INSIDEl Cuts round-up
pages 6-7

l White Paper

Issue No. 66, Autumn 2010. WHITE PAPER SPECIAL ISSUE

threat to mental
health back pagel TEN Good
Reasons to say
No to the White
Paper page 3

White Paper would combine biggest-ever cuts with biggest-ever privatisation Special

Say NO to ConDem
rationing boards!
The ConDem government’s
White Paper ‘Liberating the
NHS’ makes many controversial proposals, but at its heart
are two key factors: the fragmentation and privatisation of
the NHS – and £20 billion of
spending cuts by 2014.
The scale of these “efficiency
savings” guarantees that evenwhile it appears to give GPs
greater control over services,
the opposite is the case.
With tight budgets and cuts
to be made, consortia of GPs
established to spend £80 billion in commissioning budgets will inevitably become little
more than rationing boards.
Far from improving services
they will have to choose which
services will be cut and which
sections of patients should be
excluded from treatment.
To accept this would not be“liberation” for the GPs or theirpatients: it’ would be a capitulation to the ConDem government.
As the debate over the White
Paper begins to widen, it’s clearthat there is a strong and growing opposition to many of its
core proposals, even among
the group who appear to havemost to gain from it.
GP magazine found fewerthan one in five of the 300 GPs
who responded to an online
poll believed that the changes
would improve patient experience or the funding of primarycare services.
Twice as many (41 percent)feared a fresh “postcode lottery,” while 71 percent expected the scrapping of PCTs and
SHAs to lead to an increase in
private sector involvement incommissioning. 60 percent ofresponses in a poll on the proWhite Paper National Association of Primary Care website
also opposed the government’s
commissioning plans.
No wonder one of the leading apologists for the scheme,
Dr Michael Dixon of the NHS
Alliance, has issued a rather

If the NHS Alliance,
the Royal College
of GPs and the
BMA, along withthe health unions
simply took a firm
stand against theWhite Paper, theConDems would
not be able tocarry out theirplans.

desperate appeal for GPs not toturn their backs on the government proposals, claiming that
it would be “utterly disastrous”
if they did not “embrace theWhite Paper and make it work”.
But of course Dr Dixon has
got it the wrong way round.
The real disaster would be for
GPs and their organisations toallow themselves to be cynically used by the government

to push through proposals
which will have far-reachingand negative consequences forpatients as well as for the NHS
and its one million employees.
It will also be a disaster fortens of thousands of hospital
doctors: the proposals could effectively privatise health provision and reduce England’s NHS
workforce from almost 1 million to virtually zero by 2014.
Despite these problems, atpresent the BMA is committed
to “engage critically” with consultations on the ConDem plan.
This is a mistake. Indeed
if the NHS Alliance, the Royal
College of GPs and the BMA,
along with the health unions
which have already declaredthemselves against the proposals, simply took a firm standagainst the White Paper, andmarketisation and privatisationof health care that are implicit
in it, the ConDems would not
be able to carry out their plans.
Until a few weeks ago the
BMA was conducting just sucha campaign, now sadly side-

lined as they struggle for influence with Mr Lansley.
Perhaps the biggest reason
for standing up against theseplans, which could effectivelytransform the NHS into a National Health Market, with no
public sector providers, is that
there is absolutely no evidence
that these expensive, experimental reforms – the biggestever privatisation of health careanywhere in the world – coulddeliver the promised improvements for patients.
It’s all looking like a messwaiting to happen.
The cost of implementing
the White Paper (upwards of£1.7bn) seems like a classic
waste of money much better
spent on patient care.
But from the point of viewof Andrew Lansley and his Torycolleagues, if it resulted in denationalising the NHS, reversing the great legacy of Nye
Bevan, and opening up a new£100 billion market to privatecompanies, it would be seen as
money well spent.

AppealHelp uscampaign
to save our
NHS!

The NHS faces its biggest-everthreat: a ‘double whammy’ of
massive cuts year by year to2014, coupled with the White
Paper proposals that could
wipe out all public sector
provision of services.
The ConDem government
has no mandate to transformthe National Health Service
into a national health market.
But if there is no public
challenge, the White Paper
could be forced quickly
through Parliament.
Hospital staff haveeverything to lose andnothing to gain from the
proposals which could seetens of thousands of jobs
axed, and hundreds ofthousands pushed out of the
NHS workforce, with new
threats to their pay scales andpensions.
Every cutback that is
accepted will just encourage
desperate employers to comeback for more.
It really is do or die forthose of us who want to
defend the NHS as a public
service, and who value thestaff who deliver services.
To build a successful
campaign requires resources,
publicity, time and effort: anduntil there is a broad popular
campaign established withthe support of the main health
unions, much of the work
will fall to organisations like
London Health Emergency.
But right now, we don’t
have the resources to cope.
We need help to keep theissue in the media, and workwith local campaigners to
get the message across inmeetings, protests and local
publicity. Just producing anddistributing this newspaper
has cost £2000.
We urge any readers or
supporting organisations
that can do so to make adonation, as large as you canafford, to ensure we have theresources to keep on fighting
to scupper Lansley’s White
Paper, keep our NHS intact …
and keep it public.
n You can donate by cheque(to ‘LHE’), or online at www.
healthemergency.org.uk

l website: www.healthemergency.org.uk l email: healthemergency@gmail.com l snailmail: BCM London Health Emergency, London WC1N 3XX

Page 2

What they
are saying
about theWhite Paper

McKinsey’s:
over-paid,
over-rated,over here!
One bizarre side-effect of the
Con-Dem coalition government was the publication of
two documents which the New
Labour government had stubbornly refused to allow into the
public domain.
Both are the result of work
by US management consultants McKinsey’s, and address
the issue of the drive for ‘efficiency savings’ (aka cuts) in the
NHS to bridge a predicted £20
billion gap between a frozen
budget and rising pressures by
2016-17.
The first (smaller) document
is a national survey, elementsof which leaked into the public domain last summer, andwhich was immediately publicly disavowed by Labour ministers, who insisted that it was
not government policy andwould not be implemented.
Nevertheless it soon became clear that despite thegovernment’s view, a numberof Strategic Health Authorities were seeking to adopt a
number of the proposals, notleast in the rapid reductionof the NHS workforce – by asmuch as 10% -- as a way to savemoney.

NHS London’s secret

The second document became even more shrouded insecrecy: commissioned by NHS
London, it was a special versionof the original with more detailed facts and figures on the
London context.
For 6 months or more campaigners and health unions attempted to use the Freedom ofInformation Act to force NHS
London’s secretive bureaucracy
to allow proper public scrutinyof plans which were quite obviously controversial.
When this second document – all 159 pages of it – wasfinally published, the reason for
NHS London’s reluctance to allow it out became immediatelytransparent.
Firstly, contrary to expectations, the document is not somuch a ‘report’ as a ramshackle
collection of (sometimes quite
smart-looking)Powerpointstyle slides, each containing aseries of statistics and assertions, but with little if any connecting explanation, evaluation
or discussion of the proposal.
If this type of report were

presented as an undergraduate research project at a university it would be rejected for
inadequate use of supporting
evidence and references, thelack of any clear structure orapproach, and the lack of any
coherent or collected conclusions.
Nonetheless this document
contains many of the seed ideas around which PCTs acrossLondon, grouped into five secretive “sectors,” have been
meeting behind closed doors
to plan the cutbacks.

