Over recent years New Labour’s permanent revolution of “restructuring” inside the NHS has laid the groundwork for the privatisation of healthcare. These changes have been put in place without any public scrutiny. Now, using the political cover of the economic crisis, NHS bosses and politicians are planning enormous cuts and this will speed up plans for privatised healthcare.
Last year McKinsey management consultancy was tasked with finding £15-20 billion in savings in the NHS by 2014-15. Their report, leaked to the press, painted a bleak picture for healthcare workers and patients. Their concluding recommendation was a cut in the workforce of 10% — that’s 137,000 workers on the dole and lots of sick people going without treatment. Politicians of every stripe were quick to distance themselves from the report’s conclusions, but a survey conducted by Health Service Journal (HSJ), reveals that many Strategic Health Authorities are acting on their own initiative and implementing the recommendations.
NHS South East Coast are seeking to lay off 10,000 staff in the next four years. NHS North East have plans for an 8% reduction, or 5,500 staff by 2012. 38% of Trusts are now running recruitment freezes.
The management body, Foundation Trust Network, recommends compulsory redundancies and a list of terrible conditions for those staff who are lucky enough to keep their job:
• freezing increments on pay progression for two to three years
• reducing the number of pay points on salary bands
• stopping staff from being able to opt back into the national salary scale, “Agenda for Change”, after accepting local arrangements
• implementing robust sickness policies
• no guarantees of employment to any trainee
• capping pensions for higher earners (over £100,000)
• removing other pensionable items such as London weighting
• ending clinical excellence awards.
“Front” NHS workers are not alone in facing cuts. Both Labour and Conservative politicians have engaged in populist rants about the “bureaucracy”. Andy Burnham’s strategy paper “From Good to Great” calls for a reduction in management costs of 30% over the next four years. Up to 5,700 commissioners and administrators are facing the axe this year. (Although their severance pay, estimated at around £470 million, might, in the end, make this an empty threat.)
What none of the politicians are willing to admit is that an overloaded bureaucracy is caused by the privatisation agenda. The creation of internal markets and commissioning requires a lot of pen-pushers. Yet at the same time as there has been the proliferation of managers and administrators, frontline staff are given increased administrative responsibilities, such as organising ward supplies and shift rotas. So, in fact, frontline staff need more properly organised administrative support.
Cutting the “bureaucracy” without addressing the underlying cause of bureaucracy and the disfunctionality of the existing bureaucracy will only make this burden worse.
“Management speak” has become a means to obscure the real agenda and goals of health policy. The current buzzwords are “demand management” and “reviewing the skill mix of the workforce”. Behind the doublespeak is a sinister agenda.
The Foundation Trust Network argues that “natural wastage will fail to give the shape of workforce and skill mix required to sustain patient services in the future, and that [compulsory] redundancies are likely to be needed.” This statement only makes sense if it is the intention of NHS bosses to run down services to the extent that better-off patients will start shopping for their healthcare elsewhere.
Under the rubric of “demand management” the government is placing a cap on money paid out to acute trusts. Under new rules, if admissions to acute services increase above 2007-8 levels then the acute trusts will only get 30% of the tariff they are entitled to (the flat fee paid for each procedure done by the NHS). The remaining 70% of the tariff will be channelled into the Strategic Health Authority for “demand management”.
In theory, the SHA is supposed to use the extra cash to run public health campaigns and preventative medicine schemes. However, according to another consultancy firm, the real effect of the policy will be to run up a £7.5 billion annual deficit in the acute sector by 2015, a deficit that will “threaten their continuing viability, at least as independent institutions”.
If hospitals or hospital departments are forced to close down (and we are already seeing this, for instance, with the threatened closure of north London’s Whittington Accident and Emergency department), then — those who can afford it — will start investing in private health insurance. This is the privatising reform behind “demand management” — it is a big threat to socialised healthcare.
The cuts are likely to come quickly. Sir David Nicholson, chief executive of the NHS, rants, “I’m not interested in proposals. I want the money in the tin; I’m counting on the money.” An editorial in the HSJ makes the plea “any national negotiations over flexible working and job guarantees must be conducted efficiently and with a minimum of posturing from any of the parties involved.” The NHS bosses are aware that the unions are very weak at the moment, while savage cuts could see resistance grow quickly.
Meanwhile union officials are engaged in closed-door negotiations with trusts and the Department of Health. They want a no compulsory redundancy deal. Health Secretary Andy Burnham is exploring “the pros and cons [!] of offering frontline staff an employment guarantee locally or regionally in return for flexibility, mobility and sustained pay restraint”. Alistair Darling has already announced that from 2011-13 nurses will receive no more than a 1% increment. The most likely scenario is that staff will be offered a three-day week to avoid redundancies (and heavy redundancy costs).
Trade unionists in the health service need to mobilise their members and hold their leaders to account. The union tops may be about to give up our terms and conditions, national bargaining and pay in exchange for a no compulsory redundancy deal. We must demand much more, especially given the disastrous political implications of these cuts.
The fragmented nature of the NHS means that the cuts will hit at different times and the resistance will be patchy. It is the job of socialists to link up the struggles that do emerge and draw on the strength of stronger and more militant sections of the labour movement. The NHS, the embodiment of the working class principle of “free state of the art healthcare at the point of need”, is under threat. Only mass trade union direct action, linked up to working-class campaigns in local communities, can save it.