Bob Gill describes how an admired public health service is secretly being changed to for-profit American-style “managed care.”
Boris Johnson chairs daily Covid-19 press conference at 10 Downing Street, April 2020. (No. 10/Flickr)
By Dr. Bob Gill
in London
On the 73rd birthday of the National Health Service, the queen awarded the beloved NHS the George Cross for the valor of its staff during the Covid-19 pandemic.
No one doubts the dedication of NHS staff, and its worthiness for the highest honor, but this medal now serves to cover the insidious dismantlement of the NHS.
Having overseen a catastrophic response to the pandemic, marked by the needless deaths of hundreds of thousands of Britons, Prime Minister Boris Johnson proclaimed:
“We wouldn’t be where we are today without our health services. NHS staff have cared for us and our friends and family on the frontline of a pandemic for over a year, and I have witnessed their courage first-hand.
Thanks to their devotion and duty our NHS has saved countless lives, and the George Cross is a symbol of the nation’s gratitude. I know the whole of the UK is behind me in paying tribute and giving thanks for everything the NHS has done for us not only in the last year, but since its inception.”
In February 2020, with the country in the grip of the pandemic, the government published a white paper ahead of legislation on the future reform of the NHS. To those who read it carefully, and read between the lines, the Health and Care Bill would turn the NHS into a cash cow for private corporations.
The pre-pandemic NHS was already on its knees after a decade of de-funding. Some 17,000 beds were cut and there were chronic staff shortages with vacancies for 10,000 doctors and 40,000 nurses. Yet Johnson’s government persists with its privatization policy objectives.
Mural in Hackney, England, April 2020. (Liam, Flickr)
The Serco/Deloitte “NHS” Test and Trace system that has so far squandered £22 billion without any evidence of impact on the spread of the virus or preventing the need for the damaging lock-downs. More opportunistic profiteering such as uncontested crony deals on personal protective equipment will become standard operating procedure if progressive forces fail to stop the bill being enacted.
The government reassurances that they 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 privatization 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 The Independent Healthcare Association put it more succinctly in 2011:
“The NHS would simply be a kite-mark attached to the institutions and activities of a system of purely private providers.”
The marketized NHS with its bloated administrative and managerial bureaucracy (consuming about 10 percent 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 fully compulsory external market with all services up for grabs by the private sector.
Protest against Health and Social Care Act 2012. (Gwydion M. Williams, CC BY 2.0, Wikimedia Commons)
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 pediatrics, sexual health, elective surgery, audiology and diagnostic imaging.
Primary care was parceled up into Clinical Commissioning Groups (CCG), fronted by entrepreneurial general practitioners. The actual purchasing, contracting and outsourcing, of services and control of financial flows performed by Commissioning Support Units (now Lead Provider Framework) made up of private corporations including Optum (U.K. subsidiary of UnitedHealth, the world’s largest private health insurance conglomerate) the big four accountancy firms (KPMG, PWC, EY, Deloittes) embedded in NHS back-room financial and organizational structures.
Shrinking Capacity
The result of the 2012 Act has been to shrink NHS capacity by 17,000 NHS beds, fragment provision of services with outsourcing of clinical care and entrench the power of private corporations in controlling NHS budgets, supervised by Simon Stevens since 2014, having returned to the NHS after 10 years at UnitedHealth of which three years were spent as as chief executive of UnitedHealth Medicare.
American healthcare is more than twice as expensive per head of population compared to the United Kingdom and delivers worse outcomes with lower life expectancy, higher infant and maternal mortality.
The leading cause of household bankruptcy is due to medical bills (most people had private health insurance but still went bankrupt). Thirty million American 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, the elderly are locked out of the system.
The U.S. 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 by 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.
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The bill will create new legal entities, public-private partnerships known as Integrated Care Systems (ICS). The 42 ICS NHS bodies across England will control fixed tax-funded budgets for 1-to-2 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 function.
Corporate profits are maximized by employing the fewest and cheapest healthcare staff through down-skilling and task shifting as seen in private health systems across the world. Additional downward pressure on staff wages and an end to national pay bargaining will reduce overhead costs.
NHS workers’ wages protest in Norwich, U.K., Aug. 8, 2020. (Roo Pitt, CC BY 2.0, Wikimedia Commons)
Repeal of section 75 of the 2012 Health and Social Care Act will end open competitive tendering, removing the legal obstacle for a private sector monopoly within the NHS. UnitedHealth/Optum are uniquely well placed to gain control of ICS budgets, with their 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 to Optum 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 as “low value” procedures. Optum’s algorithms and ICS deadly postcode lottery will prioritize generating profit streams above patients’ health.
