Tag: PFI

The budget will not alleviate inequality, poverty and hardship that government policies have created

Watch Jeremy Corbyn’s excellent response to the budget, while facing the braying, sneering, smirking government. 

Hammond is economical with copies of the Budget 

The Labour party have accused the chancellor Philip Hammond of breaking the ministerial code after opposition parties were not given a copy of the budget in advance. The code states that when a minister makes a statement to MPs in the Commons “a copy of the text of an oral statement should usually be shown to the opposition shortly before it is made”. The rules are that 15 copies and associated documents should be sent to the chief whip’s office at least 45 minutes before a statement. The government have frequently flouted these rules, prefering to follow the rampant authoritarianism protocol of avoiding scrutiny, transparency and above all, democratic accountability

However, a Treasury source claims that there was ‘no official rule’ that other parties should get an early look at budget measures. “We did not do anything differently from what we have been doing for the past 20 years,” the source said. I half expected him to add that the Ministerial Code isn’t really a code, but more a kind of ‘loose guideline’. 

The opposition is said to be considering a formal complaint. 

Austerity has not ended

Jeremy Corbyn accused the government of a U-turn on Theresa May’s party conference pledge that austerity was over. Hammond told MPs that austerity was “coming to an end”. The Labour leader replied: “The prime minister pledged austerity is over. This is a broken promises budget. What we’ve heard today are half measures and quick fixes while austerity grinds on.”

The Labour party also criticised income tax cuts, which it said would favour the better off and said there were no guarantees that government departments would not face further cuts. The Resolution Foundation have also concluded the same. 

Government rattles the Office for Budget Responsibility

The Office for Budget Responsibility (OBR), whose role, unsuprisingly, is to scrutinise the budget are also disgruntled because the government only handed over the final Budget policy measures on 25 October, a day late. This means the OBR hasn’t been able to check that the government’s sums actually add up.

The precise changes to universal credit came too late for the OBR to assess them properly, too. The budget red book says that the roll-out of universal credit is now scheduled to end in December 2023. It says:

In response to feedback on universal credit, the implementation schedule has been updated: it will begin in July 2019, as planned, but will end in December 2023.

But until recently, as this House of Commons library briefing (pdf) reveals, the roll-out was due to end in March 2023.

Officially the government says that, if the UK had to leave the EU with no deal, it could manage. But the OBR doesn’t share this view:

A disorderly one [Brexit] could have severe short-term implications for the economy, the exchange rate, asset prices and the public finances. The scale would be very hard to predict, given the lack of precedent.

The Press Association (PA) reports that the Labour leader said eight years of austerity has “damaged our economy” and delayed the recovery, adding the government has not abandoned the policy despite the chancellor’s latest spending pledges. The PA says:

Leading the response to the budget, Corbyn also said the proposals announced will “not undo the damage done” by the squeeze on spending.

He told the Commons: “The prime minister pledged austerity was over – this is a broken promise budget.

“What we’ve heard today are half measures and quick fixes while austerity grinds on.

“And far from people’s hard work and sacrifices having paid off, as the chancellor claims, this government has frittered it away in ideological tax cuts to the richest in our society.”

Corbyn added: “The government claims austerity has worked so now they can end it.

“That is absolutely the opposite of the truth – austerity needs to end because it has failed.”

Corbyn later said the “precious” NHS is a “thermometer of the wellbeing of our society”, adding: “But the illness is austerity – cuts to social care, failure to invest in housing and slashing of real social security.

“It has one inevitable consequence – people’s health has got worse and demands on the National Health Service have increased.”

Corbyn also condemned the “horrific and vile antisemitic and racist attack” in Pittsburgh, noting: “We stand together with those under threat from the far-right, wherever it may be, anywhere on this planet.”

The Labour leader criticised pay levels for public sector workers, adding: “Every public sector worker deserves a decent pay rise, but 60% of teachers are not getting it – neither are the police nor the Government’s own civil service workers.”

The economy is also being damaged by a “shambolic Brexit”, Corbyn added.”

Elements of the budget have revealed a Conservative party in ideological retreat. One of Jeremy Corbyn’s greatest achievements as leader of the opposition is the undermining of the neoliberal hegemony and his presentation of an alternative narrative and economic strategy. Personally I am glad that neocon neoliberal Francis Fukuyama didn’t get the last word after all. 