Closures

Here are the proposals for“levers to reduce costs of care”
including “reduced double running costs through a single
point of access to urgent care“(in other words the rundownand closure of A&E units in London).
The document goes on toclaim that more savings could
also be had from “increasing
scale, efficiency and quality from
centralisation” of other hospital
services (i.e. more closures).
Other “levers” to cut costs include reducing costs of clinicalstaff, using nurses and healthprofessionals to replace doctors, and reduced costs of overheads (suggesting that the rollout of polyclinics could bringan 80% cut in clerical and admin staff working for GPs).
The report also discusses atsome length the “decommissioning of some services” – effectively imposing a system ofrationing access to treatment
for conditions such as varicose
veins, hernia and even joint replacements, leaving patients inpain with the “choice” of going
private or going without.

No analysis

Time and again the ideas
proposed in the McKinsey
document are simply thrownin without any serious analysis of possible down-sides andproblems, and without any discussion of the systems changes that would be needed toachieve the desired result.
In almost none of the examples is there even a costing of
the likely investment required
to make the change happen,
let alone a balance sheet toshow how any significant savings could result.

Carillion, which has contracts
for PFI hospitals and outsourcing was “excited”, Virgin-owned
private healthcare provider Assura Medical’s chief executive
was “enthusiastic”.

The McKinsey document is also confirmed as the central
inspiration for those NHS managers who want to switch as
many as 60% of A&E patients, and 50% of outpatients awayfrom hospital facilities and into ‘polyclinics’ or other as yet nonexistent facilities in primary care.
Yet the document also reveals how strange this obsession
with running down A&E services has become, since the total
London spend on existing A&E units is just 5% of the hospitalbudget and 2.65% of the total cost of London’s NHS, so even a
big proportional saving would not amount to much.
And there are no big savings to be made: in 2007-8 London’s
A&E units treated almost 4 million patients – at an average costof just £79 each: it is hard to see how switching services to newpremises could save very much from this, and of course there
has been new research evidence to show that it would not besafe to switch anything like 60% of A&E cases into primary care.

Instead savings are sought
in all kinds of unhelpful andunlikely areas: we are told that
there should be a reduction in
numbers of patients referredfor outpatient care – despite
the fact that 18 out of 31 London PCTs are already referring
fewer than the national average. Nowhere is there a discussion of the possible impact onpatient care of being denied
specialist outpatient treatment.

Sick ideas

Sickness rates in London’s
hospital staff are the second
lowest in England and below
the national average – but
McKinsey’s claim that moremoney could be saved if fewer
staff got sick: they don’t tell us
how, and appear to have no detailed analysis of the causes ofsickness absence.
The London document argues for “possible but challenging” targets to save £2.4
billion through acute sector
productivity, but this turns out
to require a massive 21-37% increase in productivity by nurses, a 9-43% increase in doctors’
productivity and a massive 3442% saving on overhead costs:
but it offers no practical ways inwhich these savings might be
made.
McKinsey’s appear to re-gard all paperwork, all admin,and even discussion with othernurses as outside the nurse’s
proper role, but they do notsuggest who else should dothese roles instead of nurses.
McKinsey’s also prove to be
the source of the suggestionthat very large sums of money
could be saved in primary careby slashing the average time
allocated to patient appointments with GPs – by one third,from 12 minutes per patient tojust 8.
This could ‘save’ a massive£570m, argues the slide, but it
offers no discussion of the possible impact on patient care or
patient satisfaction, let alone
the job satisfaction of GPs: theRoyal College of General Practitioners is currently campaigning for longer consultation
times.
The document also claims
that the same level of community services could be deliveredby 11-15% fewer staff, if district
nurse productivity could justbe increased. Once again weare given no clues on how thisshould be done.
There are more examples –a long and shapeless list – buttime and again the same gaps
and evasions recur.
It seems clear that a lot ofmoney has been wasted onthese reports. Any money spenton them was wasted, because
the total silence on exactly how
any of the proposals are to be
implemented means that they
are as useful as a chocolate fireguard.
But as the ConDem coalition
cranks up the heat, demanding£20 billion of NHS cutbacks –by 2014 – these proposals are
the only ones on the table.
So even though the ideas
are ill-judged, inconsistent andimpractical, this does not meanthat they will necessarily be discarded. Watch out for a McKinsey-style cutback near you!

Healthinvestor
magazine
has also eagerly embraced thewhite paper, which it argues“offers the private sector a raftof opportunities in the healthcare market by enabling patients to achieve greater choiceand control over their treatment and care through accessto any willing provider”.
Pulse magazine, responding
to FAQs warns that: “The White
Paper will lead to huge newopportunities for private companies, with firms such as UnitedHealth, Tribal, Bupa and Harmoni already offering to run
commissioning and accountancy services and back-office
functions for GP consortiums.”
The NHS Alliance welcomed
the white paper as a “unique
opportunity for frontline GPs”,
and Dr Michael Dixon of the Alliance has issued a rather desperate appeal for GPs not toturn their backs on the government proposals, claiming that
it would be “utterly disastrous”
if they did not “embrace thewhite paper and make it work.”
The National Association ofPrimary Care has also said it
was “vital that primary care clinicians embrace the new worldopen heartedly”.
The Royal College of General
Practitioners declared before
the white paper was even published that it was the “right direction of travel”: but its chairelect Clare Gerada said “For
most GPs, it’s like rabbits in theheadlights. There is also a natural disinclination to working
with external organisations, forfear of going to the dark sideand being part of the privatisation agenda.’
Right wing think tank Civitas warned that the upheaval
could disrupt plans to drive
through £20 billion in “efficiency savings”. Stressed the“scant evidence base” for Lansley’s plans, Civitas argued they
could set the entire NHS backby at least a year, and “anyslight blip will mean one thingfor patients: a return to rationing, either by waiting or by reductions in services.”

The Conservative Party’s
Bow Group, the oldest centre-right think tank in Britain,
claims key strands of the reforms are unfeasible and riskcreating a postcode lottery ofhealthcare.
The Nuffield Trust has warned
that the reforms “will requiresignificant management expertise to implement smoothly,”
and that “There is a huge riskthat this level of reform cannot
be implemented without major
failure”.
The slightly less right wing
Social Market Foundation
condemned the changes as “atbest a waste of time, at worst a
waste of money”, warning that
ill-prepared GPs could wind
up outgunned and outmanoeuvred by powerful hospital
Trusts.
The normally docile Patients’
Association said that thechanges are “a huge experiment without much hard evidence about how they will
work in the NHS”.
UNISON, the biggest public
sector trade union, has taken
the government to court challenging moves to implement
the proposals before they areeven debated in Parliament
and while the “consultation”
with the public is not yet concluded.
Unite, Britain’s biggest union,
has also opposed the proposals, and set up a campaign
committee.
The BMA’s National Council
has voted heavily in favour of“critical engagement” with theconsultation process, although
it has not formally spelled out
its reservations or identified
any issues which might persuade negotiators to pull out if
not resolved.
Former Health Secretary
Andy Burnham, trying to
kick-start his leadership bid in
the Labour Party, has correctly
branded the Lansley proposals as “Without doubt the mostdangerous threat to the NHS
in its 62-year history: a recipe
to turn order into chaos, a fair
service into a free-for-all, andto let market forces run riot.
For patients, it means longer
waits in A&E, months on waiting lists and a postcode lottery
writ large.”

