WHATYOU CANDO TO
DEFENDOUR NHSl Keep up to date: you can get information on the Health Bill from union
websites and Keep Our NHS Public(www.keepournhspublic.com) and
Health Emergency (www.healthemergency.org.uk), and about cuts from the
TUC’s False Economy website (www.
falseeconomy.org.uk)
l Videos are also available via www.
keepournhspublic.com:
Wake Up Call – John Lister, Health
Emergency, provides a witty insight
into the true intent of the government’splans for the NHS.
The Health Industry lobbying
tour – by Spinwatch: Tamasin Cave,
Alliance for Lobbying Transparency,
exposes how the private health careindustry has its tentacles in the heart ofgovernment.
l Write articles / letters for local
papers to draw attention to what the
Health Bill will mean, and how the cuts
are affecting local services.
l Write to and Lobby your MP andcouncillors (and local Lords and Ladies!)- ask Lib-Dems what they are doing
to follow up their recent critical party
policy- demand Labour vote andcampaign against the Bill and NHS cuts.
- demand Tories back the opposition
from backbench Tory MPs such as Sarah
Wollaston.
l Urge your union to follow up themagnificent TUC-organised march on
26th March with further co-ordinatedaction with other unions against every
cutback and move towards privatisationin public services.
l Organise local meetings tobring campaigners together – throughyour union, Trades Council, anticuts committee; involve services
users, pensioners groups and local
community groups. Local Keep Our
NHS Public groups can usually provide
a speaker.
l Join Keep Our NHS Public
nationally, and find out if there is a local
branch – if not, why not set one up withfriends, work colleagues, your union
branch, and community groups.
l Organise lobbies, protests anddemonstrations at meetings of yourNHS Trust, PCT and local authority
Scrutiny Committee, to collectinformation and to challenge cuts or
privatisation.
l Inform the local media about
what you are organising and the main
points of your campaign.
l Support the 38 Degrees
campaign efforts: www.38degrees.org.
uk/. 38 Degrees was key to forcing thegovernment to scrap plans to sell off
national forests: its next big campaign
priority is to protect the NHS.
l Watch / listen to the Andrew
Lansley Rap against the Health Care
Bill by MC NxtGen. Brilliant. www.
youtube.com/watch?v=Dl1jPqqTdNol Health & Social Care Bill SPECIAL ISSUE l Update July 2011

All unions together against ConDem cuts and privatisation on March 26: we must keep up the same level of fight against Lansley’s Health & Social Care Bill

Don’t be fooled by cosmetic amendments

Despite widespread opposition, andthe BMA calling for it to be scrapped,
Andrew Lansley’s only slightly
amended Health and Social Care Bill is
to have its Third Reading in the Houseof Commons in September, before
going on to the House of Lords.
After the empty charade of the“pause” and so-called “listening
exercise,” and still ignoring theoverwhelming opposition of GPs,
hospital doctors and almost allgroups of health professionals, theBill is still rotten to the core, with its
key proposals unchanged.
If it is passed into law it willspell the end of the NHS as weknow it, and open up the biggestever privatisation of health careanywhere in the world.
How has it got to this point withso little resistance?
One key reason is that the
ConDem government and theTories in particular have brazenly
lied through their teeth about theirintentions – and most of the press
has swallowed the lies.
Lansley and Cameron promised
to “cut the deficit, not the NHS”, andreal terms increases in NHS spending

every year – yet George Osborne’s
budget means that this next financial
year will see a £1 billion CUT in realterms NHS spending, with more cuts
to follow year after year.
And this is on top of the £20
billion target for “efficiency savings”
by 2014: already the tide of job losses
is mounting.
Lansley cynically promised to stop
closures of A&E and maternity units:
yet many of those he promised to saveand many more will be among theservices axed as the cuts take shape.
Lansley and his LibDem bagmen
promised to cut management costsin the NHS: but instead we have theprivatisation of NHS management and“back office” functions, with admin andmanagement tasks being dumped
onto over-stressed front line staff.
Lansley’s White Paper last summerand Health and Social Care Bill –too complex and lengthy for many
journalists to study or analyse indetail – claimed to be about putting
GPs in the driving seat of the NHS:
yet GPs are being given on thepretence of control. In reality they arebeing set up to fail.
They will be hog-tied by brutal

