A&E fears fall on deaf ears

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Andy Burnham, Shadow Health Secretary: He’d rather listen to real doctors than spin doctors.

The title of this article should seem brutally ironic, considering that the Coalition government famously ‘paused’ the passage of the hugely controversial Health and Social Care Act through Parliament in order to perform a ‘listening exercise’ and get the views of the public.

… Then again, maybe not – as the Tories (with the Liberal Democrats trailing behind like puppies) went on to do exactly what they originally wanted, anyway.

Have a look at the motion that went before the House of Commons today:

“That this House is concerned about recent pressure in Accident and Emergency departments and the increase in the number of people attending hospital A&Es since 2009-10; notes a recent report by the Care Quality Commission which found that more than half a million people aged 65 and over were admitted as an emergency to hospital with potentially avoidable conditions in the last year; believes that better integration to improve care in the home or community can relieve pressure on A&E; notes comments made by the Chief Executive of NHS England in oral evidence to the Health Select Committee on 5 November 2013, that the NHS is getting bogged down in a morass of competition law, that this is causing significant cost and that to make integration happen there may need to be legislative change; is further concerned that the competition aspects of the Health and Social Care Act 2012 are causing increased costs in the NHS at a time when there is a shortage of A&E doctors; and calls on the Government to reverse its changes to NHS competition policy that are holding back the integration needed to help solve the A&E crisis and diverting resources which should be better spent on improving patient care.”

Now have a look at the amendment that was passed:

“That this House notes the strong performance of NHS accident and emergency departments this winter; further notes that the average waiting time to be seen in A&E has more than halved since 2010; commends the hard work of NHS staff who are seeing more people and carrying out more operations every year since May 2010; notes that this has been supported by the Government’s decision to protect the NHS budget and to shift resources to frontline patient care, delivering 12,000 more clinical staff and 23,000 fewer administrators; welcomes changes to the GP contract which restore the personal link between doctors and their most vulnerable patients; welcomes the announcement of the Better Care Fund which designates £3.8 billion to join up health and care provision and the Integration Pioneers to provide better care closer to home; believes that clinicians are in the best position to make judgements about the most appropriate care for their patients; notes that rules on tendering are no different to the rules that applied to primary care trusts; and, a year on from the publication of the Francis Report, notes that the NHS is placing an increased emphasis on compassionate care, integration, transparency, safe staffing and patient safety.”

Big difference, isn’t it?

From the wording that won the vote, you would think there was nothing wrong with the health service at all – and you would be totally mistaken.

But this indicates the sort of cuckooland where the Coalition government wants you to live; Jeremy Hunt knows what the problems are – he just won’t acknowledge them. And he doesn’t have to – the media are run by right-wing Tory adherents.

So here, for the benefit of those of you who had work to do and missed the debate, are a few of the salient points.

Principal among them is the fact that ward beds are being ‘blocked’ – in other words, their current occupants are unable to move out, so new patients cannot move in. This is because the current occupants are frail elderly people with no support in place for them to live outside hospital. With no space on wards, accident and emergency departments have nowhere to put their new admissions, meaning they cannot free up their own beds.

Health Secretary Jeremy Hunt had nothing to say about this.

Andy Burnham, who opened proceedings, pointed out the huge increase in admissions to hospital accident and emergency departments – from a rise of 16,000 between 2007 and 2010 to “a staggering” 633,000 in the first three years of the Conservative-Liberal Democrat Coalition government.

Why the rapid rise? “There has been a rise in people arriving at A and E who have a range of problems linked to their living circumstances, from people who have severe dental pain because they cannot afford to see the dentist, to people who are suffering a breakdown or who are in crisis, to people who cannot afford to keep warm and are suffering a range of cold-related conditions.”

He said almost a million people have waited more than four hours for treatment in the last year, compared with 350,000 in his year as Health Secretary; the statement in the government amendment that waiting times have halved only relates to the time until an initial assessment – not total waiting time. Hospital A and Es have missed the government’s targets in 44 of the last 52 weeks.

Illnesses including hypothermia are on the rise, and the old Victorian ailments of rickets and scurvy are back, due to increased malnutrition.

Hospitals are filling up with the frail elderly, who should never have ended up there or who cannot get the support needed to go home because of a £1.8 billion cut in adult social services and support. This, Mr Burnham said, was “the single most important underlying cause of the A and E crisis”; ward admissions cannot be made because the beds are full. The number of emergency admissions of pensioners has topped 500,000 for the first time.

Ambulances have been held in queues outside A and E, unable to hand over patients to staff because it is full. That has left large swathes of the country — particularly in rural areas — without adequate ambulance cover.

The government is downgrading A and E units across the country into GP-run clinics, while pretending that they are still to be used for accidents and emergencies – in the middle of the A and E crisis.

People in England are reducing the number of drugs they are taking because they cannot afford to buy them. Families are choosing between eating, heating or other essentials, like prescriptions.