A better policy: the BMA’s Hamish Meldrum and BMA activists joina demonstration fighting the marketisation of the NHS

Page 3

NHS White Papersummed up
The NHS White Paper “Equity
and Excellence: Liberating the
NHS” is the most radical NHS reform in 62 years since the NHS
was formed.
Among its proposals:‘Efficiency savings’ of £20
billion are to be generated by
2014.
It aims to abolish the existing commissioning organisations – 152 Primary Care Trusts
and 10 Strategic Health Authorities – and hand the main
responsibility for commissioning services with a combined
budget of £80 billion to GPs.
GPs will be required bytheir contract to be membersof around 500 local “consortiums” which will be statutory
bodies to carry out the responsibilities of commissioning.
They will receive a management allowance to allow themto buy in support, which may
be from former NHS employees
or from the private sector.
A new NHS Commissioning Board will be established
to commission primary careservices, specialist care and maternity services. It will oversee
the GP consortiums, and havepowers to assign GPs to a consortium if they have not alreadyjoined one. It will have regional
offices, and will employ NHS
managers – but it is not known
how many.
The 90 plus NHS Trusts
which are not yet Foundation
Trusts will have to achieve
Foundation status, or become
part of a larger Foundation
Trust by 2013, when the legal
status of NHS Trust will be abolished.
The “cap” that limits the
proportion of Foundation
Trust income that can be derived from private medicine
or contracts with the private
sector will be removed. FTs will
be given greater freedom tooperate as social enterprises,
though they “will not be privatised”. They will be encouraged
to negotiate local variations
on national pay and terms andconditions.
GP consortia and the NHS
Commissioning Board will buy
in health care from “any willing provider” – Foundation

Trusts, social enterprises or thefor-profit private sector. Competition law will apply.
Patients must be given freechoice of GP (not restricted towhere they live), choice of any
provider, choice of named
consultant team, and choices in maternity care, mental
health, diagnostic testing,long term conditions and endof life care.
Performance targets including waiting times are to
be scrapped and replaced by“outcome targets”.
The Foundation Trust regulator, Monitor, is to become an
economic regulator for all organisations providing NHS care.
The public health andhealth promotion functions of
PCTs are to be taken over by local government through new‘health and wellbeing boards’,
which will also take over therole of councils’ oversight andscrutiny of local health services.
The patient voice is also to
be changed again: Local Involvement Networks (LINks)
are to be replaced by new
Healthwatch groups fundedby local government, which
will take on additional roles tomake them “more like a ‘citizen’s advice bureau’ for healthand social care” (DH).
The White Paper is out toconsultation until October.
Most of its proposals are forswift implementation, and allof the proposals are to be carried through before 2014.
The full text is available:
www.official-documents.
gov.uk/document/
cm78/7881/7881.pdf

Just say ‘NO’: TEN GOOD Reasons
to oppose the NHS White Paper1.

on the work these bodies did
will divert GPs from their mainrole in delivering clinical care.
Many consortia will either
re-hire redundant PCT staff, orbring in private management
consultants: the total level of‘bureaucracy’ will be little different from now.

Andrew Lansley’s “reforms”
would bring the biggest
privatisation of health care anywhere in the world. It would
transform our National HealthService into a competitive National Health Market, in which£100 billion of public money
would be used to buy services from privatised providers.
Competition and privatisation
can force standards down, as
happened when hospital cleaning services were privatised in
the 1980s.

2.

GPs will be compelled tojoin local commissioning “consortia”, each probably
including 80-100 GPs. These
statutory bodies will takedecisions on how the money
should be spent. But the White
Paper includes the biggestever squeeze on NHS funding,with £20 billion of “efficiency
savings” required by 2014. So
consortia will become Rationing Boards, offering GPs andtheir patients FEWER choices

How big could£20bn cuts be?

The King’s Fund’s chief economist John Appleby
has recently spelled out the scale of threat to the
NHS from the coming cash squeeze.
Arguing in the British Medical Journal (17August) in favour of protection of the NHS against
the general round of cuts affecting most otherpublic services, he argues that if the NHS were
not protected it would have to find actual cutsamounting to around 14% of its budget (£18
billion) over the next few years, and suggests five
ways it could do this:30% real pay cut for all staff
Abolish the NHS in London
No drugs
Sack all consultants and general practitioners
Abolish the NHS in Scotland and Wales
A different approach would be “for wholeservices to close down: no NHS dentistry (£2bn), no
community services (£9bn), no ophthalmic services (£0.5bn) – and still another £6.5bn to find”.
He sums up: “Fourteen per cent is equivalent to £18bn for the UK NHS. This is not a cut thatcan be achieved through a bit of salami slicing of everyone’s budgets. The NHS would have tothink at least on the scale of the suggestions above.”Appleby makes the obvious point that none of these proposals is very appealing.
But the ConDem White paper looks to make £20 billion of ‘efficiency savings’ by 2014.
So are we going to let them do it?

6.
than they have now.

3.

A recent poll of GPs suggests fewer than one infive believes the White Paper
will improve the patient experience of the NHS. Almost threequarters believe it will increase
the role of the private sector
in commissioning. If GPs andconsultants stood together tooppose it, this “reform” package
could not pass.

4.

Each PCT area would
have 2-3 consortia, eachof them taking its own decisions, with no overall planning
authority, creating a new “postcode lottery” in which someconsortia fund treatments that
others will not.

5.

PCTs and Strategic
Health Authorities will
be scrapped, and thousandsof skilled and experienced
managers and service planners
will lose their jobs. But taking

It will be less accountable to local people or to
Parliament. Ministers will nolonger answer questions ortake any responsibility for local
health services, which will be“regulated” by Monitor and theCare Quality Commission, neither of which has a successful
track record. The new National
Health Market would be evenless publicly accountable thancompanies supplying gas or
broadband.

7.

The White Paper is silent
on how consortia could
avoid being ‘captured’ by thebiggest and best resourced GP
practices, most of which are
in wealthy areas. There is norequirement for GP consortia
to work with other consortia,
or take any wider view beyond
their own local catchment
population. Contradictorydecisions could result in thecollapse or withdrawal of somelocal hospital and mental
health services, again reducing
choice for patients.

8.

Every remaining NHS Trust
will be forced to become aFoundation Trust – or be takenover by one – by 2013. Foundations will be removed from the
NHS balance sheet. They would
all become “social enterprises”,
and encouraged to tear up
national pay scales for theirstaff, who would no longer be
NHS employees. Legal limits on
the amount of money Foundations can raise from private
medicine are abolished by theWhite Paper. With NHS funding
frozen, this will mean FTs willconcentrate on drawing in paying patients from the UK andother countries, and open up a
new 2-tier health service.

9.

A competitive healthcare
market will make it moredifficult for GPs to collaborate
with their medical colleagues
in hospitals, and for consultants and hospital staff to share
best practice. Competition
law will apply, and will brandcooperation of this type as“collusion”. The split between“purchaser” and “provider” will
be widened.

10

All these changes areproposed without ashred of evidence that they will
deliver the promised improvements. The last Tory government’s experiment with GP
Fundholding was an expensive
failure in the 1990s, and new
figures now show that “practicebased commissioning” experiments under New Labour weremore expensive than the system they replaced, with highlevels of overspending.

Page 4

Evidence-free market-style “reforms” that fragment care, increase costs, and let i

We’ve been
here before!
Bob Dylan once famously
sang that “you have to pay
to get out of going throughall these things twice”.
George Santayana told
us that those who do notlearn the lessons of history
are doomed to repeat it.
Karl Marx said that history
repeats itself, “the first timeas tragedy, the second time
as farce”.
Even the NHS
Confederation, representing
health service employers,
recently published a critical
study of reorganisations
over the last ten years,
entitled ‘The triumph ofhope over experience”.
But Andrew Lansley’s NHS
White Paper is ignoring
the lessons of two decadesof failed “reforms” andreorganisation – and today’s
Condem coalition is going
far further and faster down
the road of privatisation
than Margaret Thatcher’sradical government evercontemplated.
JOHN LISTER looks backto show the similarities
between today’s policies
andyesterday’s costly
failures.

What will it cost?

