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The Plot Against the NHS
Revealing the British coalition government’s plans, this examination demonstrates how a small �policy community” inside and outside the department of health have schemed for 10 years to replace the National Health Service (NHS) with a U.S.-style health care market without informing parliament or the public. While ex-ministers, officials, and the like profit from lucrative positions in private health companies, the population must cope with the increasing health care costs and the diminishing quality of care. With accounts from NHS patients and doctors, the key strategies of implementation are uncovered and the companies involved—their lobby, their businesses, their fortunes, and, in some cases, their crimes—exposed.
- GenresPoliticsNonfictionHealth
Paperback
First published April 14, 2011
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August 17, 2014
Written in the heat of the Health and Social Care Bill that the Tories were trying to push through Parliament in early to mid 2011 this book is a passionate call to arms for the defence of our beloved National Health Service. It documents the recent history of creeping privatisation under New Labour and the inevitable follow through of the LibCon Coalition, a move for which they have no mandate.
Independent Sector Treatment Centres (ISTCs) was the first move, created under Labour, took money away from the NHS. The private companies that ran them were paid for the number of treatments contracted for whether they were carried out or not, and at a significantly higher price than NHS providers received. Clinical risk was also covered by the NHS if failures occurred. Patients were induced by GPs to choose certain services at ISTCs and some were even paid a bonus for every patient they referred to private care.
The authors also document a number of former health ministers and secretaries who stand to gain personally from increased privatisation in the health service including Alan Milburn and Patricia Hewitt. Some excellent follow up work has been done on this at a blog not associated with this book, but it’s worth placing the link http://socialinvestigations.blogspot....
The same companies and people crop up throughout whose only concern is feathering their own nests at the expense of the sick and the needy. Lord Darzi, Penny Dash, Alliance Healthcare, United Health, Netcare... the list is long and comprehensive. Just one of these companies, the biggest player in the US with significant interests here is UnitedHeatlh whose CEO made a cool $102million in 2009 alone. UnitedHealth has been dogged by proven corruption with former CEO Dr William McGuire having to pay a fine of $620million for fraudulent behaviour which also implicated one Channing Wheeler – now working at the Department of Health. The company has settled many cases of medical malpractice out of court.
For lovers of marketisation: Administrative costs have risen in the NHS from 5per cent of total spend in the 1970s to 14 per cent in 2003. Most of these costs were incurred by the burden of having to operate the NHS within an internal market system (payment by results). This means around £10billion of NHS money is attributable to the introductory market system, the market itself is the administrative and bureaucratic burden and increased market activity will also increase the amount of money spent on administrative costs. In the United States, one dollar in every three spent on health care goes on administration. Also deducted from the government spend are the shareholder dividends and large corporate pay packages and bonuses.
The Department of Health has collected no data whatsoever on the patient outcomes from operations carried out in the private sector paid for by the NHS. We hear of choice but are not allowed to see the vital information of operative success and failure rates outside of NHS services. When it comes to choice 65% of people believe it is more important to provide a good service across the NHS than having the burden of choosing which hospital is best for their care. Even of those who want a great deal of choice a significant majority do not want private health companies involved on any level. The Department of Health disowned the results of its own surveys on patient choice when the public didn’t come back with the responses they wanted. A statement issued claimed “these results are not the views of the department”, but they were the views of the people, but that doesn’t matter.
An example of vested interest referral can be seen in Hounslow. UnitedHealth will control the referrals of all patients and controlling what happens if the first consultant thinks a patient needs to be seen by a second one. The scope for conflict of interest and fraudulent practice here is huge. Referring patients to a provider with which the commissioner has a financial interest may be banned but no indication of this has been given and it couldn’t be seriously monitored without tremendous expense. Mutual backscratching would be inevitable.
Under the Health and Social Care Bill we will have a Consortia lottery. Similar to a post code lottery different Consortia will approach their budgets with different priorities. Some patients will get good renal care while they have to forgo decent ENT services. Private companies are lobbying for “co-payments” to be introduced for patients (wealthy ones) to top up their immediate care with extra services. The bill is nothing but a stalking horse for full privatisation of the NHS in England, only in England mind you. Things previously taken as given on the NHS will be slowly reduced to make sure primary care free for now and the government will claim they are keeping the NHS free at the point of need. Queen Charlotte hospital in London is already offering a tailored style service to the wealthy, making sure you have the same midwife throughout your pregnancy – for a fee of £4000. This will become the norm.
