Sicko UK: Repurposing the NHS to a for-profit US-style managed care

Save the NHS
Boris Johnson's Health and Care Bill will turn the entire NHS into a cash cow for private corporations.

On the 73rd birthday of the National Health Service (NHS) the Queen awarded it the George Cross. One of a multitude of establishment misdirections — as we enter the final phase of the covert dismantlement of the nation’s beloved health service — ensuring the vast majority of citizens, including NHS staff, remain unaware of how it has been fundamentally repurposed.

Never one to miss an opportunity and with unmatched cynicism, Prime Minister Boris Johnson — who has overseen one of the worlds most expensive yet catastrophic coronavirus pandemic responses — proclaimed: “We wouldn’t be where we are today without our health services. NHS staff have cared for us and our friends and family on the frontline of a pandemic for over a year, and I have witnessed their courage first-hand.

“Thanks to their devotion and duty our NHS has saved countless lives, and the George Cross is a symbol of the nation’s gratitude. I know the whole of the UK is behind me in paying tribute and giving thanks for everything the NHS has done for us not only in the last year, but since its inception.”

Cash cow

With the country still in the grip of the COVID-19 pandemic, the government published a white paper in February ahead of legislation on the further reform of the NHS. The health and care bill will double down on turning the entire NHS into a cash cow for private corporations.

The pre-pandemic NHS was already on its knees after a decade of de-funding, 17,000 beds cut and chronic staff shortages including 10,000 doctor and 40,000 nurse vacancies. In a display of sociopathic recidivism, Johnson’s government persists with their privatisation policy objectives. Other than rhetoric, there is absolutely no sign that 100,000 preventable coronavirus deaths — according to former chief scientist Sir David King, as a result of the catastrophic outsourced pandemic response — has de-railed their corporatist ideological objective.

The Serco/Deloitte “NHS” Test and Trace system has so far squandered £22 billion without any evidence of impact on the spread of the virus or preventing the need for damaging lock-downs. More opportunistic profiteering — such as uncontested crony deals on personal protective equipment — will become standard operating procedure if progressive forces fail to stop the bill being enacted.

The government reassurances that they will “protect the NHS” or “the NHS is not for sale” run counter to the impact of decades of health policy or stated intent from the privatisation lobby. Pro-privatisation MPs Oliver Letwin and John Redwood co-authored the pamphlet Britain’s Biggest Enterprise in 1988, where they outlined their vision for healthcare:

“A system of this sort would be fraught with transitional difficulties. And it would be foolhardy to move so far from the present one in a single leap. But need there be just one leap? Might it not, rather, be possible to work slowly from the present system toward a national insurance scheme?

“One could begin, for example, with the establishment of the NHS as an independent trust, with increased joint ventures between the NHS and the private sector; move on next to use of ‘credits’ to meet standard charges set by a central NHS funding administration for independently managed hospitals or districts; and only at the last stage create a national health insurance scheme separate from the tax system.”

Dr Tim Evans of the now defunct Independent Healthcare Association put it more succinctly in 2011: “The NHS would simply be a kitemark attached to the institutions and activities of a system of purely private providers.”

Marketisation

The marketised NHS with its bloated administrative and managerial bureaucracy (consuming about 10% of the total NHS budget according to 2005 estimates) has continued to expand. The 2012 Health and Social Care Act converted the NHS internal market into a full compulsory external market with all services up for grabs by the private sector.

Section 75 of the Act compelled open competitive tendering of all NHS services. Behind the NHS logo, private companies have expanded in the provision of services such as district nursing, community paediatrics, sexual health, elective surgery, audiology and diagnostic imaging.

Primary care was parcelled up into Clinical Commissioning Groups (CCG), fronted by entrepreneurial general practitioners. The actual purchasing, contracting and outsourcing, of services and control of financial flows performed by Commissioning Support Units (now Lead Provider Framework) is made up of private corporations — including Optum (the British subsidiary of UnitedHealth, the world’s largest private health insurance conglomerate) and the big four accountancy firms (KPMG, PWC, EY and Deloittes) — embedded in NHS back-room financial and organisational structures.