Competition rules have been stifling care, Mr Burnham said: “The chief executive of a large NHS trust near here says that he tried to create a partnership with GP practices and social care, but was told by his lawyers that he could not because it was anti-competitive.”

He added: “Two CCGs in Blackpool have been referred to Monitor for failing to send enough patients to a private hospital. The CCG says that there is a good reason for that: patients can be treated better in the community, avoiding costly unnecessary hospital visits. That is not good enough for the new NHS, however, so the CCG has had to hire an administrator to collect thousands of documents, tracking every referral from GPs and spending valuable resources that could have been spent on the front line.”

And the health trust in Bournemouth wanted to merge with neighbouring Poole trust, but competition rules stopped the merger taking place.

Mr Burnham demanded to know: “Since when have we allowed competition lawyers to call the shots instead of clinicians? The Government said that they were going to put GPs in charge. Instead, they have put the market in charge of these decisions and that is completely unjustifiable. The chief executive of Poole hospital said that it cost it more than £6 million in lawyers and paperwork and that without the merger the trust will now have an £8 million deficit.

“The chief executive of NHS England told the Health Committee about the market madness that we now have in the NHS: ‘I think we’ve got a problem, we may need legislative change… What is happening at the moment… we are getting bogged down in a morass of competition law… causing significant cost and frustration for people in the service in making change happen. If that is the case, to make integration happen we will need to change it’ – that is, the law. That is from the chief executive of NHS England.”

The response from current Health Secretary Jeremy Hunt needs to be examined carefully.

He said more than 96 per cent of patients were seen within four hours – but this conforms with Mr Burnham’s remark; they were seen, but not treated.

He tried to rubbish Mr Burnham’s remarks about scurvy by saying there had been only 26 admissions relating to scurvy since 2011 – but this misses the point. How many were there before 2011? This was an illness that had been eradicated in the UK – but is now returning due to Coalition policies that have forced people into malnutrition.

He dodged the issue of competition rules strangling the NHS, by saying that these rules were in place before the Health and Social Care Act was passed. In that case, asked Mr Burnham, “Why did the government legislate?” No answer.

As stated at the top of this article. he did not answer the question of the frail elderly blocking hospital beds at all.

The vote was won by the government because it has the majority of MPs and can therefore have its own way in any division, unless the vote is free (unwhipped) or a major rebellion takes place among its own members.

But anyone considering the difference between the Labour Party’s motion and the government’s amendment can see that there is a serious problem of perception going on here.

Or, as Andy Burnham put it: “This Secretary of State … seems to spend more time paying attention to spin doctors than he does to real doctors.”

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Will the government really penalise GPs whose patients opt out of data sharing?

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It seems the government has found a way to dissuade GPs from letting patients opt out of having their medical records sold to private firms – the threat of penalties or even an investigation into the way they run their practice.

Vox Political revealed earlier this month that the government is planning to make a profit from selling the private records of NHS patients in England to healthcare and pharmaceutical firms.

The records are said to be ‘anonymised’, but in fact anyone buying your details will be able to identify you.

The system, originally called the General Patient Extraction Service (GPES), now the Health and Social Care Information Centre, may also be described as the care.data scheme. Health Secretary Jeremy Hunt wants you to think the information will be used for medical research and screening for common diseases, but in fact it could be used by private health companies as evidence of failures by the National Health Service, and could help them undercut NHS bids to continue running those services – accelerating the privatisation that nobody wanted.

Patients have the right to withhold their data, but they must specifically inform their medical practice of their wishes. This is why medConfidential created a web page containing a special opt-out form, along with a form letter in various formats, allowing patients to opt out themselves, their children and any adults for whom they are responsible.

Now GPs are living in fear of reprisals if they don’t deliver enough details to the new system.

According to GPonline.com, Health minister Dr Daniel Poulter failed to rule out penalising GP practices with a higher-than-average proportion of patients opting out of new NHS data sharing arrangements.

In a written answer to Labour MP and health select committee member Rosie Cooper, Dr Poulter also refused to say what level of patient opt-out from the scheme would trigger an investigation.

Asked whether practices would be penalised, who would investigate practices with a high opt-out rate, and at what threshold this would apply, Mr Poulter said: “NHS England and the Health and Social Care Information Centre will work with the BMA, the RCGP, the Information Commissioner’s Office and with the Care Quality Commission to review and work with GP practices that have a high proportion of objections on a case-by-case basis.”

Ms Cooper took this as an admission that GPs were “being threatened and bullied into ensuring patients don’t choose to opt-out”.

Reacting on Twitter, NHS national director for patients and information Tim Kelsey ruled out fines for practices where large numbers of patients opt not to share data. He wrote: “Nobody is going to get fined if patients opt out.”

None of this offers a good reason for you to leave your medical records unprotected – in fact, it gives you more reasons to opt out than before, and might provide GPs with the excuse they need to retaliate.

