NHS in crisis, Channel Four News

Stop the Massive Hospital Rip-Offs, The Mirror

Staff work unpaid overtime to help NHS, BBC

Tough Choices Lie Ahead Warn NHS Bosses, Medical News UK

Public Health Services; compound fractures

The NHS has undergone two decades of ruthless fragmentation, splitting the service into pieces.

When the Tories began this process the idea was simple. If they were to sell off the NHS it was not possible to sell it in one piece, because there was no single company able to take on one of the largest employers in the world. Just like with the railways, by slicing the service into bite sized chunks they hoped to encourage potential buyers and promote competition between previous allies.

So by carving the NHS into piecemeal fiefdoms (or Trusts) they were laying the groundwork for something far more fundamental. But even the initial stages did not stop there, a process of outsourcing work began, the developing privatisation by the front and back door.

This meant that work that may have previously been done by NHS employees, but was not directly health care related, like cleaning or catering, was often farmed out into the private sector, at greater cost, poorer service and far worsened working conditions. Out sourcing has now become the norm rather than the exception from maintenance to payroll to accountancy (Big Four step in to turn around NHS finances, ,Accountancy Age and NHS outsourcing plan exposed, Indymedia), and each and every instance of this is an instance of financial mismanagement. This work was consistently farmed out (under public procurement) to companies like Capita, whose boss, Rod Aldridge, gave a million pounds in ‘loan’ to New Labour (BBC).

Private companies also began supplying health workers to the NHS via agencies, first undermining and then superseding the NHS 'bank' workers. These agency workers would often have a higher hourly rate than the NHS employees, but were working on zero hour contracts with no guarantees of work from one week to the next - more importantly the private agency would be taking a cut for every hour the agency worker worked, often without having to supply or do anything. That is public money going into the pockets of private companies for supplying staff that were previously organised by the NHS on more secure contracts.

Also services like old people's homes and care in the community services were carved into newly launched charities (that frequently go bust). These charities, even when they act in professional and competent manner, which is atypical, cannot rely on any of the advantages of economy of scale - for training, staffing, payroll, etc. So costs go up and services decline.

New Labour did not simply leave this fragmentation untouched, they pursued a policy of deepening and widening the NHS disintegration and privatisation agenda with a renewed vigour. Foundation hospitals and trusts, the brain child of the Blair government were completely opposed by the medical profession and unions. For example the BMA statement on foundation trusts read "Reforms of this type have an internal logic in which the financial strength of the individual organisation is pursued at the expense of other concerns and of competitors within the sector, and which is inevitably in tension with public sector values and concerns."

And public sector union UNISON said that "Foundation Trusts will undermine the provision of an integrated and planned health service and will reinforce inequalities in access to health care. They will have an extremely negative impact on the NHS and staff as there is an emphasis on meeting financial needs rather than health needs."

Currently 25 NHS Trusts have foundation status, and their record is hardly inspiring (BBC News, Foundation Trust Records Deficit) but it is not unsurprising that Trusts are running up record deficits when there are so many people taking their cut. For example, the cost of operations has increased by 9% purely on the basis that private companies have a greater involvement in their delivery.

One area of increasing costs has been drugs which accounts for more than 12% of the NHS budget, all of which goes into the coffers of the drugs companies, despite the fact that we could take a lead from the Brazilian or South African governments and begin producing the same drugs at a far reduced cost by removing the profit motive from the supply of drugs with one swift move – the nationalization of the drugs industry.

The belligerent orthodoxy of the market, the idea of introduction of free competition and private finance has been revealed to be operating on an uneven playing field. As Martin Wicks states in his article Keep our NHS public "In fact there is no competition. NHS organisations are being instructed to hand over work to the private sector. In Yorkshire for instance, the Department of Health has instructed the Trusts in that area to increase the value of work given to the private sector from £3.2 million to £18 million. Brighton hospital has learned that 85% of its orthopaedic work will be simply handed over to a private hospital down the road. Oxford's Nuffield hospital is faced with closing up to half of its beds because it is losing work to a private hospital which has just been opened up nearby. There are many other examples. Between 10-15% of elective work will initially be given over to private companies, not as a result of competition but by instruction of the Department of Health."

