On 5 February 2021 Health Policy Insight published a leaked draft of a White Paper outlining plans for an NHS overhaul. The proposals, supposedly emanating from needs highlighted by the Covid pandemic, promised to remove bureaucracy from the NHS, to integrate health care with social care, and to give local authorities more control over provision in their area. Subsequently, on 11 February, Health Minister Matt Hancock introduced the White Paper in the House of Commons. The initial announcement gave rise to belief that it was being proposed to dismantle the ‘internal market’ system introduced in 1997 as a vehicle for gradual privatisation of the service, with the relatively slow start being accelerated by David Cameron’s Health and Social Care Act 2012.
With the introduction of the ‘internal market’ came a whole new level of bureaucracy, since the NHS was divided into ‘providers’ and ‘consumers’ so that internal competition could be introduced, with funds being allocated to one section of the NHS so that they could ‘purchase’ services from another, as well as a range of services such as cleaning and catering from the private sector. All this required competitive tendering – one layer of time-consuming bureaucracy necessitating the expensive employment of large numbers of additional ‘managers’, and accountancy, requiring the equally expensive employment of a large number of additional bean counters – all out of taxpayer money supposedly being used for the treatment of patients. The 2012 Act brought in the requirement of allowing private concerns to tender to supply clinical services, with the expectation that those offering them at the lowest prices would get the contracts – which the privateers were all too often able do because they were free to employ people at rock bottom wages and generally to cut costs in a myriad of other ways liable seriously to affect the quality of the service, while hammering the working conditions of the staff.
So when Matt Hancock, the Health Secretary, announced that NHS bureaucracy was to be reduced, it was all too easy to rejoice on the assumption that he meant to do away with the ‘internal market’. However, not a bit of it! Much less did he intend to sweep away the privateers fattening themselves out of the public purse on the pretext of providing services to the NHS! Tout au contraire, mon ami!
“The NHS campaign group We Own It has stated its opposition to the restructuring, saying it would leave the NHS even more vulnerable to privatisation than before.
“The group criticised the ability the white paper would give for private companies to sit on NHS boards, as well as the provision allowing the government to hand out contracts without competition. It added that the reforms opened the door to privatisation by offering patients more choice from private providers” (Jasmine Norden,’ The reasons why Matt Hancock’s proposed NHS reforms should worry us all’, The Canary, 16 February 2021).
Professors Peter Roderick and Allyson Pollock, who have always stressed that ‘market’ norms cannot but starkly conflict with patient interests, have written in the BMJ in great detail (‘A new bill to reform the NHS in England: the wrong proposals at the wrong time’, 11 February 2021) about the government’s nefarious plans to expand the process of piecemeal selling off the NHS, stressing, among others, the following points:
1. No material change
“The core elements of the disastrous  reforms remain in place: no duty on the government to provide key services throughout England to everybody; entitlement to services dependent on membership, now of clinical commissioning groups (CCGs), in the future of ‘Integrated Care System (ICS) NHS bodies,’ though abolition of CCGs is implied, not expressed; commercial contracts and the purchaser-provider split still the basis for delivering services; foundation trusts still able to receive 49% of their income from outside the NHS; and public health functions and communicable disease control remain outside the NHS.”
2. The end of compulsory competitive tendering
While on the face of it this removes an unnecessary layer of bureaucracy, it at the same time removes the only protection the NHS has of cronyism in the award of contracts for the provision of services to the NHS:
“…transparently competing for contracts is the check against corruption and cronyism within a market model. Contracts worth £10.5 billion were awarded directly without any competition during the pandemic to the end of July 2020; this will now become the norm”.
And it is now notorious that not a few of these contracts were awarded to private entities with no previous experience in the field:
The New York Times, for instance, reported:
“When the pandemic exploded in March, British officials embarked on a desperate scramble to procure the personal protective equipment, ventilators, coronavirus tests and other supplies critical to containing the surge. In the months following those fevered days, the government handed out thousands of contracts to fight the virus, some of them in a secretive ‘V.I.P. lane’ to a select few companies with connections to the governing Conservative Party.
“To shine a light on one of the greatest spending sprees in Britain’s postwar era, The New York Times analyzed a large segment of it, the roughly 1,200 central government contracts that have been made public, together worth nearly $22 billion. Of that, about $11 billion went to companies either run by friends and associates of politicians in the Conservative Party, or with no prior experience or a history of controversy. Meanwhile, smaller firms without political clout got nowhere” (Jane Bradley, Selam Gebrekidan and Allison McCann, ‘Waste, Negligence and Cronyism: Inside Britain’s Pandemic Spending’, 17 December 2020).
“…a wealthy former investment banker and Conservative Party grandee, Paul Deighton, who sits in the House of Lords, was later tapped to act as the government’s czar for personal protective equipment.
“Eight months on, Lord Deighton has helped the government award billions of dollars in contracts –– including hundreds of millions to several companies where he has financial interests or personal connections.
“The contracts that have been made public are only a part of the total. Citing the urgency of the pandemic, the government cast aside the usual transparency rules and awarded contracts worth billions of dollars without competitive bidding. To date, just over half of all of the contracts awarded in the first seven months remain concealed from the public, according to the National Audit Office, a watchdog agency”.
And to add insult to injury:
“In the government’s rush to hand out contracts, officials ignored or missed many red flags. Dozens of companies that won a total of $3.6 billion in contracts had poor credit, and several had declared assets of just $2 or $3 each. Others had histories of fraud, human rights abuses, tax evasion or other serious controversies. A few were set up on the spur of the moment or had no relevant experience — and still won contracts”.