The whole thing stinks and this is a brilliant book that should be read by anyone who loves the NHS and what stands for. Up to 2009 (latest available figures) has been improving in all areas; waiting times, staff to patient ratios, life expectancy, drug availability. The government charge that the NHS lags behind other countries in survival rates but the steady improvement we have made is closing this gap rapidly. The “no alternative” marketisers have been proved entirely wrong by the figures on show, but they choose not to stick to facts and rely on rhetoric. They also try and portray NHS in Scotland as a failure where in reality waiting times have fallen faster in Scotland than anywhere else in the UK without any marketisation of services. Mortality rates for major diseases have also fallen at the same rate as England – and that’s with a populous who are widely regarded as less healthy than other areas of the UK. This is one big con, and they’re doing it so they can rob the sick and needy. Read this book!!!
Independent Sector Treatment Centres (ISTCs) was the first move, created under Labour, took money away from the NHS. The private companies that ran them were paid for the number of treatments contracted for whether they were carried out or not, and at a significantly higher price than NHS providers received. Clinical risk was also covered by the NHS if failures occurred. Patients were induced by GPs to choose certain services at ISTCs and some were even paid a bonus for every patient they referred to private care.
The authors also document a number of former health ministers and secretaries who stand to gain personally from increased privatisation in the health service including Alan Milburn and Patricia Hewitt. Some excellent follow up work has been done on this at a blog not associated with this book, but it’s worth placing the link http://socialinvestigations.blogspot....
The same companies and people crop up throughout whose only concern is feathering their own nests at the expense of the sick and the needy. Lord Darzi, Penny Dash, Alliance Healthcare, United Health, Netcare... the list is long and comprehensive. Just one of these companies, the biggest player in the US with significant interests here is UnitedHeatlh whose CEO made a cool $102million in 2009 alone. UnitedHealth has been dogged by proven corruption with former CEO Dr William McGuire having to pay a fine of $620million for fraudulent behaviour which also implicated one Channing Wheeler – now working at the Department of Health. The company has settled many cases of medical malpractice out of court.
For lovers of marketisation: Administrative costs have risen in the NHS from 5per cent of total spend in the 1970s to 14 per cent in 2003. Most of these costs were incurred by the burden of having to operate the NHS within an internal market system (payment by results). This means around £10billion of NHS money is attributable to the introductory market system, the market itself is the administrative and bureaucratic burden and increased market activity will also increase the amount of money spent on administrative costs. In the United States, one dollar in every three spent on health care goes on administration. Also deducted from the government spend are the shareholder dividends and large corporate pay packages and bonuses.
The Department of Health has collected no data whatsoever on the patient outcomes from operations carried out in the private sector paid for by the NHS. We hear of choice but are not allowed to see the vital information of operative success and failure rates outside of NHS services. When it comes to choice 65% of people believe it is more important to provide a good service across the NHS than having the burden of choosing which hospital is best for their care. Even of those who want a great deal of choice a significant majority do not want private health companies involved on any level. The Department of Health disowned the results of its own surveys on patient choice when the public didn’t come back with the responses they wanted. A statement issued claimed “these results are not the views of the department”, but they were the views of the people, but that doesn’t matter.
An example of vested interest referral can be seen in Hounslow. UnitedHealth will control the referrals of all patients and controlling what happens if the first consultant thinks a patient needs to be seen by a second one. The scope for conflict of interest and fraudulent practice here is huge. Referring patients to a provider with which the commissioner has a financial interest may be banned but no indication of this has been given and it couldn’t be seriously monitored without tremendous expense. Mutual backscratching would be inevitable.
Under the Health and Social Care Bill we will have a Consortia lottery. Similar to a post code lottery different Consortia will approach their budgets with different priorities. Some patients will get good renal care while they have to forgo decent ENT services. Private companies are lobbying for “co-payments” to be introduced for patients (wealthy ones) to top up their immediate care with extra services. The bill is nothing but a stalking horse for full privatisation of the NHS in England, only in England mind you. Things previously taken as given on the NHS will be slowly reduced to make sure primary care free for now and the government will claim they are keeping the NHS free at the point of need. Queen Charlotte hospital in London is already offering a tailored style service to the wealthy, making sure you have the same midwife throughout your pregnancy – for a fee of £4000. This will become the norm.