Over the last couple of years, the government have imported policy ideas and adopted rhetoric from the Labour party to use as strategic window dressing. Hammond announced an end to the government signing off on much-loathed private finance initiative contracts – something Corbyn had already promised. As a former Treasury advisor noted:

Originally introduced by John Major, and continued under New Labour, PFIs are essentially a way for the state to finance and then look after new infrastructure. The traditional way for the government to build a new piece of infrastructure, such as a hospital, a school, or a new road bypass, was to raise the money in taxes, or borrow it from the bond markets, and then pay builders to deliver the project. After that, the public sector would own the asset. 

The theoretical justification for Private Finance Initiatives (PFI) is that the private sector is more efficient at delivering and managing infrastructure projects than civil servants. PFI also supposedly transfers the financial risk of a construction project over-running from the public to the private sector. However earlier this year, the National Audit Office (NAO), released a new report which highlighted a lack of evidence that PFIs offer value for money for taxpayers.

The report followed the collapse of the construction and services firm Carillion which has shone a bright spotlight on the flawed process of  state contracting and outsourcing.

According to the Treasury data there are 716  PFI projects (of which 686 are operational) with a capital value of just under £60bn. Of this total the Department of Health was responsible for £13bn, the Ministry of Defence £9.5bn and the Department of Education £8.6bn.

Hammond pledged a tax crackdown with a UK “digital services tax”, aimed only at multimillion companies rather than startup businesses. On universal credit, the government attempted to neutralise the toxic issues with an extra £1bn to ‘ease issues with its rollout.’

But Hammond’s generous tax cuts to the very wealthiest households indicate that this is still very much a government for the few, not the many. 

Alison Garnham, chief executive of the Child Poverty Action Group, commented:

The work allowance increase is unequivocally good news for families receiving universal credit but a bigger salvage operation is still needed for the benefit. And bringing forward higher tax allowances – which will cost much more than the universal credit change – will mainly benefit the richest half of the population. We look forward to hearing more detail on how the secretary of state will use the extra £1bn to ease the migration of people on existing benefits to universal credit.

This is crunch time for universal credit. We hope the chancellor’s positive announcements on work allowances will be followed by a pause in the roll-out to allow for a fundamental review of its design and, crucially, for a commitment to restoring all the money that’s been taken out of universal credit.

Final comment:

 


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Rationing and resource gatekeeping in the NHS is the consequence of privatisation

People march through London to mark 70 years of the NHS

People march through London yesterday to mark 70 years of the NHS.

Gatekeeping has become a watchword within our public services over the past seven years. It’s being driven by the government’s deep affection for neoliberal dogma, the drive for never-ending ‘efficiency savings’ and the Conservatives’ lean, mean austerity machine. Perish the thought that the public may actually need to use the public services that they have funded through their contributions to the Treasury, in good faith. 

In the NHS, even the resource gatekeepers have gatekeepers, those receptionists standing sentry at the end of the telephone, and in general practices, who ration access to the GPs so assiduously we patients often get better before we’ve managed to arrange an appointment. Or ended up at an Accident and Emergency Department.

Only a service dedicated to keeping the public and service providers apart could have devised a system so utterly demeaning. It turns patients into supplicants and receptionists into bouncers who make decisions they are unlikely to be qualified to make, neither being roles to which any of us aspired.

Now, it has been decided that the NHS needs to scrap more medical procedures, including injections for back pain, surgery to help snorers and knee arthroscopies for arthritis, which form part of an initial list of 17 operations that will be discontinued completely or highly restricted by NHS England as many of these problems “get better without treatment.”

I can assure you that arthritis of the knee, or anywhere else for that matter, doesn’t tend to get better. Medical interventions can help patients with ‘managing’ the condition, however. 

Varicose vein surgery and tonsil removal also feature on the list of routine operations to be axed as part of NHS England’s drive to cease “outdated” and “ineffective” treatments.

The latest round of rationing is hoped to save £200m a year by reducing “risky” or “unnecessary” procedures. Patients are to be told they have a responsibility to the NHS not to request “useless treatment.”

However, complications from varicose veins, for example, include leg ulcers which require more costly specialist treatment to help them heal. 