cash limits, and forced to implement
rationing and cutbacks, with local
Clinical Commissioning Groups firmly
under the thumb of a remote andbureaucratic NHS Commissioning
Board – which is accountable tonobody by the Health Secretary.
Lansley also claimed that patientswould have more control: “nothing
about me without me”. But patients
will have less choice than ever, as theirlocal hospitals are forced to cut staff
and services, and dozens of treatments
are excluded from NHS provision by
GPs desperate to cut spending.
For more and more treatmentsfrom varicose veins and cataracts
through to hip replacements,
patients will have a choice alright:
pay privately – or go without.
Lansley says it’s about “efficiency”
and “modernisation” but alreadywaiting times for operations
are rising, and BMA consultants’spokesman Mark Porter has pointed
out that the reforms threaten to dragthe NHS back to the 1930s rather
than forward into the 21st century.
In fact the Bill is purely and simply
about maximising the slice of the
public NHS budget that can be

grabbed by private sector providers.
David Cameron has now made clearthat this is government policy for thewhole private sector: anything else
the ConDems say is simply hogwash.
Lansley’s insistence on“competition” in the NHS coupledwith the demand from Monitor,
the NHS regulator that Foundation
Trusts should only deliver services
that make a surplus, threaten
to wipe out many NHS services
which the private sector sees asunprofitable – leaving terrible gaps
in care for the old, the chronic sick,and those with mental illness.
These policies based not on
evidence, but on Thatcherite ideology– a vision of the minimal public sector
and a largely privatised state.
It’s Lansley’s dream. Few shareit, but depressingly few have yet
recognised the nightmare his Bill
would create.
It’s vital that the health unions
and wider labour movement carry on
and raise the tempo of the fight tostop the Bill.
Don’t rely on the House of Lords:
Kill Lansley’s Bill before it kills off
our NHS. Once it’s gone, it’s gone!

Mark Thomas, Unite

Kill Lansley’s Bill –before it kills NHS

Angry Speech and Language Therapists
tell Andrew Lansley what they think of
him and his policies

Page 3

Life (and death) under Lansley’s NHS
From NHS to a national
health market
Never mind the b******t about empowering patients and GPs: inrecent events and policies taking shape we can already see theforeshadowing of Andrew Lansley’s new free-market NHS to be
ushered in by his sweeping Health and Social Care Bill.

It’s a grim picture, a nightmare scenario of chaos in public sector
services, growing power and influence of private, profit-seeking
providers – with even non-profit social enterprises forced to act like forprofit businesses in order to survive in a new harsh competitive market.
Just think ahead, and imagine that the Tory and LibDem ranks holdfirm behind David Cameron and nod through Lansley’s enormous Bill.
What would life be like for Mr and Mrs Patient of Middle England?

Who will reallychoose yourcare?
Giving you a choice of hospital or provider
does not mean you will get your choice,since referrals will go first to “referralmanagement teams” – some of themalready being run by private companies.
That means a clerical worker or
accountant who knows nothing and caresless about you will decide whether you
should get the treatment you and yourGP agreed – or whether instead to send
the referral back to your GP, demanding
they prescribe some cheaper alternative
treatment instead.

Everything about
you without you
Despite Lansley amending the Bill to require ClinicalCommissioning Groupsto meet in public and publish
their Board papers, you won’t be involved in any actual
decisions on local services.
Nor in fact will many GPs – as some are alreadystarting to point out in Buckinghamshire and Berkshire,
where GP consortia have been launched with no clear
mandate even from local GPs themselves.
In other words, in the complete opposite of Andrew
Lansley’s promises, everything about you will be decided
without you, and you will first hear about most of thechanges only after they have been agreed.

PFI profits left
intactOne area of shocking waste in the NHS is deliberately
ignored by Lansley’s NHS Bill: the billions to beshelled out to private sector banks and shareholders
in payments for new hospitals funded through thePrivate Finance Initiative will not be touched.
Instead, PFI hospitals face inflated and rising
overhead costs in legally binding payments for
decades ahead, while their income is squeezed by
reduced tariff payments for treatment, limits on
hospital referrals, and the slice of NHS budgets to besnatched by private providers.
Already hugely expensive PFI hospitals are
running with wards and whole floors closed for lackof cash: how long until the first one goes bankrupt?