The whole thing stinks and this is a brilliant book that should be read by anyone who loves the NHS and what stands for. Up to 2009 (latest available figures) has been improving in all areas; waiting times, staff to patient ratios, life expectancy, drug availability. The government charge that the NHS lags behind other countries in survival rates but the steady improvement we have made is closing this gap rapidly. The “no alternative” marketisers have been proved entirely wrong by the figures on show, but they choose not to stick to facts and rely on rhetoric. They also try and portray NHS in Scotland as a failure where in reality waiting times have fallen faster in Scotland than anywhere else in the UK without any marketisation of services. Mortality rates for major diseases have also fallen at the same rate as England – and that’s with a populous who are widely regarded as less healthy than other areas of the UK. This is one big con, and they’re doing it so they can rob the sick and needy. Read this book!!!
September 4, 2013
THE END OF NYE'S NHS
The National Health Service, created in the aftermath of six years of total war and during a period of crippling austerity, has succummed to a twenty odd year campaign by private interests, aided and abetted by a multitude of mendacious politicians from every major party, to be finally re-engineered from an institution crucial to civilising this country, into what will essentially be a feeding trough for the private sector. Lay and Players "The Plot Against the NHS" is a short and sharp account of that campaign and the prosepects for the NHS after Andrew Lansleys recent Parliamentary Bill takes effect.
The story they tell is depressing. Tentative moves to privatise the NHS under Thatcher and Major gain speed during the Blair/Brown era. Miserable specimens of humanity such as Alan Milburn and Patricia Hewitt drive that agenda forward step by step in tandem with all manner of mendacious statements that serve to veil their actual intent. Notions such as democratic and public accountability are emasculated, the performance of private health care in the NHS is measured with all the care that the "coalition" employed counting civilian bodies in Iraq. Ministers and civil servants flit between the public and private sector with lightening rapidity. Companies with histories that include a whole host of crimes ranging from fraud to the buying and selling of human organs are presented as suitable partners for the NHS.
An under regulated economy serving the interest of private capital collapses. The Tories and the so called Liberals are elected and use the aforementioned collapsed economy as the excuse (ala Naomi Kleins "The Shock Doctrine") to turn the NHS into an under regulated cash cow serving the interests of private capital. This, argue the authors, will in time bring the NHS in England to a end: costs will grow hand in hand with the inefficiencies that a fragmented "market" will clearly bring, pressure will increase for patients to pony up for an increasing array of now free at the point of use treatments. The eventual outcome will be a system that reflects the experience of the United States, and the country will be paying over the odds for a health care system that does not deliver the goods except in black ink on corporate accounts.
This book deserves and needs to be widely read and acted on, sooner rather than later, as there is always an alternative to the destruction of public institutions and the priviliging of private interests over our collective well-being: this being a point the authors explore with regard to developments in post-devolution Scotland and Wales, whose respective administrations have held back from moving in a similar direction. In short this is a well written book, that narrates the story of "The Plot Against the NHS" along with an analysis of the marketisation inflicted on it thus far, and the prospects for it during the unfolding Cameron/Clegg era. Totally recommended.
The National Health Service, created in the aftermath of six years of total war and during a period of crippling austerity, has succummed to a twenty odd year campaign by private interests, aided and abetted by a multitude of mendacious politicians from every major party, to be finally re-engineered from an institution crucial to civilising this country, into what will essentially be a feeding trough for the private sector. Lay and Players "The Plot Against the NHS" is a short and sharp account of that campaign and the prosepects for the NHS after Andrew Lansleys recent Parliamentary Bill takes effect.
The story they tell is depressing. Tentative moves to privatise the NHS under Thatcher and Major gain speed during the Blair/Brown era. Miserable specimens of humanity such as Alan Milburn and Patricia Hewitt drive that agenda forward step by step in tandem with all manner of mendacious statements that serve to veil their actual intent. Notions such as democratic and public accountability are emasculated, the performance of private health care in the NHS is measured with all the care that the "coalition" employed counting civilian bodies in Iraq. Ministers and civil servants flit between the public and private sector with lightening rapidity. Companies with histories that include a whole host of crimes ranging from fraud to the buying and selling of human organs are presented as suitable partners for the NHS.