Steve Powis, the medical director of NHS England, said: I’m confident there is more to be done”, adding that the list of 17 operations formed “the first stage” of rooting out futile treatments that are believed to cost taxpayers £2bn a year.

“We are also going to ask ‘Are there other procedures and treatments we should add to the list?’. Additions could include general anaesthetics for hip and shoulder dislocations and brain scans for patients with migraines.

Hip and shoulder dislocations are notoriously excruciating, as is the process of having the joint relocated, though the latter is short-lived. It’s particularly brutal to leave patients without pain relief, and especially children.

The reason why brain scans are often very important when people develop migraine symptoms is that they can determine whether the severe headaches are caused by something more serious, such as a subarachnoid haemorrhage (which happened to me) or a tumour (which happened to my mother). Sometimes ‘migraines’ are something else.
Powis added: “We have to spend taxpayers’ money wisely. Therefore, if we are spending money on procedures that are not effective, that is money we could spend on new treatments that are clinically effective and would provide benefits to patients. It’s absolutely correct that, in getting more efficient, one component of that is to make sure we are not undertaking unnecessary procedures.”

The rationing comes as the government prepares to raise taxes and ditch an increase to the personal income tax allowance to pay for NHS funding plans. According to proposals, £20.5bn of extra funding would be set aside for the health service by 2023. In a speech at the Royal Free hospital in London a fortnight ago, Theresa May said tax rises were inevitable.

However, there doesn’t seem to be any indication that this additional measure will ensure the public has value and adequate health care for their money. 

The prime minister said: “As a country, taxpayers will need to contribute a bit more.But we will do that in a fair and balanced way. And we want to listen to people about how we do that, and the chancellor will bring forward the full set of proposals before the spending review.”

Here are the 17 treatments NHS England may axe

Four procedures will only be offered at the request of a patient:

  • Snoring surgery
  • Dilation and curettage for heavy menstrual bleeding
  • Knee arthroscopies for osteoarthritis
  • Injections for non-specific back pain

A further 13 treatments will only be offered when certain conditions are met:

  • Breast reduction
  • Removal of benign skin lesions
  • Grommets for glue ear
  • Tonsillectomy
  • Haemorrhoid surgery
  • Hysterectomy for heavy menstrual bleeding
  • Removal of lesions on eyelids
  • Removal of bone spurs for shoulder pain
  • Carpal tunnel syndrome release
  • Dupuytren’s contracture release
  • Excision of small, non cancerous lumps on the wrist called ganglia
  • Trigger finger release
  • Varicose vein surgery

Some of these procedures do improve the quality of people’s lives. I’m wondering how this sits with the government’s drive to push people with disabilities and medical conditions into work.

Although it was announced recently that the NHS is to hire 300 employment coaches to find patients jobs to “keep them out of hospital.” It’s what the government probably calls the ‘two birds and one bullet’ approach.

A man with a birthday placard as thousands of people march to mark 70 years of the NHS

Yesterday, tens of thousands of people marched through London to mark the NHS’s 70th anniversary and demand an end to government cuts and further privatisation of the health service. Bearing placards reading “Cuts leave scars”, “For people not profit” and “Democracy or corporate power” demonstrators moved down Whitehall on Saturday afternoon to the chant of “Whose NHS? Our NHS”.

The protesters stopped outside Downing Street to demand Theresa May’s resignation en route to the stage where they were greeted by a choir singing “the NHS needs saving, don’t let them break it”. Shortly after, Jeremy Corbyn addressed the crowd – organisers said there were about 40,000 people present – demanding an end to privatisation, the closure of the internal market, for staff to no longer be subcontracted to private companies and for social care to be properly funded.

Corbyn said: “There have been huge attacks on our NHS over many years,” he said. “The Tories voted against the original legislation and have always sought to privatise it and continue an internal market.

“Paying money out to private health contractors, the profits of which could and sometimes do, end up in tax havens around the world.

“Think it through, you and I pay our taxes because we want a health service for everybody, I don’t pay my taxes for someone to rip off the public and squirrel the profits away.”

I absolutely agree. 

