INSIDE L Cuts Round-Up Pages 6-7 L White Paper Threat to Mental Health Back Page L TEN Good Reasons to Say No to the White Issue No

INSIDE l Cuts round-up pages 6-7 l White Paper threat to mental health back page l TEN Good Reasons to say No to the White Issue No. 66, Autumn 2010. WHITE PAPER SPECIAL ISSUE Paper page 3 White Paper would combine biggest-ever cuts with biggest-ever privatisation Special Appeal Help us campaign Say NO to ConDem to save our NHS! The NHS faces its biggest-ever threat: a ‘double whammy’ of massive cuts year by year to 2014, coupled with the White Paper proposals that could wipe out all public sector rationingThe ConDem government’s boards! provision of services. White Paper ‘Liberating the The ConDem government NHS’ makes many controver- has no mandate to transform sial proposals, but at its heart the National Health Service are two key factors: the frag- into a national health market. mentation and privatisation of But if there is no public the NHS – and £20 billion of challenge, the White Paper spending cuts by 2014. could be forced quickly The scale of these “efficiency through Parliament. savings” guarantees that even Hospital staff have while it appears to give GPs everything to lose and greater control over services, nothing to gain from the the opposite is the case. proposals which could see With tight budgets and cuts tens of thousands of jobs to be made, consortia of GPs axed, and hundreds of established to spend £80 bil- thousands pushed out of the lion in commissioning budg- NHS workforce, with new ets will inevitably become little threats to their pay scales and more than rationing boards. pensions. Far from improving services Every cutback that is they will have to choose which accepted will just encourage services will be cut and which desperate employers to come sections of patients should be back for more. excluded from treatment. It really is do or die for To accept this would not be those of us who want to “liberation” for the GPs or their defend the NHS as a public patients: it’ would be a capitu- service, and who value the lation to the ConDem govern- staff who deliver services. ment. to push through proposals lined as they struggle for influ- To build a successful As the debate over the White If the NHS Alliance, which will have far-reaching ence with Mr Lansley. campaign requires resources, Paper begins to widen, it’s clear and negative consequences for Perhaps the biggest reason publicity, time and effort: and that there is a strong and grow- the Royal College patients as well as for the NHS for standing up against these until there is a broad popular ing opposition to many of its and its one million employees. plans, which could effectively campaign established with core proposals, even among of GPs and the It will also be a disaster for transform the NHS into a Na- the support of the main health the group who appear to have tens of thousands of hospital tional Health Market, with no unions, much of the work most to gain from it. BMA, along with doctors: the proposals could ef- public sector providers, is that will fall to organisations like GP magazine found fewer- fectively privatise health provi- there is absolutely no evidence London Health Emergency. than one in five of the 300 GPs the health unions sion and reduce England’s NHS that these expensive, experi- But right now, we don’t who responded to an online workforce from almost 1 mil- mental reforms – the biggest- have the resources to cope. poll believed that the changes lion to virtually zero by 2014. ever privatisation of health care We need help to keep the would improve patient experi- simply took a firm Despite these problems, at anywhere in the world – could issue in the media, and work ence or the funding of primary present the BMA is committed deliver the promised improve- with local campaigners to care services. stand against the to “engage critically” with con- ments for patients. get the message across in Twice as many (41 percent) sultations on the ConDem plan. It’s all looking like a mess meetings, protests and local feared a fresh “postcode lot- White Paper, the This is a mistake. Indeed waiting to happen. publicity. Just producing and tery,” while 71 percent expect- if the NHS Alliance, the Royal The cost of implementing distributing this newspaper ed the scrapping of PCTs and ConDems would College of GPs and the BMA, the White Paper (upwards of has cost £2000. SHAs to lead to an increase in desperate appeal for GPs not to turn their backs on the govern- along with the health unions £1.7bn) seems like a classic We urge any readers or private sector involvement in not be able to which have already declared waste of money much better supporting organisations commissioning. 60 percent of ment proposals, claiming that it would be “utterly disastrous” themselves against the propos- spent on patient care. that can do so to make a responses in a poll on the pro- carry out their als, simply took a firm stand But from the point of view donation, as large as you can White Paper National Associa- if they did not “embrace the White Paper and make it work”. against the White Paper, and of Andrew Lansley and his Tory afford, to ensure we have the tion of Primary Care website plans. marketisation and privatisation colleagues, if it resulted in de- resources to keep on fighting also opposed the government’s But of course Dr Dixon has got it the wrong way round. of health care that are implicit nationalising the NHS, revers- to scupper Lansley’s White commissioning plans. in it, the ConDems would not ing the great legacy of Nye Paper, keep our NHS intact … No wonder one of the lead- The real disaster would be for GPs and their organisations to be able to carry out their plans. Bevan, and opening up a new and keep it public. ing apologists for the scheme, Until a few weeks ago the £100 billion market to private n You can donate by cheque Dr Michael Dixon of the NHS allow themselves to be cyni- cally used by the government BMA was conducting just such companies, it would be seen as (to ‘LHE’), or online at www. Alliance, has issued a rather a campaign, now sadly side- money well spent. healthemergency.org.uk l website: www.healthemergency.org.uk l email: [email protected] l snailmail: BCM London Health Emergency, London WC1N 3XX Page 2 Page 3 What they NHS White Paper McKinsey’s: summed up over-paid, are saying The NHS White Paper “Equity Trusts, social enterprises or the and Excellence: Liberating the for-profit private sector. Com- NHS” is the most radical NHS re- petition law will apply. form in 62 years since the NHS Patients must be given free about the was formed. choice of GP (not restricted to over-rated, Among its proposals: where they live), choice of any ‘Efficiency savings’ of £20 provider, choice of named billion are to be generated by consultant team, and choic- 2014. es in maternity care, mental over here! White Paper It aims to abolish the exist- health, diagnostic testing, Carillion, which has contracts The Conservative Party’s ing commissioning organisa- long term conditions and end One bizarre side-effect of the presented as an undergradu- for PFI hospitals and outsourc- Bow Group, the oldest cen- tions – 152 Primary Care Trusts of life care. Con-Dem coalition govern- ate research project at a uni- ing was “excited”, Virgin-owned tre-right think tank in Britain, and 10 Strategic Health Au- Performance targets in- ment was the publication of versity it would be rejected for private healthcare provider As- claims key strands of the re- thorities – and hand the main cluding waiting times are to two documents which the New inadequate use of supporting sura Medical’s chief executive forms are unfeasible and risk responsibility for commission- be scrapped and replaced by Labour government had stub- evidence and references, the was “enthusiastic”. creating a postcode lottery of ing services with a combined “outcome targets”. bornly refused to allow into the lack of any clear structure or budget of £80 billion to GPs. The Foundation Trust regu- Healthinvestor magazine healthcare. public domain. approach, and the lack of any GPs will be required by lator, Monitor, is to become an has also eagerly embraced the The Nuffield Trust has warned Both are the result of work coherent or collected conclu- their contract to be members economic regulator for all or- white paper, which it argues that the reforms “will require by US management consult- sions. of around 500 local “consor- ganisations providing NHS care. “offers the private sector a raft significant management exper- ants McKinsey’s, and address Nonetheless this document tiums” which will be statutory The public health and of opportunities in the health- tise to implement smoothly,” the issue of the drive for ‘effi- contains many of the seed ide- bodies to carry out the respon- health promotion functions of care market by enabling pa- and that “There is a huge risk ciency savings’ (aka cuts) in the as around which PCTs across sibilities of commissioning. PCTs are to be taken over by lo- tients to achieve greater choice that this level of reform cannot NHS to bridge a predicted £20 London, grouped into five se- They will receive a manage- cal government through new and control over their treat- be implemented