FRFI 211 October / November 2009

Health care for London

‘The days of the district general hospital seeking to provide all services to a high enough standard are over’, said Sir Ara Darzi, responsible for the ten-year plan for reorganising health provision in London. Commissioned by Gordon Brown in 2007 and promoted to a ministerial post in the Department of Health, he resigned in June this year.

The NHS Next Stage Review Interim Report, published in June 2008, showed there were significant variations in access to and quality of primary medical care services across Britain. The Equitable Access to Primary Medical Care programme was launched to address this. This includes at least one GP-led health care centre in each Primary Care Trust area.

Darzi’s plan was to shift work from hospitals into polyclinics and urgent care centres. 150 polyclinics (GP-led health centres are linked to this model of service), with long opening hours, would provide community-based care at levels between GP practices and district general hospitals, including pharmacy, dentistry, social and mental health, x-ray and ultrasound services, blood tests and minor surgery.

Darzi’s changes opened the way for private companies to bid to run these centres. The Department of Health expects Primary Care Trusts to commission 15% of their services from the private sector. NHS London’s timetable included inviting suitable providers to tender by April this year and sign contracts for the preferred provider by December 2009. ‘Suitable providers’ include GP practices, NHS bodies, private sector companies and ‘third sector organisations’ such as charities. Clearly GP practices cannot compete equally with multinationals in such a bidding process, and whilst health centres may continue to be described as ‘GP-led’ for public consumption, they will in fact be run for profit by health care multinationals and consortia.

Fifty ‘GP-led’ health centres have already opened around Britain. In 17 of these, up to 80% of the GPs are newly qualified or are just finishing GP training. Once private companies take over, information about what they are doing may become commercially confidential.

On 31 July, Camden NHS awarded a ₤20 million contract for running its new GP-led health centre in north London to Care UK, a company that in April 2009 was criticised for the poor quality of its elderly homecare. Yet again, the decision was made two months before the conclusion of a public consultation. A legal challenge is being mounted.

US multinational United Health currently runs three GP practices in south Camden, despite local opposition. In August, Connect Physical Health Ltd (CPH) was awarded a three-year contract to provide physiotherapy services at the Royal Free Hospital, to treat over 11,500 people a year. The pay of staff who choose to stay will be protected but they will not be able to add to their NHS pension. Camden physiotherapy will now be fragmented while CPH manages the referrals, records and appointments from a central database in Northumberland, 350 miles away.

In Hackney, two ‘GP-led’ health centres are planned and again, sticking to the minimum legal requirement for consultation, it is clear that the Primary Care Trust in Hackney has not adequately informed local people.

Private finance and the crisis

The cost of private finance for hospital building has increased with the global financial crisis. Guarantees for repayments of capital to bond holders are now more risky and so this method has become more expensive. However, bank loans have also become more costly. Before the crisis, interest rates on bank loans were between 0.6 and 0.8% above basic bank borrowing rates; they are now 1.5-1.6% above this rate. The government’s plan to increase public borrowing to support the banking sector means that the public sector is locked into making Private Finance Initiative (PFI) repayments to banks at these higher rates. As Alyson Pollock of the Centre for International Public Health Policy at the University of Edinburgh says: ‘Having bailed out the banks at taxpayers’ expense, the government is further conflicted because in allowing the banks to charge an excessive premium for finance it is protecting shareholders’ and investors’ interests at the expense of the taxpayer, the citizen and public services.’

Cutting NHS staff

Management consultancy firm McKinsey has come up with solutions to the financial shortfall and reducton in NHS budgets. Commissioned by the Department of Health in England, it is advising a cut of 10% in the workforce by 2014. This will drastically affect health care provision. Money is however being wasted on the administration of the increasingly privatised system: it now represents 12% of the total NHS budget, compared to 6% in 1991 before the introduction of the internal market.

As the NHS is progressively broken up and its services sold off, concepts such as inefficiency and productivity become paramount whilst universal health care and needs-based planning fall off the agenda. Competition in this context prevents resources being directed to where they are needed. The privatisation of the NHS must be opposed for the health of us all.

Hannah Caller