A brief history of the travailing NHS under Conservative governments

The government has failed to adequately fund the NHS since taking office as part of the coalition in 2010, and has overseen a decline in the once widely admired public health service, as a way to privatise it by stealth. 

The Tories have utilised a spin technique that carry Thatcher’s fingerprints – it’s called ‘don’t show your hand.’

Image result for nhs safe in our hands

Jeremy Hunt and the Conservatives insist the NHS is ‘safe in our hands’

Chris Riddell 16.08.09

The direction of travel was set 25 years ago by the NHS review announced by Margaret Thatcher on the BBC Panorama programme in January 1988. The Conservatives have a poor track record with the NHS. Thatcher ushered in the NHS internal market, the mechanism that introduced what many in the health service still revile: competition.

Health authorities ceased to run hospitals but instead “purchased” care from hospitals who had to compete with others to provide it and became independent, self-governing trusts. The stated aim was to ‘increase efficiency’ and ‘eliminate waste’ through competition. Yet by the time John Major was prime minister, we saw the crisis deepen, with the postcode lottery and patients parked on hospital trolleys in hospital corridors for hours on end, waiting to see a worn out, overworked doctor.  

In order to assess the impact of Thatcher’s legacy on healthcare, it’s essential to appreciate that NHS market reforms began on her watch. Even the apparently relatively minor step of outsourcing hospital cleaning services was to cast a dark shadow over hospital care decades later. Putting cleaning services out to competitive tender meant that the job of cleaning wards went to the lowest bidder – often to companies that used casual, untrained staff, supplied by job centres. The contrast between the high quality of surgical treatment and the dirtiness of wards became notorious. The level of hospital-acquired infections grew steadily, including those caused by  ‘superbugs’  including MRSA. 

A study published by the Health Service Journal laid the blame for the rise of antibiotic resistant infections on poor hygiene standards; finding hospitals full of rubbish, uncollected left-over food in canteens and dirty linen strewn over bedroom floors. The impact outsourcing has had on cleaning services has been a constant source of tension since those early reforms. While trade unions and medical professionals have consistently argued against it, business leaders have always rejected any connection between outsourcing, infection rates, and declining standards.

Public sector outsourcing is central to the present government’s ideological strategy, despite the evidence that is now stacked against it being genuinely ‘competitive’. Since 2010, the number of large contracts awarded has increased by over 47% with tens of thousands of workers in various sectors – health, defence and IT – being transferred to corporate employers like Serco, Capita and G4S. The UK’s public sector has become the largest outsourcing market in the world, accounting for around 80% of all public sector contracting in Europe. These multinationals are not particularly interested in competition; they’re interested in profit and being in a monopoly position where they can dominate the market. Despite the wake of scandals that follows these companies, growth in the public sector outsourcing market shows no signs of slowing and the government shows no signs of learning from these events. 

Thatcher wanted to introduce even more radical changes – such as a shift to an insurance based healthcare model, with ‘health stamps’ for the poor – but in a busy decade, it seems that her battles with trade unions and left-wing Labour councils took priority.

It was under Thatcher’s administration that the climate of austerity began within the NHS. 

Then there was the Black Report into health inequalities, published in 1980 after a failed attempt by the  Conservatives to block its publication, noted that health inequalities in the UK were linked to socio-economic factors such as income, housing and conditions of work. The government rejected the report’s findings and recommendations.

Conservatives published a policy book called Direct Democracy in 2005. It claimed that the NHS was “no longer relevant”, and a system was proposed whereby patients were funded “either through the tax system or by way of universal insurance, to purchase health care from the provider of their choice” – with the poor having their contributions “supplemented or paid for by the state”. The authors included the current health secretary Jeremy Hunt. 

Against a backdrop of austerity and public cuts, healthcare facilities are continuing to contract out their facilities management and clinical services. But, the practice remains deeply controversial and the consequences are becoming more visible. 

Thatcher’s competitive tendering was introduced for cleaning, catering and other ancillary non-medical services, and were extended by the Tories in the ’90s under the NHS and Community Care Act – the first piece of legislation to introduce an internal market into the provision of healthcare. This was followed by the Private Finance Initiative (PFIs) in 1992 under the Major government.  Lansley’s reforms – premised on ‘increasing the diversity of providers in the management of the NHS’ – represent only the culmination of this legacy.