without major billion gap between a frozen cretive “sectors,” have been ment allowance to allow them ‘health and wellbeing boards’, budget and rising pressures by meeting behind closed doors ment and care through access failure”. The McKinsey document is also confirmed as the central to buy in support, which may which will also take over the 2016-17. to plan the cutbacks. to any willing provider”. The slightly less right wing inspiration for those NHS managers who want to switch as be from former NHS employees role of councils’ oversight and The first (smaller) document Closures Pulse magazine, responding Social Market Foundation or from the private sector. scrutiny of local health services. is a national survey, elements many as 60% of A&E patients, and 50% of outpatients away Here are the proposals for to FAQs warns that: “The White condemned the changes as “at A new NHS Commission- The patient voice is also to of which leaked into the pub- from hospital facilities and into ‘polyclinics’ or other as yet non- “levers to reduce costs of care” Paper will lead to huge new best a waste of time, at worst a ing Board will be established be changed again: Local In- lic domain last summer, and existent facilities in primary care. including “reduced double run- opportunities for private com- waste of money”, warning that to commission primary care volvement Networks (LINks) Just say ‘NO’: TEN GOOD Reasons which was immediately pub- Yet the document also reveals how strange this obsession ning costs through a single panies, with firms such as Unit- ill-prepared GPs could wind services, specialist care and ma- are to be replaced by new licly disavowed by Labour min- with running down A&E services has become, since the total point of access to urgent care“ edHealth, Tribal, Bupa and Har- up outgunned and outma- ternity services. It will oversee Healthwatch groups funded isters, who insisted that it was London spend on existing A&E units is just 5% of the hospital (in other words the rundown moni already offering to run noeuvred by powerful hospital the GP consortiums, and have by local government, which not government policy and budget and 2.65% of the total cost of London’s NHS, so even a and closure of A&E units in Lon- commissioning and account- Trusts. powers to assign GPs to a con- will take on additional roles to to oppose the NHS White Paper would not be implemented. big proportional saving would not amount to much. don). ancy services and back-office sortium if they have not already make them “more like a ‘citi- Nevertheless it soon be- And there are no big savings to be made: in 2007-8 London’s The normally docile Patients’ Andrew Lansley’s “reforms” on the work these bodies did over by one – by 2013. Founda- The document goes on to functions for GP consortiums.” joined one. It will have regional zen’s advice bureau’ for health came clear that despite the A&E units treated almost 4 million patients – at an average cost Association said that the would bring the biggest will divert GPs from their main tions will be removed from the claim that more savings could offices, and will employ NHS and social care” (DH). 1. government’s view, a number of just £79 each: it is hard to see how switching services to new The NHS Alliance welcomed changes are “a huge experi- privatisation of health care any- role in delivering clinical care. NHS balance sheet. They would also be had from “increasing managers – but it is not known The White Paper is out to of Strategic Health Authori- premises could save very much from this, and of course there the white paper as a “unique ment without much hard evi- where in the world. It would Many consortia will either all become “social enterprises”, scale, efficiency and quality from how many. consultation until October. ties were seeking to adopt a has been new research evidence to show that it would not be opportunity for frontline GPs”, dence about how they will transform our National Health re-hire redundant PCT staff, or and encouraged to tear up centralisation” of other hospital The 90 plus NHS Trusts Most of its proposals are for number of the proposals, not safe to switch anything like 60% of A&E cases into primary care. and Dr Michael Dixon of the Al- work in the NHS”. Service into a competitive Na- bring in private management national pay scales for their services (i.e. more closures). which are not yet Foundation swift implementation, and all least in the rapid reduction liance has issued a rather des- tional Health Market, in which consultants: the total level of staff, who would no longer be Other “levers” to cut costs in- perate appeal for GPs not to UNISON, the biggest public Trusts will have to achieve of the proposals are to be car- of the NHS workforce – by as gard all paperwork, all admin, £100 billion of public money ‘bureaucracy’ will be little dif- NHS employees. Legal limits on clude reducing costs of clinical turn their backs on the govern- sector trade union, has taken Foundation status, or become ried through before 2014. much as 10% -- as a way to save and even discussion with other would be used to buy serv- ferent from now. the amount of money Founda- staff, using nurses and health ment proposals, claiming that the government to court chal- part of a larger Foundation The full text is available: money. nurses as outside the nurse’s ices from privatised providers. tions can raise from private professionals to replace doc- it would be “utterly disastrous” lenging moves to implement Trust by 2013, when the legal www.official-documents. proper role, but they do not Competition and privatisation It will be less account- medicine are abolished by the NHS London’s secret tors, and reduced costs of over- if they did not “embrace the the proposals before they are status of NHS Trust will be abol- gov.uk/document/ suggest who else should do can force standards down, as 6. able to local people or to White Paper. With NHS funding The second document be- heads (suggesting that the roll- white paper and make it work.” even debated in Parliament ished. cm78/7881/7881.pdf these roles instead of nurses. happened when hospital clean- Parliament. Ministers will no frozen, this will mean FTs will came even more shrouded in out of polyclinics could bring and while the “consultation” The “cap” that limits the ing services were privatised in longer answer questions or concentrate on drawing in pay- secrecy: commissioned by NHS an 80% cut in clerical and ad- McKinsey’s also prove to be The National Association of proportion of Foundation has also said it with the public is not yet con- the 1980s. take any responsibility for local ing patients from the UK and London, it was a special version min staff working for GPs). the source of the suggestion Primary Care Trust income that can be de- was “vital that primary care cli- cluded. health services, which will be other countries, and open up a of the original with more de- The report also discusses at that very large sums of money rived from private medicine nicians embrace the new world Unite, Britain’s biggest union, GPs will be compelled to than they have now. “regulated” by Monitor and the new 2-tier health service. tailed facts and figures on the some length the “decommis- could be saved in primary care or contracts with the private open heartedly”. has also opposed the propos- join local commission- Care Quality Commission, nei- London context. sioning of some services” – ef- by slashing the average time sector will be removed. FTs will 2. als, and set up a campaign ing “consortia”, each probably A recent poll of GPs sug- ther of which has a successful A competitive healthcare For 6 months or more cam- fectively imposing a system of allocated to patient appoint- The Royal College of General be given greater freedom to committee. including 80-100 GPs. These gests fewer than one in track record. The new National market will make it more paigners and health unions at- rationing access to treatment ments with GPs – by one third, Practitioners declared before operate as social enterprises, 3. 