By Maggie (Unison Worcester Acute Branch) and Andy Fenwick, Worcester South Labour Party
On Thursday, we carried a review of the John Pilger documentary on the privatisation of the NHS. Here, Andy and Maggie Fenwick, add their own take on this excellent programme.
The powerful investigation into the privatisation of the NHS shown on ITV last week was a hard-hitting piece of journalism by the John Pilger. But the only problem with this documentary was that it was broadcast a week late. If it had been shown on December 10 the general election might have gone another way. But that is ITV bias.
Unusually for a documentary on a commercial broadcaster this program was “crowd-funded” with hundreds of ordinary people donating to make it. Being such a complex subject a full 115 minutes was dedicated to it.
Patients discharged to homeless shelters
It started with a scene from the USA, where an elderly woman in a hospital gown is found on the cold streets of Chicago, and in some pain. This is what is called ‘patient dumping’ by medical insures in the USA. To get more bed space so more patients are seen and more money is made, hospitals will discharge patients with low insurance cover onto the streets or into homeless shelters.
The practice has now arrived in the UK, as patients are discharged from mental health bodies at seven in the evening, or a patient with just nine days after an open-heart operation is dropped off at a shelter. After a few clips of adverts from USA medical insurance companies, an NHS doctor explains that the NHS has moved from healthcare to money extraction. We share the cost of care but this £128billion is an opportunity for vultures to pray on it. In 2019 more of the NHS was privatised than at any other time, but john Pilger explains this is hidden under a blanket of descriptions such as ‘reforms’ and ‘partnerships’.
The opening piece shows two brothers who recall the death of their father because a private ambulance did not have a functioning defibrillator, to save money. It was second-hand and had not been calibrated. The private ambulance provider could not be contacted an in the end a call was put through to the fire brigade to bring a defibrillator. At the coroner’s court the cardiologist stated that if treatment had been timely the father would have lived.
More examples were given, such as the use of private hospitals taking up waiting list patients only to be caught out by inadequate emergency medicine, threatening lives.
Pilger delivered a history lesson on the foundation of the NHS with clips of Churchill been heckled when he denounced the utopian idea of national healthcare, and of RAF servicemen striking in the Far East because they were fighting for the future for their families. All of this and Nye Bevan’s words echoing down the years of freedom from want, a real socialist expression of what can be done.
This was too much for the Tories and Thatcher had to turn back this piece of socialism. Nicholas Ridley, minister and a close ally of Thatcher, advised that the Tories should have a “policy of preparation for return to the private sector by stealth”. In the same year, management consultants McKinsey & Company advised that hospitals should be more like hotels and charge patients a daily rate for bed and breakfast.
In January 1988, Oliver Letwin and John Redwood published a paper entitled “Britains’s biggest enterprise, ideas for radical reform of the NHS” which would get the NHS away from a public service to become an entirely insurance-based corporation. However, realising that it would cause a backlash, it had to be done circuitous and covertly.
Servicing of PFI debt is a huge burden
Pilger refused to pull any punches and laid the blame for the current NHS problems at the feet of Tony Blair with his nifty trick of buying new hospitals on the never-never of PFI. The PFI contract has its money ring-fenced so regardless of the finances of a hospital, the private company owning the PFI contract, still gets its over-inflated price. It ends up that the servicing of PFI debt is greater that the provision of services to patients.
Under PFI schemes, an initial £11bn debt would eventually cost the NHS £90bn. The program described how the Blair government, with executive amendments opened the backdoor to private healthcare providers. Later on, Blair’s NHS salesman ‘Labour’ MP Alan Milburn, was rewarded with a seat on the board of Bridgepoint Private Equity. The revolving door of people between government departments and American health corporations was examined by Pilger.
This program was good at explaining why the NHS has such multitude of corporate organisations like commission bodies and healthcare providers. It is thanks to management consultants who cover their backs with paper to confuse any enquiry. In 2014 NHS spending on management consultants reached £640million in one year, more than 5% of the total budget. Yet a study by Bristol University said that management consultants are not only failing to improve efficiency in the NHS, they are making it worse.
Another target of Pilger’s were the lobbyists who hide under the umbrella of NHS Providers. So Virgin Health and Care UK use lobbyists to get bigger slices of the NHS and this is justified by a spokesman saying that GPs are private contractors so what is wrong with more private involvement? These lobby groups setup bogus fronts such as “GPs for Reform”, knowing that the press and the BBC will buy into whatever spin is being pushed.