The White Paper will cost at least£1.7 billion to implement, althougha recent editorial in the British Medical Journal estimated that the cost
could be closer to £3 billion. Runningalongside a massive squeeze on NHS
budgets aimed at generating ‘efficiency savings’ of £20 billion by 2014, thereorganisation will also bring a loss of
thousands of NHS jobs, many of them
managers, but many more admin staff,
clerical workers and clinical staff in
front lines services.
However this does not mean that
there is any guarantee the new poli-

Commissioning Board

cies will actually deliver savings on bureaucracy.
The difference would be that the
new bureaucrats may no longer be
directly employed by the NHS, or accountable through NHS organisations.
This is because closing down Primary Care Trusts and Strategic Health
Authorities is linked with passing on
the responsibility for the £100 billion
NHS budget to GPs – most of whomlack the expertise, time and resources
to take this work over without damaging the level of care they can give totheir patients.
So GPs will have to employ staff
to administer each of the 500 or GP
Consortiums, which will be formed as
the new statutory bodies to commission health care at local level. As suchthey will need responsible officers andmanagement.
The GPs may choose to employ staff
who will only recently have lost theirjobs in PCTs and SHAs: or they may
opt to bring in private sector management consultants, who (scenting profitable work on the way for them) havebeen among the most prominent supporters of Lansley’s White Paper. 71%
of GPs in a recent poll said they feared
the White Paper would bring a greater
private sector involvement in the commissioning process.
60% of those responding to a pollon the website of the strongly proWhite Paper National Association ofPrimary Care were opposed to thegovernment’s commissioning plans –that the NAPC is vociferously supporting.

In addition to the local commissioners
the new NHS Commissioning Board
will need to keep a watching brief on
every GP consortium, and on the individual practices from which the Board
will be commissioning primary careservices, in addition to its other roleof commissioning specialist care andmaternity services.
This means, at least in the view ofsome experts, that the new Board willneed to be big, with its own managerial structure, regional offices and directorates, and is likely to recruit seniorstaff from Strategic Health Authorities
and PCTs.
But there will inevitably also be
additional bureaucracy at the levelof NHS Trusts and Foundation Trusts,
since each Trust will be dealing witha far larger number of commissioning
bodies, and negotiating with them. In
the new competitive health market
Foundation Trusts will require moremarketing and commercial staff, who
do not contribute to health care, but
enable the Trust to compete with social enterprise and private providers.
So how much if anything will besaved from bureaucracy in real terms
is open to considerable doubt.

High cost of markets

We already know that markets are
more expensive as a way of administering the NHS than the previous integrated structure prior to 1990.
Earlier this year the Commons select committee revealed that the NHS
was spending a staggering 14% of its
budget – £15.4 billion per year – on
management and administration: thiscompares with 8% in 1991-92, and
11% in 1995-96 as the costs of Margaret Thatcher’s controversial ‘internalmarket’ reforms began to grow.
Numbers of senior managers haverisen by a staggering 91% since 1995,
more than double the 35% increase in
the total of doctors and nurses.
More recent changes towards
a more open market system havepushed costs even higher: recent figures show that even a limited roll-out
of Practice-Based Commissioning, aprecursor to the White Paper proposals, cost around twice as much in increased costs as it appeared to generate in savings, even as a voluntary
scheme. The PBC practices overspent
their budgets by an average of 2.5 per-The cost of replacing PCTs

Of course Lansley chose soft targets when he singled out the PCTsand SHAs for closure, and cunningly
pushed the right buttons with somefrustrated GPs when he suggested
they take over the commissioning
role. It would be hard to find anywhere
else in the public sector where thepossible loss of 60,000 jobs creates solittle anger or militant resistance.
Few PCTs or SHAs have done anything to endear themselves to local
communities – many of which havebeen systematically patronised andignored in spurious “consultation” exercises – or to the many sections ofstaff in NHS staff in provider services
who have been on the receiving endof some of their decisions.
So it’s true that nobody could build
a credible campaign simply to defend
PCTs or SHAs. But by no means every-

thing they have done has been without value, nor are all their staff pointless bureaucrats. Nor is it true that
simply scrapping them will necessarily
produce anything better.
Subdividing 150 PCTs into 5-600 GP
consortia, each of 80-100 GPs, will inevitably raise the question of how these
are to work either singly or together.
It seems certain that many of themwill resort to re-hiring staff made redundant from PCTs – or spend evenmore to bring in private management consultants to do much of theadministrative work that still needs tobe done: and with NHS providers having to negotiate with more separate
groups of “purchasers” the total bill forbureaucracy will not fall by much if it
falls at all.
But the new bureaucracy will beeven less accountable than the PCTs.

cent, equivalent to a massive £2 billion
overspend if applied to the whole £80
billion commissioning budget.

When GP Fundholders
held on to funds

However we also know that the previous Conservative experiment in delegating commissioning to GPs was an
expensive failure.
By 1994, just a couple of years into
the GP Fundholding scheme, NHS
chief Executive Alan Langlands wascomplaining that GPs faced a “paper
overload,” and the BMA was complaining that doctors were being turned
into a “demoralised and demotivatedworkforce”. Millions had been spent
offering GPs £16,500 lump sums as a
non-refundable down payment for
expressing an interest in the scheme,
and millions more on £30,000 start-up
payments for those who signed up.

Of course some GP Fundholders
did very nicely in holding on to funds:
figures obtained by Alan Milburn MP
showed just 585 fundholders had retained a total of £28 million in 1993-4– an average of £47,000 for each practice. In NE Thames region fundholders
held on to £1 for every £6 allocated,equivalent to £77,000 per doctor.
Admin costs were also high, since
Trusts had to deal with a rapidly rising number of small-scale purchasersof health services, at an extra cost estimated in 1997 as at least £1m on average per Trust – or £500m a year.
The fragmentation of the NHS andthe consequent bureaucratic costs appear to be very similar in each case:under the new White Paper each PCT
will be replaced by on average three orfour consortia, each of which will needmanagers and have to negotiate its
own deals and contracts.

Fundholding = 2-tier NHS
What were the results of fundholding for patients? Even Andrew Lansley now admits that fundholding led to a “two-tier NHS”.
By 1994 almost half of the 173 hospitals surveyed by the BMA were offering
preferential services to fundholders’ patients, with 41 of them promising fast track
admission while other NHS patients were left to wait even longer.
We are now assured of course that GP consortia would be very different, because all GPs would be compelled to be members of a consortium, whereas fundholding was only open to the largest GP practices.
Lawrence Buckman, chair of the BMA’s GP Committee insists that “This is definitely not the son of fundholding. … if it looked like fundholding mark 2 I would
not be interested in it.”
Buckman has focused on the fact that consortiums and GP practices will not
be able to retain unspent surpluses: but they are likely
to face potential penalties for overspending, which could
potentially skew the clinical judgement of some GPs.
Many GPs already fear that the fragmentation of commissioning, a feature under fundholding, once again
threatens a return of the same “postcode lottery” onwhether patients are offered certain treatment, as different consortiums exert their own rights to decide.
Different decisions between one consortium and thenext on what level of services to commission would leavepatients in some areas with access to certain treatments
and others in other areas without.
Neighbouring consortia could even take opposing
views on whether to commission local services from
hospitals or mental health providers: the danger here isthat the withdrawal of even part of the current funding for some services could insome cases force Trust bosses into wholesale cutbacks or service closures, reducing the choices for patients.
The proposal to limit the management budgets for the new consortia is likely
to restrict the resources to buy in locum care to enable GPs from smaller practices
to get involved in decision-making.
This would strengthen the influence in consortiums of the larger and more
wealthy practices, which tend (as with the pioneers of Fundholding) to be basedin the wealthier areas.
So the needs of more affluent patients are in many areas likely to dominate
over those on lower income with greater health needs who live in relatively deprived and inner city areas. This could bring the very opposite of the “Excellenceand equity” promised in the White Paper.