9. statutory bodies will take five believes the White Paper Health Market would be even difficult for GPs to collaborate tempted to use the Freedom of for conditions such as varicose from 12 minutes per patient to the white paper was even pub- The BMA’s National Council though they “will not be priva- decisions on how the money will improve the patient experi- less publicly accountable than with their medical colleagues Information Act to force NHS veins, hernia and even joint re- just 8. lished that it was the “right di- has voted heavily in favour of tised”. They will be encouraged should be spent. But the White ence of the NHS. Almost three companies supplying gas or in hospitals, and for consult- London’s secretive bureaucracy placements, leaving patients in This could ‘save’ a massive rection of travel”: but its chair- “critical engagement” with the to negotiate local variations Paper includes the biggest- quarters believe it will increase broadband. ants and hospital staff to share to allow proper public scrutiny pain with the “choice” of going £570m, argues the slide, but it elect Clare Gerada said “For consultation process, although on national pay and terms and ever squeeze on NHS funding, the role of the private sector best practice. Competition of plans which were quite obvi- private or going without. offers no discussion of the pos- most GPs, it’s like rabbits in the it has not formally spelled out conditions. with £20 billion of “efficiency in commissioning. If GPs and The White Paper is silent law will apply, and will brand ously controversial. sible impact on patient care or headlights. There is also a natu- its reservations or identified GP consortia and the NHS No analysis savings” required by 2014. So consultants stood together to on how consortia could cooperation of this type as When this second docu- Instead savings are sought patient satisfaction, let alone ral disinclination to working any issues which might per- Commissioning Board will buy 7. Time and again the ideas consortia will become Ration- oppose it, this “reform” package avoid being ‘captured’ by the “collusion”. The split between ment – all 159 pages of it – was in all kinds of unhelpful and the job satisfaction of GPs: the with external organisations, for suade negotiators to pull out if in health care from “any will- proposed in the McKinsey ing Boards, offering GPs and could not pass. biggest and best resourced GP “purchaser” and “provider” will finally published, the reason for unlikely areas: we are told that Royal College of General Prac- fear of going to the dark side not resolved. ing provider” – Foundation document are simply thrown their patients FEWER choices practices, most of which are be widened. NHS London’s reluctance to al- there should be a reduction in titioners is currently campaign- and being part of the privatisa- in without any serious analy- Former Health Secretary Each PCT area would in wealthy areas. There is no low it out became immediately numbers of patients referred ing for longer consultation tion agenda.’ sis of possible down-sides and Andy Burnham, trying to have 2-3 consortia, each requirement for GP consortia All these changes are transparent. for outpatient care – despite times. 4. problems, and without any dis- Right wing think tank Civi- kick-start his leadership bid in of them taking its own deci- to work with other consortia, proposed without a Firstly, contrary to expecta- the fact that 18 out of 31 Lon- The document also claims 10 cussion of the systems chang- tas warned that the upheaval the Labour Party, has correctly sions, with no overall planning or take any wider view beyond shred of evidence that they will tions, the document is not so don PCTs are already referring that the same level of commu- es that would be needed to could disrupt plans to drive branded the Lansley propos- authority, creating a new “post- their own local catchment deliver the promised improve- much a ‘report’ as a ramshackle fewer than the national aver- nity services could be delivered How big could achieve the desired result. through £20 billion in “effi- als as “Without doubt the most code lottery” in which some population. Contradictory ments. The last Tory govern- collection of (sometimes quite age. Nowhere is there a discus- by 11-15% fewer staff, if district In almost none of the exam- ciency savings”. Stressed the dangerous threat to the NHS consortia fund treatments that decisions could result in the ment’s experiment with GP smart-looking) Powerpoint- sion of the possible impact on nurse productivity could just ples is there even a costing of “scant evidence base” for Lans- in its 62-year history: a recipe others will not. collapse or withdrawal of some Fundholding was an expensive style slides, each containing a patient care of being denied be increased. Once again we the likely investment required ley’s plans, Civitas argued they to turn order into chaos, a fair local hospital and mental failure in the 1990s, and new series of statistics and asser- specialist outpatient treatment. are given no clues on how this to make the change happen, could set the entire NHS back service into a free-for-all, and £20bn cuts be? PCTs and Strategic health services, again reducing figures now show that “practice tions, but with little if any con- should be done. let alone a balance sheet to Sick ideas by at least a year, and “any to let market forces run riot. Health Authorities will choice for patients. based commissioning” experi- necting explanation, evaluation There are more examples – The King’s Fund’s chief economist John Appleby 5. show how any significant sav- Sickness rates in London’s slight blip will mean one thing For patients, it means longer be scrapped, and thousands ments under New Labour were or discussion of the proposal. a long and shapeless list – but has recently spelled out the scale of threat to the ings could result. hospital staff are the second for patients: a return to ration- waits in A&E, months on wait- of skilled and experienced Every remaining NHS Trust more expensive than the sys- If this type of report were time and again the same gaps NHS from the coming cash squeeze. lowest in England and below and evasions recur. ing, either by waiting or by re- ing lists and a postcode lottery Arguing in the British Medical Journal (17 managers and service planners 8. will be forced to become a tem they replaced, with high the national average – but It seems clear that a lot of ductions in services.” writ large.” August) in favour of protection of the NHS against will lose their jobs. But taking Foundation Trust – or be taken levels of overspending. McKinsey’s claim that more money has been wasted on the general round of cuts affecting most other money could be saved if fewer these reports. Any money spent public services, he argues that if the NHS were staff got sick: they don’t tell us on them was wasted, because not protected it would have to find actual cuts how, and appear to have no de- the total silence on exactly how amounting to around 14% of its budget (£18 tailed analysis of the causes of any of the proposals are to be billion) over the next few years, and suggests five sickness absence. implemented means that they ways it could do this: The London document ar- are as useful as a chocolate fire- 30% real pay cut for all staff gues for “possible but chal- guard. Abolish the NHS in London lenging” targets to save £2.4 But as the ConDem coalition No drugs billion through acute sector cranks up the heat, demanding Sack all consultants and general practitioners productivity, but this turns out £20 billion of NHS cutbacks – Abolish the NHS in Scotland and Wales to require a massive 21-37% in- by 2014 – these proposals are A different approach would be “for whole crease in productivity by nurs- the only ones on the table. services to close down: no NHS dentistry (£2bn), no es, a 9-43% increase in doctors’ So even though the ideas community services (£9bn), no ophthalmic services (£0.5bn) – and still another £6.5bn to find”. productivity and a massive 34- are ill-judged, inconsistent and He sums up: “Fourteen per cent is equivalent to £18bn for the UK NHS. This is not a cut that 42% saving on overhead costs: impractical, this does not mean can be achieved through a bit of salami slicing of everyone’s budgets. The NHS would have to but it offers no practical ways in that they will necessarily be dis- think at least on the scale of the suggestions above.” which these savings might be carded. Watch out for a McKin- Appleby makes the obvious point that none of these proposals is very appealing. made. sey-style cutback near you! A better policy: the BMA’s Hamish Meldrum and BMA activists join But the ConDem White paper looks to make £20 billion of ‘efficiency savings’ by 2014. McKinsey’s appear to re- a demonstration fighting the marketisation of the NHS So are we going to let them do it? Page 4 Page 5 Evidence-free market-style “reforms” that fragment care, increase costs, and let in private sector Foundations of privatisation Foundation Trusts are another area of concern. The White Paper has made it quite clear that all NHS Trusts must become Foundations, or be taken We’ve been over by one by 2013. It is also clear that if Lansley gets his way, Foundations will be removed from the NHS balance sheet. This would mean that their staff would no longer NHS employees, while their assets would be privatised, whether they remain as non-profit ‘social en- here before! terprises’ or are eventually absorbed Commissioning Board into the for-profit private sector. Bob Dylan once famously In addition to the local commissioners Although the White Paper declares sang that “you have to pay the new NHS Commissioning Board that “Foundation Trusts will not be pri- to get out of going through will need to keep a watching brief on vatised”, that only means that the leg- all these things twice”. every GP consortium, and on the indi- islation to impose these changes will vidual practices from which the Board not privatise them. George Santayana told will be commissioning primary care However once they are off the NHS us that those who do not services, in addition to its other role balance sheet, and run as free-stand- learn the lessons of history of commissioning specialist care and ing businesses, answerable only to are doomed to repeat it. maternity services. Monitor – the same body that is also Karl Marx said that history This means, at least in the view of supposed to regulate for-profit