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Unison fiddles while health service burns

A 1,000 amendments later and the health bill that returns to Parliament today still contains the plan to deepen market penetration and competition in the NHS, building on the previous New Labour government’s handiwork.

Remember Alan Milburn, the health secretary in the first post-1997 Blair government? When Frank Dobson was removed after abolishing the internal market, his replacement Milburn announced in 2002 that in future Foundation Trusts (FTs) would run the NHS.

That was followed by the creation of private treatment centres. They have been a financial disaster for the taxpayer. Only 12 of the original 31 contracts, worth at least £1.47bn in total, are still operating.

FTs are “public benefit corporations”, free from central government control and can raise capital from both the public and private sectors. Trusts can retain financial surpluses – and, of course, have to bear losses and make cuts to balance the books. Up to 20 hospitals are in serious financial difficulties and the government has started talks with profit-driven corporations to take over their management.

Already, whole wards within Foundation hospitals are restricted to private, fee-paying patients only. Existing limits on the extent of private facilities are to be abolished by the Coalition’s bill. So too is the secretary of state’s present legal commitment to maintain a health service free at the point of use.

As two clinicians warn today:

Over time, all hospitals will have to become Foundation Trusts (FTs), effectively commercial bodies. They would have the power to close services without public consultation, and caps on income from private patients in NHS hospitals will be removed, tempting many to increase their income at the expense of NHS patients.

As in any commercial organisation, the main objectives for these FTs will be profit generation, they write, warning:

A profit driven model will undermine all that is precious about the NHS. Furthermore, it will produce an underclass of patients with chronic, debilitating illness, who will be seen as pariahs by those organisations who seek financial benefits over and above good health.

Add in whole new layers of paralysing bureaucracy created by the bill, plus the £20 billion of “efficiency savings” announced by the previous government, and the wrecking of the National Health Service as originally conceived by the first post-war Labour government is well and truly at hand.

The response of the leaders of main health union Unison has, as usual, been pathetic. Having sat on their hands while New Labour undermined the NHS, Unison has restricted its present campaign to publicity drives. The current Labour leadership under Ed – I want a prosperous capitalism – Miliband also remains committed to market “solutions”.

Christina McAnea, the union's head of health, says the public “will not forgive Lib Dem MPs for colluding with the Tories to break up and privatise the NHS” and that “voting through this Bill will be the end of the NHS as we know it.” We await with bated breath Unison’s fine words being turned into action against the government.

The Coalition is driven by the deepening economic crisis to create conditions for a “return to growth” at any cost, which includes opening up the NHS to the corporations. A similar strategy is being developed around local government services. As the experience of private treatment centres shows, competition allows the private sector the privilege of state guaranteed-profits while services deteriorate.

Taking the profit out of health and other services will require more than fiddling with bits of legislation. We have a market state committed to doing whatever it takes to revive a broken capitalist economy. The present parliamentary system and corporate power are the problems, not the solution. Replacing them with democratic, truly accountable people’s assemblies is the best way to answer the Coalition’s onslaught on the NHS.

Paul Feldman
Communications editor
6 September 2011