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ON the 73rd birthday of the National Health Service we are entering the final phase of its dismantlement — yet the vast majority of people, including NHS staff, have no real appreciation of how the nation’s beloved institution has been fundamentally repurposed.
With the country still in the grip of the pandemic, the government published its white paper in February 2021, to be followed by the imminent Health Bill, which is set to double down on turning the entire NHS into a cash cow for private corporations.
There is no sign that the privatisation policy goal, which had brought the pre-pandemic NHS to its knees, has been abandoned.
This is despite the 100,000 preventable coronavirus deaths, according to former chief scientist Sir David King, as a result of the catastrophic outsourced pandemic response.
The Serco/Deloitte “NHS” Test and Trace system has so far squandered £22 billion without any evidence of impact on the spread of the virus or preventing the need for the damaging lockdowns.
More opportunistic profiteering such as uncontested crony deals on PPE will become standard operating procedure if progressive forces fail to stop the Bill being enacted.
The cynical false government reassurances that it will “protect the NHS” or “the NHS is not for sale” run counter to the impact of decades of health policy or stated intent from the privatisation lobby, such as MPs Oliver Letwin and John Redwood, who co-authored a pamphlet from 1988, Britain’s Biggest Enterprise, in which they outlined their vision for healthcare:
“A system of this sort would be fraught with transitional difficulties. And it would be foolhardy to move so far from the present one in a single leap.
“But need there be just one leap? Might it not, rather, be possible to work slowly from the present system toward a national insurance scheme?
“One could begin, for example, with the establishment of the NHS as an independent trust, with increased joint ventures between the NHS and the private sector; move on next to use of ‘credits’ to meet standard charges set by a central NHS funding administration for independently managed hospitals or districts; and only at the last stage create a national health insurance scheme separate from the tax system.”
Dr Tim Evans of the now defunct Independent Healthcare Association put it more succinctly in 2011: “The NHS would simply be a kitemark attached to the institutions and activities of a system of purely private providers.”
The marketised NHS with its bloated administrative and managerial bureaucracy (consuming about 10 per cent of the total NHS budget, according to 2005 estimates) has continued to expand.
The 2012 Health and Social Care Act converted the NHS internal market into a full external market with all services up for grabs by the private sector.
Section 75 of the Act compelled open competitive tendering of all NHS services. Behind the NHS logo, private companies have expanded in the provision of services such as district nursing, community paediatrics, sexual health, elective surgery, audiology and diagnostic imaging.
Primary care was parcelled up into clinical commissioning groups (CCGs), fronted by entrepreneurial general practitioners.
The actual purchasing, contracting and outsourcing of services and control of financial flows is performed by commissioning support units (now lead provider frameworks) made up of private corporations including Optum (UK subsidiary of UnitedHealth, the world’s largest private health insurance conglomerate) the big four accountancy firms (KPMG, PWC, Ernst and Young, Deloitte) embedded with NHS back-room financial and organisational structures.
The result of the 2012 Act has been to shrink NHS capacity, with 17,000 fewer NHS beds; fragment provision of services with outsourcing of clinical care; and entrench the power of private corporations in controlling NHS budgets.
All this was supervised by Simon Stevens since 2014, who returned to the NHS after 10 years at UnitedHealth, of which three years were spent as as chief executive of UnitedHealth Medicare.
US healthcare is more than twice as expensive per head of population compared to the UK and delivers worse outcomes with lower life expectancy, higher infant and maternal mortality.
The leading cause of household bankruptcy is due to medical bills — and most in this category had private health insurance but still went bankrupt.
Thirty million US citizens don’t have insurance and for every million uninsured, there are 1,000 preventable deaths per year.
The system is dominated by the private health insurance industry and private hospital chains.
The unprofitable groups of people, including the poor and the elderly, are locked out of the system.
The US taxpayer has to step in to fund market failure, with Medicare for the elderly and Medicaid for the young.
This public funding is spent via private providers and increasingly funds are controlled by private insurers.
UnitedHealth is a big player in Medicare, delivering profitable “managed care” by avoiding spending money on sick patients using various methods to deny payment for care.
It is this same model, the subject of Michael Moore’s film Sicko, which is being replicated by the Health Bill.
The Bill will create new legal entities, public-private partnerships known as integrated care systems (ICSs).
The 42 ICS NHS bodies across England will control fixed tax-funded budgets for one to two million people from which they will be able to make profit.
ICS boards will be dominated by the same private corporations currently providing outsourced services and performing commissioning functions.
Profit maximisation will be achieved by employing the fewest and cheapest healthcare staff through down-skilling and downward pressure on wages with an end to national pay bargaining.
Repeal of Section 75 of the 2012 Act will end open competitive tendering, removing the legal obstacle for a private-sector monopoly within the NHS.
UnitedHealth/Optum is uniquely well placed to gain control of ICS budgets, with its personnel appointed to key NHS positions — not least Simon Stevens, chief executive of NHS England since 2014 — importation of “managed care” software and protocols, and upwards of £17 million in payments for training NHS and local council leaders.
Optum software and data analytics will form the core mechanism for the denial of care to potentially expensive patients.
The ICS will have the power to decide which services are to be provided across the ICS — for example, fertility treatment, cataract extraction or knee surgery could be removed for the entire ICS population, as previously drawn up plans by management consultants McKinsey described them as “low-value” procedures.
Optum’s algorithms and an ICS postcode lottery will prioritise generating profit streams above patients’ health.
Legal safeguards to ensure patients are discharged home safely will be removed and replaced by a “discharge to assess” scheme, enabling the kind of patient dumping that is notorious in the US.
Deregulating health professionals and introducing a new secretive patient safety body will assist the decline of clinical standards while concealing predictable consequences.
Patients in their most vulnerable state struggle to access overstretched NHS hospitals or GP surgeries, staffed by fewer and less qualified health personnel, providing lower quality services.
The US medical-industrial complex has set its sights on the £120bn annual NHS budget.
As Americans continue their decades-long struggle for tax-funded universal healthcare, not even achieved in the face of a pandemic, consecutive British governments have covertly mutated the NHS along the endemically fraudulent, expensive and deadly “managed care” model.
The Health Bill will deliver the NHS to the private providers and the health insurance lobby, reduced to a logo and a funding stream, unless enough people can see the magnitude of the threat and take a stand against this massive betrayal of the public interest.
If not then our political-media-corporate nexus will have pulled off a monumental deception, a crime against the nation enabling wealth extraction by foreign interests while costing thousands of lives every year.
Br Bob Gill is a GP and producer of The Great NHS Heist.
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