Page 5in private sector

Foundations ofprivatisation
Foundation Trusts are another area ofconcern. The White Paper has madeit quite clear that all NHS Trusts must
become Foundations, or be takenover 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 nolonger NHS employees, while theirassets would be privatised, whether
they remain as non-profit ‘social enterprises’ or are eventually absorbed
into the for-profit private sector.
Although the White Paper declaresthat “Foundation Trusts will not be privatised”, that only means that the legislation to impose these changes will
not privatise them.
However once they are off the NHS
balance sheet, and run as free-standing businesses, answerable only to
Monitor – the same body that is also
supposed to regulate for-profit private providers – what is to stop Foundations being taken over by a privatecompany, or even deciding to become a for-profit business?
Even if they don’t go this far, thecompetitive National Health Market
system outlined in the White Paper
will force all social enterprises andFoundations to run just like private
businesses – and that’s not good forstaff or for patients.

Foundations that
Caps off
for private went wrong
patients
Another experiment ignoring
negative experience is the proposal
in the White Paper to remove thelegal “cap” which restricts the
proportion of a Foundation Trust’s
income that can be derived fromprivate medicine or deals with theprivate sector.
This strict limit, confining Trusts
to the percentage of income
from private work that they had
before Foundation status, wasintroduced back in 2003 as part of
the government effort to push thecontroversial plan for Foundation
Trusts through Parliament.
Sceptical MPs demanded anassurance that the new freestanding non-profit businesses
would not simply concentrate on
private work: the Bill eventuallyscraped through with a majority ofjust 17.
One reason for such strong
concerns was that it was well known
that in the early and mid 1990s oneof the first “freedoms” that the new
NHS Trusts began to exploit was the
freedom to build or expand theirprivate patient wings – although
there is little evidence that many,
if any, of them made much actual
profit from them.
This siphoning off of resourcesfrom NHS patients resulted inanother widening of inequality
within the NHS, driven by market
forces.
One attraction to Foundation
Trusts of income from commercial
medicine is that it is not restricted
or squeezed in the same way as
public sector NHS budgets will be
for at least the next five years.
So this also means that asbudgets are frozen in real terms,
and pressures increase, Foundation
Trusts will be more tempted to seekout profitable paying customers– whether from the UK or abroad –to compensate for shrinking NHS
income, and to prioritise this workover the treatment of NHS patients.
Some specialist Foundation Trusts
are already looking to expand theirincome from overseas patients.

Experience in other countries where
hospitals have been floated off as
foundation trusts also gives grounds
for concern.
One early foundation-style hospital was privatised – swallowed up by
the private sector. This is what happened to one of the first Swedish
Foundation Trusts, St Goran’s in Stockholm. Now it’s the country’s biggest
private hospital.
In New Zealand in the ill-fated market reforms of the 1990s the equivalent to NHS Trusts were allowed toborrow money freely from the private
sector: they quickly ran up hundredsof millions in debts, which it eventually took the government years to pay
off.
In both Sweden and New Zealandthe government had to step in tobring the hospitals back under control
and prevent worse damage.
However the White Paper reforms
will push the Foundations and their
massive multi-billion assets so far outside the control of the Health Secretary and NHS Commissioning Board
that only radical legislation on thescale of the 1948 NHS Act – which nationalised the mish-mash of municipal, charitable and teaching hospitalsdelivering health care – could bringthem back into the pubic sector.

Ignoring history lessons
So what is the historical experience ofwholesale organisational changes likethose proposed in the White Paper?
In its recent survey on this, the
NHS Confederation points to a rapid
succession of changes in the NHS especially over the last ten years, all ofthem based on little hard evidence,and subject to little if any proper evaluation.
Conspicuously it notes that after
1997: “99 health authorities were split
into a large number of primary caregroups and then primary care trusts
because it was thought that they were
too large to create to primary care. The
302 PCTs were then reduced to 152 …
“One reason given for this was thatthe small groups had high overheads
and did not map closely enough tolocal government boundaries. There
were also questions about whether
there were enough high-calibre managers to staff 302 organisations.”(The triumph of hope over experience: page 8)
By contrast Andrew Lansley is now
proposing to increase again even further – from 152 PCTs to 500 or more local GP consortiums, and seeking to cut
management costs. This appears to beignoring the lessons learned the hardway in the last decade.
Former NHS Commissioning Director Mark Britnell, now firmly in theprivate sector, has warned Lansleythat his GP consortiums are too small
to work effectively, and to succeed
would need to be as big as PCTs: “It
won’t work if we create 500 cottagesized commissioning bodies”.
One head of procurement at an
NHS Trust, speaking anonymously toSupplymanagement.com echoed thesame point, arguing that GP commissioning will lead to a “fragmented
service”.
The Nuffield Trust also argues thatthe disruption flowing from the reorganisation and the need for GPs tolearn new skills and new ways of working mean that it would take “several
years” for the new system to make any
savings, and that in the meantime big
deficits could be run up.
Even the NHS Alliance, which hastaken an ambiguous position on the
proposals has warned that the deficits which PCTs are likely to pass on
the GP consortiums could mean thatthe experiment in commissioning is“doomed to fail”.

The biggest-ever privatisation of health care
If the White Paper is carried throughto its logical conclusion, by 2014
there will be no NHS or public
sector providers delivering healthcare services in England. Hospitals,
community health services andmental health will all have been
forced to become, or join Foundation
Trusts, or will have been put out totender to ‘social enterprises’ or thefor-profit private sector.
Privatisation on this scale isunprecedented anywhere in theworld, and there are no directcomparisons that can be made.
However we do know thatcompetition and private sector
providers can force standards down,
as happened when hospital cleaning
services were privatised underThatcher in the 1980s.
The result of that experimenthas now been widely recognised

as a catastrophe: a break-up of the
NHS team, the casualisation of theworkforce, a plunge in hospitalhygiene, and the spread of MRSA
and hospital infections.
The minimal apparent short-term
cash savings made at the expenseof their lowest-paid staff by thehospitals which contracted out these
services have been subsequently
more than swallowed up by inferior
quality of services and the costs ofadditional bed days, closed wards
and other problems from hospitalacquired infections.
There is more unhappy
experience of private sector
involvement.
Repeated attempts by New
Labour to draw the private sector
into providing NHS services havealso proved costly and delivered
questionable results.

Contracts with private hospitals
to deliver waiting list treatment
have cost massively more thannormal NHS costs, while thedelivery of minor elective surgery
in “Independent Sector Treatment
Centres” cost an average of almost
12% more than the standard NHS
price, but also wound up spending
millions on operations that did nottake place as patients chose to go to
NHS hospitals instead.
Private sector bids for primarycare contracts have tended to force
down the quality of care, reducing
prices by employing fewer, lessqualified staff than established local
GP practices. Huge questions hangover the quality of services and poor
regulation and monitoring of privatecompanies delivering out of hours
GP cover.

Page 6

Business as usual, as

The NHS Confederation has warned NHS bosses that theymust “think big” and seek large-scale changes if they are tomeet tough targets to squeeze down costs and spending.
This could mean that “beds and wards need to be closed,
but also entire buildings and possibly whole sites.”
And the Confed report ‘Dealing with the Downturn’ also
challenges the myth widely spread by NHS managers at every
level that savings of this scale can be made with no further
impact on frontline staff.
“The changes that will be required are so significant that it
is almost certain that frontline services will be affected.”