A centrally funded health service has demonstrated its a major contribution to reducing health inequality, by permitting healthcare practitioners and policy makers to design services and deliver care based on need, not the profit incentive. An increasingly privatised NHS has simply led to rationing and inadequate healthcare.

The biggest single contribution to health inequality is social inequality, a problem that has deteriorated significantly in the wake of the Conservative agenda of combined economic austerity and welfare reform.

Image result for hands up NHS
Image courtesy of Robert Livingstone 

 

Related

The Coalition has deliberately financially trashed the NHS to justify its privatisation

Rogue company Unum’s profiteering hand in the government’s work, health and disability green paper

Private bill to introduce further charges to patients for healthcare services is due for second reading today

Labour challenge government about ‘shocking’ rise in coroner warnings over NHS patient deaths

 


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WORKING FOR PATIENTS OR NOT? – a guest post by Suzanne Kelsey

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A guest post by Suzanne Kelsey, who is a key campaigner for the NHS, amongst other things.

In 1988, when Margaret Thatcher had been in office for some 9 years, and the very foundations of our NHS had been shaken with more of the public encouraged to use private medical care,  there were serious concerns about capacity in the hospital services as waiting lists increased and wards closed.  The Conservative government appointed a group of people, without consulting the health professions, to look at this growing problem.

As a result of this the NHS experienced the most significant cultural shift since its inception with a White Paper entitled, ‘Working for Patients, ’ which proposed what we now  know as the ‘Internal Market’ and the development of the purchase provider split. GPs become the purchaser and the hospitals are the providers. This passed into law as the NHS and Community Care Act 1990. Understandably there was a great deal of opposition from trade unions, Labour and the general public but it went ahead as did the Private Finance Initiative in 1992 implemented for the first time in the UK by the Conservative government of John Major.

There is no doubt that further major problems were created for our NHS, although I would question if on the same scale as we are currently witnessing with the threat of complete privatisation and the sell-off of our publically funded service to huge private international companies, who have been waiting in the wings for quite some time and would have been rubbing their hands in glee some years ago if Thatcher and the Conservatives had continued in office.

The definition of ‘privatisation’ also needs to be acknowledged because with the downgrading of facilities and existing provision struggling to meet demands, more and more people will become anxious and tempted to pay for their treatment even if it is to ensure they have a hospital bed!

We must never let this practice become the ‘norm.’ Campaigners must ensure that the ‘free at point of use’ core principle is upheld or we will be taken back to pre-war years, removing freedom from fear that was fought long and hard for by our champions of social justice. At the same time we must remember the mantra, ‘public health not private wealth’ with numerous examples available to us of how private companies will always put profits before patients, but more of that later.

When Tony Blair became Prime Minister in 1997 he inherited a very impoverished NHS and although we expected him to abolish the internal market this did not happen, perhaps for a variety of justifiable reasons. How do you replace crumbling hospitals and inadequate resources without massively raising taxes, whilst also limiting the upheaval that had already been caused?

Alan Milburn was Minister of State at the Department of Health during this time and he stated that after years of the Tory’s gross underfunding, there was absolutely no money to fund the infrastructure, hence the use of John Major’s PFI initiative. Labour therefore it would seem had little choice but to implement this because of the historic neglect of the NHS under the Conservatives that led to understaffing and an NHS unable to manage with the rising expectations of the population, coupled with the costly advances in modern medicine and technology.

A global recession, which was not Labour’s fault, further compounded the challenges of meeting the complex needs of the nation’s health care. Dennis Skinner MP for Bolsover Derbyshire, passionately summarised this in parliament in 2014 when he stated; ‘Between 1997 and 2010 Labour dragged the NHS from the depths of degradation that the Tories had left it in and hoisted it back to the pinnacles of achievement.’

I would like to pose some questions to those experts of marketisation and competition. My knowledge is very limited on the economic implications but I am learning, slowly but surely, through my long involvement with local and national campaigning, speaking to key people in politics and campaign groups, who are also passionate about our NHS. I become increasingly frustrated when people continually blame Labour for the introduction of privatisation  Yes Blair did carry on certain aspects of it which was a disappointment for many, including me, but perhaps my arguments surely go some way to addressing why this was.

