This book is written in the classic muck-raking style. But
then, there’s a great deal of muck to be raked. It deals with the introduction
of Independent Sector Treatment Centres into the NHS. ISTCs are capitalist
firms operating for profit. It was a New Labour brainwave for them to be given
NHS surgical procedures to perform. The argument was that harnessing the
private sector would help do away with the horribly long hospital waiting lists
left after 18 years of Tory penny pinching. Actually we never needed them. As
Player and Leys point out it was later admitted that, “cutting out waiting
times for elective care – was being eliminated by the increased funding going
to the NHS after 2000.” (p. 73)
So why were they brought in? There was certainly a great
deal of secrecy about the contracts. How dare Labour Health Ministers claim
‘commercial confidentiality’ when they were spending £5.6bn of our money on the
first two wave of ISTCs alone! The stated aims of ISTC involvement were:
·
Increasing capacity
·
Innovation and best practice
·
Increased choice
·
Value for money.
Did they provide more hospital beds? The situation is
shrouded in secrecy. The Healthcare Commission inflated the number of
diagnostic procedures by 420% – 73,000 rather than 234,000 were carried out. Stalin’s
planners would have been proud of them.
The authors comment, “As of February 2007 approximately 25%
of all work carried out by Wave 1 ISTCs was not additional work but
‘transferred activity’; work that would have been carried out by NHS trusts but
was instead given to ISTCs and performed by NHS staff. Meanwhile, so far from
being short of capacity, some NHS Treatment Centres had actually been closed
for lack of demand.” (p. 29)
Did they provide skilled staff? No, they poached them from
the NHS. At Waltham Forest ISTC 83% of staff were seconded from the NHS.
Did they provide more hospital space? No, the secretive
contracts demand that they get first bite of the cherry on hip operations etc,
since they are paid for the contracted number of procedures whether they
perform them or not (Take or Pay). They get a guaranteed throughput of
patients. Yet, according to the House of Commons Health Committee, “It is far
from obvious that the capacity provided by the ISTCs was needed in all areas
where Phase 1 ISTC’s have been built.” (p. 31) Meanwhile NHS wards and
hospitals are closed. This is madness.
Do they stimulate quality? Again silence and subterfuge
prevail. The Committee found that, “after more than three years there was still
no data on clinical outcomes that could be compared with those of NHS hospitals
and treatment centres.” (p. 46).
Professor Wallace of the British Medical Journal has
hazarded an assessment. “We expect failures of hip replacements at
approximately 1% a year and knees at about 1.5% a year. But we have got some of
the ISTCs that are looking at 20% failure rates.” (p. 44) Thanks a lot, New Labour.
Here’s what else could happen to you (pp. 61-2). “The NHS
patient was at Haslar (Gosport) in November 2004 to have an arthoscopy on his
left knee and the removal of a cyst on his right knee. On waking from
anaesthesia he discovered that surgeons had performed arthoscopies on both
knees. During the subsequent journey back to Plymouth – some 200 miles – the
ambulance driver stopped at a service station and the patient was invited out.
He was on crutches and, due to the driver’s failure to assist him, he stumbled
and fell. Later the ambulance driver explained that she wasn’t qualified to
help him because she was only driving the ambulance for extra cash. Her main
job was working for Plymouth aquarium.”
But surely the risk-loving entrepreneurs at least cough up
when they screw up? No, it’s us that pay the bill. The NHS pays the indemnity
for private sector failure.
What about choice? “The Health Committee noted that where
the establishment of an ISTC led to the closure of NHS facilities, patients
would have no more choice than before. It also noted that in the absence of
clinical outcome data, patients – and GPs – could not make an informed choice
of elective care providers.” (p. 48)
How about value for money? Despite the secrecy, we have a
result. The Committee heard that prices paid to ISTCs were upwards of 40% over
reference costs (now the NHS tariff)” (p. 51) 40% more!
Somebody is determined we should continue to pay for proven
failure. When West Oxfordshire PCT decided to award the local contract to the
well-rated Oxford Eye Hospital rather than an ISTC, Ms. Hanna told the
Committee, “All the non-executive directors were called by the chair of the PCT
and were told that he had been told that John Reid (the Secretary of State for
Health) wanted a reversal of the decision on his desk by 12 o’clock on the
Monday…we all understood that our positions as non-executive directors were
under threat.” (p. 50) of course Reid’s only known skill was bullying.
What about the rest of New Labour’s Health Ministers? Alan
Milburn resigned in 2003 to spend more time with his family. He might have
mentioned he wanted more quality time with his money. Alan Milburn took a post
for £30,000 a year as an adviser to Bridgepoint Capital, a venture capital firm
heavily involved in financing private health care firms moving into the NHS,
including Alliance Medical, Match Group, Medica and Robina Care Group.
What about Patricia
Hewitt? What caused her enthusiasm for private health provision? Well, now
she’s a ‘special consultant’ to Alliance Boots and a ‘special adviser’ to
Cinven (who own BUPA’s hospitals). Civil servant Matthew Swindells (an apt
name?), who was Hewitt’s chief executive at the NHS, has with indecent haste become
head of health for Tribal, the private sector consultancy and service company.
Tribal is, of course, bidding for some of the contracts that Swindells was,
until recently, responsible for setting up. Surely a conflict of interests? A
long list of other civil servants and New Labour crawlers who have gone through
the revolving door from administering a public health system to profiting from
private provision are given on page 96. Cuckoos in the nest!
The Health Committee smelled a rat, but the health
professionals were working full time to lead them up the garden path. The
Committee reported, “It has become clear that the level of capacity required by
the local NHS does not justify new ISTC schemes….It is not clear whether this
represents a failure coherently to articulate the situation or a more profound
incoherence in terms of policy.” (p. 64) In fact policy was quite coherent. It
was to break up the NHS into bite-sized pieces ready for privatisation
The National Health Service is the most popular institution
in Britain. It is Labour’s supreme political achievement. Even the Tories say
they accept it is here to stay. Now it is being dismantled bit by bit by the
corroding acid of money by stealth. Don’t let it happen.
Those
who have seen Michael Moore’s film ‘Sicko’ (See Film Review: Sicko)
will realise what a vastly inferior ‘private enterprise’ health system Americans
put up with. Despite spending twice as much as we do as a proportion of
national income on health care, 50m Americans have no health cover. The system
is riddled with vast frauds perpetrated by private health care firms. Is that
where we’re going? No thanks.