Even the Tory shadow health spokesman Andrew Lansley has said "I know that we needed to build hospitals and it is right to do so, but to do it, as the Government did, in a way that transferred little risk but large amounts of profit through PFI, is not necessarily the right way." (Hansard) This, to be honest, is a bit hard to get your head around. But then thankfully he started blaming health workers wages for the health crisis which sets the world back the way you might expect it.

The implications for the resistance

The implications for those who wish to resist further attacks has been that organising campaigns, and trade unions has become that much harder.

Take a hospital that may have once had at most two employers, now there could five or six each with different service conditions, each in different sectors. Bringing all these workers into one union branch is an obstacle that is often (but not always) insurmountable.

There are some notable exceptions, like Colchester General where midwives, cleaners, catering staff and other health workers are all in one branch of unison and all have well trained stewards integrated into a single UNISON branch. But even in this case of good practice recruitment of agency workers and casual admin staff can seem impossible.

Coupled with constant reorganisations in the NHS - that not only demoralise staff but cost money and undermine the effectiveness of services - it leaves union members often disorientated and branches merge, split or simply wither on the vine.

Steve Webb, Lib Dem shadow health spokesman argued that the "constant revolution in the NHS is creating serious financial instability for Trusts. Ministers are making it impossible for Trusts to plan ahead because of their endless reforms. The Government is trying to sort out long term financial imbalances at breakneck speed, with devastating consequences for local services." Unfortunately the Lib Dems simply want to see a more stable, partly privatized, NHS rather than one brought back into public hands and democratic accountability.

And when talking about any latest round of cuts often it will be services that are easy to cut that go first - mental health and learning disabilities, youth services, day services, the very services that have the most dispersed workforces which are therefore often the hardest to organise.

How much are we talking about?

The Royal College of Nursing (RCN) recently commissioned a report that stated that "70 per cent of nurses say their trust is struggling to make ends meet. Nearly 40 per cent of nurses say wards have been closed at their hospitals in order to save money. And more than a quarter, 27 per cent, say they know of operations that have been delayed for financial, rather than medical reasons."

The official government figures say that the total deficit in the UK for NHS Trusts is £1.6 billion between 167 Trusts (Hansard) and this does not include official "efficiency savings" (sometimes called cuts by unreasonable people) of £769 million already made this year.

Perhaps it’s unsurprising that the recent Budget was not used as an opportunity to right off these ‘deficits’ although it is perhaps odd that the NHS got no mention what-so-ever in the budget despite the nationally recognized emergency.

It's hard to see what this might mean at the ground level, so if we look at the figures produced by Eastern Region UNISON of the deficits in the six counties that make up the region.

Cambridgeshire £32.2 million

Norfolk £32.95 million

Suffolk £52.85 million

Bedfordshire £13.96 million

Hertfordshire £46.14 million

Essex £28.15 million

The BBC has compiled a breakdown Trust by Trust on the 27th Jan. So in Cambridgeshire they are going to have to find £32.2 million pounds of savings, even though the government "hit squad" admitted that there was nowhere that cuts could be made. Nevertheless the mental health services are now having to cut around £3 million form day services, Addenbrookes hospital has had to close at least one old people’s ward (F4) and the small Newmarket hospital has cut 16 inpatient beds and the Young People's Service is facing a terrifying level of cut backs.

But whilst this helps illustrate what the cuts mean it also produces a strong element of nimby-ism in those who correctly oppose the slashing of services. David Hewitt, Lib Dem Cambridgeshire MP has argued against the cuts on the basis that the government is biased against Cambridge, Peterborough campaigners have called for the cuts to be shifted to elsewhere in the region and some Hertfordshire groups have argued on the basis of Hertfordshire exceptionalism.

