KEEP OUR NHS PUBLICKEEP OUR NHS PUBLIC

Wendy Savage MBBCh(Cantab) FRCOG Wendy Savage MBBCh(Cantab) FRCOG MSc(Public health Hon DScMSc(Public health Hon DSc

CroydonCroydon

55thth June 2008 June 2008

KeepKeep OurOur NHS PublicNHS Public

Launched September 2005 by Launched September 2005 by

NHS Consultants Association, NHS Consultants Association,

NHS Support FederationNHS Support Federation

and Health Emergencyand Health EmergencyWebsite Website

www.keepournhspublic.comwww.keepournhspublic.com

Aims of KONPAims of KONP

To build a broad non-party political To build a broad non-party political coalition which will campaign to protect coalition which will campaign to protect the NHS from further privatisation and the NHS from further privatisation and fragmentation fragmentation To inform the media, public and MPs To inform the media, public and MPs about the government ‘reforms’about the government ‘reforms’To keep our NHS public which means To keep our NHS public which means publicly provided as well as fundedpublicly provided as well as funded

Background to the ‘reforms’Background to the ‘reforms’

The NHS Improvement plan 2004The NHS Improvement plan 2004

Original plan was published in 2000, updated Original plan was published in 2000, updated in June 2004in June 2004

  The stated aims are: The stated aims are:

To increase capacityTo increase capacity

To extend choiceTo extend choice

  To reduce waiting timesTo reduce waiting times

ProgressProgress so farso far33 KONP groups have been established.33 KONP groups have been established.72 other groups, many pensioners or those fighting cuts 72 other groups, many pensioners or those fighting cuts locally locally 90 unions or union branches have affiliated. 90 unions or union branches have affiliated. Over 5000 people have expressed interest in the group. Over 5000 people have expressed interest in the group. KONP speakers have addressed meetings in many towns KONP speakers have addressed meetings in many towns including Bristol, Sheffield, Lancaster, Liverpool, including Bristol, Sheffield, Lancaster, Liverpool, Bournemouth, Norwich, Northampton, Harlow, Bournemouth, Norwich, Northampton, Harlow, Southampton and several places in London.Southampton and several places in London.Distributed 53,000 leaflets, 3000 postcards and sold 13,000 Distributed 53,000 leaflets, 3000 postcards and sold 13,000 copies of ‘Patchwork Privatisation’copies of ‘Patchwork Privatisation’Sold over 100 copies of Confuse and Conceal Sold over 100 copies of Confuse and Conceal

Important consultationsImportant consultations

Your health,Your health, Your care, Your sayYour care, Your say widespread widespread consultation September-November 2005.consultation September-November 2005.

Four sites for public events, Gateshead, Leicester, Four sites for public events, Gateshead, Leicester, Birmingham, London. 42,000 people contibuted Birmingham, London. 42,000 people contibuted via Q, focus groups etc. Report and White paper via Q, focus groups etc. Report and White paper January 2006 Our Health. Our Care, Our SayJanuary 2006 Our Health. Our Care, Our SayDarzi 2007 ‘Framework for Action’ Consultation Darzi 2007 ‘Framework for Action’ Consultation closed in February for both NHS staff and GPs closed in February for both NHS staff and GPs 1515thth and public 25 and public 25thth but there is Lord Darzi’s blog but there is Lord Darzi’s blog on on www.ournhs/nhs.ukwww.ournhs/nhs.uk which you can complete if which you can complete if you missed thisyou missed this

March 2005 Creating a ‘patient-led’ NHS-March 2005 Creating a ‘patient-led’ NHS-delivering the NHS improvement plan.delivering the NHS improvement plan.