Doctors have been pushed further and further by the Conservative-led government’s changes to the NHS. For example, they were told they would have a greater say in where the money went, as members of Clinical Commissioning Groups (CCGs), but that was not true – they don’t have the time to take part in such decisions so they have been handed over to firms that are often part of the private companies now offering services to the NHS (for a price).

Now they are being told they may face reprisals if they do not betray the principle of doctor-patient confidentiality.

But you can only push a person a certain distance before they push back.

How will NHS doctors in England respond?

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Is Jeremy Hunt trying to fool us with the same con trick, all over again?

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Andrew Lansley, Care Bill, CCG, Clause 118, clinical commissioning group, close, closure, companies, company, competition, Conservative, consult, firm, government, GP, GP commissioning, health, Health and Social Care Act, Health Secretary, healthcare, hospital, Interest, Jeremy Hunt, Lewisham, Mike Sivier, mikesivier, National Health Service, NHS, patient, patient choice, people, PFI, politics, private, Private Finance Initiative, privatisation, privatise, public, sector, sick, solvent, South London Healthcare Trust, success, The Guardian, Tories, Tory, Vox Political

It seems that Jeremy Misprint Hunt is trying to pretend that his planned law making it easier to close good hospitals to prop up bad ones (and boost private health firms in the process) is happening because “Conservatives genuinely care about the NHS”.

Writing in The Guardian, he tells us that Clause 118 of the Care Bill currently on its way through Parliament – the so-called Hospital Closure Clause, “is necessary because we need the power to turn around failing hospitals quickly and – in extremis – put them into administration before people are harmed or die unnecessarily.

“The process has to happen quickly, because when a hospital is failing lives can be put at risk. That is why it matters so much – and why, in opposing it, Labour are voting to entrench the failures they failed to tackle.”

For information, Clause 118 was included in the Bill after Mr Hunt lost a legal battle to close services at the successful and financially solvent Lewisham Hospital in order to shore up the finances of the neighbouring South London Healthcare Trust, which was losing more than £1 million every week after commissioning new buildings under the Private Finance initiative.

The private firms that funded this work were apparently charging huge amounts of interest on it, meaning that SLHT would never be able to clear its debt.

PFI was introduced by the Conservative government of 1979-97 and, sadly, continued by the Labour government that followed it.

It seems likely that it will contribute to the absorption of many NHS trusts by the private sector, as the effects of the Health and Social Care Act 2012 take hold.

Clause 118 means the Health Secretary will be able to close successful local hospitals in England on the pretext of helping neighbouring trusts that are failing – without full and proper consultation with patients and the public, or even agreement from the (in name alone) GP-led Clinical Commissioning Groups.

The resulting, merged, organisation could then be handed over to private firms who bid to run the service at a price that is acceptable to the government.

So it seems that this is a plan to speed up the process of privatisation, rather than anything to do with caring about the NHS.

It seems to me that Mr Hunt is trying to lull the public into false security by claiming the NHS is safe, in exactly the same way his forerunner as Health Secretary, Andrew Lansley, provided assurances before Parliament passed his nefarious Health and Social Care Act.

Mr Lansley said his law would increase the range of choice available to patients (it doesn’t; in fact, it increases the ability of service providers to choose which patients they treat, on the basis of cost rather than care); he said GPs would be able to commission the services they need for their patients (in practice, they don’t; the running of the new Clinical Commissioning Groups has been handed over primarily to private healthcare consultants, many of which are arms of private healthcare providers, creating a conflict of interest that is conspicuously never mentioned); and he said that CCGs would be able to choose who provides services on the basis of quality (they can’t; if they restrict any service to a single provider, they risk legal action from private healthcare firms on the grounds that they are breaching competition rules).

Mr Lansley lied about all those matters; it seems Mr Hunt is lying about this one.

Or am I mistaken?

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Plebgate v NHS lies – why is one the lead on the news when the other was buried?

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Why does the BBC want us to pay more attention to a squabble between this overprivileged cyclist and a policeman than to the wholesale privatisation of the National Health Service, for which we have all paid with our taxes?

In the mid-1990s I interviewed for a reporter’s job at the then-fledgeling BBC News website. I didn’t get it.

Considering the BBC’s current output and apparent lack of news sense, I am now very glad that I did not succeed. I would be ashamed to have that as a line on my CV.

Unfortunately, the BBC accounts for 70 per cent of news consumption on British television – and 40 per cent of online news read by the public. It has a stranglehold on most people’s perception of the news – and it is clearly biased.

Take today’s story about PC Keith Wallis, who has admitted misconduct in the ‘Plebgate’ affair by falsely claiming to have overheard the conversation between Andrew Mitchell and another police officer. He admitted the falsehood at a court hearing in the Old Bailey.

The case is important because he had been lying in order to support the allegation that Mr Mitchell had shouting a torrent of profanities at the other police officer, Toby Rowland, after being stopped from cycling through Downing Street’s main gates. PC Rowland had alleged that one of the words used had been the derogatory word “pleb”, and the resulting scandal had forced Mitchell to resign as Tory Chief Whip.