Lansley drops“moratorium”
on closures
Andrew Lansley’s much-vaunted “moratorium’ on closuresof A&E and maternity units,
which he theatrically unveiled
at one of the threatened hospitals, Chase Farm in Enfield, isalready dead and buried.
In fact even as he announced it, Lansley pointed
out that it would probably not
apply to closures that had already gone through the usualsham NHS “consultation” procedure.
The pledge to halt amy clo-sures was only ever an opportunist electoral ploy, and once
the Lib Dems had smoothed
the path to Tory power there
was no need to maintain thepretence any longer.
One early embarrassed
casualty of this was Bexley MP
James Brokenshire, who had
rather unwisely trumpeted his
claim to have a personal promise from Lansley to rescue thethreatened Queen Mary’s Hospital in Sidcup.
Brokenshire was left pub-

licly dangling for a few weeks
after the election, until a “review”
of the closures at QMH was announced – to be conducted by
Simon Robbins, the chief hitman
driving through the closure!
Other services like to be
hacked back on a similar basisof already completed consultation include Chase Farm (yesthe same one where Lansleydrew his line in the sand).
The end of the moratori-um was flagged up at the endof July by NHS Chief Executive David Nicholson, who explained that it would be up to
Strategic Health Authorities todecide, by October 31, whether
contested closures should goahead, and warning against“potentially vexatious objections” from stakeholders who
remained opposed.
And there is evidence fromaround the country that theeffective veto that Lansley appeared to offer GPs, apparently
allowing them to block closures they did not support, isbeing brazenly disregarded bydesperate Trust and PCT bosses
trying to force through spending cuts.
In Kent, GP organisations
have complained that a controversial closure of maternity and paediatric services at
Maidstone Hospital are being
pushed through despite thenoverwhelming (91%) opposi-tion of local GPs.
In North East London, GPs
are furious that their objections
are being ignored as healthchiefs press ahead with theclosure of A&E and other services at King George’s Hospitalin Ilford. Health for North East
London even admitted that
there had been “more disagreement than support” for theirplans to axe services at King
George’s – but insisted that patients “would benefit” from thechanges.

only be maintained if theygenerate massive ‘productivity
gains’ totalling over £500 million a year.
The financial projections
suggest that if no ‘savings’ aremade, inner NE London would
on a best case (“upside”) face a£118m shortfall by 2017, while
the worst case would see a gapof £257m. The figures for outer
NE London are similar, with abest case gap of £144m and aworst case of £283m.
To redress this gap the sector plan suggests a combination of measures:“Decommissioning services”(estimated savings £60m-£150m)“Shifting acute activity toa lower cost setting” with (unexplained) estimated savings
ranging from £10m to £70m.
Putting a range of primarycare, mental health and community services out to tender,
with forecast “potential” savings of £200m to £550m “depending on how aggressive thecommissioners chose to be”.
The NE London estimates“assume net savings of £142m
from decommissioning andshifting settings of care,” andanother £273m a year to be cut
from non-acute services, giving a grand total of £415m ofsavings by 2017, with the lion’sshare of these savings to begenerated by local hospitals,
mental health Trusts and community services.
The biggest savings target
is a 35% saving on expenditureby the Barking Havering & Redbridge Trust, but Bart’s & the
London is required to generate
the largest amount in savings(£211m), equivalent to 32% of
its current spending.
Among the “opportunities
for productivity gains”, the NE
London health bosses propose:
A 21% to 37% saving on
nursing costs
A saving of between 9% and
43% in spending on doctors
Slashing drug spending by
22-25%
Reducing overhead costs to“benchmarked best practice”,
saving 34-42% of overhead
costs
Other “productivity gains”(such as in theatres and diagnostics) to save up to 32% of
costs.

London health chiefs
dust off their plansfor cuts and closures

A look at the Strategic
documents covering
London’s health careseems like a real blastfrom an alreadyforgotten past ofpolyclinics, Darzi
plans, and the mumbojumbo of “World Class
Commissioning”.
But as the cash
squeeze tightens on
Trusts and PCTs, thecuts proposed in the
dying days of Gordon
Brown’s government
are the only real
proposals on the table,
and controversial
closure plans arebeing dusted off again
after the brief Lansley

moratorium.

Health for North East London
certainly seems determined
to grind on with controversial
cuts and closures it outlined at
the end of last year.
Under the plans, just two
hospitals, The Royal London
in Whitechapel and Queen’s
Hospital in Romford, would
become “major acute” hospitals: others (Homerton, Whipps
Cross and Newham) would be
downgraded to “local hospitals” – and King George’s Hospital in Ilford would be strippedof most of its acute services
and effectively reduced to alarge polyclinic with as few as
50 beds.
827 acute beds would be
cut in NE London, just over
20% of the total. More thanhalf of them would be atKing George’s, but also 146 in
Whipps Cross Hospital and ahefty 234 beds in Bart’s and theLondon, raising extremely serious questions over the affordability of the Trust’s £1 billion
PFI scheme, which will not evenopen until 2013.
So massive would be thereduction in activity at King
George’s that its remaining
acute services would require
just one third of the space it
currently occupies, and morethan half the site to be mothballed or stripped of services
and sold off. The plans includea £6 million allocation for redundancies.
Hospital outpatient appointments would be morethan halved, with almost a million appointments in NE London moved out of hospital clinics to primary care “settings” including polyclinics.
With hefty losses of income
from this relocation of work,
the financial viability of hospital Trusts in NE London could

North Central London

South West London

North Central London’s Strategy is driven by the needto bridge a projected resource gap of £560m by 2017,
and seeks to ‘reconfigure’ hospital services with theloss of 250-500 beds, and to reduce the number ofmental health beds in addition to squeezing more “efficiencies” from staff and shifting large volumes of A&E
and other work from hospitals to primary care.
The five acute Trusts within the sector face a potential combined deficit of over £350m by 2016/17 – almost 20% of their current combined revenue.
The publication of the plan came in the midst of
growing public anger at plans that threaten the futureof A&E services at Islington’s Whittington hospital andthe running down of services at Enfield’s Chase Farm
Hospital, where A&E services remain controversially
under threat, along with obstetric, neonatal, inpatientpaediatric and emergency gynaecology services.

In South West London only St George’s is guaranteed
to retain its existing services, since it has been designated as the only “major acute” hospital in the sector.
This means that Kingston, Epsom & St Helier and Mayday Trusts all have a doubtful future, with the possibility of the loss of maternity, paediatrics, or other services
The Case for Change document warns that
“If no changes are made we estimate that by
2016/17 the NHS in south west London could be
spending around £300 million more than its predictedbudget”.

South East London

North West London

Covering eight London boroughs and accounting foralmost a quarter of London’s health spending NW London faces a huge cash gap for both commissioners
and providers, seeking a £796m reduction in hospitalbudgets through shifting work elsewhere, “decommissioning” services, “cost improvement plans” and othercuts.
As a result NW London faces some of the more drastic upheavals in the capital, and health chiefs admit intheir Integrated Strategic Plan that it will “inevitably resultin fewer beds in the acute sector” and “substantial acutehospital reconfiguration”. This could potentially leave nomajor acute hospital between St Mary’s Paddington and
the M25 (17 miles) or Heathrow airport (15 miles).
Chelsea and Westminster Hospital is to be effectively downgraded to a “specialist and local hospital,” as isCentral Middlesex Hospital.

