[R-G] [BillTottenWeblog] The Great Consolidation

[Bill Totten]

What more can the government shut down? Oh yes, doctors' surgeries.

by George Monbiot

Published in the Guardian (April 29 2008)


Everything is getting bigger and further away. Hospitals, post offices,
schools and prisons are being "rationalised" and "consolidated". The
government says that this process improves efficiency. Instead, it
outsources inefficiency: we must travel further to use public services.
This is bad for the environment, bad for community life, bad for
universal provision. But we haven't seen anything yet. We are about to
be confronted with the biggest shutdown of all: the government has
started the process of closing England's network of doctors' surgeries.

If you know nothing of this, don't blame yourself. The announcement was
buried in an interim report published last October by a health minister
{1}. The report was 52 pages long, and the policy was explained in a
single paragraph on pages 25 and 26. Rather than being brought before
parliament, it was released four days before MPs returned from their
recess. Since then there has been no further public announcement. But in
December the Department of Health sent a letter to all the strategic
health authorities in England, demanding that the policy be implemented
immediately {2}. The greatest transformation in the history of the NHS
is taking place without public debate, public consent or formal
consultation.

The government's policy is to consolidate doctors' surgeries into a
series of giant health centres or polyclinics. Thousands of small
practices will be closed and patients will be processed in buildings
containing up to fifty GPs. The new clinics will also house some
services currently provided by hospitals, which allows the government to
claim that it is bringing healthcare "closer to home". The net effect
will be a massive reduction in convenience.

The policy was launched by Ara Darzi, a colorectal surgeon who has been
raised to the peerage and made under-secretary of state for health. He
wrote his interim report in three months, during which he claims to have
spoken to thousands of people. But it contains no record of who they
are, how they were selected or what their answers were: he reveals only
that "their views have helped shape this interim report". {3} His final
report will not be published until June, but the Department of Health
has instructed England's primary care trusts  (PCTs) to advertise for
bidders for the new polyclinics by May 2008 {4}: the first notices have
already been posted in the Health Service Journal.

During a parliamentary debate launched by the Conservatives last week,
Alan Johnson, the secretary of state for health, claimed three times
that this policy is not being imposed on primary care trusts. "There is
no national policy", he said, "for replacing traditional GP surgeries
with health centres or, indeed, polyclinics"; "we are not specifying
polyclinics as any part of the exercise"; "[the Tories say] we are
imposing a system of polyclinics throughout the country. We are not."
{5} Three times, in other words, he misled the House. The letter sent by
the Department of Health in December ordered that "each PCT will be
expected to complete procurements during 2008/09 {6}. In a parliamentary
answer in Febrary, the health minister Ben Bradshaw confirmed that
"every PCT in the country will be procuring a new ... health centre
during 2008-09" {7}. A press release published by the Labour Party on
April 15th confirmed that the new health centres would be built "in
every town and city" {8}. I hope MPs demand that Alan Johnson apologise
to parliament.

Lord Darzi insists that polyclinics will offer "a more personalised
service" {9}. This is nonsense: in the huge new centres we are less
likely to be able to see the same GP and more likely to get lost in the
system. A recent paper in the British Medical Journal reveals that
"patients in small practices rate their care more highly in terms of
both access and continuity" and that small practices "achieved slightly
higher levels of clinical quality than larger practices" {10}. The new
centres will be built not where they are most convenient for patients
but - as Darzi revealed to the Commons health committee - where the NHS
happens to own land {11}. If you live in a village or a distant suburb
and depend on public transport - as many elderly and sick people do -
visiting the doctor could take all day. Ara Darzi is the new Dr
Beeching, shutting down the branch lines of our primary health service.

So why is this happening? In seeking surreptitiously to privatise
healthcare, the government has a problem. Primary care is already in
private hands: GPs run their own practices. But they are the wrong
hands: the corporations demanding guaranteed streams of income from the
taxpayer can't play. Polyclinics are perfectly designed to let them in,
while preventing doctors from competing.

It's not just that GPs can't raise the capital; because the contracts
are much bigger than ordinary practices and involve many different
services, the tendering process is expensive and fiendishly complex. The
big service companies can produce the same bid for any number of
clinics: they need spend their money only once. The Department of Health
says that primary care trusts should use a type of contract called
Alternative Provider Medical Services {12}, which is designed to allow
corporations to bid. This is not a public-private partnership: it is the
outright privatisation of primary healthcare.