Optum’s headquarters in Eden Prairie, Minnesota. (chaddavis.photography CC BY 2.0, Wikimedia Commons)
Legal safeguards to ensure patients are discharged home safely will be removed and replaced by a “discharge to assess” scheme enabling patient dumping notorious in America. 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 will struggle to access overstretched NHS hospitals or primary care services, staffed by fewer and less qualified health personnel, providing lower qualify services as funding is siphoned away from healthcare delivery.
The American medical-industrial complex has set its sights on the £120 billion annual NHS budget and destroying the superior Beveridge system of healthcare by mutating it into the managed care model which it has sold as a “sustainable” solution for healthcare in the developed world.
As U.S. citizens continue their decades’ long struggle for tax-funded, single-payer universal healthcare, not even achieved in the face of a pandemic, consecutive U.K. governments have covertly pushed the NHS along the endemically fraudulent, expensive and deadly managed care model.
The health bill will deliver the NHS to the global private providers and private health insurance conglomerates, reducing itself to a logo and a funding stream. The warm glow of a George Cross and ratcheting up of duplicitous political rhetoric must not obscure the magnitude of the impending threat to the health of the nation.
Dr. Bob Gill is a general practitioner and producer of “The Great NHS Heist.” Follow him on Twitter at @drbobgill.
The views expressed are solely those of the author and may or may not reflect those of Consortium News.
Many thanks for this Bob. Everyone needs to read The Great NHS Heist. All of this knowledge needs to be on mainstream media and then perhaps people will stop voting tory. Pity there are a number of idiotic comments on this page. As someone who works for the NHS, I’d say to these commentators you need a reality check. The public are being duped. Time to wake up.
This is utter nonsense. The article bares no relation to the tag line that it will descibe how the NHS will be privatised by stealth as a result of the proposed changes made in the white paper. Yes the removal of the tender requirements did raise concerns regarding private providers but equally it means that contracts can be awarded to public providers without private ones under cutting them. In fact the NHS long term plan mandated exactly that. Yes Simon Steven used to work for a private healthcare organisation does this mean he should be banned from working for a public one. He is stepping down before these changes will be implemented let alone before he gets the opportunity to sell the NHS to his former employers.
It should also be noted that the majority of GP practices are and always have been ran as a private company and many make significant profits. It might be worth asking why this GP feels so strongly about this issue. Maybe his business will be less powerful and less profitable as a result of the changes.
Thank you very much for this insightful article.
Grad
So sad this is not too of all opposition agendas.
Lansley was a nightmare but this is horrific reality.
People need to wake up and politicians with any moral fibre fight this tooth and nail
Profit = money, in the eyes of rapacious capitalism.
Profit, more imperatively, also means a benefit, as in “something that produces good or helpful results or effects, or that promotes well-being.”
All governments today – with some few remaining exceptions (Iceland, to name the only one outstanding example that immediately comes to mind) no longer serve the beneficial interests of their populace. They are about sleight of hand treachery, in service to the private owners of wealth!
When “the queen (of all of Great Britain and her ‘Commonwealth’) awarded the beloved NHS the George Cross for the valor of its staff during the Covid-19 pandemic”, it is one hundred percent certain that she, in this centuries long magical realm, was in on this ‘secret’ bait and switch policy!
Nothing new to see here, for any long time observer of the act!
Lefty wing bullshit, NHS funding has increased
MatthewSykes – that the NHS transformed into a giant marketplace, the receipients of a large part of that marketplace being HUGE private companies (Circle health, Spire health, Virgin care and may more) leading to costs increasing and more money being needed are all linked.
It’s VITAL to ask “Where is all the money going?”
All that lovely NHS money means private healthcare companies are constantly pushing for greater and greater access to the NHS.
Which the “privatise anything that moves” Conservatives are more than willing to allow.
In real terms (inflation, etc.) NHS funding has decreased year on year. Many allocations of ‘new’ cash turn out to be old money just reallocated to new budgets (Eg. New Hospitals funding – smoke and mirrors). There has also been no allowances in NHS budgets made for the fact that the UK population has increased by many millions over the last decades – with circa. 300,000 new immigrants still entering the UK each year.
Hard facts tell a different story to right wing Tory propaganda.
Great article thank you! #StealthPrivatisationOfTheNHSIsMurder #BloodOnToryHands
I watched a history of the NHS on a BBC documentary years back and it was amazing how the British public pulled together against extreme odds in order for it to come to fruition. It is a history that any country that hasn’t universal health care coverage should learn and one that we who do have universal single payer health care would do well to learn as well so that we don’t lose ours either with the corporate forces being plied on governments everywhere to adopt the very profitable (for corporations and insurance companies) private model. hxxps://www.youtube.com/watch?v=-ywP8wjfOx4
It should come as no surprise to anyone that when you let “conservatives” get control of the government, the first thing they want to do is sell off (at fire sale prices usually) state assets to their capitalist cronies. Britain saw this in the 60s/70s when labor and the tories would go back and forth privatizing and nationalizing industries. Then labor became the tories and the Brits were screwed. Sorry, mates, they’re doing the same thing here in the states.