pri- some experts, that the new Board will vate providers – what is to stop Foun- repeats itself, “the first time need to be big, with its own manage- dations being taken over by a private as tragedy, the second time rial structure, regional offices and - di company, or even deciding to be- as farce”. rectorates, and is likely to recruit senior come a for-profit business? Even the NHS staff from Strategic Health Authorities Even if they don’t go this far, the and PCTs. competitive National Health Market Confederation, representing But there will inevitably also be system outlined in the White Paper health service employers, additional bureaucracy at the level will force all social enterprises and recently published a critical of NHS Trusts and Foundation Trusts, Foundations to run just like private study of reorganisations since each Trust will be dealing with businesses – and that’s not good for a far larger number of commissioning cies will actually deliver savings on bu- staff or for patients. over the last ten years, bodies, and negotiating with them. In reaucracy. their budgets by an average of 2.5 per- payments for those who signed up. entitled ‘The triumph of the new competitive health market The difference would be that the cent, equivalent to a massive £2 billion Of course some GP Fundholders hope over experience”. Foundation Trusts will require more new bureaucrats may no longer be overspend if applied to the whole £80 did very nicely in holding on to funds: marketing and commercial staff, who Caps off Foundations that But Andrew Lansley’s NHS directly employed by the NHS, or ac- billion commissioning budget. figures obtained by Alan Milburn MP do not contribute to health care, but countable through NHS organisations. showed just 585 fundholders had re- White Paper is ignoring enable the Trust to compete with so- went wrong This is because closing down Pri- tained a total of £28 million in 1993-4 the lessons of two decades cial enterprise and private providers. When GP Fundholders for private mary Care Trusts and Strategic Health – an average of £47,000 for each prac- So how much if anything will be Experience in other countries where of failed “reforms” and Authorities is linked with passing on held on to funds tice. In NE Thames region fundholders saved from bureaucracy in real terms hospitals have been floated off as Ignoring history lessons reorganisation – and today’s the responsibility for the £100 billion However we also know that the previ- held on to £1 for every £6 allocated, is open to considerable doubt. patients foundation trusts also gives grounds Condem coalition is going NHS budget to GPs – most of whom ous Conservative experiment in del- equivalent to £77,000 per doctor. So what is the historical experience of ignoring the lessons learned the hard Admin costs were also high, since for concern. far further and faster down lack the expertise, time and resources egating commissioning to GPs was an Another experiment ignoring One early foundation-style hospi- wholesale organisational changes like way in the last decade. to take this work over without damag- expensive failure. Trusts had to deal with a rapidly ris- negative experience is the proposal those proposed in the White Paper? Former NHS Commissioning Di- the road of privatisation High cost of markets ing number of small-scale purchasers tal was privatised – swallowed up by ing the level of care they can give to We already know that markets are By 1994, just a couple of years into in the White Paper to remove the In its recent survey on this, the rector Mark Britnell, now firmly in the than Margaret Thatcher’s of health services, at an extra cost esti- the private sector. This is what hap- their patients. more expensive as a way of adminis- the GP Fundholding scheme, NHS legal “cap” which restricts the NHS Confederation points to a rapid private sector, has warned Lansley mated in 1997 as at least £1m on aver- pened to one of the first Swedish radical government ever So GPs will have to employ staff tering the NHS than the previous inte- chief Executive Alan Langlands was proportion of a Foundation Trust’s succession of changes in the NHS es- that his GP consortiums are too small age per Trust – or £500m a year. Foundation Trusts, St Goran’s in Stock- contemplated. to administer each of the 500 or GP grated structure prior to 1990. complaining that GPs faced a “paper income that can be derived from pecially over the last ten years, all of to work effectively, and to succeed The fragmentation of the NHS and holm. Now it’s the country’s biggest Consortiums, which will be formed as Earlier this year the Commons se- overload,” and the BMA was complain- private medicine or deals with the them based on little hard evidence, would need to be as big as PCTs: “It JOHN LISTER looks back the consequent bureaucratic costs ap- private hospital. the new statutory bodies to commis- lect committee revealed that the NHS ing that doctors were being turned private sector. and subject to little if any proper eval- won’t work if we create 500 cottage- to show the similarities pear to be very similar in each case: In New Zealand in the ill-fated mar- sion health care at local level. As such was alreaday spending a staggering into a “demoralised and demotivated This strict limit, confining Trusts uation. sized commissioning bodies”. under the new White Paper each PCT ket reforms of the 1990s the equiva- between today’s policies they will need responsible officers and 14% of its budget – £15.4 billion per workforce”. Millions had been spent to the percentage of income Conspicuously it notes that after One head of procurement at an will be replaced by on average three or lent to NHS Trusts were allowed to and yesterday’s costly management. year – on management and admin- offering GPs £16,500 lump sums as a from private work that they had 1997: “99 health authorities were split NHS Trust, speaking anonymously to four consortia, each of which will need borrow money freely from the private The GPs may choose to employ staff istration: this compares with 8% in non-refundable down payment for before Foundation status, was into a large number of primary care Supplymanagement.com echoed the failures. managers and have to negotiate its sector: they quickly ran up hundreds who will only recently have lost their 1991-92, and 11% in 1995-96 as the expressing an interest in the scheme, introduced back in 2003 as part of groups and then primary care trusts same point, arguing that GP com- own deals and contracts. of millions in debts, which it eventu- jobs in PCTs and SHAs: or they may costs of Margaret Thatcher’s contro- and millions more on £30,000 start-up the government effort to push the ally took the government years to pay because it was thought that they were missioning will lead to a “fragmented What will it cost? opt to bring in private sector manage- versial ‘internal market’ reforms began controversial plan for Foundation off. too large to create to primary care. The service”. The White Paper will cost at least ment consultants, who (scenting prof- to grow. Trusts through Parliament. In both Sweden and New Zealand 302 PCTs were then reduced to 152 … The Nuffield Trust also argues that £1.7 billion to implement, although itable work on the way for them) have Numbers of senior managers have Fundholding = 2-tier NHS Sceptical MPs demanded an the government had to step in to “One reason given for this was that the disruption flowing from the re- a recent editorial in the British Medi- been among the most prominent sup- risen by a staggering 91% since 1995, What were the results of fundholding for patients? Even Andrew Lansley now ad- assurance that the new free- bring the hospitals back under control the small groups had high overheads organisation and the need for GPs to cal Journal estimated that the cost porters of Lansley’s White Paper. 71% more than double the 35% increase in mits that fundholding led to a “two-tier NHS”. standing non-profit businesses and prevent worse damage. and did not map closely enough to learn new skills and new ways of work- could be closer to £3 billion. Running of GPs in a recent poll said they feared the total of doctors and nurses. By 1994 almost half of the 173 hospitals surveyed by the BMA were offering would not simply concentrate on However the White Paper reforms local government boundaries. There ing mean that it would take “several alongside a massive squeeze on NHS the White Paper would bring a greater More recent changes towards preferential services to fundholders’ patients, with 41 of them promising fast track private work: the Bill eventually will push the Foundations and their were also questions about whether years” for the new system to make any budgets aimed at generating ‘efficien- private sector involvement in the com- a more open market system have admission while other NHS patients were left to wait even longer. scraped through with a majority of massive multi-billion assets so far out- there were enough high-calibre man- savings, and that in the meantime big cy savings’ of £20 billion by 2014, the missioning process. pushed costs even higher: recent fig- We are now assured of course that GP consortia would be very different, be- just 17. side the control of the Health Secre- agers