These campaigners are not only on a hiding to nothing trying to shift the pain from one trust to another but also they are refusing to face up to the facts that the local health crisis that they oppose is utterly dependent upon the national government policy of breakup and privatise.

The only way that these local cuts can be fought is by forcing a national policy shift, and this has been why UNISON in particular has had difficulty getting fully behind a campaign to shift the ministers, because the leadership has been engaged in a battle within its own ranks to doggedly hold on to its financial relationship to the very government that has deepened the crisis .

So nationally UNISON has been very good at combating Council Housing sell offs, because it does not require a direct confrontation with national government (and often on a local level they may be opposing Lib Dem or Tory councils) but pulled out of a lobby of Parliament on the NHS crisis earlier this year. This has got to change, Amicus and Unison members are the key players if a real combative campaign is to successfully defend the NHS.

If these local campaigns, despite some of the problems in their rhetoric, can fuse with trade union activists to fight on both a local and national level we can create the seeds of a far more wide ranging and national campaign that might actually win the idea that the profit motive and the NHS simply do not mix.

In Cambridge this campaign has begun

There was a very successful demo in Cambridge in December:

This is to be followed by a ‘May Day’ demonstration on Saturday 29th April:

Coupled with this Youth Service workers have been pursuing a vociferous campaign against the cuts and members of the ‘Friends of Fulbourne Hospital’ have been very active in their opposition to the cuts. The Cambridge MP has publicly attacked the health minister (Howarth attacks Hewitt, CEN) and the Council has refused to accept the cuts in mental health services (£3m mental health cuts put on hold, CEN) but this can only delay rather than prevent what’s happening.

These cuts will have tragic consequences if they are not stopped, in fact they are already biting deep. The Cambridge Evening News reports Julie Deloughery killed herself, possibly directly linked to these cuts in mental health services (Julie's death brings action call from MP and 'I am sorry you had to find my body').

The immediate impact on services are that “Two rehabilitation wards are being closed; an acute in-patient ward is being closed; three adult day care centres are being reduced to two; a ward for older acute patients is being closed; and arts therapies, physiotherapy and electroconvulsive therapy between them have to save £150,000. Other services are still under threat, including the young people's service,” (see here).

Karen Bell, the new Chief Executive of Cambridgeshire and Peterborough Mental Health Partnership NHS Trust demonstrated her complacency when she told the CEN "As well as cutting services, we have £87 million that we are spending. We want to change the way we deliver services so they are in line with the National Service Framework for Mental Health. For example: crisis resolution. It is about being available.”

Whilst Ms Bell might feel that a 10% budget cut is nothing to write home about how are mental health services going to be “available” after they have been withdrawn? So concerned were mental health professionals that they wrote a letter to the News from concerned psychiatrists.

Bell then signed a letter gagging staff from protesting against the cuts. It seems staff are not meant to be too available.

NHS Trusts in the Cambridge area have resorted to selling off assets to pay off their debts but whilst the PCT might be able to find part of this year’s £15 million cut, there is a further £23 million of cuts expected in following years and it will eventuially run out of land and buildings to sell.

Interestingly the local Labour Party has begun to rail agianst those who are “pretending that it is the government that is making the cuts. This is another fabrication. The Primary Care Trusts which are responsible for the funding of the Mental Health Trusts received an 8.4% increase in their budgets from the government this year. They have overspent and have chosen to pass some of their deficit onto the Mental Health Trust.” (See here.)

So the Mental Health Trust has to reduce spending by £3 million pounds and it is not a cut? How silly of us to think so.

Related links

Work stress finding in NHS survey, BBC

NHS death bed tragedy, The Sun

NHS overspending increases waiting times for patients, Financial Times

Katie Grant- No news is bad news for our stressed NHS, Sunday Times

NHS Trusts- who is to blame?, Accountancy Age

IMF warns Britain of £50bn hole in future NHS bill, Telegraph

Post code lottery; on the same day in Norfolk

For more information, see the Keep our NHS Public website.