Your call isimportant to us …

To make a GP appointment you will no longer ring a
receptionist at your local GP practice or health centre, butinstead be switched through to a call centre, hundreds – orthousands – of miles away, where nobody knows you, yourfamily, your town or your doctor.
After twenty minutes of muzak, and being told how
important your call is, you may be given an appointment
with a GP.
This type of system, backed by Mr Lansley, is already being
piloted by (privately-run) GP practices in England.
Call centres are seen by almost everyone as an indicationof contempt for the customer. Now it seems the NHS will use
them as a way to show how little ministers value patients.

Mental healthcare lottery

GPs underpressure

Private sector
in control

Your GP when you visit them will be under
extreme financial pressure, having to restrict
spending to the limits set by a local “ClinicalCommissioning Group” (CCG), itself overseen by aremote national NHS Commissioning Board.
This may mean – as now in Redbridge in NE
London – that they can only refer a handful ofpatients a week to hospital care, regardless of
their needs.
Remember the NHS faces three successive yearsof cuts in real terms funding, and an unprecedented£20 billion target for “efficiency savings”.

However the Clinical Commissioning Groups
are most unlikely to do much of the work ofcommissioning themselves – if they did, the doctors
would have no time to see you as a patient.
They will hire in management teams, either
from redundant PCT staff, or from private
management consultancies.
So despite Mr Lansley’s rhetoric, it will NOT
be GPs, but this new backroom management
team that will be drawing up most if not all of theunsavoury options for cutting and rationing yourcare.

Who would prefer ‘any qualified provider’ to NHS care?

If you are referred for hospital treatment, your GP will be required
by Competition Law to offer you a “choice” of providers, and will not
be allowed to steer you to the reliable local NHS
hospital.
Your GP will have no say over what companies
and charities appear on the list: this will be decided
nationally by unaccountable bureaucrats in Monitor,
the financial regulator (which will have the task ofmaximising competition in health services), and theCare Quality Commission.
They will draw up a list of “any willing provider” –companies and social enterprises who are thought tomeet minimal standards.
For-profit private companies, including Americanand other multinationals with far-from savoury
reputations, some of them the villains exposed in

If you have a mental health problem,
your choices of treatment and theresources available to help you will varyeven more drastically, depending on
which GP consortium has decided onwhat services to buy.
Mr Lansley has ignored mental
health charities – and the vast majority
of GPs, who have time and again madeclear they do not really understandmental health and do not want to be incharge of commissioning mental healthcare. Meanwhile some of the biggest
cuts are already hitting mental health
Trusts, putting crucial services at risk.

Postcode lottery = growing inequality

From statutory rights to DIY health care?
Lansley also plans to scrap the Primary Care Trusts andStrategic Health Authorities.
But even though “Clinical Commssioning
Groups” will be obliged to meet in public,
the NHS Commissioning Board which willoversee them with extensive powers tointervene in local decsions, will not.
PCTs and SHAs also carry statutory
responsibilities for allocating resources
and for efforts to tackle inequalities anddeprived populations.
Mr Lansley has said that many of these statutory
obligations will be scrapped, although he has not yet
said which ones. We will lose the protection they give.
How long will it be before the NHS follows the grisly

example of social care in Oxfordshire, where budget
cuts mean hundreds of the existing council staff
delivering local services will lose their jobs,
and clients will be given an inadequate
lump sum of cash to fend for themselves,
and take their chances in buying inservices from a variety of more and lessdodgy private providers?
Could we see NHS patients being
given a voucher and sent off to choose
their health provider without thepretence of “commissioning” – health care reduced
to a straightforward marketplace open to “any willingprovider”, but leaving the least and worst “choices” tothe poor, the vulnerable and the frail?