to staff 302 organisations.” deficits could be run up. reorganisation will also bring a loss of 60% of those responding to a poll ures show that even a limited roll-out cause all GPs would be compelled to be members of a consortium, whereas fund- One reason for such strong tary and NHS Commissioning Board (The triumph of hope over experi- Even the NHS Alliance, which has thousands of NHS jobs, many of them on the website of the strongly pro- of Practice-Based Commissioning, a holding was only open to the largest GP practices. concerns was that it was well known that only radical legislation on the ence: page 8) taken an ambiguous position on the managers, but many more admin staff, White Paper National Association of precursor to the White Paper propos- Lawrence Buckman, chair of the BMA’s GP Committee insists that “This is defi- that in the early and mid 1990s one scale of the 1948 NHS Act – which na- By contrast Andrew Lansley is now proposals has warned that the defi- clerical workers and clinical staff in Primary Care were opposed to the als, cost around twice as much in in- nitely not the son of fundholding. … if it looked like fundholding mark 2 I would of the first “freedoms” that the new tionalised the mish-mash of munici- proposing to increase again even fur- cits which PCTs are likely to pass on front lines services. government’s commissioning plans – creased costs as it appeared to gen- not be interested in it.” NHS Trusts began to exploit was the pal, charitable and teaching hospitals ther – from 152 PCTs to 500 or more lo- the GP consortiums could mean that However this does not mean that that the NAPC is vociferously support- erate in savings, even as a voluntary Buckman has focused on the fact that consortiums and GP practices will not freedom to build or expand their delivering health care – could bring cal GP consortiums, and seeking to cut the experiment in commissioning is there is any guarantee the new poli- ing. scheme. The PBC practices overspent be able to retain unspent surpluses: but they are likely private patient wings – although them back into the pubic sector. management costs. This appears to be “doomed to fail”. to face potential penalties for overspending, which could there is little evidence that many, potentially skew the clinical judgement of some GPs. if any, of them made much actual Many GPs already fear that the fragmentation of com- profit from them. The cost of replacing PCTs missioning, a feature under fundholding, once again This siphoning off of resources The biggest-ever privatisation of health care from NHS patients resulted in threatens a return of the same “postcode lottery” on If the White Paper is carried through as a catastrophe: a break-up of the Contracts with private hospitals Of course Lansley chose soft tar- thing they have done has been with- whether patients are offered certain treatment, as differ- another widening of inequality gets when he singled out the PCTs out value, nor are all their staff point- within the NHS, driven by market to its logical conclusion, by 2014 NHS team, the casualisation of the to deliver waiting list treatment ent consortiums exert their own rights to decide. there will be no NHS or public workforce, a plunge in hospital have cost massively more than and SHAs for closure, and cunningly less bureaucrats. Nor is it true that Different decisions between one consortium and the forces. pushed the right buttons with some simply scrapping them will necessarily One attraction to Foundation sector providers delivering health hygiene, and the spread of MRSA normal NHS costs, while the next on what level of services to commission would leave care services in England. Hospitals, and hospital infections. delivery of minor elective surgery frustrated GPs when he suggested produce anything better. patients in some areas with access to certain treatments Trusts of income from commercial they take over the commissioning Subdividing 150 PCTs into 5-600 GP medicine is that it is not restricted community health services and The minimal apparent short-term in “Independent Sector Treatment and others in other areas without. mental health will all have been cash savings made at the expense Centres” cost an average of almost role. It would be hard to find anywhere consortia, each of 80-100 GPs, will inev- Neighbouring consortia could even take opposing or squeezed in the same way as else in the public sector where the itably raise the question of how these public sector NHS budgets will be forced to become, or join Foundation of their lowest-paid staff by the 12% more than the standard NHS views on whether to commission local services from Trusts, or will have been put out to hospitals which contracted out these price, but also wound up spending possible loss of 60,000 jobs creates so are to work either singly or together. hospitals or mental health providers: the danger here is for at least the next five years. little anger or militant resistance. It seems certain that many of them So this also means that as tender to ‘social enterprises’ or the services have been subsequently millions on operations that did not that the withdrawal of even part of the current funding for some services could in for-profit private sector. more than swallowed up by inferior take place as patients chose to go to Few PCTs or SHAs have done any- will resort to re-hiring staff made re- some cases force Trust bosses into wholesale cutbacks or service closures, reduc- budgets are frozen in real terms, thing to endear themselves to local dundant from PCTs – or spend even and pressures increase, Foundation Privatisation on this scale quality of services and the costs of NHS hospitals instead. ing the choices for patients. is unprecedented anywhere in additional bed days, closed wards Private sector bids for primary communities – many of which have more to bring in private manage- The proposal to limit the management budgets for the new consortia is likely Trusts will be more tempted to seek been systematically patronised and ment consultants to do much of the out profitable paying customers the world, so there are no direct and other problems from hospital- care contracts have tended to force to restrict the resources to buy in locum care to enable GPs from smaller practices comparisons that can be made. acquired infections. down the quality of care, reducing ignored in spurious “consultation” ex- administrative work that still needs to to get involved in decision-making. – whether from the UK or abroad – ercises – or to the many sections of be done: and with NHS providers hav- to compensate for shrinking NHS However we do know that There is more unhappy prices by employing fewer, less This would strengthen the influence in consortiums of the larger and more competition and private sector experience of private sector qualified staff than established local staff in NHS staff in provider services ing to negotiate with more separate wealthy practices, which tend (as with the pioneers of Fundholding) to be based income, and to prioritise this work who have been on the receiving end groups of “purchasers” the total bill for over the treatment of NHS patients. providers can force standards down, involvement. GP practices. in the wealthier areas. as happened when hospital cleaning Repeated attempts by New Huge questions hang over of some of their decisions. bureaucracy will not fall by much – if So the needs of more affluent patients are in many areas likely to dominate Some specialist Foundation Trusts So it’s true that nobody could build it falls at all. are already looking to expand their services were privatised under Labour to draw the private sector the quality of services and poor over those on lower income with greater health needs who live in relatively de- Thatcher in the 1980s. into providing NHS services have regulation and monitoring of private a credible campaign simply to defend But the new bureaucracy will be prived and inner city areas. This could bring the very opposite of the “Excellence income from overseas patients. PCTs or SHAs. But by no means every- even less accountable than the PCTs. The result of that experiment also proved costly and delivered companies delivering out of hours and equity” promised in the White Paper. has now been widely recognised questionable results. GP cover. Page 6 Page 7

