Independent Treatment Centres are the latest in a line of destructive initiatives that Labour has foisted on the NHS... You wouldn't have let Thatcher do this!
WORKERS, JULY 2005 ISSUE
If Thatcher were trying to do what Blair is doing to the NHS working people would be up in arms. It has been said before, but it bears saying again: the working class allows a Labour government to get away with actions that it would not tolerate from a Conservative administration.
So what is Labour doing to the NHS? Relentless privatisation is too benign a description. It is dismantling the infrastructure, in particular eroding the skills of the workforce and its ability to develop the skills of the next generation.
The first speech of the new health secretary, Patricia Hewitt, signalled clearly that this weakened Labour government will be ever more vicious in decline. She announced the government plans to increase to 15% the proportion of operations on NHS patients to be carried out in the private sector. This treatment is to be carried out in the Independent (read: private) Treatment Centres known as ITCs.
At a stroke this will double the public money spent on surgical treatment in the private sector. Bear in mind that large amounts of public funds are already being channelled to the private corporations via the Private Finance Initiative where private consortiums now own a significant proportion of NHS buildings and equipment. Increasingly, workers are rumbling the Private Fnance Initiative and becoming clear that PFI should stand for Profiting from Illness. However, there is not yet clarity about the potentially destructive impact of the growing number of ITCs.
Why are ITCs destructive?
The hype around ITC is seductive. It is all about reducing waiting lists, claims the government. The private companies will receive NHS money for doing the simple uncomplicated operations and because they will not have to take the emergencies and complicated cases from Accident and Emergency Departments, they will be able to maintain throughput (read: maintain profit levels). Essentially the ITCs will cherry pick the easiest work and leave the NHS to carry out all the more expensive and difficult cases. And of course deal with any errors that happen at the ITCs when a case goes wrong.
As reported in last month's Workers, Unison, the Royal College of Surgeons and the Association of Surgeons of Great Britain and Ireland have already spoken out against this trend. Inevitably the cherry picking process takes away what would normally be a reliable slice of income which would flow to the local hospitals and destabilises local finances. However, it is not just a financially destabilising process.
Impact on education
The type of operation which will move to the ITCs is the very type that junior doctors and other health workers carry out under supervision as their skills are developing. The Royal College of Surgeons has already highlighted the impact on the training of new surgeons.
Once the protest develops the government is bound to suggest that the patient comes first and the student must follow the patient. Such assertions ignore the fact that student learning always has some impact on throughput (read: profit) and the Independent Treatment Centres may well refuse to take students. They are, after all, independent and can do what they like. Even more alarming is the thought that some ITCs may welcome students, perceiving them as cheap labour.
ITCs would lack the infrastructure that currently surrounds student learning in the NHS. At present all teaching hospitals and teaching GP practices in the NHS are subject to annual educational audits which ensure there are adequate supervisors, resources etc. for students. This process in turn puts significant demands on education staff who have to visit the units and monitor the quality of the environment both for the patient and the learner.
If the number of teaching areas were to multiply to include places such as ITCs, then already overstretched resources would be further extended and proper teaching circuits which allow students to progress under supervision from novice to competent would be disrupted and fragmented. So those who comfort themselves by saying, well only 15% of the work is going to the private sector, the rest stays in the NHS, do not appreciate the impact on the whole organism which is clinical learning in the NHS of moving the simplest (read: most profitable) work.
GP services
Diverting pubic money into the private sector is also occurring in general practice. It is already the case that less than 50% of the British public have access to an NHS dentist. In areas such as South Devon only one in 10 dentists offers NHS treatment. This is a privatisation by stealth, which now spans many years.
The assault on medical general practitioner services is more recent. It has intensified and speeded up since the election on 5 May. In primary care the jargon is to talk of alternative providers (read: private providers).
On 31 May, the Times revealed that there had been a secret Whitehall meeting where private companies have been assured of more than £1 billion of NHS money to take over the running of some GP services. At this closed meeting health officials outlined plans to ring-fence 10% of health trusts' primary care budgets for contracts with the private sector.
This move coincides with another policy development which will be formally announced later in the year. This will allow companies that invest in building local health centres to also provide health care for that community — a scheme very similar to US health care provision. The NHS has appointed a commercial director, Ken Anderson, who has said the treatment centre model is very much the direction to travel. And who would 'we' be in this context exactly?
