The Health and Care Bill breaks England into 42 American-style Integrated Care Systems, effectively de-nationalising the NHS. Until now, NHS funding has come from a central pot of public money; but each ICS will have its own fixed, publicly-funded budget controlled by private corporations free to extract profits by cutting routine and emergency services and denying care. Corporations including American insurance giant UnitedHealth / Optum will decide who gets care from private providers. Long waiting lists and loss of public confidence will push those able to afford it to buy top-up cover from insurers. In the US model, the rich are routinely sold treatments they don’t need; the insured pay some £5,500 per person or £16,000 per family of four each year and risk being dumped by their insurer when treatment gets pricey; and medical bills are the No 1 cause of household bankruptcy, with three quarters of those bankrupted having medical insurance. Remedy? Set up a task force to reverse 40 years of privatising legislation, and fully renationalise the NHS.
Since the 1980s, over 100 A&Es have been closed, and half of hospital beds have been cut at a time when the UK population has grown by about 10 million. Shrinking NHS capacity in this way is an essential element of undermining the NHS to create inadequate provision, which erodes public confidence and stimulates the growth of private care. The running down and concentrating of NHS services creates economies of scale to cut costs for the private sector for when the Bill switches us to for-profit American-style care. Privatisation, austerity and the mishandling of the pandemic have put 6.5 million people on waiting lists for non-urgent treatments, delayed life-threatening diagnoses and treatment, and threatened patient survival. Since 2010, 10,000 mental health beds have been cut, creating a severe mental health crisis, worsened by Covid. Since 2020, the government has had two years to invest in more beds to treat the 10% increase in patients due to Covid but instead shrank NHS capacity by 8%, creating a further 18% shortage of beds and contributing to 100,000 excess deaths. Remedy? Reverse A&E hospital closures and invest immediately in at least 20% more beds.
The NHS is short of 100,000 doctors and nurses. Business-style performance targets, cuts, closures, exhaustion, burn out, PTSD and financial hardship are pushing doctors and nurses out in droves. In addition, salaries of frontline NHS staff have been frozen at levels less than inflation for many years, resulting in real-terms wage cuts of close to 30% over 10 years for many NHS workers. This has resulted in many talented, dedicated staff quitting the NHS, which in turn has damaged national health outcomes for patients, as well as value for money. Remedy? Incentivise recruitment and professional excellence with a 15% pay rise and proper overtime for all low paid staff ie, junior doctors, nurses, midwives, porters, secretaries, physios and occupational therapists. Create a working environment where frontline staff are valued and feel invested in NHS care – provide hot drinks, healthy snacks, overnight rest and shower rooms, free parking and access to mental health professionals.
Since 1990, an army of highly paid bureaucrats has been hired to run the NHS as a business, pushing admin costs from about 4% of the total NHS budget in 1990 to over 20% and rising. At least £200 billion has been spent on the internal market, managers, multinational accountancy firms and corporate consultants, £100 billion on private providers, and £37 billion on failed corporate Test and Trace. Some £88 billion of grotesquely expensive Private Finance Initiative debt repayments have been pushing NHS hospitals into insolvency. In 2014, Simon Stevens, the former President of Global Health at American private insurance giant UnitedHealth, was made CEO of NHS England. He spent the next seven years embedding his former employer (here Optum) throughout NHS England. In 2021, Samantha Jones, former CEO of US health insurer Centene (here Operose), was made the PM’s expert advisor for NHS transformation, then Chief Operating Officer. Centene now owns 70 GP practices around the country. Remedy? Liberate £billions by using the task force to establish how to legally pull out of PFI contracts, and end US insurance and private sector contracts that divert funds away from patient care into the pockets of managers and shareholders.