The NHS Confederation has warned NHS bosses that they Business as usual, as must “think big” and seek large-scale changes if they are to meet tough targets to squeeze down costs and spending. Jobs on Brum’s This could mean that “beds and wards need to be closed, Lansley drops but also entire buildings and possibly whole sites.” And the Confed report ‘Dealing with the Downturn’ also the line £2.6bn challenges the myth widely spread by NHS managers at every “moratorium” level that savings of this scale can be made with no further The most recent global impact on frontline staff. estimate is that 11,000 job PFI “The changes that will be required are so significant that it losses have been announced in on closures is almost certain that frontline services will be affected.” the NHS this year by 106 Trusts, raising the concern that 40,000 fiasco Andrew Lansley’s much-vaunt- sures was only ever an oppor- could be lost in England alone. effective veto that Lansley ap- tion of local GPs. l Plymouth’s Derriford The new £627m super- ed “moratorium’ on closures tunist electoral ploy, and once Wiard Andrew peared to offer GPs, apparently In North East London, GPs Hospital has announced hospital in Birmingham of A&E and maternity units, the Lib Dems had smoothed licly dangling for a few weeks um was flagged up at the end allowing them to block clo- are furious that their objections which he theatrically unveiled the path to Tory power there after the election, until a “review” of July by NHS Chief Execu- plans to cut £27.5m from opened to patients in a sures they did not support, is are being ignored as health its £370m budget: no job fanfare of publicity in June, at one of the threatened hos- was no need to maintain the of the closures at QMH was an- tive David Nicholson, who ex- being brazenly disregarded by chiefs press ahead with the pitals, Chase Farm in Enfield, is pretence any longer. nounced – to be conducted by plained that it would be up to cuts yet identified. but within a couple of weeks desperate Trust and PCT bosses closure of A&E and other serv- l Reading’s Royal the 1213-bed hospital already dead and buried. One early embarrassed Simon Robbins, the chief hitman Strategic Health Authorities to trying to force through spend- ices at King George’s Hospital In fact even as he an- casualty of this was Bexley MP driving through the closure! decide, by October 31, whether Berkshire Hospital is to cut was diverting patients ing cuts. in Ilford. Health for North East £60m with 600 job losses to surrounding hospitals nounced it, Lansley pointed James Brokenshire, who had Other services like to be contested closures should go In Kent, GP organisations London even admitted that out that it would probably not rather unwisely trumpeted his hacked back on a similar basis ahead, and warning against from its 4,500 staff. because it couldn’t cope. have complained that a con- there had been “more disagree- l Kent’s three PCTs Plumbing problems apply to closures that had al- claim to have a personal prom- of already completed consul- “potentially vexatious objec- troversial closure of mater- ment than support” for their ready gone through the usual ise from Lansley to rescue the tation include Chase Farm (yes tions” from stakeholders who have revealed plans to compounded the misery, nity and paediatric services at plans to axe services at King axe 40% of management with patients complaining sham NHS “consultation” pro- threatened Queen Mary’s Hos- the same one where Lansley remained opposed. Maidstone Hospital are being George’s – but insisted that pa- cedure. pital in Sidcup. drew his line in the sand). And there is evidence from posts over three years. of scalding showers and pushed through despite then tients “would benefit” from the l The pledge to halt amy clo- Brokenshire was left pub- The end of the moratori- around the country that the Nurses in Shropshire freezing water in wash basins, overwhelming (91%) opposi- changes. have been asked voluntarily while nurses could not get to cut their shifts to help Mid Yorks £55m cuts: 500 jobs cold water out of taps in management avoid axing jobs. clinical areas. Bizarrely the same managers UNISON has warned for years attacks on staff terms and con- staff. But the Trust is already fac- banks – which are now pocket- One patient was almost at the Royal Shrewsbury that the full cost of the new ditions and the draconian new ing severe bed shortages, and ing huge profits once again. struck by a light fitting which London health chiefs and Telford’s Princess Royal £353m Private Finance Initia- management regime for staff scouring the local community The Mid Yorkshire Hospitals fell from a ceiling. Hospitals are also trying to tive (PFI) hospitals in Wakefield transferring into the new build- for additional beds, while Julia Trust’s financial problems flow Short-staffed nurses under cut use of agency staff. and Pontefract would mean ing. Squire insists that “more care in large measure from the in- stress were heard by patients l York Hospitals massive cuts in staff, pay and This is not incompetent or will move closer to people’s creased costs of the PFI project, arguing with doctors about Foundation Trust has conditions. thoughtless management, but homes.” which delivers guaranteed staffing rotas and inadequate dust off their plans Trust Chief Executive Julia a deliberate plan to press more Ms Squire claims to the Ex- profits to the private sector for announced the need to numbers to cope with a cut £30m over three years Squire has now admitted to staff to walk away – and dump press that the workforce plan the next 32 years, and which higher than expected number and asked staff to suggest the local Express that the Trust the work on those staff who re- has been the product of discus- means the NHS will fork out of emergencies. how it should be done. aims to cut £55m by 2012 – in- main. sions and ‘open meetings’ with £1.2 billion for a hospital valued The hospital is one of the for cuts and closures l 130 PCT management cluding £38m this year, which That’s what they mean by staff: but the reality is a hard- at £353m. first PFI-funded hospitals means cutting the wage bill by ‘natural wastage’ and ‘staff turn- faced management who have The UNISON branch has Health for North East London PFI scheme, which will not even jobs are to be axed by to exclude non-clinical A look at the Strategic £20m by next March. over’: either way it means more refused to answer questions, vowed to fight “any redundan- certainly seems determined open until 2013. NHS Leeds over three support services from the documents covering 500 jobs are affected, with work, and more stress on the consult with the unions or even cies whatsoever, whether com- to grind on with controversial So massive would be the years to save £5 million. contract: but it will still cost an estimated 150 redundan- staff who stay on. respond when grievances and pulsory or ‘voluntary’”, and de- London’s health care cuts and closures it outlined at reduction in activity at King l Wakefield PCT is to cut the Trust a massive £2.58 cies: in other words the Trust is The opening of the new disputes are formally notified. manded the full nationalisation seems like a real blast the end of last year. George’s that its remaining more than 40 management billion over 35 years, with looking to squeeze out another Pinderfields Hospital brings a Of course the “public sector of the Royal Bank of Scotland, from an already- Under the plans, just two acute services would require jobs to save £1.4m. Further payments beginning at £47m, 350 staff without paying a pen- cut of 100 elderly care beds – a deficit” driving the squeeze on “to eliminate profiteering from hospitals, The Royal London just one third of the space it cuts of £4m will follow and ending in 2048 with a forgotten past of ny in severance. reduction of 43% – and the loss NHS spending flows from the health care and lift the burden in Whitechapel and Queen’s currently occupies, and more in the next two years. payment of £108m. polyclinics, Darzi That helps explain the new of 64 whole time equivalent crisis of the private sector – the of PFI”. Hospital in Romford, would than half the site to be moth- l NHS Northamptonshire plans, and the mumbo- become “major acute” hospi- balled or stripped of services is to cut 56 jobs and leave jumbo of “World Class tals: others (Homerton, Whipps and sold off. The plans include 22 vacant posts unfilled Commissioning”. Cross and Newham) would be a £6 million allocation for re- as it struggles to cut Firms bid to run Hinchingbrooke Hospital But as the cash downgraded to “local hospitals” dundancies. management costs by £3.5m. – and King George’s Hospital in Hospital outpatient ap- l Aintree Hospital is squeeze tightens on Ilford would be stripped of most pointments would be more planning to cut the equivalent Trusts and PCTs, the of at least 300 jobs, and If these of its acute services and effec- than halved, with almost a mil- cuts proposed in the tively reduced to a large poly- lion appointments in NE Lon- is asking all 5,000 staff to dying days of Gordon clinic with as few as 50 beds. don moved out of hospital clin- NHS London consider voluntary redundancy Brown’s government 827 acute beds would be ics to primary care “settings” in- or moving on to flexible hours. companies are cut in NE London, just over cluding polyclinics. suggest that if no ‘savings’ are worst case of £283m. explained) estimated savings are the only real 20% of the total. More than With hefty losses of income Cambridge made, inner NE London would To redress this gap the sec- ranging from £10m to £70m. UNISON in Cambridge proposals on the table, half of them would be at from this relocation of work, on a best case (“upside”) face a tor plan suggests a combina- Putting a range of primary University Hospitals Trust and controversial King George’s, but also 146 in the financial viability of hospital the answer … £118m shortfall by 2017, while tion of measures: care, mental health and com- has pledged to fight plans to Whipps Cross Hospital and a Trusts in NE London could only closure plans are the worst case would see a gap “Decommissioning services” munity services out to tender, axe 170 