Forcing Trusts into closures
It’s very likely these and other cuts being imposed are
already forcing your local hospital Trust to reconsider
which services it should provide.
Monitor has told Foundation Trusts
only to deliver those services thatmake a surplus, and to close down any
that make a loss. Mr Lansley wants all
NHS Trusts to be Foundations, run as
businesses seeking surpluses – and nolonger as public services seeking tomeet local health needs.
Services that are not closed
altogether may be “centralised” into
fewer, bigger units: this may mean you
making long, awkward journeys, oftenwith no viable public transport available,

to get the treatment you need. Or it may mean yourlocal service becomes even more over-crowded withpatients diverted many miles from other closed units.
Of course you would have the “choice” togo without.
Already we can see this type of‘centralisation’ happening with a newround of A&E closures – including someof those Andrew Lansley and his Torycolleagues promised to rescue if they got
elected. A&E services at Queen Mary’s in
Sidcup were among the early casualties,
with more to follow across England,along with maternity units and specialist
services.
Who would willingly choose that?

Michael Moore’s film “Sicko,” will be free to bid for registration and offer
any health services they see as profitable.
Mr Lansley was belatedly forced to retreat from plansto open up price-based ‘competition’ between all these
private providers and existing NHS hospitals and services –which every health professional knows is a sure-fire way toundermine the quality of care.
It’s almost guaranteed to result in cheap and nasty
services: remember what happened to hospital hygiene when
Margaret Thatcher opened up hospital cleaning services tocompetitive tender, with the cheapest bid winning? The grim
legacy of MRSA is still with us 30 years later.
Mr Lansley wanted to do the same to clinical services. But
even without price competition the squeeze will still be on,since GPs and consortia will be focused on the cash limits andseeking every way to force down the price they pay for care.

We’re short-staffed – find yourown corridor and dump yourself

Whether you can access many forms of treatment at all on the NHS will depend not on your healthneeds, but where you live.
Different Clinical Commissioning Groups will come to different conclusions on whether toimplement the recommendations of NICE, the body which was set up to eliminate this type of
postcode lottery, but has had its powers cut by Mr Lansley.
And Clinical Commissioning Groups are NOT even obliged to work with their neighbouring
CCGs: this will create even more inequality from one area to the next.
Among the common services already being rationed or excluded in some areas but not others
are IVF treatment and hip and knee replacements: but in some areas even budgets for life-saving
AIDS drugs are being cut to save money. Patients there will have the “choice” of paying privately
for costly treatment, or dying.
Primary Care Trusts are already declaring that a growing list of treatments and services will nolonger be routinely covered by the NHS: GP consortiums will have to do more of the same as they
are compelled to carry through the biggest-ever cuts in the National Health Service to “save” £20
billion by 2014.

Foundations ofa 2-tier service
The £20 billion squeeze will bring a year-by-year reduction in
the amount Foundation Trusts get paid for treating each NHS
patient, and make them less and less interested in treating
local NHS patients.
Instead many can opt to attract wealthy private
customers from home and abroad..
Andrew Lansley’s Bill would end all of the present
restrictions on how much Foundation Trusts can earn fromprivate medicine, while new EU regulations also encourage‘health tourism’, opening up a new European market.
NHS patients would become second class citizens – in
hospitals built with taxpayers’ money.

Mind the gaps!
Monitor will continue urging Foundation
Trusts to work at a profit – but at the sametime maximising the number of privatecompetitors seeking a slice of the fundingthat keeps the Foundation Trusts afloat.
Monitor has no responsibility to ensure
universal access to care or comprehensive
care, opening the possibility of widening
gaps in care where a hospital or community
health service is forced to close, and no
Foundation or private provider can befound willing to offer services they see as
unprofitable.
This is called “market failure”: it meansno care for those who need it, no choice for
local patients.

A plan for privatisation nobody wants, promoted by a government nobody electedFighting back against cuts and privatisation

SALTs shake up cuts plans

the night before the strike –Unite booked a hall, sorted the
speakers (including General
Secretary Len McCluskey) andpublicised it. And the strike, on
3rd February, was solid.
The outcome is an
important partial victory. Threetherapists and three assistants
have lost their jobs – stilldisgraceful, but less damaging
than it might have been. All ofthem have found other work.
The gains were won as a direct
result of strike action. The
campaign to defend every job
in the local service goes on.
The courage anddetermination of theSouthwark SALTs struck areal chord with people. Local
parents understood that
this was a strike in defenceof services – and threw
their weight behind it. Local
teachers supported thedispute. Southwark anti-cuts
campaigners gave solid andactive support.
And the Southwark
therapists did the leg work
– it’s their sheer hard workand determination more thananything else that pushed