  •  My first question is in the title of this article; ‘IS THIS WORKNG FOR PATIENTS OR NOT?’
  •  If Labour had made such massive inroads into privatisation surely there would have been no need for the Coalition’s unwieldy and costly three billion pound reforms, so huge they were just about visible from outer space and the truth is many of those who voted for it would not have time to read it fully. The bill was a long time in the writing and despite the pause because of massive opposition it was nevertheless hastily introduced by the Coalition, despite all the election promises, notably, ‘there will be no top down reorganisation of the NHS.’ They have as predicted caused unprecedented chaos and in fact a major crisis in our NHS, with exhausted frontline workers propping up a system, becoming totally stressed, angry and demoralised.

Many of the population are afraid of becoming ill, because of worrying inadequacies not only at primary and secondary health care levels but also in social care. The frail and elderly feel a burden as they are constantly labelled as ‘bed blockers,’ Thus long queues have been created to see your GP and at A+E, the gateway to the hospital, all of which can result in a lack of timely care. In contrast however Labour ensured patient satisfaction was at its highest with waiting times were at their lowest and the NHS during their time was lauded as one of the best, if not the best health service in the world.

  • Were the massive and unprecedented reforms therefore unnecessary and unjustified?
  • What are the implications for binding private contracts that have taken place across large swathes of the country if hopefully there is a change of government?
  • What lesson have been learnt from the withdrawal of Circle, the private company that took over Hitchingbrooke hospital, with claims of managers installed by these private operators creating a ‘blame culture?’ Allegedly Circle were willing to ensure local GPs incurred financial losses as long as it meant corporations continued to make a profit and the damning report about the quality of care in this hospital is shocking. CQC inspecting the hospital felt obliged to intervene when they became fearful of a sickening child and Professor Mike Richards the chief inspector of hospitals said that the findings were the worst it had ever published.
  • Clive Efford Labour MP for Eltham, South East London,   presented a private members bill to parliament in November 2014,which in order to avoid further top down reorganisation, focussed on the most damaging aspects of the Health and Social Care Act 2012, that gave powers to competition regulators to interfere in decisions of local health care commissioners. The most significant change is that the Secretary of State is once again accountable to you and me through parliament. If the bill is passed he can no longer avoid answering parliamentary questions by saying that it is down to local decision making and not his responsibility. Efford’s Bill also provides that neither EU competition rules nor EU procurement rules will apply. That is an important change from the present because, at the moment, a disappointed private provider can sue an NHS commissioner for damages for failing to put a service out to tender or running a tender process wrongly. My thanks to Clive Efford for that explanation and for securing a vote of 241 for the bill to 18 against.
  • How is this Bill progressing and how it is being supported by NHS campaign groups and health professionals.
  • If the Conservatives are allowed to waltz back in by a public who have been influenced by the hype and propaganda through a biased media and/or have become disengaged, disenchanted or disillusioned , or indeed confused by the outrageous claims of some minor parties who seem to be making it up as they go along, what do we do next!?

I hear talk of a revolution being the only answer from those extremists who are likely to be the least affected by one. Perhaps we would do well to remember that our NHS has just seen the biggest revolution since its inception in 1948. Unfortunately we have seen a glimpse into our future and the outcomes are dire, if we do not use our votes wisely.

Suzanne Kelsey 1stFebruary 2015

http://www.nhshistory.net/shorthistory.htm#_ednref15

http://www.nhs.uk/NHSEngland/thenhs/nhshistory/Pages/NHShistory1948.aspx

https://abetternhs.wordpress.com/2011/01/18/commissioning-and-the-purchaser-provider-split/

http://www.healthp.org/node/71

http://labourlist.org/2014/11/commons-pass-vote-on-clive-effords-nhs-bill/

http://www.telegraph.co.uk/news/politics/11333986/Damning-report-as-first-private-firm-to-run-NHS-hospital-pulls-out.html

Battle with GPs led to Circle’s retreat from Hinchingbrooke hospital,   The Guardian, January 9, 2015

Hinchingbrooke staff in CQC abuse concerns fear bosses BBC, September 29, 2014

http://www.independent.co.uk/news/uk/uks-healthcare-ranked-the-best-out-of-11-western-countries-with-us-coming-last-9542833.html