Ellen Graubart looks at the privatisation of the NHS and the campaigns fighting to save it

The National Health Service was established in July 1948, and from then on for the next 65 years the entire population of the UK was provided with health care free at the point of delivery with equal treatment for all on the basis of need not on the ability to pay.

In his election campaign of 2010 David Cameron made a big thing of assuring us that the NHS would be safe in his hands. He betrayed us, but the betrayal began a long time ago.

In the beginning there was Thatcher

The seeds of our betrayal were planted when Margaret Thatcher had a dream. David Cameron is close to realising her dream, which we might soon have to experience as a nightmare.

Thatcher introduced the concept of the internal market and fundholding to the NHS as a result of a report produced by businessman Roy Griffiths in 1983 that suggested that the NHS should be run like a supermarket to increase efficiency and effectiveness.

Thatcher’s directives to the NHS in the 1980s to contract out of considerable parts of non-clinical services such as cleaning and portering – because contracts were signed on the basis of low cost -  led to the inevitable deterioration of patient care in hospitals.

The direction of travel certainly began in the 80s under Thatcher, and every reform since then has been a strengthening of the market structure, transforming the NHS from a publicly funded body into a huge mix of private providers. But it was Thatchers’ imposition of the “Purchaser/provider split” in 1990 which decisively opened the way for the marketisation of the NHS.

John Major, Tony Blair, Gordon Brown and David Cameron dutifully followed her lead.

Then came new Labour

Labour put in large scale investment, created in a tier of managers, brought in targets and incentives, and – surreptitiously – opened the door to privatisation.

In 2000 Alan Milburn, the then Secretary of State for Health, commissioned Richard Branson’s Virgin to report on customer services in the NHS and how to make hospitals a more user-friendly environment. The report was classified as ‘restricted’ and was a Trojan Horse for Labour’s agenda of privatising the NHS.

The report was not made public until January 2013, following a Freedom of Information Inquiry request by Mr. N. Csergo of KONP (Keep Our NHS Public) but the names of the team responsible for inclusion of the new policy have been redacted from the document.

The Labour government also introduced the concept of ‘any willing provider’ in 2007, which later became ‘any qualified provider‘, which established the policy of  market competition which means competition on price rather than on quality of care.

Con-dems take up the reins

The coalition government then went on to provide the tools for bringing to a conclusion the neo-liberal agenda of privatising the NHS,  by extending the ‘any qualified provider model’ to most sections of healthcare.

They pushed through Parliament the Health and Social Care Act 2012, a massively long and complicated bill, which has provided the mechanism – now enshrined in law – for the final dismantling of the NHS as we know it.  The Health and Social Care Act 2012 has:

• removed the UK government’s obligation to provide universal healthcare in England
• opened the door for charges without limit for NHS services.
• permitted private providers to take over any NHS services.
• allowed up to 49% of the business of NHS hospitals to be private. (The intention is almost certainly to eventually increase this to 100%,  thereby creating a US-style insurance-based system)

Dr. Lucy Reynolds, an academic in health policy at the London School of Hygiene and Tropical Health has said:

“The health and social care bill was passed in the form as if it were an aeroplane with no engines. The structure was all there. Its significance was not very plain to many people unfortunately.”   “They couldn’t find the thing in it that was actually going to accomplish the privatisation because really the only marker of it was a little clause explaining that regulations would be issued.”

“and those regulations provide the jet engines to make that privatisation go ahead.”  Regulations that “will create rights for private providers to supply which will not only allow them to take quite a lot of the share of the NHS budget for their business right now, it also potentially makes the privatisation irreversible in the future. So all of the rest of the plane was put in place last year”

Financial beneficiaries/conflicts of interest

There are serious issues of conflict of interest involved in the passing into law of the Health and Social Care Act which would have remained secret if pressure from Labour had not forced the Coalition Government to create a register of interests. There are over 200 parliamentarians with recent past or present financial links to companies involved in healthcare; they were all were allowed to vote on the Health and Social Care bill, turning it into an Act.

Key Facts of Lords and MPs connections to healthcare:

• 225 parliamentarians have recent or present financial private healthcare connections
• 145 Lords have recent or present financial connections to companies involved in healthcare
• 124 Peers benefit from the financial services sector
• 1 in 4 Conservative Peers have recent or present financial connections to companies involved in healthcare
• 1 in 6 Labour Peers have recent or present financial connections to companies involved in healthcare
• 1 in 6 Crossbench Peers have recent or present financial connections to companies involved in healthcare
• 1 in 10 Liberal Democrat Peers have recent or present financial connections to companies involved in healthcare
• 75 MPs have recent or present financial links to companies involved in private healthcare
• 81% of these are Conservative
• 4 Key members of the Associate Parliamentary Health Group have parliamentarians with financial connections to companies involved in healthcare
• 4 Patrons of the pro-reform think tank 2020health have Peers with private healthcare links
• Nearly 40% of the most powerful individuals in healthcare are from companies with links to Lords and MPs.
• 333 donations from private healthcare sources totalling £8.3 million has been gifted to the Tories.
• 4 MPs and 1 Lord have worked for Huntsworth Health, run by a Peer who gave money to Cameron’s leadership campaign
• 25 of the Finalists in the HealthI nvestors Awards 2012 have parliamentarians connected to them
• 2 companies, DACBeachcroft, Cumberlege Connections., which have Lords as a partner and as an owner respectively, moved themselves into a position to make money from the reforms as the Lords voted on the bill, and before the bill became Act
• 5 organisations link to Baroness Cumberlege: Her company, Cumberlege Connections, Associate Parliamentary Health Group, 2020health, Huntsworth plc, MJM, healthcare solutions
• 19 Lords and MPs have financial links to Pharmaceutical giant GlaxoSmithKline
• 9 Lords and MPs have received payment from a company run by Baroness Cumberlege, called Cumberlege Connections, which is a healthcare training and political networking company
• 1 – the amount of times the BBC challenged Andrew Lansley in the last three years on the donation received to fund his private office when shadow health minister from John Nash the chair of Care UK. Mr Nash was made a Lord.

All were able to vote on the Health and Social Care bill (now Act), despite having a prejudicial interest, which would not have been allowed at local council level.

Retracting the act?

NHS SOS, chapter 7,  From Cradle to Grave by Allyson M Pollock and David Price:

“The Health and Social Care Act 2012 must be revoked because it removes the democratic and legal basis of the NHS and allows services to be closed and reconfigured on an unprecedented scale.  The Coalition Government has no mandate for this act.  We did not vote for the abolition of our NHS.  Neither was it part of the Coalition agreement.”

“In February 2013 Lord Owen, himself a former Health Minister, took up the challenge and tabled a private member’s bill in the House of Lords that would reinstate the Secretary of State’s duty to provide comprehensive health services”.

Andy Burnham, shadow health secretary, has promised that the Labour party will repeal the Health and Social Care Act in the first Queen’s speech if they are elected. We must make sure the Labour Party publishes these promises in its manifesto, and ensure that they stick to them if they win office, and that they restore the Secretary of State’s duty to provide comprehensive health services. In order to frighten off predatory private companies from taking over NHS services wholesale in the run-up to the election, they must publish in their manifesto a commitment to abandon the policy of “Any Qualified Provider”. The NHS is definitely going to be a crucial issue in the 2015 General Election, and the Labour Party must commit to safeguarding the NHS as a publicly owned service that provides universal health care, free at the point of need.

Fight back

Some victories:

Public outrage resulting in large demonstrations has already achieved some victories against government decisions to close hospitals and cut services.

• Jeremy Hunt lost his appeal over A&E closure at Lewisham Hospital. (He is now attempting to do a ‘badger‘  by seeking to change the goal posts.)
• Plans to axe two south London A&E units have been rejected.
• GP group the City and Hackney Urgent Healthcare Social Enterprise  (CHUHSE) have taken over a £6.4m out-of-hours contract from a private company.

There are many other battles being fought to retain services as people become aware of cuts to services.

Conclusion: we can reclaim the future

Why was universal healthcare instituted when the UK was literally bankrupt?  The answer is not about economics, but about politics.

There is an awakening taking place in the minds of the public.  The People’s Assembly in June 2013 at Central Hall Westminster which was attended by 4,500 people, gave a clear indication of the level of the anger and frustration over the harsh regime of cuts imposed on the country by the Coalition government – in the name of ‘Austerity’  -  against  a background of massive bailouts of failing banks and tax cuts for the rich.

The momentum created by the People’s  Assembly in June has resulted in the setting up of people’s assemblies over the length and breadth of the UK. There are now about 80 PAs holding public meetings, discussing practical ideas and strategies for creating a fairer society for all. We are confident that united we can win the fight against the planned demolition of  the NHS.  We now have the tools for the battle to fight for a fairer society.  We must learn to use them: we cannot afford to accept the dark future that has been planned for us and our children. We must reclaim our NHS.

Actions we can take

1. Inform ourselves.  Buy a copy of NHS SOS – How the NHS was betrayed – and How We Can Save It (edited by Jacky Davis and Ramond Tallis, with a forward by Ken Loach), which exposes thoroughly and eloquently the inside story of the “deceit, corruption and incompetence behind the threatened destruction of the NHS”.  (All profits go to the Keep Our National Health Public campaign.)
2. Join a campaign:
   • KONP (Keep Our NHS Public)
   • NHS Support Federation
   • 38 Degrees
   • The People’s Inquiry

   There are also local groups being set up around the country in response to cuts and closures.

3. Keep track of changes to NHS services in your locality: join your local PPG (Patients’ Participation Group – every GP surgery has to have one)
4. Contact Unite the Union to report cuts and closures to services
5. Keep up the political pressure: The betrayal of the NHS and the consequences will be an important issue in the next election.  We must keep it in the spotlight and hold Labour to their promises to reverse the legislation when back in power