This moves from ‘patient centred NHS’ to This moves from ‘patient centred NHS’ to ‘patient-led NHS’‘patient-led NHS’.‘the ambition is to move from a service that .‘the ambition is to move from a service that does things to and for its patients to one which does things to and for its patients to one which is patient-led.’is patient-led.’‘‘the ambition is …..to change the whole system’the ambition is …..to change the whole system’Simon Stevens advisor to Blair ‘creative Simon Stevens advisor to Blair ‘creative destruction’- he is now the president of United destruction’- he is now the president of United Health EuropeHealth Europe

Key elements of the ‘patient-led’ NHSKey elements of the ‘patient-led’ NHS

Patient choicePatient choice Payment by resultsPayment by results Tariff payment ie a fixed national price for each Tariff payment ie a fixed national price for each procedure used to have a block contract systemprocedure used to have a block contract system Multiple providers from the NHS, private and Multiple providers from the NHS, private and voluntary sectorsvoluntary sectors A strategic shift into primary careA strategic shift into primary care Practice based commissioningPractice based commissioning

Creating a health care marketCreating a health care market

Commercial Directorate set up June 2003Commercial Directorate set up June 2003First Wave ISTC contract September 2003First Wave ISTC contract September 2003

Expected to provide 170,000 procedures a Expected to provide 170,000 procedures a year for 5 years at a cost of £1.6 billionyear for 5 years at a cost of £1.6 billionGSupp contracts 125,000 operations a year GSupp contracts 125,000 operations a year for 5 years for £200 millionfor 5 years for £200 millionMay 2005 Extended Choice Network of May 2005 Extended Choice Network of private hospitalsprivate hospitalsMarch 2008 Hospitals can advertiseMarch 2008 Hospitals can advertise

Ask your GP if you could choose to have your treatment at any of the following hospitals in Lancashire: * Euxton Hall Hospital, Chorley . . *Classic Fylde Coast Hospital, BlackpooI*Fulwood Hall Hospital, Preston *Abbey Gisburne Park Hospital, Gisburn • Renaeres Hall Hospital, Ormskirk Picture of a stethosope here

As an NHS patient. you could now have your elective surgery in a treatment centre within an independent hospital.

Visit our website for more information about the services we offer as well ~

as contact details for each treatment centre, www.ramsayhealth.co.uk/nhs

Alternative provider medical Alternative provider medical services 21.4.04services 21.4.04

APMS offers substantial opportunities for APMS offers substantial opportunities for the restructuring of services to offer greater the restructuring of services to offer greater patient choice, improved access and greater patient choice, improved access and greater responsiveness to the specific needs of the responsiveness to the specific needs of the community. It will provide a valuable tool community. It will provide a valuable tool to address need in areas of historic under-to address need in areas of historic under-provision, enable re-provision of services provision, enable re-provision of services where practices opt out, and improve access where practices opt out, and improve access in areas with problems with GP recruitment in areas with problems with GP recruitment and retention.and retention.

Creation of a health care market-Creation of a health care market-ideology not evidenceideology not evidence

Private sector considered more efficient than NHSPrivate sector considered more efficient than NHS

ISTC programme-read Confuse and ConcealISTC programme-read Confuse and Conceal

Privatised procurement –NHS logistics – DHLPrivatised procurement –NHS logistics – DHL

Privatised commissioning-United Health and Privatised commissioning-United Health and Humana amongst 8 private companies 2008Humana amongst 8 private companies 2008

GP contracts to corporations including UH who GP contracts to corporations including UH who have long history of fraud in US and currently have long history of fraud in US and currently negotiating fine from State of California and are negotiating fine from State of California and are being investigated in New York Statebeing investigated in New York State

The resultThe result

In February 2008 ATOS origin awarded In February 2008 ATOS origin awarded contract in Tower Hamlets despite good bids contract in Tower Hamlets despite good bids from two local practicesfrom two local practices

In April United Health awarded contract for In April United Health awarded contract for three GP practices in Camden despite good bid three GP practices in Camden despite good bid from local GPs who had been running one of from local GPs who had been running one of these and had excellent results. VFM criterion these and had excellent results. VFM criterion added after interviewing.added after interviewing.