Banks are costing NHS
an arm and a leg
A dozen UK Uncut supporters set up a hospital inside the NatWest
branch in Redhill in February to highlight the Bank’s role in theeconomic crisis and the cuts to the NHS and other vital services.
Dressed in white coats and hospital scrubs, they treated‘patients’ with bandages, medical equipment and plenty of fakeblood. (see www.redhillanticuts.org.uk/?p=372)
They gave out leaflets to bank customers, staff and passers-by,
who were very supportive of what they were doing.
After about 40 minutes, the police asked them to leave. They
then leafleted outside.
Why NatWest?
It’s owned by the Royal Bank of Scotland, bailed out with
£20bn of public money in 2008.
Instead of being made to pay for the crisis it caused, RBS
continues to gamble with public money and pay its executives
massive bonuses. And it has been let off paying billions in tax.
The action in Redhill was just one of over 40 across the country,
coordinated by UK Uncut. More information about UK Uncut’s
from: www.ukuncut.org.uk/targets/banks/rbs-natwest

bosses into a climb down.
A one-day strike by acouple of dozen people could
be seen as small beer. Thatwould be a huge mistake.
Southwark speech andlanguage therapists showedthat it’s possible to fight backand win. If they can do it inSouthwark, health workers
anywhere can do it.
Many of the Southwark
therapists joined the ‘Day X
for the NHS’ protest from theRoyal London Hospital to
Barts, by way of the City on 9th
March. This was good – large,
lively, noisy, and full of healthworkers.
There’s a sense of things
really starting to shift in
London now. There arestill problems of weakorganisation, and some lackof confidence – but the scaleof the attack is so great, thatthe need for a fightback is
beginning to overcome thoseobstacles.
If a group of ordinary
clinicians in a quiet corner ofLondon can go on strike, it
shows it’s possible for others to
do the same – and win.

Over 50,000 jobs are alreadyset to be cut from the NHS.
Information from the unionfunded website ‘False Economy’(www.falseeconomy.org.uk)
exposes the lies the Con-Dem
government are telling aboutprotecting NHS services. The
scale of the proposed cutsis even greater than underThatcher.
Health workers know thatwhether it’s so-called ‘backroom’ or frontline jobs, there
will be a massive impact onservices. It’s not possible to
make cuts of this size without
damaging essential care andtreatment.
Some of the biggest cuts
are in acute hospitals serving
some of the poorest people
in urban areas in England,

PFI rip-off challenged

John Usher

Southwark speech andlanguage therapists became
the first group of frontline
clinicians to strike against the
Coalition Government’s cutson February 3.
A third of the SALT
department in Southwark – 11people – had been put on
notice of redundancy because
the local authority funding
ring-fenced for Sure Start is nolonger protected. Southwark
PCT, their employer, said it wasnothing to do with them – andjust assumed the remaining
therapists would work harderand fill the gaps.
It’s currently the Yearof Speech, Language andCommunication. Colin Firthhas just won an Oscar forhis performance as a man
conquering speech difficulties.
So the profession of speech
and language therapy has
been in the news.
SALT staff don’t just offer
therapy to help support
people with speech difficulties,
they work with otherprofessionals in identifying
problems and supporting
parents.
The therapists had been
told that if 11 people went,
including managers and admin
staff, they wouldn’t have to do
extra work. But they knew it
wasn’t true. Those jobs had
been created to free up more
specialist clinical time to see
service users.
So the SALT staff voted
overwhelmingly for strikeaction not just to keep thoseparticular jobs, but also
because they care about thequality of service that they
offer to children and families
across the borough.
Unite backed the one-day
strike, organising leaflets andplacards – on the basis of
instructions from the SALTs.
The therapists asked for a rally

Organise now to stop
NHS jobs massacre

Healthworkers demonstrated
outside the Royal Liverpool
Hospital on 10 March against
cuts and the use of PFI financeto rebuild the hospital.
The Joint Staff-side demo
was strongly supported by
UNISON, UNITE, Society ofRadiographers, GMB, Keep Our
NHS Public and the public.
The Trust has to impose£60m worth of cuts this year,
while ploughing
on with a PFI set tocost £1.24 billion
over 34 years.
The Joint Staffs
are pursuingboth issues withmanagement.
Money drained out of the local
health economy by PFI willcause a health crisis in future.
A legal challenge mounted
by Sam Semoff of Keep
Our NHS Public collapsed
in February when legal aid
was withdrawn after a local

Councillor complained to theLegal Services Commission.
Semoff uncovered a stringof flawed assumptions in the
Outline Business Case, andexposed the scheme’s full cost.
Liverpool City Council
leader Joe Anderson debatedwith Semoff on the BBC, only
to admit “I know it doesn’t
provide Value for Money now
or in the future”.

