I feel passionately about the NHS. It is something we as a nation should be immensely proud of, and we are lucky we established it when we did, because I expect it would be very difficult to set up such a scheme now with all the vested interests who would oppose it. It stands as a symbol of fairness and solidarity in a society which is otherwise becoming more unequal and fractured.

I am involved with the NHS and I never cease to be amazed by how selfless and ethical most of the people who work in it are. “I think I am paid enough for what I do” a chief officer remarked recently to me when the chance of an increase was mooted. This attitude contrasts markedly with those of many who run our large banks and other corporations.

But I know I am not the only person who cares deeply about it, and when changes in the NHS are discussed people become very agitated and make a large amount of noise. The problem is we all know in our hearts that things cannot go on the way they are, and a radical solution has to be found. We are bombarded continuously with statistics describing a shortage of specialists, GPs and nurses. Last Saturday it was the Society for Acute Medicine warning us that it was becoming increasingly difficult to fill rotas for emergency care, and I expect we will continue to receive such pronouncements.

There is a need for more resources, few dispute this. Even Andrew Lansley, architect of the controversial 2012 reforms, admits this. But however much more money can be procured, the system cannot continue without fundamental reform.

I have written before about the changes we need. Fewer but better specialist hospitals, more care and support provided outside hospital, and serious efforts to promote good health and prevent illness when we can. (The North East, by the way, is good at this, having the best smoking reduction figures in the country.)

The NHS has brought forward proposals which will move in this direction, called Sustainability and Transformation Plans, or STPs. These will involve changing hospital provision and improving community support and care. Now I make it my business to talk to as many groups as I can about the challenges facing the NHS and what we can do, because there needs to be a serious debate. I consider myself as being on the left, and thought that those who thought like me would want to make sure the NHS survived.

I am really worried by the reaction by many on the left to the ideas in the STPs.It is assumed that the “progressive” position is to oppose these plans, rather than to campaign for better resources to make them work properly. I keep hearing that the STPs are there to make cuts, and to promote privatisation. Little evidence is put forward about the second proposition, but many seem to believe it as gospel. In fact many in the NHS do not like privatisation of services and there has been less of it in the North East than elsewhere.

I do not understand the logic. If changes are not made the NHS will simply not be able to continue even if there is more money. I would ask those attacking the STPs to think about the direction of the changes. If successful they would mean far more integration of services. Hospitals, local authorities and the providers of community health would need to work together. There would be a cooperative model, rather than the competitive one we have now. It would become much harder to privatise individual parts. Secondly local authorities, which are elected, would be working much more closely with the NHS which would give elected representatives more influence over what is going on.

Yes, the NHS needs more resources and I would urge all who care about it to campaign for these. But please also think about the sort of NHS you want, with more care provided locally, more control by the local community and better specialists hospitals. I am fed up with knee jerk reactions – I want a proper debate.

To summarise, I believe that the STPs have potential and as socialists we should try and develop them as part of an integrated accountable NHS. They will not be successful unless they have more resources, and we have to campaign for these. But they are not necessarily a vehicle for privatisation. If services are integrated they will be more difficult to privatise. We need to quietly get rid of the 2012 Act so ther eis no longer an obligation to put services out to tender. At present privatisation is often seen as the only way to deliver a service within a reduced financial envelope, and will eventually fail as experience such as Hinchinbrooke has shown. Please do not dismiss STPs but engage in the debate as to what they are about, which seems to me to be desirable.

This is an extended version of an article which appeared in the Newcastle Journal on 19th April 2017

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4 Comments

  1. delapole1 says:

    I would agree with this analysis it is the marketization and privatisation of the NHS that is both wasteful and hugely bureaucratic. STPs have potential but not when linked to markets and insurance based formulas of risk management the CCGs have been developed for. It is easy to see STPs s as the issue as they may involve hospital closures and the history of hospital closures in the UK has not been good. I think the real issue is that no one has any real idea of who is in charge of the mess Cameron’s and Hunt’s reforms and what the real aims are. We should campaign to abolish CCGs or make them fully accountable and ensure that public money is spent in the most effective and transparent way.

  2. Adrian Mercer says:

    David, You ask for a reasoned debate, so here are a couple of reasonable points.

    Firstly, we are in agreement about the need for more resources for the NHS.