Threats for health care as a wholeThreats for health care as a whole Fragmentation of care, with loss of continuity of Fragmentation of care, with loss of continuity of the patient pathwaythe patient pathway

Doctors loss of control of which patients they seeDoctors loss of control of which patients they see

Unclear clinical governance issues around the Unclear clinical governance issues around the private sector and foundation trustsprivate sector and foundation trusts

Perverse financial incentives will lead to Perverse financial incentives will lead to inappropriate management of patientsinappropriate management of patients

Loss of staff to the private sectorLoss of staff to the private sector

Adverse effects on teaching and training  Adverse effects on teaching and training  

Threats for health care as a wholeThreats for health care as a whole

Closure of NHS units leading to less real Closure of NHS units leading to less real patient choicepatient choice

Increasing dominance by the private sectorIncreasing dominance by the private sector

Patients become commodities, and high risk Patients become commodities, and high risk patients will be unattractive leading to patients will be unattractive leading to ‘patient dumping’‘patient dumping’

Inability to plan services as a result of Inability to plan services as a result of ‘patient choice’‘patient choice’

Market-driven politicsMarket-driven politics

1.1. Real markets are deeply political-state Real markets are deeply political-state omnipresent-national politics and the state omnipresent-national politics and the state always targets-businesses want to enter NHSalways targets-businesses want to enter NHS

2.2. Convert services into commodities and Convert services into commodities and workforce into one orientated to profit and workforce into one orientated to profit and get government to underwrite risk.get government to underwrite risk.

3.3. Market competition transforms commoditiesMarket competition transforms commodities4.4. Consequences, inequality of provision, high Consequences, inequality of provision, high

costs and corruption (eg US health system)costs and corruption (eg US health system)

Current situationCurrent situationDarzi review due to report in JulyDarzi review due to report in JulyThreat of polyclinics being imposed all PCTs Threat of polyclinics being imposed all PCTs instructed to set one up with very short timescale. instructed to set one up with very short timescale. BMA has launched a campaign to ‘Save our GP BMA has launched a campaign to ‘Save our GP surgeries ‘return signed petition by tomorrow surgeries ‘return signed petition by tomorrow Friday 6.6.08Friday 6.6.08

http://http://www.supportyoursurgery.org.ukwww.supportyoursurgery.org.uk//Head of Commercial Directorate resigned –fraud Head of Commercial Directorate resigned –fraud allegations in USAallegations in USAKings Fund questions polyclinic plan 5.6.08Kings Fund questions polyclinic plan 5.6.08

What can we do ?What can we do ?

Join Keep Our NHS PublicJoin Keep Our NHS Public

Donate money to this campaignDonate money to this campaign

Talk to your MP about the practical Talk to your MP about the practical problems you have experienced or foreseeproblems you have experienced or foresee

Respond to articles or letters in the Respond to articles or letters in the newspapers national & local to inform the newspapers national & local to inform the publicpublic

Attend PCT and OSC meetings regularlyAttend PCT and OSC meetings regularly

Further readingFurther readingColin Leys Market-driven politics (2001) Verso Colin Leys Market-driven politics (2001) Verso Allyson Pollock NHS-plc (2005) Verso Allyson Pollock NHS-plc (2005) Verso John Lister Health Policy Reform (2005) The NHS after John Lister Health Policy Reform (2005) The NHS after 60:for patients or profits? (2008) 60:for patients or profits? (2008)

Middlesex University Press www.MUpress.co.ukMiddlesex University Press www.MUpress.co.ukDonaldson C and Ruta D. Should the NHS follow the Donaldson C and Ruta D. Should the NHS follow the American way? BMJ 2005 v331 pp1328-30American way? BMJ 2005 v331 pp1328-30Lane R and Paton A. Bevan betrayed : the demise of the Lane R and Paton A. Bevan betrayed : the demise of the NHS. BMJ 2005 331 852NHS. BMJ 2005 331 852Craig D & Brooks R Plundering the Public Sector Craig D & Brooks R Plundering the Public Sector Constable 2006Constable 2006Stewart Player & Colin Leys Confuse and ConcealStewart Player & Colin Leys Confuse and Conceal

Merlin Press 2008Merlin Press 2008