| First they came for the Regional Health Authorities, then the District Health Authorities. Now a new management tier is in place – and it is a deliberate threat to the NHS... |
A strategy to take our NHS away
WORKERS, MAR 2007 ISSUE
The TUC currently characterises the constant changes being wrought upon the National Health Service as a "permanent revolution". If the foundation of the NHS after World War 2 was a revolution, then the changes are more like a permanent counter-revolution.
At the lobby of Parliament on 23 January, the TUC's call was not for the changes to be halted, but for them to be slowed down. It has to be admitted that it isn't the catchiest of slogans; "What do we want? Things to be slowed down. When do we want it? Errrr...now, but slowly."
The TUC's opposition is unengaging and does not give recognition to the significance of the changes nor to the damage they will inflict if allowed to continue. There is a sinister purpose in government's constant reforms of NHS management – the deliberate sowing of confusion hides a break-up of health services into bite-size pieces for private takeover. It must be understood and exposed.
In Workers, we have covered government health policy from a variety of perspectives. For example, there have been articles on the use of private, often foreign-owned health companies used in the NHS as a means of fragmenting and handing over control to others.
These companies frequently emanate from countries with no national health service to speak of, particularly America. Articles have also appeared on the threat to hospital departments and hospitals themselves, on the reconfiguration of Primary Care Trusts and consequent job loss – the list is extensive.
One area that has not yet received our attention is what is known as the intermediate-tier of management in the NHS, Strategic Health Authorities. These, too, have been subject to immense and damaging change.
Twelve years ago, Regional Health Authorities (RHAs) were abolished. These were large and labour-intensive by today's standards, employing over a thousand people each. They were responsible for planning health care, training different grades of employee, including an input into medical and nurse training and the holding of contracts. They also headed a cadre of managers who could be introduced into hospitals and departments where there was perceived to be a need to strengthen this level of administration.
Negotiating with unions
Marching for Whipps Cross Hospital, north east London: the review of hospital provision in the area is being driven by the new strategic authority, NHS London.
Photo: Workers
Importantly, not only did RHAs have notional representatives of the public, (which is all that local councillors can ever really claim to be) they also had a negotiating function, being the point of contact between NHS employers and NHS employees through their trade unions.
The Regional Joint Committees determined both regional and local policy as well as interpreting national agreements. In 1995, Virginia Bottomley abolished them. They were replaced by smaller regional bodies, losing hundreds if not thousands of jobs across the country.
While this can be explained in part by the introduction of progressive waves of new information technology systems, rendering this work less labour-intensive, RHA functions were also split up. Some of the educational and training elements went into higher education; others were to devolve to hospitals themselves.
This change came at a time when hospitals were forced to become NHS Trusts, thereby becoming freestanding corporate bodies – the greatest single break in regional administration, effectively ending it.
The situation carried on until after the 1997 general election.
Within three years of Blair entering Downing Street, a new plan "shifting the balance of power" was introduced, which abolished the only remaining tier of local management above hospital level, the District Health Authorities (DHAs).
The DHAs had formed an integral part of the old regional structure and were swept away, shifting the balance. In the case of London they were brought together in a single London body for the NHS, which in turn was swiftly replaced by five new bodies known as Strategic Health Authorities (SHAs). Lo and behold, after less than five years these bodies have now been replaced by a single SHA for London, called NHS London.
This process is being mirrored throughout the rest of the country, and untold hundreds of millions of pounds wasted on these unwanted unnecessary and inefficient changes.
While the Tories bleat on about wasting public funds it is we who are the true conservatives. We want to conserve our precious assets and not see them squandered in this cavalier fashion. In the course of these transformations, now tagged the "permanent revolution" quoted above, thousands of skilled administrators and health workers have lost their jobs.
Example of London
By way of example, before July 2006 the five Strategic Health Authorities in London employed over 700 workers. They were planners, administrators, managers of specific projects and providers of support to hospitals throughout the capital. On 1 July 2006 they were supplanted by the new NHS London.
By the end of March 2007, the new body is to have no more than 135 employees. That figure will be reduced further to somewhere a little over 120. This is not only mass unemployment (at the time of writing over 200 people have gone under various negotiated packages, leaving an even greater number to be sacked at the end of March). The job losses and the reorganisation which is causing them are symptomatic of a new kind of NHS.
The opposite of an NHS
The new NHS is a body which is no longer national, no longer a service and only notionally to do with health. It is not national because already Wales and Scotland effectively run their own services (changes that require further analysis) but there is a fragmentation and an internationalisation of the health service under way.
The erroneous phrase "globalisation" is frequently kicked around to describe what is in effect a control by principally American-based transnational companies. This phenomenon is now to be visited on the NHS.
Companies such as Kaiser Permanente, United Health are being encouraged, indeed dragooned, into running not just the provider side of health care (hospitals, clinics and so on), but also the commissioning side ("planning", "organisation", and indeed the previous "purchasing" side of the dreaded Thatcherite internal market). Management consultancy companies such as McKenzies and KPMG are also heavily involved.
So this new NHS does not need skilled administrators. Instead, it needs people who can oversee the transition from a service run by health workers for the people of Britain into one run by private companies for the benefit of their shareholders.
And that is what is happening in the transition to the new Strategic Health Authorities. Human resource managers (previously personnel officers) are now being transformed into "business leaders". A whole host of babyish terminology is introduced to hide the fact that the failed transfer of public assets to the private sector is being contemplated (outsourcing for privatisation; market-isation for outsourcing and so forth). This equally applies to the names of those carrying out these functions.
What lies ahead? There is speculation that Brown already has plans in place for his first 100 days. Speculation includes the proposing of "independent" boards on the NHS, much like Brown handed over governance of the Bank of England to a board. Should this happen, then the last vestiges of planning and organisation which Thatcher assiduously began dismantling over 20 years ago will be in prospect.
Independent of what one may ask? The politicians want it to be independent of them so that when the proverbial hits the fan they don't smell.
In practice it will be independent of working people and in particular of their trade unions, whose very presence within the administrative heart of the NHS, these new SHAs, is now compromised. A majority of London's 700 plus SHA employees were union members. Only a minority of the approximately 130 retained will be.
This pattern is replicated across the country and is a deliberate attempt to drive organised workers out of the planning system.
Rule from without
Moves to dismantle the NHS are not just about closing hospitals; some hospitals need to close. Neither is it about reorganising services; this, too, is needed from time to time. It is about ensuring that the NHS is removed from the control of the people who pay taxes and no longer planned by those who work in the service.
What lies ahead is a service governed by definition from "without", preferably as far without as you can get, perhaps Texas being the optimum location.
The challenges ahead are great and the ideals for which generations of British workers have fought to establish a National Health Service are threatened as never before.
A debate on the scale and pace of change is necessary. But we must not limit ourselves simply to calling for bad things to happen more slowly. We want to put an end to these bad things and to start having changes introduced which benefit us and our families.