It casts doubt on the integrity of Metropolitan police officers – a further four are facing charges of gross misconduct.

However, the officer at the centre of the case – PC Rowlands – is not among them. He remains adamant that his version of events is correct and is suing Mitchell for libel over comments he made about the incident which the officer claims were defamatory.

This is the story the BBC decided to make the lead on all its news bulletins, all day. It contains no evidence contradicting PC Rowland’s allegations against Mitchell; the worst that can be said is that the admission of guilt casts a shadow over the entire Metropolitan police service – and in fairness, that is a serious matter.

But the fact is that people will use this to discredit PC Rowland and rehabilitate the reputation of an MP who was a leading member of the Coalition government until the incident took place – and that is wrong. It is an inaccurate interpretation of the information, but the BBC is supporting it by giving the story the prominence it has received.

In contrast, let’s look at the way it handled revelations about the Coalition government’s plans to change the National Health Service, back when the Health and Social Care Act was on its way through Parliament.

You will be aware that Andrew Lansley worked on the then-Bill for many years prior to the 2010 election, but was forbidden from mentioning this to anybody ahead of polling day (see Never Again? The story of the Health and Social Care Act 2012). Meanwhile all election material promised no more top-down reorganisations of the NHS. Former cabinet minister Michael Portillo, speaking about it on the BBC’s This Week, said: “[The Tories] didn’t believe they could win an election if they told you what they were going to do.” Considering the immensity of the changes – NHS boss David Nicholson said they were “visible from space” – this lie should have sparked a major BBC investigation. What did we get?

Nothing.

After Lansley released his unpopular White Paper on health, David Cameron tried to distance himself from the backlash by claiming “surprise” at how far they went. This was an early example of the comedy Prime Minister’s ability to lie (so many have issued from his lips since then that we should have a contest to choose the Nation’s favourite), as he helped write the Green Papers that preceded this document (see Never Again). If it was possible for the authors of Never Again to dig out this information, it should certainly have been possible for the BBC. What did we get?

Not a word.

In contrast to Cameron, Lansley, and any other Tory’s claims that there would be no privatisation of the NHS, KPMG head of health Mark Britnell (look him up – he’s an interesting character in his own right) said the service would be shown “no mercy” and would become a “state insurance provider, not a state deliverer”. This important revelation that the Tories had been lying received coverage in less popular outlets like The Guardian, Daily Mirror and Daily Mail but the BBC only mentioned it in passing – four days after the story broke – to explain a comment by Nick Clegg.

One of the key elements used to get members of the medical profession on-side with the Lansley Act was the claim that GPs would commission services. This was a lie. It was well-known when the plans were being drafted that general practitioners simply would not have time for such work and it was expected that they would outsource the work to private management companies – many of whom would also have a hand in service delivery. There is a clear conflict of interest in this. East London GP Jonathan Tomlinson told Channel 4 that the scale of private involvement would be so large as to include “absolutely everything that commissioning involves”. This was a clear betrayal of the promise to GPs. The BBC never mentioned it.

Another phrase trotted out by the Tories was that the changes would increase “patient choice” – by which we were all intended to believe patients would have more opportunity to choose the treatment they received and who provided it. This is a lie. The new Clinical Commissioning Groups created by the Act – and run, not by doctors, but by private healthcare companies on their own behalf – have a duty to put services out to tender unless they are sure that only one provider is able to offer a service. In reality, this means all services must be opened up to the private sector as no CCG could withstand a legal challenge from a snubbed private provider. But this makes a mockery of Andrew Lansley’s promise that CCGs could choose when and with whom to commission.

In turn, this means private firms will be able to ‘cherry-pick’ the easiest and cheapest services to provide, and regulations also mean they can choose to provide those services only for those patients they believe will cost the least money. Anyone with complicated, difficult, or long-term conditions will be thrown to the wolves. In other words, far from patients having increased choice, the Health and Social Care Act means private companies will be able to choose the patients they treat.

We are still waiting for the BBC to report this.

Add it all up and you will see that the largest news-gathering organisation in the UK – and possibly the world – sees more news value in a slanging match between an MP and a policeman than it does in the wholesale betrayal of every single citizen of the country.

Why do we allow this to continue?

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How much can YOU pay? A&E charges would speed NHS privatisation

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accident, CCG, charge, Chris Ham, clinical commissioning group, Department of Health, doctor, emergency, expensive, Freedom of Information, GP, health, healthcare, hospital, insurance, Kaiser Permanente, managed care, Managed Care Organisation, market, MCO, National Health Service, NHS, Personal Care Budget, private, privatisation, top-up, UK, undercut, USA

Health-CARE? It seems increasing number of GPs want the person on the stretcher to stump up a fiver or a tenner before the medical staff in the photograph can begin treatment. (Image: BBC – intentionally left fuzzy to preserve anonymity of those involved)

It is strange that more has not been made of the revelation that one-third of GPs apparently believe a £5 or £10 charge should be imposed on everybody turning up at hospital Accident and Emergency departments.

