How our NHS has been abolished

Size: px

Start display at page:

Download "How our NHS has been abolished"

Jeffry Lawson
5 years ago
Views:

2 How our NHS has been abolished

3 The abolition of want before the war was easily within the economic resources of the community: want was a needless scandal due to not taking the trouble to prevent it. Beveridge 1942

4 Society becomes more wholesome, more serene, and spiritually healthier, if it knows that its citizens have at the back of the consciousness the knowledge that not only themselves, but all their fellows, have access, when ill, to the best that medical skill can provide. Aneurin Bevan, 1942

7 How the Health and Social Care Act 2012 abolishes Our NHS Removed the Duty on Sec of State to secure and provide health care for all: the abdication Act Introduced insurance structures, like the US Gives sec of state legal powers to create a market; allows providers to pick and choose which patients will get care, services to be provided, and what will be charged for

8 Organising principles of NHS Redistribution: taxation and services provided on basis of need Universality, equity Free at point of delivery Public ownership and control Public accountability Integration

9 Organising principles of markets Risk Selection and Risk Avoidance Risk identification Risk prediction Risk pricing: the PREMIUM the market charges for bearing the risk Risk Allocation Risk transfer through commercial contract Risk segmentation: fragmentation

10 Universal versus Market Markets operate through risk selection The structures, funding and bureaucracy must be designed to enable providers to select out profitable patients and treatments and dump those that can t afford to pay

11 Why Structures Matter? NHS: Unit of Public administration: GEOGRAPHIC areas (every one is covered) Market: Unit of administration: INSURANCE FUNDS (not everyone is covered because of risks)

12 Funding flows and planning: NHS pre 1999 Secretary of State Department of Health Geographic needs based formula RAWP 14 Regions 160 District Health Authorities GPs Capitation and fee for service Itemised service block budgets Hospitals and Community Service Salaried Staff National ownership and control

15 CCG CCG CCG CCG

16 CCG CCG Homeless Elderly CCG Chronic dis CCG

17 Clinical Commissioning Groups Insurance funds are not area based People in an area are not automatically covered Recruit on basis of membership of a practice, not residency Patients will be excluded because they are not eligible to be accepted by GP practice; or CCGs dont provide services and patients can t afford to pay

18 NHS Providers Services are being broken up and put out to tender to commercial companies- staff are privatised NHS hospitals are starved of funds; go into deficit and franchised or sold off to commercial sector Loss of planning on basis of need Commercial shareholders have new legal powers to decide who gets care, what they get and what they pay for

19 19

20 112 billion pounds NHS funds are flowing to hundreds of commercial for -profit providers, shareholders and banks Alliance Medical Atos Healthcare Care UK Fresenius Inhealth Interhealth Nations Healthcare (Circle) Netcare Partnership Health Group (Care UK) Ramsay Health Care Spire Healthcare UK Specialist Hospitals Walk in Health NHS Information Centre

21 NHS expenditure as a percentage of GDP Financial years to

22 Four stages of NHS privatisation Phase I Efficiency & management 1979 control moves away from professionals Griffith s supermarket management reforms Phase II Internal market 1991 purchaser/provider split public corporations REVERSED IN SCOTLAND, NHS REFORM (SCOTLAND) Act Phase III PFI - PPPs 1992 privatise asset base & non-clinical services Phase IV NHS Plan 2000 privatise clinical services- foundation trusts pricing- financial flows, DTCs etc local pay bargaining - GP/ consultant contracts service unbundling- like post office Phase V Remove Duty to secure and provide:

23 Service unbundling: soft clinical services - pathology radiology medical records GPs nurses & doctors pharmaceuticals - services dentistry PFI infrastructure hospitals premises buildings maintenance clinical & non-clinical - equipment UK NHS ancillary services - eg, catering cleaning laundry ophthalmology long term care 23

24 m Capital value and unitary payments for signed PFI projects in Northern Ireland, England and Wales ( ; n=500) Capital value in m Total unitary charge in m billions billions years Source: HM Treasury (2008). Signed Projects List (March 2008). Available at: (Accessed: 24 November 2008).

25 NorwayJune201325

26 Markets and healthcare costs. Health care expenditure is 17.4% GDP in US and 9.8% in UK in 2009 Total health expenditure as a share of GDP, 2009, OECD countries

27 Typology of different forms of privatisation Private patient Income generation:49% FTs Private prescribing User charges: eg GP charges, hotel costs Foundation Trust: reduction in Mandatory services - driven by deficits Private Health Insurance : CCGs

Interview Survey, January March 2011 by Robin A. Cohen, Ph.D., and Michael E.

28 US Health Insurance Coverage Uninsured,61million people Insured, 245million people Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January March 2011 by Robin A. Cohen, Ph.D., and Michael E. Martinez, M.P.H., M.H.S.A., Division of Health Interview Statistics, National Center for Health Statistics

Allocation of Spending for Hospital and Physician Care Paid through Private Insurers Insurer Marketing and Profit 11% Insurer Billing 8% Hospital Billing 4% Physician Billing 5% Medical Care

29 Allocation of Spending for Hospital and Physician Care Paid through Private Insurers Insurer Marketing and Profit 11% Insurer Billing 8% Hospital Billing 4% Physician Billing 5% Medical Care 64% Medical Care Administration 8% Source: James G. Kahn et al, The Cost of Health Insurance Administration in California: Estimates for Insurers, Physicians, and Hospitals, Health Affairs, 2005

30 Estimated sources of excess costs in US market system of health care (2009) (US Institute of Medicine report, 2012) (Total spending at 2009: $2.9 trillion; 50 million Americans cannot get health insurance) Unnecessary Services $210 billion Inefficiently Delivered Services $130 billion Excess Administrative Costs Prices that are too high $190 bilion $105 billion Missed prevention opportunity $55 billion

comprehensive health care throughout England http://www.dcscience.net/?

31 What do we need to do? Support David Owen s Emergency Bill to restore the Duty on the Sec of State to provide and secure comprehensive health care throughout England Campaign against privatisation and demand the full contracts are in the public domain Campaign against hospital and service closures and cuts in staff, lobby MPs, join KONP

The dismantling of our NHS and why we need an NHS bill to reinstate it

The dismantling of our NHS and why we need an NHS bill to reinstate it Professor Allyson Pollock Director, Institute of Health and Society Newcastle University This talk will Tell you what is happening