The result of the Health and Social Care Act has been to shrink NHS’ capacity with 17,000 fewer NHS beds, fragment provision of services with outsourcing of clinical care and entrench the power of private corporations in controlling NHS budgets. This has been supervised by Simon Stevens who in 2014 returned to the NHS after a ten years at UnitedHealth, of which three years were spent as as Chief Executive of UnitedHealth Medicare.

US healthcare is more than twice as expensive per head of population compared to Britain’s and delivers worse outcomes with lower life expectancy and higher infant and maternal mortality. The leading cause of household bankruptcy in the US is medical bills (most had private health insurance but still went bankrupt). Thirty million US citizens don’t have insurance and for every million uninsured, there are 1000 preventable deaths per year.

The system is dominated by the private health insurance industry and private hospital chains. So-called unprofitable groups of people including the poor and elderly are locked out of the system. The US taxpayer has to step in to fund market failure with Medicare for the elderly and Medicaid for the young. This public funding is spent via private providers and increasingly funds are controlled by private insurers.

UnitedHealth are a big player in Medicare delivering profitable “managed care” by avoiding spending money on sick patients using various methods to deny payment for care. It is this same model, the subject of Michael Moore’s film Sicko, which is being replicated by the NHS' new Health and Care Bill.

The bill will create new legal entities, public-private partnerships known as Integrated Care Systems (ICS). The 42 ICS NHS bodies across England will control fixed tax-funded budgets for one to two million people from which they will be able to make profit. ICS boards will be dominated by the same private corporations currently providing outsourced services and performing commissioning function.

Corporate profits are maximised by employing the fewest and cheapest healthcare staff through down-skilling and task shifting as seen in private health systems across the world. Additional downward pressure on staff wages and an end to national pay bargaining will reduce overhead costs.

Repeal of section 75 of the 2012 Health and Social Care Act will end open competitive tendering, removing the legal obstacle for a private sector monopoly within the NHS. UnitedHealth/Optum are uniquely well placed to gain control of ICS budgets with its personnel appointed to key NHS positions, (not least Simon Stevens, chief executive of NHS England since 2014), importation of managed care software and protocols, and upwards of £17 million in payments to Optum for training NHS and local council leaders.

Optum software and data analytics will form the core mechanism for the denial of care to potentially expensive patients. The ICS will have the power to decide which services are to be provided across the ICS — for example fertility treatment, cataract extraction, or knee surgery could be removed for the entire ICS population. Plans previously drawn up by management consultants McKinsey described such procedures as “low value”. Optum’s algorithms and the ICS' deadly postcode lottery will prioritise generating profit streams above patient health.

Patient safety sacrificed

Legal safeguards to ensure patients are discharged home safely will be removed and replaced by a “discharge to assess” scheme, enabling the patient dumping notorious in the US. Deregulating health professionals and introducing a new secretive patient safety body will assist the decline of clinical standards, while concealing predictable consequences such as medical error.

Patients in their most vulnerable state will struggle to access overstretched NHS hospitals or primary care services — staffed by fewer and less qualified health personnel, providing lower qualify services — as funding is siphoned away from healthcare delivery.

The US medical-industrial complex has set its sights on the £120 billion annual NHS budget and destroying the superior Beveridge system of healthcare by mutating it into the managed care model which it has sold as a “sustainable” solution for healthcare in the developed world.

As US citizens continue their decades-long struggle for tax-funded, single-payer universal healthcare, not even achieved in the face of a pandemic, consecutive British governments have covertly pushed the NHS along the endemically fraudulent, expensive and deadly managed care model.

The new health Bill will deliver the NHS to global private providers and private health insurance conglomerates, reducing itself to a logo and a funding stream. The warm glow of a George Cross and ratcheting up duplicitous political rhetoric must not obscure the magnitude of the impending threat to the health of the nation.

It is time to take a stand against the biggest betrayal of the public interest if we are to prevent our political-media-corporate complex from pulling off a monumental deception, a treacherous plot enabling wealth extraction by foreign corporate interests that will also claim thousands of human lives every year.

[Dr Bob Gill is a General Practitioner, NHS campaigner and producer of The Great NHS Heist. Follow him on Twitter at: @drbobgill.]