This seems to be a clear next step towards the marketisation of what used to be the National Health Service, disguised with a claim that it would “reduce frivolous use of the NHS and the growing pressure on emergency departments”.

It seems that a poll of more than 800 doctors found 32 per cent said “fees would be the most cost-effective way of cutting the number of people who go to A&E, who could have gone to their GP or a pharmacist instead or did not need medical attention at all”. Presumably they have already tried simply telling people what to do, then.

The story in The Guardian states that “specialists believe between 30 per cent and 40 per cent of all visits are unnecessary and that many patients could have sought help elsewhere because their illness was minor or not urgent”. That leaves 60-70 per cent of visitors paying extra for services their taxes have already funded!

According to the book NHS SOS (edited by Jacky Davis & Raymond Tallis; published by Oneworld), the plan is to convert the publicly-funded nationwide health service into one of “managed” care along the lines provided by Kaiser Permanente in the USA.

This is based on a flawed use of figures (p.39) so Kaiser is in fact far more expensive, but that didn’t stop then-Department of Health strategy director Chris Ham from defending the claims and allowing Kaiser to emerge as the model for NHS reform. This was seen as particularly useful for those with cash to invest in the company or other MCOs (Managed Care Organisations) as they reaped huge profits – until market saturation, government and employer schemes to keep health care costs down, and a series of scandals made the pendulum swing the other way. Then these companies started lowering patient benefits, increasing premium fees and withdrawing from unprofitable markets, and this is very similar to the current situation in England.

Finally, these firms began to expand internationally, to countries including the UK, where the NHS was seen as a hugely attractive business opportunity.

MCOs decide how services are organised and funded for their clients, through contracts with selected providers and rigorous control of hospital admissions. This seems uncannily close to the work of Clinical Commissioning Groups, which were set up under the pretext that they would allow GPs to control budgets, but in practice allow the money to be controlled by private firms that have been hired by overworked doctors – as was always intended by the Tory-led Coalition government.

Government regulations mean private companies must be allowed to bid to provide as many services as possible. Freedom of Information rules mean they can find out how the public service operates and then undercut its bid. Without funding, the public service will close, leaving the way clear for the private provider to pump up its prices – so they will eat up more and more of the limited NHS budget. But which services do they choose?

They choose those that are easiest and cheapest to provide – the services that provide the most opportunity to make a profit.

Accident & Emergency is not one of those services. It will remain with the public sector providers who are being “continuously cut and squeezed into downsizing, mergers, centralisation and closures”, reducing care to “short-staffed, overloaded, ‘centralised’ units”, covering “only those services that the private sector does not wish to provide” (ibid, p.18).

How can services like A&E continue, if the private operators are taking all the cash? The only answer, it seems, is to bring in health insurance. That is the plan, at least – and the proposed A&E charges seem intended to be a palatable way of opening that door to a public that would once have treated the very idea as anti-British and voted the government that proposed it out of office for a considerable period of time.

Next it seems likely that “top-up” insurance will be offered to people whose complex ongoing conditions qualify them for so-called Personal Care Budgets. The budget money will be limited, forcing patients (or rather, customers) to “top them up” with insurance.

Be very clear on this: You are not looking at the thin end of the wedge. The wedge has already been driven in and England is well on the way to having a privatised health service, with the NHS as nothing but a brand under which taxpayers’ money can be handed out to private firms that handle only the simplest procedures.

The intention, it seems clear, is to allow publicly-funded services to wither over a period of time, in order to soften you up – make you more receptive to the idea of paying for healthcare that once was free but may not even be available in the future if you don’t come up with some cash.

Are you going to sit there and wait for that to happen? Private health care, and health insurance, is far – far – more expensive than the NHS, which was the most cost-effective and efficient health provider in the world until the Tory-led Coalition got hold of it. Don’t believe the propaganda – the service had record satisfaction levels in 2010.

You can still stop the rot. To find out how you can work to reverse the damage being done to the most cherished organisation in the UK, visit www.keepournhspublic.com and www.nhscampaign.org.uk

If you’re living in Wales, Northern Ireland or Scotland, don’t think that devolution of healthcare will save you because it won’t. Budgets are already under pressure from Westminster and the Tories will do whatever they can to force regional governments into the same, or similar, patterns.

One of life’s certainties is that you will become ill at some point. Don’t wait until that happens, because it will be too late.

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Are these the men who would be king?

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Unelected rulers? Thomas Watjen of Unum, Thierry Breton of Atos, and Michael Andrew of KPMG. As things stand, it seems whoever you support in 2015, these people will be behind them. Do you want that?

There is a certain kind of person who takes great delight in commenting on political blogs with a variant of the following:

“It’s no use voting! They’re all the same! It doesn’t matter what you vote for – a politician always gets in!”