The British public will be very surprised when they wake up one day and face “managed health care” run by for-profit corporations that only care about profits, and have no incentive whatsoever to take care of everyone in need of medical attention. The US system is more like an organized crime ring than a healthcare system. I really hope that the UK does not have to face the same situation.
Just watch John Pilger’s film “The Dirty War on the NHS.” McKinsey & Company, and other such “advisors” and lobbyists feature heavily in that they’re actually now a part of NHS decision making.
Because the rapacious American medical-industrial complex, which in USA siphons a larger slice of GDP than their military-linked colleagues, is strategic and penny-pinching, apparently they left Australia for later, UK being a much larger market. From my recollection, medical services consume ca. 17% of GDP in USA and 6-7 in Australia (with better outcome), so ca. 10% supports an enormous swampy ecosystem, in the case of military IC, that could be ca. 5% versus 1%, so ca. 4% for the swamp (or valuable wetlands? judging from his behavior, Trump never could make his mind).
I fear the battle has been lost. Already, ‘NHS’ Dentists, Opticians and Care Services are essentially private. GPs on the whole are over paid, underworked Pill Pushers who only do a very small minority of the work they used to do 20 years ago. To actually get real care in the UK you either have to be seriously ill and admitted to a Hospital on a stretcher or else pay for private care.
The Tory manifesto ‘promised’ 40 new hospitals and 40,000 new nurses – they have delivered nothing, SFA. Nurse and Doctor training has been cut back in favour of hiring foreign healthcare staff. NHS funding has been cut back year on year. The NHS itself has been consciously and purposely fractured into many competing units that has impacted efficiency and swamped the service with managers and contractors who are mainly private sector provided, all feeding off the reduced healthcare budget.
The Government ministers and senior NHS leaders are all privateers – Simon Stevens, in particular, a buddy of Bozo and the Tories.
Can this be stopped ? Doubtful. Jeremy Corbyn was the only real hope for the NHS but the establishment quickly dispatched him.
The message is simple: don’t get sick in the UK unless you are rich.
This all accelerated under the Labour government of Tony Blair, not under the Tories. Jeremy Corbyn had a spine like a boiled noodle. He wasn’t going to help anybody. You all had a wonderful thing in the UK, that we never had here in the U.S., and you let it go.
Jeremy Corbyn was the one who stood up and warned the UK that the Tories were planning NHS privatisation, but was pilloried and called a liar by the media. I suggest you do a bit of reading before you express opinions on Jeremy Corbyn
How have you came to the conclusion that Jeremy Corbyn “had a spine like a boiled noodle”?
I’m intrigued as he has been one of the only people to speak up against the Tories and their cronies. But the powers that may be quickly sabotaged his run because they didn’t want to him to get in the way of the money.
But please, enlighten me. How have you came to the conclusion Jeremy Corbyn was spineless?
I don’t dispute that Blair and Brown didn’t help the NHS, they are the part of the new breed of what is known as ‘Red Tories’; However, I remind you that the Tories have been in power in the UK since 2010. More than adequate time to save the NHS but they haven’t. The Tories and the BMA opposed the NHS from it’s conception – they are playing the long game which is now coming to fruition.
Corbyn had real, costed plans to save and fund the NHS but the establishment, including his own party, driven by zionist lobbies and funding finished him. His ‘apparent’ indeciveness over Brexit was the ‘coup de grace’ that let Johnson sliver in.
The british public didn’t ‘let the NHS go’, they were lied to and hoodwinked – now it’s probably too late.
Ah yes… Having to see 50-60 patients a day on a full clinical case load, diagnose and manage within 10 mins, with fractured and defunded community care services (I don’t have my district nurses, tissue viability nurses, community phlebotomists) unavailable to coordinate my patients and a mountain of paperwork to complete afterwards definitely sounds underworked to me….
I personally know of half a dozen GP practices in the South West and South Wales where none of the GPs work five days a week, let alone eight hours a day. This is not unusual. Many GPs moonlight in private practices or have other ‘interests’. Most STEM professionals have to work five or six days a week with long days and large commutes not being unusual. And for a lot less that the large Salaries GP are paid.
The NHS is complicit in the closure of many GP surgeries – but personal experiences, particularly with regard to Covid mean that many people see GPs as overpaid and workshy – the solution to this is in GPs hands.
An excellent and disturbing exposure of the continuing onslaught on our health service by Tories and the right wing of the Labour party. It’s not enough just to say, “Oh dear” and bemoan the state of the country. I urge readers in the UK to join the campaigning organisations working hard to reverse the privatisation of the NHS:
hXXps://keepournhspublic.com/
hXXps://weownit.org.uk/
I would add NHS Fightback.
hXXps://southwestnhsfightback.wordpress.com/