As experienced managers quit the NHS, profit-hungry private firms will fill the commissioning vacuum, warns Dr Anna Livingstone.
Earlier this month, David Cameron said: ‘I don't just want to know about waiting times. I want to know how we drive the NHS to be a fantastic business.' He said it just as failing Hinchingbrooke Hospital was handed to private company Circle Healthcare to run for profit.
On my weekly visit to my demented mum in her nursing home, I said, as so often: ‘Do you remember...?' And with a spark of her old wit, she replied of her lost memory: ‘That's an obscenity.'
I am an East End GP. Many of my patients, as the children of unemployed families in the 1930s, remember when they couldn't afford the doctor. For me and my community, the obscenity is that the present Government wants us to lose our memory of our right to healthcare in the NHS of Aneurin Bevan, which is provided
to meet the needs of the public by public servants through our taxes. Instead, it wants to replace it with ‘wealth care' for the few, where our taxes fund companies, generally now multinationals, which are using and developing healthcare in pursuit of profit.
It isn't new. A trickle of privatisation became a stream under New Labour. But now it is a river.
Companies who invest in services carrying the NHS logo at a time of recession rely on getting their ongoing profits through tax, and ruthlessly cutting staff and services for patients if need be.
The purchaser-provider divide, introduced in 1990, grew in bureaucracy. We are told about patient choice, competition for excellence and slimming down that bureaucracy – but instead chosen services are cut, competition rules exclude experienced local services and bureaucracies grow.
The 152 PCTs are morphing into over 200 clinical commissioning groups, as well as health and wellbeing boards and clinical senates. But the real decisions about what to buy from whom, and what general practices will have to do, will no longer be taken by NHS management, but instead by a small number of commissioning support organisations which will be provided by private companies.
These companies are not ‘independent', but tied into multinationals. And despite the illusion of protection through competition rules, without doubt they will increasingly connect back into the business of service provision for profit.
Meanwhile, GPs are pushed into CCGs, persuaded that the later we go live, the less we'll get to do. ‘Clinical leaders' emerge from the flat structure of general practice to do the work of pushing us to cut spend.
However, this major restructuring of how NHS services are commissioned, coinciding with draconian cutbacks in management staff, is not one which CCG board members in general have the time or the skills to oversee.
So who comes along? In London, pathfinder CCGs are contracting for ‘intensive organisational support' with our friends in the private sector, such as McKinsey, KPMG and Pricewaterhouse-Coopers. They are to provide expertise and training in leadership, organisational development, finance and market analysis.
We know McKinsey in the East End. We had them a couple of years ago, paid them millions of pounds for ‘supporting development' of our very effective integrated care packages for immunisation, diabetes and other long-term conditions, while they learned for free how we provided sophisticated care and IT, skills they could then use in the health market.
If these private companies can be funded to provide support, why can't existing managers do this? It is no coincidence that the health bill ignores the need to provide for training, whether for clinicians or on the management and organisation of services.
Yes, the NHS has fantastic business opportunities – and developing CCGs is just one of these.
Dr Anna Livingstone is a GP in Tower Hamlets, east London, and secretary of Tower Hamlets Keep our NHS Public