    You appear to believe that there is no explicit evidence within STPs that privatisation is the aim. I agree. However, privatisation may be less-evident in the north-east, but community services, GP services, patient transport, diagnostics, treatment centres, and so on, are all real examples of privatisation elsewhere. Is it really your contention that it is going to stop now? Indeed, the first tender for a Local Care Organisation has just been launched in Manchester. The US model beloved of United Health/Kaiser is predicated upon a model of integrated service provision and insurance, which ACOs here would make it easier to replicate. It is, I suggest, counter-intuitive to believe that the trend towards privatisation of the NHS would stop with the creation of ACOs

    You would like more local control over the NHS. I agree. Let’s start with local people having a voice on STPs. Currently, these are top-down, imposed plans and local engagement is minimal. Integrated services might bring councillors into play, but is that it?

    If your argument is that change is needed in the NHS that’s fine. But STPs are not, and cannot be, the vehicle. They would have potential if funding was available to support the transformation element (which there isn’t); if the NHS had the capability to deliver wholesale system change (which it doesn’t have); if they had been developed and owned locally; and if the government wasn’t rigidly tied into an ideology which prioritises privatisation over effective and safe public provision.

    Regards,
    Adrian

    https://www.sochealth.co.uk/2017/03/14/nhs-sustainability-transformation-plans-transformation-possible/

  3. Ron singer says:

    The over riding fact is that STPS are the vehicle being used to achieve £22bn of cuts in the NHS budget. That means shrinking some services to pay for shortfalls in provision.
    The Tony’s loath the NHS. Private companies want part of the NHS simply to make money. Look at some the services particularly in general practice that are worse than what was there before.

    When the NHS budget is above EU average and we have similar numbers of doctors and nurses then talk about reform

    Ron Singer

  4. lallygag26 says:

    If you have paid so little attention to the real debate taking place over the NHS that you think it is just about more money and mindless opposition to the STPs then it is your position that is ‘knee jerk’ not the campaigners’.

    It is true that spattered through the ST Plans there are references to previous evidence based work, such as Marmot’s, which appear to give them an underpinning of credibility. But an examination of the proposals exposes a different reality. One is a form of ‘magical thinking’ where improvements in population health and social care are to be used to reduce the need for emergency services. There are problems with this approach. Firstly that the services changes are happening now, whereas population health changes take years to implement (50 years hard work in the case of tobacco). Secondly that diverting resources from health services to social care will improve neither. Social care is suffering from a serious shortfall of money. The NHS cash will be used for stuffing holes in the system – and to encourage the private social care providers to stay. They are getting very antsy about their profit margins. Indeed Andrew Lansley’s ex SpAd Bill Morgan warned in Conservative Home last year that the spectre of re-nationalisation of care homes was looming if the sector did not get more money soon. And last, but not least, the evidence base for social care and US ‘integrated care’ dramatically reducing emergency admissions is patchy and certainly offers no reason to believe that overall hospital provision can be substantially reduced in the short term – or even the medium to long term.

    None of this is meant to imply that public health issues are not of the greatest importance. But public health budgets have been slashed and free market governments are loathe to take the strict regulatory approach to business needed to reduce hidden sugars in processed foods, etc. Closing hospitals and saying ‘care in the community will save the day’ is not a solution.

    A more critical eye cast over the move to stop emergency services from interrupting planned work also reveals that it is more to do with the profitability of services than the standard of care. How can you defend a system which treats emergencies as an inconvenience? As for centralisation of services and networking, this is a model which has had some success in dense Metropolitan areas which are relatively well resourced. In the country they are a disaster. Any national health system with patient need at its heart rather than profit will understand that accessibility is also a public health issue. Good standards of care need to be accessible and affordable. ‘Excellence’ which is a 100 miles away might as well be on the moon for many people. When travel becomes an out-of-pocket health cost the poor are priced out.

    As for privatisation, economies of scale and the Accountable Care system offer much greater potential for profit through denial of care than individual service contracts. Manchester’s whopping £6bn/10 year contract for a range of ‘blended’ services has gone up to European tender because under competition law its size requires it. Even if a Foundation Trust or NHS consortium wins it this time round, there’s no guarantee it will stay that way. And there is bound to be aggressive competition from the private sector for such contracts.

    The additional issues around mixing ‘free at the point of clinical need’ with social care’s largely means tested provision and the ability to charge extra on local taxes to pay for what should be national services, not to mention discretion over what treatments are to be offered…..really, you have not been paying attention if you think all this somehow minimises privatisation and is somehow a missed opportunity on the part of progressives.

    As for ‘socialist’? I think my granddaughter’s Barbie doll has probably got more claim to that description than you.

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