Do I need to explain the implications? The US health system, which the
British government seems determined to emulate, is both more expensive
and less efficient than ours; those who can't afford to pay are either
excluded or treated like battery pigs {13}. The independent sector
treatment centres  (ISTCs - private clinics performing routine
operations for the NHS - that the government introduced in England in
2003 have been a costly disaster. Private companies receive their money
whether or not they carry out the work they are contracted to do. The
government refuses to release comparative figures, but the little
evidence we have suggests that their costs are much higher than the
public sector's {14}. The risks have been transferred back to the
taxpayer and in some cases the standards of treatment are appalling. In
2006 Angus Wallace, professor of orthopaedic and accident surgery at
Nottingham University, told the Guardian, "We expect failures of hip
replacements at approximately one per cent a year and knees at about
1.5% a year. But we have got some of the ISTCs that are looking at
twenty per cent failure rates." {15} Because they put profits first,
companies that run these centres have generated a stack of litigation
claims and a huge NHS bill for repairing the damage they have caused
{16}. Far from reversing its policy in the light of this evidence, the
government is setting up a competition panel, to ensure that the health
service never discriminates in favour of the public sector when awarding
contracts {17}.

Did any of us ask for this? Are there crowds on the streets demanding
the privatisation of the NHS? Even the Tories, for God's sake, have come
out against it: David Cameron's speech last week placed them to the left
of Labour {18}. Why, after the sixty-odd consecutive quarters of growth
that Gordon Brown keeps boasting about, can he not maintain a public
service founded in the midst of poverty and rationing? What mysterious
hold on policy do the corporations possess, that they can persuade this
government to wreck Labour's finest achievement and damage its chances
of re-election?

www.monbiot.com

References:

1. Ara Darzi, October 2007. Our NHS, Our Future. NHS Next Stage Review:
Interim report. National Health Service. http://www.ournhs.nhs.uk/

2. Ben Dyson, Commissioning and System Management Directorate,
Department of Health, 21st December 2007. Letter to SHA Directors of
Commissioning.

3. Ara Darzi, ibid, page 3.

4. Ben Dyson, ibid, paragraph 14.

5.
http://www.publications.parliament.uk/pa/cm200708/cmhansrd/cm080423/debtext/80423-0003.htm#08042357000001

6. Ben Dyson, ibid, paragraph 5.

7.
http://www.publications.parliament.uk/pa/cm200708/cmhansrd/cm080229/text/80229w0008.htm#08022970000046

8. The Labour Party, 15th April 2008. NHS on your side.
http://www.labour.org.uk/nhs_on_your_side,2008-04-15

9. Ara Darzi, ibid, page 30.

10. Martin Roland, 22nd March 2008. Assessing the options available to
Lord Darzi. British Medical Journal, volume 336, pages 625-626.
doi:10.1136/bmj.39510.702234.80

11. Professor Lord Darzi of Denham KBE, 25th October 2007. Minutes of
Evidence taken before the House of Commons Health Committee. Answer to
Q94.
http://www.publications.parliament.uk/pa/cm200607/cmselect/cmhealth/uc1106-i/uc110602.htm

12. Ben Dyson, ibid, Annex A.

13. During the Commons debate last week, Richard Taylor MP cited two
recent papers about the failures of the US medical system, published in
the BMJ and the New England Journal of Medicine.
http://www.publications.parliament.uk/pa/cm200708/cmhansrd/cm080423/debtext/80423-0003.htm#08042357000001

14. Allyson M Pollock and Sylvia Godden, 23rd February 2008. Independent
sector treatment centres: evidence so far. British Medical Journal,
volume 336, pages 421-424. doi:10.1136/bmj.39470.505556.80

15. Quoted by Sarah Boseley, 1oth March 2006. NHS forced to fix bungled
private sector hip replacement operations. The Guardian.

16. See also Stewart Player and Colin Leys, April 2008. Under the knife.
Red Pepper magazine.

17. Nicholas Timmins, 16th March 2008. NHS providers to win right of
appeal. Financial Times.

18. David Cameron, 21st April 2008. Speech on Primary Care.
http://www.conservatives.com/tile.do?def=news.story.page&obj_id=143765&speeches=1

Copyright (c) 2006 Monbiot.com

http://www.monbiot.com/archives/2008/04/29/the-great-consolidation/


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