The tin lid has been supplied by the recent revelation that a contract for the supply of vaccination vials went to one of the Health Secretary’s neighbours:
“The former publican and neighbour of Matt Hancock who secured lucrative work producing millions of vials for NHS Covid tests is under investigation by the UK’s medicine agency, the Guardian can reveal.
“Alex Bourne, who used to run the Cock Inn near the health secretary’s old constituency home in Thurlow, won about £30m of work producing the test tubes despite having no prior experience in the medical devices industry.
“Prior to the pandemic, his company, Hinpack, made plastic cups and takeaway boxes for the catering industry. Now it supplies tens of millions of vials from its production site on an industrial potato farm complex in Cambridgeshire” (Felicity Lawrence, ‘Matt Hancock’s ex-neighbour under investigation by UK’s medicine agency’, The Guardian, 21 February 2021).
If this level of graft on the part of the government itself is not bad enough, the future extends the opportunities:
3. Private companies will be involved in the body which doles out contracts to provide services to the NHS
The Clinical Commissioning Groups that now give out the various contracts will be replaced by a new ‘representative’ body with wider powers:
“A statutory ‘ICS NHS body’…will receive a ‘single pot budget’ which will merge the budgets for general practice with acute and other services. … Its board will include representatives of NHS trusts, local authorities and general practice ‘and others determined locally.’ General practices taken over by US corporations would be included. No controls are proposed over whom the other board members may be. They could therefore include, for example, private hospital groups, nursing home chains and the 67 companies awarded a £10 billion contract last November for NHS inpatient, day case, pathology and imaging services, urgent elective care, cancer treatment, and diagnostic services…
“…The opportunity, for example, for private companies to be either or both members of the ICS NHS body, and commissioned to provide services, is obvious. …”
Moreover, if in spite of all this the ‘ICS NHS body’ should favour bids from the NHS, in the belief that they are likely to prove more reliable even if marginally more costly on the face of it, then any disappointed privateer will be able to sue: “Private health companies unhappy at being shut out of health service contracts will also be told to take the NHS to court under reforms to outsourcing due this week as part of new legislation” (Chris Smyth, ‘NHS shake-up offers patients more private choice’, The Times, 10 February 2021).
4. And yet: there is a dearth of provision for transparency or accountability.
5. The power of local communities to influence decisions is less than ever.
6. The right of the government to issue instructions to the NHS bodies, ‘taking back control’, carries a demonstrable risk of being misused, as has been the case during the pandemic.
If Lord Deighton, multiple Tory Party donors and Matt Hancock’s publican were richly rewarded during the pandemic, how many had to be disappointed because of NHS ‘bureaucracy’ which the government lacked the power to overcome?
Apart from all else, it has come to light that Matt Hancock has been receiving generous handouts to the tune of £32,000 from the Institute of Economic Affairs, a think tank that is campaigning for the NHS to be replaced by a privatised healthcare system. This worthy organisation has “criticised the NHS as ‘nothing special’ and unworthy of the ‘adulation’ it has received during the pandemic”!!! (Eleni Courea, ‘Matt Hancock took cash from ‘anti-NHS’ Institute of Economic Affairs’, The Times, 10 February 2021).
Greater ‘patient choice’ – a cover for more comprehensive privatisation
So why are we not surprised that “Patients will be promised greater rights to choose private treatment and have it paid for by the NHS….
“People waiting for routine care will be able to choose treatment from any company that meets NHS standards and prices as the health service struggles to reduce waiting lists that have grown sharply during the pandemic” (Chris Smyth, op.cit.).
The NHS has already suffered greatly as a result of underfunding and the accelerating rate of privatisation, a fact that has been brought into high relief as a result of the pandemic. That the NHS didn’t collapse in 2020 or before is more to do with the tenacity of the dwindling number of doctors, nurses and support staff within the ever-shrinking number of hospitals across the country. When people praise the NHS and hold it up as something dear to them, it is those hospital doctors, nurses and support staff that they are thinking of, not the cost and staff cutting managerial elites sitting on the Health authority boards, CCGs and NHS England. Had the NHS been funded better, with a truly national organisation spreading the wealth equally with all parts working in harmony, instead of having to vie against each other, and without the atrocious haemorrhaging of its cash straight out into the private sector through so many gaping holes, the greatest of which is the private ownership of drug and medicines production, followed not far behind by outrageous super rents courtesy of the Labour Party’s PFI schemes, its staff would not have been pressed beyond endurance in the way that they have been during the pandemic. Had the staffing been kept at anything like a proper level, then, when those Nightingale hospitals were made and equipped in 2020 by throwing money at private companies, they would have been used to capacity instead of sitting nice, shiny and mostly empty because we had no staff for them. Moreover, this year when the numbers in hospital climbed above the 2020 numbers, those Nightingale hospitals are still not being utilised because we still lack the staff. There are very few, if any, hospitals that are fully staffed in relation to doctors, nurses or support staff, so that, to cover the shortfall, staff have to work harder while private companies are paid to send in what are called bank staff (qualified people but employed by the private company often on a day by day basis) who will try to fit in on any wards and who cost the hospital around three times as much as those employed by the hospitals themselves. Such are the joys of privatisation!
There is every reason to think that an irresistible resistance will be put up to the new proposals, and that resistance must be given every support and encouragement. If we, the people, do not rise up as one to defend our NHS, we are certain to lose it altogether in the not too distant future. It is not enough to applaud our NHS heroes! We need to defend them tooth and nail, and it cannot be doubted that the fight will be severe as the fatcats will not give up what they feel is their right to make their billions at the expense of the health of the masses of people without deploying all the vicious and dirty means at their disposal.