Staff know that PFI schemes
are poor value.
The latest example is the
Queen Alexandra Hospital in
Portsmouth, opened in July2009 after a £200m PFI rebuild,which has just cut 700 jobs
and closed 100 beds.

Scotland and Northern Ireland,
but rural poor areas are also
going to be hit. Mental
health services are also facing
massive cuts.
However a significant
number of these are proposals,
not definite plans. The
experience of Southwark
Speech & Language Therapists
is that it is worth challenging
proposals and fighting to savejobs and services.
Unions, community groups,
and service users need to run
imaginative and vigorous
campaigns to save local andnational public services.

Blank cheque for
new war for oil
There IS money for health – but
it’s a political decision what itis spent on. The whole Libyan
operation will run into tens, if not
hundreds, of millions. Suddenly
the government can find:n £3 million a day tomaintain a no-fly zone over
Libya – which would pay
for over 150 clinical support
workers for a year.
n Over £1 million for 4
Tornado fighter planes foran 8-hour return flight from
Norfolk to Libya = 52 newly
qualified midwives or 32
experienced health visitors– and that’s not counting
the missiles they fired – at£750,000 each.

A NALGO advert from the 1980s– still true today

Telegraph signals Lansley’s
death knell for the NHS

It was a great day to bury badpolicies: as the media focusedon the Murdochs squirming
under fire from MPs, Andrew
Lansley reeled off a list of eight
services to be opened up to private sector competitive bids.
Bizarrely it read like a roll-callof the services that have been
most neglected and run-down
by cash-strapped PCTs looking
for cuts: musculo-skeletal services for back pain, wheelchair
services, adult “talking therapies” for mental health, ulcer
and wound care, continenceservices, and others equally regarded as a soft touch for cuts.
But as Lansley unveiled thelist, a group of grasping voluntary sector and charitable organisations emerged from thewoodwork, eager to bid for aslice of NHS funding, and participate in the elimination of public services in these areas.
As the Daily Telegraph’s Max
Pemberton pointed out “thismeans that in these areas the
NHS will no longer exist”.
Staff delivering the services

would no longer be NHS employees, and bit by bit standards
and services would be whittled
down to ensure that the private
sector providers can maintaintheir surpluses, leaving evergrowing gaps in care which theprivate sector does not see as
profitable and for which no NHS
providers exist.
Of course ministers and theDepartment of Health continue to protest at top volume
that “we will never privatise the
NHS”: but this is unambiguous

evidence that they are determined to do so – regardless ofthe opposition of a majority ofGPs, and almost anyone whodoes not stand to profit from
Lansley’s plans.
As Pemberton points out tothe Telegraph’s staunchly Conserviative audience Lansley’s
Bill “is little more than a roadmap for destroying the NHS,
turning it into a cash cow for the
corporate sector. The focus is ontransforming public sector provision into an entirely marketled system, throwing open every service to private providers.”
The amended Bill has “15clauses that will allow privatecompanies to buy and asset-

strip NHS facilities. Clause s12
specifically enables the privatisation of high-security psychiatric services.”
The amendment to change
the wording from “any willingprovider” to “any qualified provider”, says Pemberton leaves
the competitive commissioning
process “unchanged”.
So why are MPs still defending these policies which enjoy
zero public support? Because,argued Pemberton they havenot even read the Bill they are
nodding through.
With even the Telegraphsounding the alarm, now is thetime for urgent action to kill thisbill: our NHS is at risk!

Health Emergency

has been campaigning against cuts and privatisationin the NHS for 27 years. It receives no grants or funding
other than affiliation fees, donations and the income
from research and publicity work with union branches
and regions. Branches and individuals can donate andaffiliate online at www.healthemergency.org.uk or email
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