taxation.

I have just read Allyson M. Pollock’s book NHS plc – The Privatisation of Our Health Care . I like this book a lot as it provides a great overview of the extent and scope of the privatisation now underway across the NHS.

Although the author hates privatisation and the private sector’s involvement – not surprisingly she has all kinds of self marginalising admirers on the Marxian left - she nevertheless provides free marketeers with great hope and cheer. After all, this is a book that clearly demonstrates that consumerism is winning and that the NHS as a fully nationalised system is in total collapse. Best of all, it shows just how the political class are trying to get themselves off the hook of past promises by involving the private sector in ever bolder ways.

Today, Prime Minister Tony Blair has urged people working in the NHS to get behind the government’s reforms and where necessary to accept the closure of some Accident and Emergency Departments. While the Prime Minister is right to point out that the NHS is a deeply conservative institution and that there will always be built-in resistance to such change, it is perhaps instructive, if we think for a moment how we have got into this situation.

Back in the late 1940s the government nationalised more than 3,100 hospitals, homes and clinics. For the first ten years of the NHS there was very little if any capital investment in the service. Planning permission for the first new hospital was not even granted until 1956!

To overcome the problem of capital underinvestment Enoch Powell launched the Great Hospital Plan in January 1962. It promised a £500 million programme over a decade to build 90 new hospitals, drastically remodel 134 and provide 356 further improvement schemes – each costing over £100,000.

However, with the ongoing economic crisis of the 1960s, 1970s and early 1980s the plan was overwhelmed by events. Since 1992, most new capital investment in the NHS has been arranged under the private finance initiative (PFI). However, even with the input of welcome private money, by the late 1990s less than a third of the Great Hospital Plan’s schemes were completed and a third were not even stared.

In recent years, under the general rubric of public private partnership (PPP) the government has championed a whole raft of sound market-oriented reforms in the NHS. In 2000 the Secretary of State for Health, Alan Milburn, signed a Concordat with Britain’s independent hospitals. In 2001 the government made it clear that it wanted the private sector to design, build and operate a new generation of Independent Sector Treatment Centres. And in 2002 the government made it clear that it wanted to establish a new generation of independent Foundation Hospitals. As such, it wanted NHS hospitals to be “set free” from Whitehall control and to have a greater say over how they developed and from where they raised their capital (i.e., the City).

Indeed, in doing all of this, the government not only took brave steps trying to privatise NHS provision but it started to promote the patient choice initiative. But, and here is the rub, who actually opposed Foundations Hospitals and why did they insist on the bill being watered down as it went through parliament?

In reality the Labour left and the trade unions opposed it because it represented the privatisation of provision. As ideologies with a conservative mind set they were worried that the NHS would be simply re-cast as funder of services and not the owner of the bricks and mortar (as if ownership of the latter really matters). The Conservatives opposed it because lacking vision, they could not understand a Labour government putting through such a sound proposal – so they defaulted to opposition for opposition’s sake. What did the traditional independent hospitals sector do? Terrified of the competition that unleashed Foundation Hospitals would represent they lobbied hard with the Labour left and together these three groups – Labour left, Tories and Private Hospitals – helped to water the proposals down.

As a result we are left with a government that has spent a fortune on the NHS and is still trying to push the market agenda forward. Indeed, in many ways more power is in the hands of GPs and patients and a world of cross sector choice is slowly opening up. But sadly – without full Foundation status and all that lovely capital from the City – some services are going to be cut and many are going to be ‘rationalised’.

Any decade now and a prominent trade unionist or even a Conservative politician might argue for greater privatisation of NHS provision so that local A&E services can be saved. But don’t hold your breath. This is Britain where a good old conservative vested interest remains – even in the face of total madness – a good old conservative vested interest.

I say in let’s open up the supply side of NHS provision and privatise the lot. The NHS can remain a funder and kite mark. But we really don’t need the government to own or run our hospitals. So long as they do, they will sadly remain a political football and the people working in them will be kicked from pillar to post. Nurses deserve better than this and the hospitals in which they work should be set free from the state.