The NHS is dead: facing facts

By Paul Cotterill / @BickerRecord

Neil Forster has a post up at Liberal Conspiracy suggesting that the government has a huge battle on its hands to push through its plans for the termination of the NHS:

“[M]ore and more doctors are speaking out against their plans at the same time. The Government faces the steepest of uphill battles because it mistakenly thinks this is about ‘the message’. It’s not. It’s about motives and in particular the trust of the messengers.”

If only it were so.

Sadly, the facts indicate that the battle for the NHS has already been lost, and that it doesn’t matter whether doctors are trusted more than politicians, or that their representatives think the Tory changes are bad news.

To understand this, it’s important to understand the government’s main attack point on the NHS.

There hasn’t been a direct attack on state hospitals, or a direct attack on GPs. The attack has been much more effective than that. The attack has been in the form of the abolition (in 2013) of Primary Care Trusts, and the establishment of three waves of GP commissioning consortia, already covering 35 million people in England.

This has created the space in which most GP consortia, who have nothing like the capacity to commission their own secondary care services, will buy in what the commissioning PCTs used to provide.

This time it won’t be the PCTs who provide it, but private sector health management firms like Capita, Dr Foster and the US giants like McKinsey, who are already working with 25 consortia.

Sure, some ex-PCT staff will get jobs in these management firms, as their technical understanding of secondary care contract development and monitoring will be needed, but little will remain of the PCT’s public-health oriented, public service ethos.

These private commissioning firms are there to make their profit from the management service they provide.

They will do this firstly by focusing entirely on the core business of purchasing secondary care, to the exclusion of all other considerations around preventative and public health. The regular PCT contracts for voluntary sector interventions will be a thing of the past, though some GP consortia may retain some kind of grant-giving programme.

Second, they will purchase as much private healthcare as they can, and the percentage of the care bought from the private sector will increase dramatically within a year or two. As state hospitals lose their business, they will close or – more likely in the shorter term – be bought up lock, stock and barrel by the private hospital operators.

Some scandals may emerge in time over ‘backhanders’ paid by the private hospitals to the private commissioners, and in some circumstances it will turn out that the people doing the commissioning are simply commissioning themselves in another name – the whole inefficiency of which the provider-purchaser split was supposed to stop – but it will all be a bit esoteric and complicated for people to understand, and there won’t be much of a fuss.

In fairly short order, we may get these new commissioners creating two tiers of provision from within GP surgeries, with one level of care for those not paying, and those who just happen to have signed the relevant insurance policy forms, which just happen to be in the GP surgery.

Insurance-based healthcare, and the exclusions that this brings, will come not through a government announcement, but by the surgery backdoor.

Will the doctors stop all this?

No, because they’ve already given in. I can take you to three GP surgeries in my area where GPs have chosen to stop being a partner in a multi-partner surgery and become an employee of a single partner. This single partner is the one who’s dealing with the consortium, while the others opt for the quieter, clinical life they trained for in the first place. Who can blame them.

The consortia will end up being led by two or three ‘movers and shakers’ in each area, whose job will be simply to negotiate a decent deal for their colleagues and let the private commissioners get on with the rest. There will be no revolt in primary care, and in secondary care no-one will actually notice till it’s too late.

That’s my doomsday scenario for the NHS.

The NHS is already lost, not least because Labour has not understood or cared about what’s happening, and because any protest movement in the left has simply ignored or not understood what’s going on under its nose, preferring to focus on the bits it does profess to understand e.g. local council cuts. While Rome burns etc…

A longer version of this post appeared at Though Cowards Flinch.