An under regulated economy serving the interest of private capital collapses. The Tories and the so called Liberals are elected and use the aforementioned collapsed economy as the excuse (ala Naomi Kleins "The Shock Doctrine") to turn the NHS into an under regulated cash cow serving the interests of private capital. This, argue the authors, will in time bring the NHS in England to a end: costs will grow hand in hand with the inefficiencies that a fragmented "market" will clearly bring, pressure will increase for patients to pony up for an increasing array of now free at the point of use treatments. The eventual outcome will be a system that reflects the experience of the United States, and the country will be paying over the odds for a health care system that does not deliver the goods except in black ink on corporate accounts.
This book deserves and needs to be widely read and acted on, sooner rather than later, as there is always an alternative to the destruction of public institutions and the priviliging of private interests over our collective well-being: this being a point the authors explore with regard to developments in post-devolution Scotland and Wales, whose respective administrations have held back from moving in a similar direction. In short this is a well written book, that narrates the story of "The Plot Against the NHS" along with an analysis of the marketisation inflicted on it thus far, and the prospects for it during the unfolding Cameron/Clegg era. Totally recommended.
June 14, 2011
An angering and enlightening read, particularly if, like me, you've ever been naïve enough to believe that politicians of any stripe might have your best interests at heart...
January 9, 2023
Published in 2011, when the Lansley reforms where still being debated in Parliament, this misses out on all that has happened since to the NHS. That said, anyone wanting to understand all that has happened since will benefit from the analysis set out in this book.
The marketisation of the NHS, which began in earnest under New Labour, was intended to be a much-needed reform that would increase efficiency by introducing the rigours of competition and so-called customer choice into the provision of health services. But the authors make a strong case that health is not a commodity which appears in markets in a fully transparent fashion, replete with a range of prices which aid the consumer in making a choice. Good health is the outcome of a vast social endeavour which requires inputs from a vast range of activities and relationships. A public health service committed to high quality, equal health care across a large population of people needs to be protected from the predation of sharks with goods and services to sell and shareholders to keep satisfied with large-size dividends.
New Labour's problem was that it thought it could contain the forces that it brought in to provide competition with the NHS through regulations and contracts. The early fruit of its endeavours, public finance initiatives which invited private capital to invest in the building of hospitals and clinics, has added to the burden of cost in running the service to eye-watering levels. Add to the the encouragement of an 'independent' sector of service providers, running their own hospitals and GP clinics, has distorted healthcare finance and sapped revenues away from the public component of healthcare in order to support a completely bogus model of so-called competition.
Regulation is a forlorn project if what you are trying to do is keep a raging bull constrained within its flimsy corral. The independent sector doesn't want to be regulated and will kick back at every opportunity against every attempt at limitation. Once through the door and with an advance guard seizing control of around 15% of NHS healthcare activity (2011 figures) the push towards handing more stuff over to, mainly, US healthcare corporations becomes irresistible. And that is exactly what has happened in the years since.
New Labour was naive in thinking that its marketisation project would remain under the tutelage of a 'progressive' centrist party. Its election defeat in 2010 opened the way to an aggressively pro-market government with no inhibitions whatsoever about giving the raging bulls more scope to rampage across the NHS. The vision at the heart of the Lansley reform was of an NHS as a sort of quality kitemark that would be leased out to a motely crew of independent providers who would compete with the public service on price rather than quality. With quality outcomes accordingly downgraded the business model was to compete for contracts by offering the lowest price for the services provided. Quality of service could only suffer when this logic became fully operative.
This is exactly where we have got to some 12 years later with underfunding of the NHS and a refusal to consider workforce implications of policies has led to a shambolic service and a horrendously overworked and underpaid staff. The way back to sanity obviously requires a national plan to put the independent providers in a box and successively expel them an association with the NHS. All the evidence suggests that this would be strongly supported by taxpaying citizens who are shocked by the extent of the decline of a once highly-regarded public institution over the course of the past dozen years.
