From reader, Sam:

Pilger’s film, The Dirty War on the NHS was shown on STV at 11.05pm. It can be accessed until Jan 17 on STV player by opening an account. Link here. I hope it can be kept as a resource.

It provides an overview of the prolonged, stealthy attack on NHS England by all the major UK parties, Conservative, Labour and Liberals (in coalition).

The privatising of cleaning and porter services under Thatcher has resulted not only in poorer pay and conditions for the NHS staff transferred but in lower standards of performance.

“In 2015 and 2016 Leicester and Nottingham Hospital trusts each had to end their cleaning contracts with Interserve and Carillion due to health and safety hazards. Their hospitals were in dire states of cleanliness, including dirty wards, broken-down lifts, failure to provide enough sheets for patients, nursing staff forced to make up for the lack of cleaners and rats seen in hospital kitchens.”

PFI contracts not only mean that a hospital may never be owned by the NHS but that contracts require NHS hospitals to give priority to debt repayment. This can result in hospitals selling assets and reducing clinical work.

“Since the policy was launched in 1992, report after report over almost two decades has shown how each wave of PFI has been associated with trust mergers, leading to 30% reductions in beds; staff lay-offs; and closures of hospitals, accident and emergency departments and an untold number of community services – all because of lack of affordability. PFI, once trumpeted as the largest hospital-building programme, was in fact the largest NHS hospital and bed closure programme.”

The 2012 Health and Social Care Act removed from the Secretary of State for Health the requirement to provide and secure services in accordance with the Act, and to provide listed health services throughout England. It opened the door to competition. Strong political links were formed with United Health Group in the USA and with Optum a sub-group of the company. Optum is heavily involved across NHS regions in England.

With competition for NHS services, doctors and nurses spend time drafting tenders for services reducing time spent on clinical work. Calculations suggest that around 29% of NHS England budget (counting the work and salaries of GPS and 18% if this service is excluded) is spent on the provision of private services.

Private practice seeks to entice NHS consultants to work for them. This has happened noticeably in oncology surgery, cataract and hip surgery.To persuade consultants to move to private practice in oncology, consultants were offered shares in the private companies. This is a huge conflict of interest and brings to mind the work of Ian Paterson the jailed breast cancer surgeon who was judged to have performed about 750 unnecessary operations on his patients.

“There are two reasons why cancer consultants are being specially targeted in this way. First, private cancer care in London is now the single biggest earner for the private hospital sector, outstripping orthopaedics and cosmetic surgery for the first time. Millions of pounds of investment have been poured into this market by international investors who see the declining NHS performance in cancer treatment as an opportunity to meet a demand from middle-class patients who are not prepared to wait and are willing to pay. The second reason why hospitals are targeting cancer consultants is that there is a finite number of them in the UK. They need to pull them towards private practice. One of the ways of gaining the commitment of an NHS cancer consultant to undertake private work is for a private hospital to offer them a share of the profits made out of their services, on top of fees they will receive for treating patients.”

It is not the case that private care performs better than the NHS. Hinchingbrooke hospital became private with these results.

“The care quality commission (CQC) gave Hinchingbrooke the inspectorate’s worst ever rating for “caring”. The CQC found it “inadequate” (the worst rating) for safety and leadership, and was so damning overall that Circle threw in the towel hours before the findings were made public.

The hospital is now in “special measures” with an uncertain future, and the real NHS will have to pick up the pieces. There are links here with the Mid Staffordshire scandal as they strove for and got semi-marketised status as a foundation trust. In both, the market ethos meant staff cuts, falling morale, an over-reliance on agency staff, and secrecy. Circle shed 46 full-time nursing posts within six months of taking over – but its plans were hidden to the public under the guise of “commercial confidentiality”.”

Cataract surgery should be relatively straightforward.

“Of the 62 patients treated by private provider Vanguard Healthcare Solutions for Musgrove Park Hospital in Somerset, only 25 had “normal” recoveries. Some patients said they felt the procedures were hurried, complained of pain during the procedures and claimed they were shouted at by medical staff. The complications reported were ten times the number that might have been expected

Marked “strictly confidential”, the report reveals that Vanguard agreed to perform 20 cataract operations a day, at least six more than the hospital’s own surgeons would usually undertake. It suggests the combination of staff, equipment and facilities had not been tried before and says that training was still going on when the first patients arrived at the mobile operating theatre. Concerns are also raised that the operations were not halted as quickly as they could have been when it became clear that patients were suffering complications.

The report gives a rare insight into how contracts between NHS hospitals and private operators work. Musgrove Park drew up a contract with Gloucestershire-based Vanguard, which subcontracted the provision of surgeons and equipment to another company, The Practice, in Buckinghamshire. It in turn subcontracted the supply of some equipment to a third company, Dorset company Kestrel Ophthalmics.”

How might this affect the NHS in Scotland. First PFI and competition leech resources out of NHS England, reducing the ability of the service to meet targets. Specialised staff are being enticed away. by competition The likelihood is that, increasingly, those in England who can afford it, will turn to private care. Over time a two tier system will form. Work done by private care in England is not NHS work and will reduce the block grant coming to Scotland. It will put pressure on our NHS and could drag it down the same path of increased private care.