But the biggest doubts hang over the future of
Ealing Hospital and the financially challenged West
Middlesex Hospital in Isleworth. Ealing is to be mergedwith the newly-merged PCT provider services in Ealing,
Brent and Harrow to become an ‘Integrated Care Organisation’ – In other words the hospital will effectively
wither away and close, leaving nothing more than apolyclinic at best on the site.
The West Middlesex board has apparently “clarified
that they do not believe that their organisation has anindependent future”. It seems it could follow Hinchingbrooke Hospital, in Huntingdon as one of the first to
have its management put out to tender, and it could
be reduced to a ‘local’ hospital or to purely an elective
centre.

In South East London Powerpoint slides from Simon
Robbins, the “senior responsible officer,” project a funding gap of £467m to 2014. By 2016/17 the potential
gap is projected to reach £810-£1,090m.
SE London apparently plans to tackle the funding
gap through imposing cuts to the tariff for acute care(£224m) and significantly also for mental health (£62m)– equivalent to 13% of the income of the two mental
health Foundation Trusts that deliver services to thesector (Oxleas and South London & Maudsley).
Substantial disinvestment from mental health isplanned.
SE London is also looking to save £31m by transferring acute activity to “lower cost settings,” £79m bydecommissioning services, preventive measures andbetter management of long term conditions, and ahefty £109m from reducing costs in non-acute services(community and primary care).
The NHS London map shows that the decision on
one SE London hospital (Queen Mary’s Sidcup) has already been taken: it will be downgraded to an “urgent
care centre” and elective centre, losing most of its acuteinpatient services.

Page 7

Brum’s
£2.6bnPFI
fiascoJobs onthe line
The most recent global
estimate is that 11,000 job
losses have been announced in
the NHS this year by 106 Trusts,
raising the concern that 40,000
could be lost in England alone.
l Plymouth’s Derriford
Hospital has announcedplans to cut £27.5m fromits £370m budget: no job
cuts yet identified.
l Reading’s Royal
Berkshire Hospital is to cut£60m with 600 job losses
from its 4,500 staff.
l Kent’s three PCTs
have revealed plans to
axe 40% of management
posts over three years.
l Nurses in Shropshire
have been asked voluntarily
to cut their shifts to help
management avoid axing jobs.
Bizarrely the same managers
at the Royal Shrewsbury
and Telford’s Princess Royal
Hospitals are also trying to
cut use of agency staff.
l York Hospitals
Foundation Trust hasannounced the need tocut £30m over three years
and asked staff to suggest
how it should be done.
l 130 PCT management
jobs are to be axed by
NHS Leeds over three
years to save £5 million.
l Wakefield PCT is to cut
more than 40 management
jobs to save £1.4m. Further
cuts of £4m will follow
in the next two years.
l NHS Northamptonshireis to cut 56 jobs and leave
22 vacant posts unfilled
as it struggles to cut
management costs by £3.5m.
l Aintree Hospital isplanning to cut the equivalentof at least 300 jobs, andis asking all 5,000 staff toconsider voluntary redundancy
or moving on to flexible hours.

Cambridge

UNISON in Cambridge
University Hospitals Trust
has pledged to fight plans to
axe 170 nursing jobs as partof a £40m cuts programmeover three years. But the
local Scrutiny Committee has
warned that the cuts could
be as high as 500 jobs in total,
with vacancies left unfilled.
UNISON will oppose any
staffing cuts which put patientcare and standards at risk.

North East

Hundreds of jobs are at
risk and 450 beds (14% of thetotal) threatened with closurein the North East by 2104
to carry through savings of£800m, driven by the Condem
government’s £20 billion
target for “efficiencies”. The first
redundancies could begin as
early as October. 1,700 jobs
are to go in Cumbria and theNorth East. County Durham
and Darlington NHS Trustis aiming to cut £60m, 300
beds and 300 nursing jobs.

BristolCampaigners who raised£4 million to fund a specialist
children’s unit at Frenchay
Hospital are furious that it will
now be closed and the services
moved to the other side ofBristol, at a cost of £20 million.
Frenchay will be
downgraded to acommunity hospital, as a
new “superhospital” fundedthrough the Private FinanceInitiative opens in Southmead.

Mid Yorks £55m cuts: 500 jobs
UNISON has warned for years
that the full cost of the new£353m Private Finance Initiative (PFI) hospitals in Wakefield
and Pontefract would mean
massive cuts in staff, pay andconditions.
Trust Chief Executive Julia
Squire has now admitted to
the local Express that the Trustaims to cut £55m by 2012 – including £38m this year, whichmeans cutting the wage bill by£20m by next March.
500 jobs are affected, withan estimated 150 redundancies: in other words the Trust islooking to squeeze out another350 staff without paying a penny in severance.
That helps explain the new

attacks on staff terms and conditions and the draconian new
management regime for staff
transferring into the new building. This is not incompetent or
thoughtless management, but
a deliberate plan to press more
staff to walk away – and dump
the work on those staff who remain.
That’s what they mean by‘natural wastage’ and ‘staff turnover’: either way it means morework, and more stress on thestaff who stay on.
The opening of the new
Pinderfields Hospital brings a
cut of 100 elderly care beds – areduction of 43% – and the lossof 64 whole time equivalentstaff. But the Trust is already fac-

ing severe bed shortages, andscouring the local community
for additional beds, while Julia
Squire insists that “more care
will move closer to people’s
homes.”
Ms Squire claims to the Express that the workforce plan
has been the product of discussions and ‘open meetings’ withstaff: but the reality is a hardfaced management who haverefused to answer questions,consult with the unions or evenrespond when grievances anddisputes are formally notified.
Of course the “public sector
deficit” driving the squeeze on
NHS spending flows from thecrisis of the private sector – thebanks – which are now pocket-

ing huge profits once again.
The Mid Yorkshire Hospitals
Trust’s financial problems flowin large measure from the increased costs of the PFI project,which delivers guaranteed
profits to the private sector forthe next 32 years, and whichmeans the NHS will fork out£1.2 billion for a hospital valuedat £353m.
The UNISON branch has
vowed to fight “any redundancies whatsoever, whether compulsory or ‘voluntary’”, and demanded the full nationalisationof the Royal Bank of Scotland,“to eliminate profiteering fromhealth care and lift the burdenof PFI”.

transferred by ambulance to an
NHS hospital.
Private hospitals have rela-

tively few full-time staff (mainly
nursing and support staff ) with
doctors mostly working only
on sessional basis.
Neither Circle nor Serco has
any previous experience ofrunning a large, busy general
hospital. Each of them has aquestionable record of involvement with the NHS.
UNISON has argued fromthe beginning that none of theshortlisted companies is suitable to take on the management of Hinchingbrooke, andthat the quality of patient careis being put at risk.
If these companies are
the answer, then NHS East of
England has been asking thewrong questions.
l The track record of private sector management attempting to take over and turnaround NHS hospitals has been
disastrous. It was a lamentable

The new £627m superhospital in Birmingham
opened to patients in a
fanfare of publicity in June,
but within a couple of weeks
the 1213-bed hospital
was diverting patientsto surrounding hospitals
because it couldn’t cope.
Plumbing problems
compounded the misery,
with patients complainingof scalding showers andfreezing water in wash basins,
while nurses could not get
cold water out of taps inclinical areas.
One patient was almost
struck by a light fitting whichfell from a ceiling.
Short-staffed nurses understress were heard by patients
arguing with doctors about
staffing rotas and inadequate
numbers to cope with ahigher than expected numberof emergencies.
The hospital is one of thefirst PFI-funded hospitals
to exclude non-clinicalsupport services from thecontract: but it will still cost
the Trust a massive £2.58
billion over 35 years, withpayments beginning at £47m,
and ending in 2048 with apayment of £108m.