No doubt you’ll be familiar with their work.

They are extremely annoying. Their insistence that all politicians are the same breed of pond scum does a huge disservice to those in public service who genuinely want to improve the lives of their fellow human beings; the fanaticism with which they disseminate their opinions may be seen as an attempt to stop ‘casual’ voters from bothering, thereby condemning the country to the current status quo.

Also, most annoyingly of all, they may have a point.

Take the three men pictured above. The one on the right is Michael Andrew, chairman of accounting firm KPMG. This is one of the ‘Big Four’ accountancies who are, among other things, involved in rewriting UK tax law for George Osborne at the Treasury, partly to suit their own desires as architects of the largest tax avoidance schemes currently available to corporations and wealthy individuals resident in the UK.

Today, thanks to an illuminating blog article by Tom Pride over at Pride’s Purge, we learn that KPMG has taken over the running of no less than a quarter of all the clinical commissioning groups (CCGs) that Andrew Lansley swore blind would be run by doctors when the Conservative-led Coalition government pushed through the NHS Privatisation Act of 2012 (otherwise known as the Health and Social Care Act).

The pretext for creating these organisations was that doctors were in the best position to commission health services in any part of England, as they had the detailed knowledge required to determine what was needed.

In fact it was well known that GPs would not be able to carry out this important work – it would be too much for them to take on in addition to their ‘day job’, and they simply did not have the necessary skills. Lansley knew this, and therefore knew that his law would open the door for private firms to take over.

This is borne out by an article in GP online which is now almost a year old; so readers should bear in mind that the current situation may be much further advanced. It stated that KPMG had confirmed the firm was working with “just over 50” of the 211 CCGs in England, along with 11 commissioning support units (CSUs).

The article indirectly quoted Tim Rideout, who said CCGs did not have the capacity to commission in an effective way.

This is an interesting revelation from the former chief executive of the NHS in Leicester City who was then seconded to the Department of Health as the senior responsible officer for the development of – guess what? – NHS commissioning boards. If the new commissioning groups don’t have the capacity to work properly, why didn’t he do something about it at the appropriate time?

Oh, wait. Here’s the answer: In March 2012, Mr Rideout was hired by KPMG as an associate director responsible for – who would have thought it? – commissioning.

In the same article, national clinical commissioning lead for England, Dr James Kingsland, said clinicians and GPs should not be involved in complex procurement, and added: “We are seeing a lot of misunderstandings, disillusionment and despondency.”

Mark Britnell, KPMG’s head of healthcare since 2009 – and another former NHS chief executive, was quoted by The Observer in 2011 as stating: “In future, The NHS will be a state insurance provider not a state deliverer”, and that “The NHS will be shown no mercy and the best time to take advantage of this will be in the next couple of years.”

The following day, KPMG released a statement in which he said the quotes did “not properly reflect” what he had said.

So we have a firm moving to take over CCGs, helped by the fact that its roster now includes the man responsible for setting them up in the first place. Going back to Tom Pride’s piece, he states that the situation chillingly reflects the way the Dutch health service was privatised in 2006. Provision of health services is being handed over to private companies, control of the health budget was handed over to private consortia made of doctors and consultants, but now those consortia are being taken over by private companies.

When private firms like KPMG run all CCGs, the Conservative plan to privatise the NHS will be complete. And the NHS, it seems, will be run by Michael Andrew, head of KPMG, from his base in Hong Kong.

But the rot doesn’t stop there.

Tom Pride correctly adds that the consulting arm of KPMG has been owned, since 2002, by another company – called Atos.

That’s right – Atos. The French firm run by Thierry Breton (pictured, centre).

The firm that Ed Miliband wants to fire from running work capability assessments for the DWP will still be involved in government work – at the Department of Health.

You see how this works? Let a private company inveigle its way into the plans of politicians and there’s no getting rid of it. Like the giant squid, it extends its pseudopods into every government department it can possibly contaminate, planting a sucker onto everything it thinks it can take for itself.

Over at the DWP, as everyone should know by now, Atos have been carrying out work capability assessments on claimants of Employment and Support Allowance. These were dreamed up by an insurance company called Unum, that has been working with the UK government – Conservative, Labour and Coalition – since Peter Lilley invited then-boss John LoCascio in, back in the early 1990s.

Unum is now run by Thomas Ratjen (pictured, left), who is based in Tennessee, USA. Its long-term aim seems to be the ruin of the British social security system, rendering it pointless for anyone to claim benefits. Instead, the plan appears to be to encourage working people to buy Unum insurance policies – which are themselves useless, as lawsuits in several US states have proved, while also giving the company a criminal record.

This blog recently revealed that it seemed Unum was trying to influence the policies of all three main UK political parties. The thinktank Reform, that has been part-funded by Unum, is running a fringe event at all three party conferences, entitled ‘New thinking on the welfare state’. This event was sponsored by the Association of British Insurers, which has Unum among its members.