nursing jobs as part UNISON Eastern Region has is less than 27 years old, and hefty 234 beds in Bart’s and the be maintained if they generate being dusted off again of £257m. The figures for outer (estimated savings £60m-£150m) with forecast “potential” sav- of a £40m cuts programme been battling to prevent the has a total of 310 adult beds, in London, raising extremely seri- massive ‘productivity gains’ to- NE London are similar, with a “Shifting acute activity to ings of £200m to £550m “de- over three years. But the privatisation of the manage- addition to 25 paediatric beds after the brief Lansley ous questions over the afford- talling over £500 million a year. best case gap of £144m and a a lower cost setting” with (un- pending on how aggressive the local Scrutiny Committee has ment of Hinchingbrooke Hos- and 12 SCBU cots on the site moratorium. ability of the Trust’s £1 billion The financial projections commissioners chose to be”. warned that the cuts could pital in Cambridgeshire. (run by the PCT). It has em- The NE London estimates be as high as 500 jobs in total, The Huntingdon hospital ployed up to 2,000 staff. North Central London South West London “assume net savings of £142m with vacancies left unfilled. seems set to become one of the Its scale and mix of services North Central London’s Strategy is driven by the need In South West London only St George’s is guaranteed from decommissioning and UNISON will oppose any very first District General Hos- makes it more than six times to bridge a projected resource gap of £560m by 2017, to retain its existing services, since it has been desig- shifting settings of care,” and staffing cuts which put patient pitals franchised out to a profit- bigger – and many times more and seeks to ‘reconfigure’ hospital services with the nated as the only “major acute” hospital in the sector. another £273m a year to be cut care and standards at risk. seeking private company. complex to run – than the av- loss of 250-500 beds, and to reduce the number of This means that Kingston, Epsom & St Helier and May- from non-acute services, giv- The “franchise” to manage erage private sector hospital. mental health beds in addition to squeezing more “ef- day Trusts all have a doubtful future, with the possibili- ing a grand total of £415m of North East the district general hospital Private hospitals in Eng- ficiencies” from staff and shifting large volumes of A&E ty of the loss of maternity, paediatrics, or other services savings by 2017, with the lion’s Hundreds of jobs are at was controversially put out to land have an average of just and other work from hospitals to primary care. The Case for Change document warns that share of these savings to be risk and 450 beds (14% of the

tender by NHS East of England 50 beds, and focus exclusively John Harris reportdigital.co.uk The five acute Trusts within the sector face a poten- “If no changes are made we estimate that by generated by local hospitals, total) threatened with closure 18 months ago, on the flimsiest on elective treatment for non- tial combined deficit of over £350m by 2016/17 – al- 2016/17 the NHS in south west London could be mental health Trusts and com- in the North East by 2104 of evidence – and despite be- complex conditions: they do most 20% of their current combined revenue. spending around £300 million more than its predicted munity services. to carry through savings of ing reminded of the disastrous not offer emergency surgery or transferred by ambulance to an tively few full-time staff (mainly failure at Good Hope Hospital The publication of the plan came in the midst of budget”. The biggest savings target £800m, driven by the Condem failure of the only previous medicine, and any patient de- NHS hospital. nursing and support staff) with in Solihull. There a growing public anger at plans that threaten the future is a 35% saving on expenditure government’s £20 billion attempt to franchise out man- veloping complications will be Private hospitals have rela- doctors mostly working only 3-year contract with Secta of A&E services at Islington’s Whittington hospital and South East London by the Barking Havering & Red- target for “efficiencies”. The first on sessional basis. to manage the 550-bed hos- In South East London Powerpoint slides from Simon agement of a whole hospital to the running down of services at Enfield’s Chase Farm bridge Trust, but Bart’s & the redundancies could begin as Neither Circle nor Serco has pital began amid a welter of Robbins, the “senior responsible officer,” project a fund- a private company. Hospital, where A&E services remain controversially London is required to generate early as October. 1,700 jobs any previous experience of optimistic publicity in Septem- ing gap of £467m to 2014. By 2016/17 the potential After the only remaining under threat, along with obstetric, neonatal, inpatient the largest amount in savings are to go in Cumbria and the Top ten deceptive claims … running a large, busy general ber 2003, but was terminated gap is projected to reach £810-£1,090m. public sector bid, from the paediatric and emergency gynaecology services. (£211m), equivalent to 32% of North East. County Durham hospital. Each of them has a eight months early, at the end SE London apparently plans to tackle the funding Cambridge University Hospi- NHS East of England continue to frustrate and annoy local its current spending. and Darlington NHS Trust questionable record of involve- of 2005, when the running of gap through imposing cuts to the tariff for acute care tals Trust, was withdrawn in people and campaigners by pumping out deceptive statements North West London Among the “opportunities is aiming to cut £60m, 300 ment with the NHS. the hospital was handed to the Covering eight London boroughs and accounting for (£224m) and significantly also for mental health (£62m) February, blaming “the huge such as their claim in the “Top Ten Facts” that:

Andrew Wiard Andrew for productivity gains”, the NE beds and 300 nursing jobs. UNISON has argued from management of Birmingham almost a quarter of London’s health spending NW Lon- – equivalent to 13% of the income of the two mental cost, both in time and money, “Hinchingbrooke is not being privatised. What is being London health bosses propose: the beginning that none of the Heartlands Hospital Trust. don faces a huge cash gap for both commissioners But the biggest doubts hang over the future of health Foundation Trusts that deliver services to the of the bidding process”, the offered is a franchise to operate the hospital.” A 21% to 37% saving on Bristol shortlisted companies is suit- During the contract the and providers, seeking a £796m reduction in hospital Ealing Hospital and the financially challenged West sector (Oxleas and South London & Maudsley). short list of five private com- So who are the shortlisted companies to win that franchise? nursing costs Campaigners who raised able to take on the manage- company successfully jacked budgets through shifting work elsewhere, “decommis- Middlesex Hospital in Isleworth. Ealing is to be merged Substantial disinvestment from mental health is panies has now been whit- Two private companies, with no public sector contender left in A saving of between 9% and £4 million to fund a specialist ment of Hinchingbrooke, and up its own fees by 48% in its sioning” services, “cost improvement plans” and other with the newly-merged PCT provider services in Ealing, planned. tled down to just two: Circle the frame: the management is being privatised. 43% in spending on doctors children’s unit at Frenchay that the quality of patient care first year, and by the time the cuts. Brent and Harrow to become an ‘Integrated Care Or- SE London is also looking to save £31m by trans- Health, and Serco, the services Or what about this whopper? Slashing drug spending by Hospital are furious that it will is being put at risk. acting chief executive, finally As a result NW London faces some of the more dras- ganisation’ – In other words the hospital will effectively ferring acute activity to “lower cost settings,” £79m by company that runs the Dock- “The successful franchisee will not be making a profit at the 22-25% now be closed and the services If these companies are cleared her desk, the Trust was tic upheavals in the capital, and health chiefs admit in wither away and close, leaving nothing more than a decommissioning services, preventive measures and lands Light Railway expense of patient care. They will be subject to the same clinical Reducing overhead costs to moved to the other side of the answer, then NHS East of in a far worse state that when their Integrated Strategic Plan that it will “inevitably result polyclinic at best on the site. better management of long term conditions, and a The only company with any and operational scrutiny as every NHS hospital.” “benchmarked best practice”, Bristol, at a cost of £20 million. England has been asking the she started – losing money at in fewer beds in the acute sector” and “substantial acute The West Middlesex board has apparently “clarified hefty £109m from reducing costs in non-acute services substantial experience of run- So have East of England bureaucrats told the companies that saving 34-42% of overhead Frenchay will be wrong questions. £1 million per