These lobby groups were behind the Health and Social Care Act 2012 which promoted privatisation and fundamentally changed the NHS. Pilger explained that the Act was to dismantle the old NHS and replace it with a system modelled on USA healthcare. The duty to provide healthcare is replaced with a duty to contract healthcare.
Spiralling management costs
Dr Bob Gill outlined that privatisation has led to more bureaucracy not less, and said that the old management system of national feeding into regional and then districts only placed a 5% administration cost. Now, with all the complex purchaser/provider structures, administration is running in excess of 20% of the NHS budget. It was the simplicity of Bevan’s NHS that kept the management costs down, but now with PFI and spiralling management costs, the crisis is portrayed as a failing of NHS.
The program highlighted the failings of privatisation when Circle Health won a contract to run Hinchingbrooke Hospital from 2012, the first wholly sold-off hospital. This was supported by Vince Cable Lib-Dem Business Secretary, who visited the hospital and spoke of the hospital thriving. A lead nurse challenged this and said his a hospital was not a business.
Pilger was critical of the BBC promotion of this privatisation giving a glossy overview without any real investigation. Lead nurses were told to identify patients that could be discharged daily and this would be the corporate way. If a nurse failed to highlight enough it became a competition and the lead nurse would be classed as ‘failing’.
This experiment in privatisation failed with Chief Executive walking off with a £500,000 payoff within the first year. The Quality Care Commission rated the Circle Health provision as being in need of ‘special measures’ and Circle withdrew from the contract in 2015. The damage done was tremendous and it caused great difficulty amongst staff.
An app will never replace a GP
In the future, under the Tories, we will not need GPs. The same person who brought disaster to Hinchinbrook Hospital is now promoting an app (called Babylon) to replace GPs and he has received the endorsement of Matt Hancock, Tory Health Secretary. The documentary pointed out the failings and lack of accuracy of the app. It even pointed out that the Advertising Standards Authority had raised concerns about the company’s promotion of the product.
A GP in the program stated that he has to take in many different forms of communications when he is with a patient: verbal, body language, never mind blood pressure, temperature, blood oxygen and pulse. An app cannot access the nuances of non-verbal communications.
The program shifted back to Chicago where a group of healthcare insurance companies dominate healthcare and often decide who will “live or die.” 87 million Americans have no health insurance, but even if you have, insurance profit is more important.
Every year 20,000 Americans die because they can’t get treatment. The most common cause of bankruptcy is medical bills and almost half of US cancer patients lose their life-savings in paying for treatment. These facts were portrayed on the TV screen to emphasise the importance of lack of healthcare in the USA.
Cost of drugs are high too
The program relied on insiders to blow the whistle on insurance scams. One such was a former vice-president of Cigna Health, who gave an example of a 17-year old girl needing a liver transplant. Her doctors said that her chances were good, but the medical director of Cigna, 300miles away, declined the surgery. The parents launched a media campaign and rather than face the scrutiny of the media Cigna approved the surgery five days later, but unfortunately the girl’s other organs had failed and she died a few hours after the health insurance company gave the go-ahead.
Many more examples of cruel decisions are given in the program. To save half a million dollars, an insurance medical officer said she was signing death-warrants. In the old coal-mining district of the Appalachians, for three days a miracle happens. It is like the NHS has come to town: a pop-up clinic is operated by medical volunteers with queues forming for a week before with patients living in cars waiting for treatment. Even military veterans, who are supposed to receive free medical care, were queuing up. The irony of this is that the clinic was set up in 1985 by a British doctor who believed in a free health service. A doctor explained that free care is one thing but drugs are another cost that people cannot afford. An asthma inhaler, for example, costs $400 a month and as 18 million Americans suffer from asthma, the pharmaceutical industries make huge protected profits.
Billions could be saved
Switching back to the City of London, the program note that with austerity being imposed on the Health Service, it has meant 120,000 additional deaths caused by cuts.
This was a great program and shows the misery that the Tory government and the USA insurers want to dump on us. The NHS is funded to the tune of £128bn a year and if we scrap the ‘reforms’ and return it to Nye Bevan-style administration, 15% savings could be made. If we scrapped PFI contracts, another £6bn would be saved. Kicking out all the profiteers would save another £8bn. Just think – that makes £34billion already available! If, as a nurse says at the end of the program, they were just allowed ‘to get on with our work and trust us’, we could have the NHS the 1945 Labour Government promised.
The program is available on ITV hub until 16th January 2020 watch it, promote it and use it in your campaigns to save the NHS. Get your Labour Party and trade union groups to watch it.
December 20, 2019
