It's a couple of weeks since the no-show of most MPs for the second reading of the NHS Bill – despite most NHS campaign groups rallying behind it as the best route out of the market mess the NHS is currently in.
Many of you wrote to your MPs and received replies justifying their non-attendance. Labour MPs tend to cite the fact the Bill would cause another 'top-down reorganisation' as their main reason for non-attendance. Meanwhile Conservative MPs say they have increased spending and are generally improving the NHS, so why would they want more change?
Many of you have asked us for some tips on how to respond, so here are our thoughts. Hope you find it helpful.
THE BILL IS A PROBLEM BECAUSE IT PROPOSES ANOTHER TOP DOWN RE-ORGANISATION
The Bill is designed to phase in changes with full consultation. It is a re-organisation, but not top-down.
There is a fundamental misconception about what is happening to the NHS. The Health & Social Care Act removed the Secretary of State's duty to secure or provide our health service and replaced it with an arm's length body - NHS England - which is the chief commissioner, or purchaser, of services for the NHS and 211 local purchasers, the Clinical Commissioning Groups. Many people - especially MPs - seem to think that this was the 'reorganisation' done and dusted.
But since October 2014 Simon Stevens, the CEO of NHS England (and ex-president of global operations for UnitedHealth of America) has been rolling out his complete restructuring of the way services are delivered in England - the 5 Year Forward View.
The financial constraints forced upon the Foundation Trusts by New Labour's PFI deals and the de-funding that has been going on since 2010 under the Coalition and the Tories have been used as levers to force compliance on the Trusts.
If they don't re-shape their services, they won't be bailed out of their debts.
Everything you hear about A&E closures, hospital closures and NHS asset sales, A&Es being replaced by Urgent Care Centres and more, are part of the 5 Year Forward View. Most areas will either be Vanguard transformation sites, or have Healthier Together programmes, with a heavy emphasis on withdrawing traditional healthcare settings like hospital beds, in favour of cheaper but largely unevidenced ‘care in the community’ programmes. See for example NW London’s Independent Review of their Healthier Together 'transformation' - and the damaging effect it has had on local healthcare provision.
There is a state of constant flux - a goldmine for the management consultancies who are paid many £millions to advise and supervise all these changes.
Next up is devolution, which Mark Rogers, CEO of Birmingham City Council and recent appointee to the new team leading on NHS England's Sustainability and Transformation Plans, says will give them the opportunity to make 'pretty seismic changes'. And right now there’s the 44 new ‘Sustainable Transformation footprints’ covering the whole country – and who’ll have to force through massive cuts-driven reorganisations if they want any of Osborne’s cash.
The re-dis-organisation is clearly a long way from being finished. And change costs money, although it is promoted as making the NHS more 'affordable'.
Whatever happens there will need to be some systemic organisation if we are to have an NHS which is back in public ownership and public delivery, meeting our healthcare needs. It can't be done with the current chaos of competing providers in a market network where there is a permanent 'churn' of the system. To pretend that the market, the commercialism, the competition and the fragmenting of the system can somehow be sorted out without an organisational change would be to mislead both the public and the NHS staff.
And restoring the NHS to public ownership and removing the market also removes the market costs, currently conservatively estimated as wasting £4.5bn of the NHS' money every year and possibly as much as £10bn or more.
It would appear though that most of our MPs are not prepared to argue against restructuring that furthers privatisation and cuts. It is only the kind of restructuring that restores the NHS to public ownership that offends them.
THE BILL WASN'T GOING TO PASS ANYWAY
True. Anyone who understands parliamentary procedure knew it wouldn't. Those responsible for promoting the Bill made no pretence that it would. However it was a potent symbol for campaigners, doing what is rarely done in the Commons - making the point of how much damage has already done and that there is a real desire to bring it back into public ownership.
And raising publicity for an issue which the government won't debate is very often the point of a private member's bill. The Labour Party had their own private member's bill under the Coalition, put forward by Clive Efford, for precisely that reason.
THERE ISN'T THAT MUCH PRIVATISATION
As for the Tories' oft-repeated 'only 6%' - the figures always quoted are that Labour put 4% of contracts out to private providers between 2000 - 2010 and under the Coalition that became 6%. But that was in 2013, before the H&SCA started to take effect. That was already a 50% increase in 3 years over what Labour had done in 10 years.
And by 2014/5 - the first year H&SCA took full effect (2014/5) – there was a 500% increase in privatisation of clinical contracts compared to the previous year. Although released just before the election, these figures got little attention from the media and MPs continue to rely on the older figures.
Virgin are just about to take over 4 entire community hospitals in Kent, for example. As contracts come to an end (and all public sector provision is now on contract) they have to be put out to competition, with rare exceptions. Don't let your MP tell you that it is a matter of choice. It isn't. But that 6% figure is never changed.
What is far more worrying, beyond the contracting out of clinical services, are the structural changes currently being rolled out. The NHS was designed to give us comprehensive, universal, accessible care available according to clinical need, not ability to pay, funded from the public purse.
The new models are designed to exclude people and deny care. Treatments across the country are already being removed from the NHS 'menu' and more will be removed from April 2016. These include hip and knee replacements, cataracts, hearing aids, vasectomies and IVF. Midlands CCG has just published a list for consultation which is far more extensive than this and worryingly contains 'lifestyle' illnesses. All of these are services of choice for the private sector and people will have to pay to have them. It won't stop there once the principle is established. All this is being done under the label of making the NHS 'sustainable'.
And there's another side to the privatisation that sometimes gets ignored because people don't see it as 'the NHS' but it is an important part of what's happening. The chronic under-funding of the NHS leads inevitably to increasing privatisation through the mechanism of a growing separate health insurance industry. As waiting lists get longer, those that can afford it take out health insurance policies as they lose faith in the NHS's ability to deliver timely care.
We must all fight a hard fight for our local services. But ultimately we need legislation to overturn the damage of the last 30 years and bring the NHS back into public ownership and public delivery, so it can once again be comprehensive, universal and accessible.
OurNHS has exposed sneaky moves towards charging for vital health services, withdrawing services, hospital sell-offs and the shocking failures of privatisation. We need your help. Our start-up funders can no longer support us - so we’re asking readers to step in and save OurNHS.