Labour’s version of this event took place on Monday (September 23), hosted by Anne McGuire, shadow minister for disabled people.

She defended her role in an email today, as follows:

“I don’t know why you have been led to believe that I was hosting an event by Unum. For the record, I was speaking at a round table discussion with organisations which included the European Commission, voluntary organisations, insurance companies amongst others. As it was such a conversation, it was by invitation only as was the event I attended this morning organised though the Shaw Trust and Mencap. It is not unusual to have such events at party conference.

“I also spoke at an open meeting last night on the future of welfare reform and disabled people with many disabled people in attendance and participating.

“I am aware of the strong feelings on Unum and Atos. However I trust that you will appreciate that having discussions with a range of organisations should not be seen as anything other than that and in no way implies an endorsement of any particular company or organisation.”

It simply doesn’t ring true.

Let’s look at the context: This event was organised by a right-wing thinktank (they’re ideologically opposed to state-run social security systems) that has been sponsored by Unum; was about “new” thinking on the welfare state; was itself sponsored by the Association of British Insurers, of which Unum is a member; and representatives of insurance companies – and we’re willing to bet Unum was among them – took part in the behind-closed-doors discussion.

It seems clear that this event was intended to influence Labour Party policy away from providing a well-run and reasonable state benefit system, as was the case in the UK until Peter Lilley in the early 1990s, and towards dismantling that system to make way for a system based on privately-run insurance policies, such as those produced by Unum.

The fact that it is being mirrored at the other two party conferences clearly suggests that the firms involved want to influence all major British political parties in the same way. If successful, this would mean that it won’t matter who gets into office after the 2015 election; Unum will still be in power at the Department for Work and Pensions.

Just as KPMG will still be in power at the Treasury, and at the Department of Health, alongside its owner Atos.

And the three gentlemen pictured at the top of this article will be the unelected kings of the UK because, no matter which way you vote, they will be in charge.

Well now.

That would be a good place to end this article, but then, dear reader, you might be left thinking there is nothing you can do. There is something you can do.

You can write to your MP, to local newspapers, to the party leaders and the ministers running these government departments and you can bitch like hell about it!

The people of this country deserve elected representatives who are going to run this country by their own decisions, in the best interests of the citizens who voted for them – not employees of a dubious gang of unelected corporations, running this country in their own best interests and treating the citizens like dirt.

You can make a difference.

But you need to start now.

So you thought the battle for the NHS was over, did you?

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If you’ve been following the mainstream news media, that’s probably forgiveable.

The fact is that the House of Lords will be debating – today – a so-called ‘fatal’ motion to annul the new section 75 NHS privatisation regulations, on the grounds that they do not allow clinical commissioning groups to employ service providers in the best interests of patients.

The strict wording of the motion is as follows: Lord Hunt of Kings Heath will move the humble address to the Queen, praying that “the National Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013, laid before the House on March 11, be annulled on the grounds that they do not implement the assurances given by Ministers to Parliament during the passage of the Health and Social Care Act 2012 that NHS commissioners would be free to commission services in the way they consider in the best interests of NHS patients (SI 2013/500).”

These are the regulations that were withdrawn and rewritten very hastily, after a storm of protest over backdoor privatisation of NHS services last month. Now they are back before Parliamentarians again – and the prognosis is not healthy.

Even after the criticism that led to the re-drafting, the regulations require all NHS services to be put out to competition unless the commissioners can prove there is only one provider capable of delivering them. Such decisions could expose CCGs to costly legal challenges.

It means commissioners will be forced to open up – to private sector competition – any part of the NHS that companies think will be profitable, with very few exceptions.

This means funding could be drained from NHS hospitals as services are relocated elsewhere, and local health decision-makers will be able to do little or nothing to protect them from this starvation of funds.

Now, dear reader, you might be sitting at your computer wondering what all the fuss is about. If private providers get the contracts, it will be because they can provide a superior service at lower cost, right? That’s what this is all about, right?

Wrong.

Have you ever known costs to go down after a publicly-owned organisation was privatised? Is your gas bill lower now than it was in the 1980s? How about your electricity bill? Water? If you’re still with BT for telecommunications, is that bill lower than before privatisation in the 1980s?

Even adjusting for inflation, that seems unlikely.

No, the reason NHS services (in England only, of course, as health is a devolved issue) are being offered up to tender is to make fat profits for the greedy bosses of private healthcare companies, who have made themselves very close to leading members of the Conservative Party. Over the last few years, many questions have been asked about these connections – how much have these companies contributed to the Conservative Party over the last few years? How many Conservative MPs are likely to receive financial benefits from this outsourcing of funds?

If you have a Conservative MP, a Freedom of Information request about their own interests might be illuminating in this regard.