Although privatisation of Primary Care was never mentioned in any manifesto, Blair had already introduced the mechanism know as alternate provider medical services (APMS). APMS could also stand for "Another Preposterous Money-grabbing Scheme". APMS allowed NHS trusts to pay private companies for services such as maternity care or diabetes care or out of hours cover whenever there is a shortage of NHS care.
Before the election ministers were disappointed that very few private companies showed much interest in this, but now that 10% of NHS primary care funding will be channelled their way, what once looked a bit of a business risk now looks like a nice little earner. And where will the APMS get their staff? Why from the NHS of course, without any of the cost of training them.
Alyson Pollock, Professor of Public Health at University College London, described the government's plans: "The strategy is to liquidate the old NHS and bring in the market, and it is being done quite covertly...they are redefining the NHS by stealth."
Fighting back
Opposition from doctors is growing. The British Medical Association's conference, which met at the end of May, added its voice of opposition to that of the surgeons. Their leader, Dr Hamish Meldrum, said that the government was infatuated with the private sector and questioned whether the private sector would improve efficiency and provide value for money, saying, "Where is the evidence? Even more particularly, where is the evidence that it will improve rather than destabilise our present system of general practice? ... We have to ask, if the private sector is so wonderful, so efficient, why does it need to be given such a financial leg up?".
A particular objection of the GPs is that allowing private firms to run services leads to the perverse incentive to offer as much treatment as a patient desires - and get paid for it all.
Just as with the City Academies in education, presenting hard evidence to oppose grandiose government assertions is one means of attack.
The impact on medical education is also now being discussed in the trade union movement but there is pressing need for a wider understanding of this particular aspect of the attack. A motion opposing ITCs was carried unanimously at last month's NATFHE conference following a debate that explored the educational impact. However this aspect has not received much coverage in the national or professional press.
Two key questions are being asked by health workers: Where is the evidence that the private sector does it better? Why don't you give the NHS the money and we will run these treatment centres as part of the NHS?
As ever there is an EU dimension to this Blairite attack. In this case it is the Services Directive which would allow any company registered anywhere within the EU area to set up a branch in any other EU country without regard to standards of the host country. Just think: if Blair succeeds in fragmenting our NHS into ITCs and APMS what is to stop a company from any part of the EU running your local health centre? The labour would move in freely while the standards could be allowed to move down equally freely.
The headlong rush to City Academies in education has been checked, though not repulsed, by workers challenging every assertion made about them. The GP leaders described the health privatisation as another example of this headlong rush, but the questioning has begun and must continue.
For a start, let's learn a little more about these companies. Who are ChilversMcCrea healthcare, who run 13 surgeries in Essex, London and Sussex? And who are Intrahealth, who deliver primary care to 6,000 patients in the Prime Minister's own constituency in County Durham? Keep reading Workers for further updates.
'All you get are lies and more lies, spin and more spin...'
Like so much of the NHS in northern Ireland plastic surgery is in deep crisis. At the end of May there were over 8000 people waiting to see specialist consultants, a wait that was so long that GPs were advising patients anxious about potentially cancerous blemishes on their skin not to bother trying to get an appointment with the NHS but to go private instead.
In an attempt to rectify the situation hospital managers in northern Ireland approached a Manchester-based NHS waiting list consultant for help. The notes on the 8000 people were duly passed to this individual for review and a meeting arranged with northern Ireland's three plastic surgery consultants to discuss what might be done to improve matters. The meeting was arranged, the three very busy consultants cancelled all their lists for that day and waited for the arrival of the oracle from England. And waited, and waited.
The consultant never arrived, for after all, a waiting list consultant must be very busy indeed. He also never arrived for the rescheduled meeting, when again all lists were cancelled and, to make matters worse, didn't manage to make a third meeting either. Three days when the plastics consultants could at least have done some practical work to reduce the list and ease the anxiety of the 8000 people on it.
What did arrive, however, shortly after the cancellation of the third meeting, was the returned notes of the 8000 people with more than 2000 names removed from the list. This was supposedly done after "full consultation" with the three plastics consultants that he had never deigned to meet. How a waiting list consultant makes his money: he simply removes 2,000 names in order to promote the government's lie that the NHS is ever improving, and to ensure that the government's target for waiting lists was more than met for another year.
You begin to wonder whether this was an isolated case or one which is repeated endlessly throughout the NHS. As one of the consultants said, "I always thought that Margaret Thatcher was the worst enemy the NHS ever had. But at least you knew where you stood with her. Tony Blair is much worse, much worse. All you get are lies and more lies, spin and more spin. And that is much more difficult to fight against."