month, heading hospital reconfiguration”. This could potentially leave no that they do not believe that their organisation has an (community and primary care). ning (private) hospitals, Ram- they are expected to carry out the work for no profit? Of course costs downgraded to a l The track record of pri- for a £47 million deficit , and major acute hospital between St Mary’s Paddington and independent future”. It seems it could follow Hinching- The NHS London map shows that the decision on say Health Care, an Australian not, or they would have pulled out even earlier than managers Other “productivity gains” community hospital, as a vate sector management at- threatening to pull down the the M25 (17 miles) or Heathrow airport (15 miles). brooke Hospital, in Huntingdon as one of the first to one SE London hospital (Queen Mary’s Sidcup) has al- company, was excluded from at Addenbrookes. (such as in theatres and diag- new “superhospital” funded tempting to take over and turn entire local health economy. Chelsea and Westminster Hospital is to be effective- have its management put out to tender, and it could ready been taken: it will be downgraded to an “urgent the running by East of England With the future of SHAs looking gloomy, those overpaid East nostics) to save up to 32% of through the Private Finance around NHS hospitals has been Why won’t NHS East of Eng- ly downgraded to a “specialist and local hospital,” as is be reduced to a ‘local’ hospital or to purely an elective care centre” and elective centre, losing most of its acute in August. of England jokers just keep on making it harder to find the will costs. Initiative opens in Southmead. disastrous. It was a lamentable land learn from this failure? Central Middlesex Hospital. centre. inpatient services. Hinchingbrooke Hospital to fight the Condem plans to abolish them. 2-year pay freeze – and threat of pension “review” The ConDems are imposing a pay freeze on all NHS staff paid more than £21k/year, with a below inflation increase of just £250 for those paid less than this. This would mean only 38% of NHS staff in England who are on pay points 1-15 getting a rise next year. The so called independence of the PRB will be tested once again if a pay freeze is imposed from above by the government after evidence is submitted as usual by unions in September. The biggest health union UNISON is going ahead with the data cleansing needed to ensure that its members are able to take industrial action without legal interference as agreed in the motion on pay passed at its Health Conference this year. UNISON members will be consulted on how to respond to the pay freeze: but this is by no means the only threat that NHS staff face. This autumn the ConDem Review of Public Sector Pensions makes its report. The review, which has disgracefully been chaired by former Labour Minister “Lord” John Hutton, is expected to slash NHS pension benefits, as well as those of other public sector workers. UNISON national conference in July voted for national industrial action across the public sector if pensions are attacked.

found that two thirds of those White Paper threat responding did not welcome the Lansley white paper, and 80% said they were not ade- quately equipped to take over commissioning mental health services. to mental health Mind’s chief executive Paul Mental health professionals clinical psychologists. mental health care is increas- Farmer also warned of weak- and campaigners have round- Older adult services will also ing and the severity of the nesses in GPs’ approach to ed on the ConDem govern- face cuts in professional staff. problems faced by patients is mental health issues: “There is ment for its combination of Meanwhile a trade union increasing, with a greater ex- still an instinct for some GPs to damaging cutbacks, and the representing some of the com- pectation that services will reach for the pills too quickly threat that mental health serv- munity mental health staff, be available ”closer to home”, – we have 36 million prescrip- ices will lose out even further Unite, has warned that up to 50 home visits in Oxfordshire and tions a year for anti-depres- sants, a vast amount at primary

under the new plans to hand of the Trust’s 200 staff in adult Buckinghamshire would be cut. reportdigital.co.uk Wolmuth Philip care level.” over the commissioning role to mental health teams could lose Other cuts are taking shape Workers at the Hackney Centre for Forensic Mental Health join a GPs. their jobs in the cuts, after in- in mental health services in Mental health problems on Unison protest outside East London NHS Foundation Trust against average take up between 10%- In July a heavyweight medi- patient services have already London and other parts of privatisation and cuts cal journal, the Lancet , pub- been cut “to the bone”. the country including Sussex, 20% of the time of a GP, with lished an editorial demanding where a quarter of inpatient for incapacity benefit does not many of the 1.5 million people around three out of every four Health Secretary Andrew Lans- Poorer service beds are to close, affecting take proper account of the fluc- with severe mental illnesses people who experience mental ley “tell the truth about NHS The document leaked to the services in Haywards Heath, tuation condition of many with may fail to get the treatment health problems seeking treat- cuts” in front-line services, sin- Lancet admits that the cuts will Eastbourne and St Leonards to mental illness, and that staff they need. ment from their GP. gling out the brutal cuts being bring a “reduction in quality save £4m. running the assessments are Rethink’s Chief Executive Every year 300 out of every carried through against mental of service”, poorer service re- In central London, NHS insufficiently trained in aware- Paul Jenkins said: “We often 1,000 people experience some health services in Oxfordshire, sponse with “patients waiting Camden is planning to put ness of mental health issues. hear from people with mental form of mental health prob- illness that GPs don’t under- and contrasting this with Lans- for care” and “dissatisfaction” psychological services out to GPs say no lem: but it seems that the NHS ley’s pre-election pledge to “in- among patients and carers. tender, triggering fears that a stand mental health and want has a long way to go before Long-term concerns for the crease health spending every The impact on staff is also private company could step in. to quickly refer them on to spe- this scale of importance is rec- future of mental health services year”. admitted to be serious, with Indeed other government poli- cialists. Now GPs themselves ognised in the allocation of re- under the White Paper propos- Oxfordshire and Bucking- the Trust predicting “potential cies are also causing problems are telling us that they have sources. als have been reinforced by hamshire Mental Health Foun- negative impact on staff from for mental health patients, not concerns too. Instead of moving towards the survey of GPs in July which dation Trust is pushing through them perceiving an increase in least the latest onslaught on “The proposals expected in meeting this level of demand, showed that as few as one in plans to slash £5.3m from its their workload”, “poorer staff the benefits system which will the white paper can work, but the White Paper proposals will three felt equipped to take on £42m budget (12.6%) over the retention and reduction in staff target people on incapacity only if GPs are given proper create an even more random any responsibility for commis- next four years, hitting front- satisfaction with their role”. benefit. training and support to under- “postcode lottery” for mental sioning on mental health. line services for both adults and Perhaps even more worry- The new “fit to work” policy stand the needs of people with health patients … and place Mental health charity Re- older adults. ing the document also warns could mean that people suffer- severe mental illnesses such as millions in commissioning think, which conducted the Adult services are to lose 3 the decreased patient satisfac- ing from mental illness would schizophrenia and bipolar dis- budgets in the hands of GPs survey, warned that unless out of 19 consultant psychia- tion could lead to “possible pa- be declared capable of work. order.” who recognise that they are there was rapid action to edu- trists, 16 coordinators and 9 tient withdrawal from care”. Mental health charity Mind Another survey of GPs by not trained to it properly, and cate GPs on mental health, other staff, along with cuts in At a time when demand for has warned that the new test the doctors.net website in July don’t want to do it. Health Emergency Affiliate now to Health Emergency! publicity services London Health Emergency, launched in 1983, works with local campaigns and health union branches and regions PLEASE AFFILIATE our organisation We produce professional- all over England, Wales and Scotland. to Health Emergency. looking tabloid branch and The campaigning resources of Health Emergency I enclose £15 o £25 o £…… for affiliation regional newspapers, and can depend upon affiliations and donations from also research and draft detailed organisations and individuals. 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