Think about the long-term effects. If an NHS hospital is starved of cash, this means it will be hard-pressed to provide whatever services remain with it – and these are likely to be the more costly and high-pressure accident and emergency-type services. These pressures could lead to more mistakes of the kind that have been filling up media headlines recently, and in any case the financial losses could eventually cause NHS hospitals to close – or be taken over by a private company.

What then? The only choice for people living nearby will be to go private, and pay for the health service that was previously free.

If you live in England, is that really what you want? To end up forced to pay – at great cost – for services that are currently free to everybody?

You’d better hope the Lords see sense this afternoon and send the government back to think, yet again.

NHS stealth-privatisation – get an email in to the Lords!

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CCG, clinical commissioning group, Coalition, Conservative, debate, health, House of Lords, Mike Sivier, mikesivier, NHS, Parliament, people, politics, privatisation, regulation, secondary legislation scrutiny committee, SI 257, sick, SKWAWKBOX blog, SLSC, Steve Walker, Vox Political

This is a quickie because there isn’t much time.

I just received notification from fellow blogger Steve Walker that today is the deadline for submission of evidence and concerns to the House of Lords ‘Secondary Legislation Scrutiny Committee’ (SLSC) to ask for a full Lords debate on the undemocratic attempt to force privatisation on the NHS via the new Clinical Commissioning Groups (CCGs).

Steve has written an excellent analysis of the redrafted SI 257/2013 regulations, explaining why they are a minefield likely to push CCGs further into the privatisation trap than any other outcome. You can read it here.

Rather than waste time trying to do the same job twice, I have emailed the Lords to ask for a debate, referring them to the same articles. Here’s a copy of what I have written. I would suggest that anyone who has strong feelings on the subject could use this as a template to email the Lords themselves. Here’s the email address:

seclegscrutiny@parliament.uk

And here’s the text of my email:

Dear Sir/Madam,

I understand that you are looking for submissions regarding the government’s ‘section 75’ secondary legislation. May I add my voice to those asking for a full Lords debate on this undemocratic attempt to force privatisation on the NHS via the new Clinical Commissioning Groups?

I do not intend to provide supporting arguments myself but instead would like to refer you to an excellent blog article – http://ccgwatch.wordpress.com/2013/03/12/revised-section-75-regs-mire-ccgs-in-a-legal-minefield/ – by Steve Walker, written following a careful reading of the government’s revisions to SI 257/2013.

It identifies serious concerns with the legislation, which does nothing to change the substance of the original instrument – and in fact uses uncertainty as an additional tool to tie the hands of CCGs to include private bidders for health service contracts.

With regards.

Over to you.

Battle is joined – for the future of your NHS

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This week the Labour Party will be launching its formal defence of the National Health Service, after the Coalition government stealthily slipped a “negative resolution” to enforce privatisation onto the books before the Parliamentary recess.

The resolution, as mentioned in a previous Vox article, will force clinical commissioning groups (CCGs) in England to introduce competition to provide all services for which it is practical (in other words, almost everything), whether or not they believe it to be in the best interests of all concerned.

Its arrival means either the government lied when it gave the promise that neither the Health Secretary nor Monitor would be allowed to force health commissioners to put services out to competition, or it has decided to break firm, formal promises, written by Andrew Lansley in a letter and spoken on the record in Parliament.

Labour’s Shadow Health Secretary, Andy Burnham, has announced that the party will ‘lay prayers’ against the resolution in both Houses of Parliament, and will fight “tooth and nail” to defeat it.   He has repeated his firm, unambiguous commitment to repeal the 2012 Health and Social Care Act as a priority once Labour is back in government, and to restore the lead on the commissioning of health services to local government.

If Labour win the next General Election, he will reintroduce a preferred provider policy that will allow genuine NHS organisations to be named as the providers of choice, thus ensuring that the NHS remains, at its core, a public institution. This will restore the NHS to leadership of health service provision, alongside local government as the commissioning lead.

But by that time much irrevocable damage will have been done, so concerted interim action is needed – and it is heartening that CCGs in Haringey and Bristol are already leading the way.

In Haringey, the CCG has been persuaded by campaigning organisation 38 Degrees to adopt amendments to its constitution, ensuring that they will only invite competition to buy services where “necessary or appropriate”. Contractors/providers must be “good employers” – be reputable, meet tax and NI obligations and keep to EO legislation. Other amendments exclude companies convicted of offences, and   prohibit companies that use improper tax avoidance and off shore schemes.

That is just the start of the battle for the NHS – but it’s a good one, and an example that can be taken forward.

Haringey has accepted that there is a case for arguing that awarding tenders to private providers will cause genuinely public structures to atrophy as funds are taken out of the public health economy and turned into private profits. This would be to the long-term detriment of the NHS, meaning an award to a private bidder is worse value, even if the headline price is lower.

If you are in England and concerned about the decline that the government’s negative resolution will instigate, why not get in touch with your own local CCG, ask them to examine the actions of their colleagues in Haringey, and politely request that they go and do likewise?

Expect much more on this issue in the future. It will be published here as it becomes available.