Firms bid to run Hinchingbrooke HospitalIf thesecompanies are
the answer …
UNISON Eastern Region has
been battling to prevent theprivatisation of the management of Hinchingbrooke Hospital in Cambridgeshire.
The Huntingdon hospitalseems set to become one of thevery first District General Hospitals franchised out to a profitseeking private company.
The “franchise” to manage
the district general hospital
was controversially put out totender by NHS East of England
18 months ago, on the flimsiestof evidence – and despite being reminded of the disastrous
failure of the only previous
attempt to franchise out management of a whole hospital toa private company.
After the only remaining
public sector bid, from theCambridge University Hospitals Trust, was withdrawn in
February, blaming “the hugecost, both in time and money,of the bidding process”, theshort list of five private companies has now been whittled down to just two: Circle
Health, and Serco, the services
company that runs the Docklands Light Railway
The only company with any
substantial experience of running (private) hospitals, Ramsay Health Care, an Australiancompany, was excluded fromthe running by East of Englandin August.
Hinchingbrooke Hospitalis less than 27 years old, andhas a total of 310 adult beds, inaddition to 25 paediatric beds
and 12 SCBU cots on the site(run by the PCT). It has employed up to 2,000 staff.
Its scale and mix of services
makes it more than six times
bigger – and many times more
complex to run – than the average private sector hospital.
Private hospitals in England have an average of just
50 beds, and focus exclusively
on elective treatment for noncomplex conditions: they do
not offer emergency surgery or
medicine, and any patient developing complications will be

Top ten deceptive claims …
NHS East of England continue to frustrate and annoy local
people and campaigners by pumping out deceptive statements
such as their claim in the “Top Ten Facts” that:“Hinchingbrooke is not being privatised. What is being
offered is a franchise to operate the hospital.”
So who are the shortlisted companies to win that franchise?
Two private companies, with no public sector contender left in
the frame: the management is being privatised.
Or what about this whopper?
“The successful franchisee will not be making a profit at theexpense of patient care. They will be subject to the same clinicaland operational scrutiny as every NHS hospital.”
So have East of England bureaucrats told the companies thatthey are expected to carry out the work for no profit? Of course
not, or they would have pulled out even earlier than managers
at Addenbrookes.
With the future of SHAs looking gloomy, those overpaid Eastof England jokers just keep on making it harder to find the will
to fight the Condem plans to abolish them.

failure at Good Hope Hospitalin Solihull. There a
3-year contract with Secta
to manage the 550-bed hospital began amid a welter of
optimistic publicity in September 2003, but was terminatedeight months early, at the endof 2005, when the running of
the hospital was handed to the
management of Birmingham
Heartlands Hospital Trust.
During the contract thecompany successfully jacked
up its own fees by 48% in its
first year, and by the time theacting chief executive, finally
cleared her desk, the Trust wasin a far worse state that when
she started – losing money at£1 million per month, heading
for a £47 million deficit , andthreatening to pull down theentire local health economy.

2-year pay freeze– and pension“review”

White Paper threat
to mental health

Mental health professionals
and campaigners have rounded on the ConDem government for its combination ofdamaging cutbacks, and thethreat that mental health services will lose out even further
under the new plans to handover the commissioning role to
GPs.
In July a heavyweight medical journal, the Lancet , published an editorial demanding
Health Secretary Andrew Lansley “tell the truth about NHS
cuts” in front-line services, singling out the brutal cuts being
carried through against mental
health services in Oxfordshire,
and contrasting this with Lansley’s pre-election pledge to “increase health spending everyyear”.
Oxfordshire and Buckinghamshire Mental Health Foundation Trust is pushing throughplans to slash £5.3m from its£42m budget (12.6%) over the
next four years, hitting frontline services for both adults andolder adults.
Adult services are to lose 3
out of 19 consultant psychiatrists, 16 coordinators and 9other staff, along with cuts inclinical psychologists.
Older adult services will also
face cuts in professional staff.
Meanwhile a trade union
representing some of the community mental health staff,
Unite, has warned that up to 50of the Trust’s 200 staff in adultmental health teams could lose
their jobs in the cuts, after inpatient services have alreadybeen cut “to the bone”.

Poorer service
The document leaked to theLancet admits that the cuts willbring a “reduction in qualityof service”, poorer service response with “patients waiting
for care” and “dissatisfaction”
among patients and carers.
The impact on staff is also
admitted to be serious, with
the Trust predicting “potential
negative impact on staff fromthem perceiving an increase in
their workload”, “poorer staff
retention and reduction in staff
satisfaction with their role”.
Perhaps even more worrying the document also warns
the decreased patient satisfaction could lead to “possible patient withdrawal from care”.
At a time when demand formental health care is increasing and the severity of the
problems faced by patients isincreasing, with a greater expectation that services will
be available ”closer to home”,
home visits in Oxfordshire andBuckinghamshire would be cut.
Other cuts are taking shape
in mental health services in
London and other parts ofthe country including Sussex,
where a quarter of inpatient
beds are to close, affecting
services in Haywards Heath,Eastbourne and St Leonards tosave £4m.
In central London, NHS
Camden is planning to put
psychological services out totender, triggering fears that a
private company could step in.
Indeed other government policies are also causing problems
for mental health patients, notleast the latest onslaught on
the benefits system which will
target people on incapacity
benefit.
The new “fit to work” policy
could mean that people suffering from mental illness would
be declared capable of work.
Mental health charity Mind
has warned that the new test

Philip Wolmuth reportdigital.co.uk

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 takeindustrial 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 thepay 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 areattacked.

Workers at the Hackney Centre for Forensic Mental Health join a
Unison protest outside East London NHS Foundation Trust against
privatisation and cuts
for incapacity benefit does notmany of the 1.5 million people
take proper account of the flucwith severe mental illnesses
tuation condition of many withmay fail to get the treatment
mental illness, and that staff
they need.
running the assessments are
Rethink’s Chief Executive
insufficiently trained in awarePaul Jenkins said: “We often
ness of mental health issues.
hear from people with mental
illness that GPs don’t underGPs say nostand mental health and wantLong-term concerns for theto quickly refer them on to spefuture of mental health services
cialists. Now GPs themselves
under the White Paper proposare telling us that they haveals have been reinforced byconcerns too.
the survey of GPs in July which“The proposals expected inshowed that as few as one in
the white paper can work, butthree felt equipped to take on
only if GPs are given proper
any responsibility for commistraining and support to undersioning on mental health.
stand the needs of people with
Mental health charity Resevere mental illnesses such as
think, which conducted theschizophrenia and bipolar dissurvey, warned that unlessorder.”
there was rapid action to eduAnother survey of GPs bycate GPs on mental health,the doctors.net website in July

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found that two thirds of those
responding did not welcome
the Lansley white paper, and
80% said they were not adequately equipped to take overcommissioning mental healthservices.
Mind’s chief executive Paul
Farmer also warned of weaknesses in GPs’ approach tomental health issues: “There is
still an instinct for some GPs toreach for the pills too quickly– we have 36 million prescriptions a year for anti-depressants, a vast amount at primarycare level.”
Mental health problems on
average take up between 10%20% of the time of a GP, witharound three out of every four
people who experience mental
health problems seeking treatment from their GP.
Every year 300 out of every
1,000 people experience someform of mental health problem: but it seems that the NHS
has a long way to go before
this scale of importance is recognised in the allocation of resources.
Instead of moving towards
meeting this level of demand,
the White Paper proposals
will create an even more random “postcode lottery” formental health patients … andplace millions in commissioning budgets in the hands of
GPs who recognise that they
don’t want to do it, and are nottrained to it properly.

Health Emergency
publicity services
We produce professionallooking tabloid branch andregional newspapers, and canalso research and draft detailed
responses to reconfiguration,
cuts, closures and privatisation.
For more details give John Listera call on 07774 264112.

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