It would be great of the opposition party, Labour, took this view. Under Keir Starmer and Wes Streeting all the evidence suggests that it is as deluded about the role that the private sector might play as any of its Blairite predecessors who were running the show between 1997-2010. Attributing a positive role to corporations whose ambition is to cream off lucrative services for themselves and leave the NHS to provide a basic level service in all those areas of healthcare where extracting a profit is impossible is a huge mistake and needs to be resisted. This book has provided the reasons why this resistance to privatisation is needed for the last 12 years. None of its arguments have dated and it deserves a close reading from anyone delving into the origins of our current misery when it comes to the state of the NHS.
The marketisation of the NHS, which began in earnest under New Labour, was intended to be a much-needed reform that would increase efficiency by introducing the rigours of competition and so-called customer choice into the provision of health services. But the authors make a strong case that health is not a commodity which appears in markets in a fully transparent fashion, replete with a range of prices which aid the consumer in making a choice. Good health is the outcome of a vast social endeavour which requires inputs from a vast range of activities and relationships. A public health service committed to high quality, equal health care across a large population of people needs to be protected from the predation of sharks with goods and services to sell and shareholders to keep satisfied with large-size dividends.
New Labour's problem was that it thought it could contain the forces that it brought in to provide competition with the NHS through regulations and contracts. The early fruit of its endeavours, public finance initiatives which invited private capital to invest in the building of hospitals and clinics, has added to the burden of cost in running the service to eye-watering levels. Add to the the encouragement of an 'independent' sector of service providers, running their own hospitals and GP clinics, has distorted healthcare finance and sapped revenues away from the public component of healthcare in order to support a completely bogus model of so-called competition.
Regulation is a forlorn project if what you are trying to do is keep a raging bull constrained within its flimsy corral. The independent sector doesn't want to be regulated and will kick back at every opportunity against every attempt at limitation. Once through the door and with an advance guard seizing control of around 15% of NHS healthcare activity (2011 figures) the push towards handing more stuff over to, mainly, US healthcare corporations becomes irresistible. And that is exactly what has happened in the years since.
New Labour was naive in thinking that its marketisation project would remain under the tutelage of a 'progressive' centrist party. Its election defeat in 2010 opened the way to an aggressively pro-market government with no inhibitions whatsoever about giving the raging bulls more scope to rampage across the NHS. The vision at the heart of the Lansley reform was of an NHS as a sort of quality kitemark that would be leased out to a motely crew of independent providers who would compete with the public service on price rather than quality. With quality outcomes accordingly downgraded the business model was to compete for contracts by offering the lowest price for the services provided. Quality of service could only suffer when this logic became fully operative.
This is exactly where we have got to some 12 years later with underfunding of the NHS and a refusal to consider workforce implications of policies has led to a shambolic service and a horrendously overworked and underpaid staff. The way back to sanity obviously requires a national plan to put the independent providers in a box and successively expel them an association with the NHS. All the evidence suggests that this would be strongly supported by taxpaying citizens who are shocked by the extent of the decline of a once highly-regarded public institution over the course of the past dozen years.
It would be great of the opposition party, Labour, took this view. Under Keir Starmer and Wes Streeting all the evidence suggests that it is as deluded about the role that the private sector might play as any of its Blairite predecessors who were running the show between 1997-2010. Attributing a positive role to corporations whose ambition is to cream off lucrative services for themselves and leave the NHS to provide a basic level service in all those areas of healthcare where extracting a profit is impossible is a huge mistake and needs to be resisted. This book has provided the reasons why this resistance to privatisation is needed for the last 12 years. None of its arguments have dated and it deserves a close reading from anyone delving into the origins of our current misery when it comes to the state of the NHS.
March 25, 2017
what are we - 4 years later, and nothing has changed!! except for the worse.
The history of the break up of the NHS.
Very convoluted.
quite hard to read and follow.
No one political party is to blame or is blame free it seems.
Depressing. Our lovely NHS. Gasping her last breaths.
The history of the break up of the NHS.
Very convoluted.
quite hard to read and follow.
No one political party is to blame or is blame free it seems.
Depressing. Our lovely NHS. Gasping her last breaths.
Displaying 1 - 5 of 5 reviews