“Rising Tory star” Kwasi Kwarteng MP was secretly recorded letting slip that David Cameron might have to break his pledge to ringfence NHS spending if the Tories win the 2015 election, it emerged today.
And in the small print to today’s Autumn Budget Statement we see just how they might get away with it. Chancellor George Osborne has floated the possibility of merging welfare and health budgets (‘integrated budgets across health and employment”) in the next spending review (after the election).
Yes, that would the same welfare budget they’re already planning on making excruiating (but not yet fully specified) new cuts to, as ‘austerity’ lasts til 2019 or longer.
Bye bye NHS ringfence, hello attack on ‘scroungers’?
The NHS budget rows have focused on whether Osborne’s £2.7bn - of which £1.2bn is ‘earmarked’ for primary care over the next four years - is in fact new NHS money.
But leaving that aside, the big NHS budget question is - what will it be used for?
Will it actually go to help GPs do their day job of being a GP - money that is desperately needed as GPs leave the NHS in droves in despair at cuts and privatisation?
Or will it be used to drive agendas that are more about control than health - and to enrich dubious corporations offering ‘solutions’?
It seems this merging is already underway. We can see it if we look closely at the rhetoric of ‘community services’ and ‘integration’ as well as a dubious ‘work makes us well’ agenda pushed by Lord Freud amongst others.
Health Secretary Jeremy Hunt told the Commons this week that in exchange for the Osborne cash, new ‘primary care facilities’ would be expected to join with other, non-health, services such as job centres, Pulse magazine reported. Pulse noted Hunt “provided little more detail about how this would work”.
So, just what exactly are these ‘new primary care facilities’ and other ‘non-health’ services likely to be - and who will be providing them?
In October, the government announced that it was outsourcing the writing of sick notes from GPs to a private provider, Maximus, under a programme called ‘Fit to Work’, supposedly to relieve pressure on GPs (but in reality, as everyone knew, because GPs are seen as too sympathetic to sick people). The programme is to start before the end of the year, Lord Freud announced. The scheme is known as the ‘Health and Work Service’. It wasn’t made clear how much Maximus would be paid for this work, or where the money would come from.
Maximus has also been given the contract to take over from ATOS as the provider of the separate, and already hated, Work Capability Assessments for long term sick and disabled people.
Maximus are a company with a chequered record of administering both benefit systems and healthcare. They are the leading administrator of the US’s Medicare/Medicaid system (where administrators, not GPs, take decisions about your health and needs).
The privatised ‘Health and Work Service’ seems to be run on this model. Rather than a doctor having a consultation and writing you a sick notes, Maximus will apparantly conduct telephone interviews and advise you by email whether you can have a sick note after 4 weeks off - or whether you will lose your sick pay if you don’t go back to work.
When the Coalition government scaled back NHS targets, it nonetheless beefed up new targets for the NHS around ‘getting people back to work’. Of course working might be good for someone’s health - but should your doctor take that as a given, and be set that as a key target to act on themselves, or outsource to someone else even?
The push towards telephone triage and healthcare by non-NHS bodies, rather than seeing your GP face to face, has also been highlighted elsewhere in the news this week. Over-stretched Devon GPs were slammed for advising patients to call a helpline rather than come to their GP with depression. But Devon is only doing - admittedly clumsily - something that is central to the narrative of ‘care closer to home’ and ‘telehealth’, which all major parties appear signed up for, despite flimsy evidence of benefits.
It’s not clear how much of the money earmarked by George Osborne will end up in the coffers of Maximus and other companies replacing face to face healthcare with telephone services and pressure to get back to work.
Perhaps George would like to tell us?
Will Labour ask the question? Under former Shadow Work & Pensions Secretary Liam Byrne, Labour were floating ideas that sounded remarkably similar, based on merging health and benefits system inspired by the new posterchild for neoliberalism, Australia. They were egged on by Demos (sponsored by MasterCard) who saw the possibilities of Australian-style benefit cards (recently enthusiastically embraced by Iain Duncan Smith) which included your healthcare ‘entitlements’.
These suggestions are facilitated by NHS Boss Simon Steven’s current roll-out of personal healthcare budgets, a plan reminiscent of Thatcherite healthcare vouchers. Such individualised entitlements - as we have seen in social care - would further build a private healthcare (and infrastructure) market even as they became very easy to cut and require topping up with co-payments and insurance. And even easier to cut if they are rolled into the politically charged 'welfare' budget.
Of course once upon a time we had the Department for Health and Social Security - but the privatisation of health has accelerated tenfold since that department’s existence. And the privatisation of ‘social security’ and back to work ‘support’, far more so. In these new privatised realities, we have already seen starkly with ATOS what happens when people’s medical needs are subjugated to the interests of the benefit system.
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