Labour Pains

‘Richard Branson’s company becomes one of the first of many vultures to start picking over the rich, tender flesh of the NHS now that it has been splayed open by the (Health) Bill.’ So wrote pseudonymous Telegraph doctor Max Pemberton on the news that Virgin Care has won a £500?million contract to provide community services across Surrey and began running these services, as well as the county’s prison healthcare, on April 1.

When Telegraph columnists slate private healthcare provision, the government knows it has a problem but the groundwork for all this was done by Labour. In January 2009, it published Transforming community services: enabling new patterns of provision. ‘This guidance is intended to help PCT providers of community services to move their relationship with their commissioners to a purely contractual one and consider what type(s) of organisations would best meet the future needs of patients and local communities.’

The Health Bill cements and accelerates Labour’s vision of a competitive market for healthcare but may come a cropper if the public aren’t sufficiently involved in the decision making. Section 242 of the NHS Act 2006 makes clear that formal consultation is required in ‘instances in which the manner in which services are delivered, or the range of the services, will change.’ So the game is now on to hand services to the private sector while claiming they won’t change in order to avoid formal consultation with angry protestors who vehemently disagree with the giving large sums of public money and power to private companies and their share holders.

In September 2011, patient Michael Lloyd, 75, challenged the transfer of community services from NHS Gloucestershire Primary Care Trust to a private community interest company. His argument was that the PCT did not consult adequately on the proposals or give proper consideration to alternatives that would have seen the services remain within the NHS. The challenge went all the way to judicial review, with the PCT caving in on day 2 and agreeing to advertise for ‘expressions of interest for the provision of local services’ which may keep the service within the NHS. Or it may not.

Alas the judge did not clarify how EU procurement law will affect these NHS ‘outsourcing decisions’, but companies based in the EU and eyeing up the NHS market may have a legal right to be included in the tendering process, which would make it even harder, expensive and legally tortuous for the NHS to cling onto the provision of NHS services. As David Lock QC wrote in the Health Service Journal: ‘The duties of transparency, equal treatment and non-discrimination imposed by the EU treaty and the Public Contracts Regulations 2006 mean that all contracts placed with a body outside an NHS trust should be subject to a “degree of advertising” to allow healthcare providers located in another EU country the chance to bid for the contract.’

Despite this, a private hospital in Kent is already claiming it will offer the NHS and private patients ‘the only cardiothoracic and neurosurgery tertiary care beds in the county.’ The Clydesdale Bank last week agreed a £34m loan deal to help build and run the Kent Institute of Medicine and Surgery, which is due to open in the second quarter of 2014. Another £80 million will be provided by corporate and private investors, including around 100 clinicians.

Private provision in healthcare thrives when the NHS gives up trying (e.g. long term care of the elderly, psychiatry) and with so many hospitals and PCTs in huge debt, and the Department of Health facing a ‘significant’ accounts auditing problem, the choice for many NHS community and hospital services may soon be between private provision or nothing. And Labour started it all.

The Nicholson Health Service

On March 26, at 18:00, MD posted a draft copy of the Health Bill Risk Register on this site that had been anonymously leaked. The Government’s persistent refusal to publish it prompted angry debates in both chambers and widespread press attention. Yet a week after posting it, MD has received not a single press enquiry. A few papers picked it up, but the mood was one of intense apathy. The story was not the risk register, but the refusal to publish it, and now the Bill has passed, what’s the point of exposing the risks?

The draft register – which dates back to 15 October 2010 – is helpfully colour coded into red, amber and green, and the risks are largely red. In essence, the NHS top brass – lead by former communist party chief executive David Nicholson – are petrified that such a massive, unforeseen change in structure and the unpredictable consequences will see them lose control over money, strategy and power. The delay in the passage of the Bill has simply allowed Nicholson time to claw back his power to the point that the NHS is now more centrist than it was under Labour, rendering Lansley’s Bill the most pointless and expensive reorganization in NHS history.

MD was also leaked the Business Case for the reforms and journalist Roy Lilley has posted a document entitled Developing Great Clinical Commissioning Groups (CCGs)1. Both are Trojan horses for reclaiming power from commissioning GPs. As Lilley points out: ‘The N in NHS now stands for Nicholson.’ Commissioning Support Services that didn’t even appear in the Health Bill are now sprouting up everywhere, their leaders will all be appointed by Nicholson’s Board. They’ll tell GP commissioners what they can and can’t do and what they can buy, and for how much.

Commissioning GPs clearly need to be accountable for the £60 billion they spend but many will give up when faced with the 118 ‘authorisation requirements’, site visits and box ticking exercises they have to pass before they can be approved to take over from primary care trusts in April next year. The structure of the new NHS is now so complex, confusing and bureaucratic that Nicholson must be in raptures (see diagram). Lansley promised to ‘liberate’ the NHS. Instead, it has been shackled to the centre for good. Nicholson 10, Lansley 1

http://library.constantcontact.com/download/get/file/1102665899193-914/Developing+Great+CCGs+ver1.pdf

Chew Valley Asbestos Dump – Greed is My Valley

Residents of the picturesque Chew Valley have until April 19th to raise objections to 645,000 tonnes of asbestos and other hazardous waste being dumped on top of a windy escarpment over watercourses that feed into the region’s drinking water reservoir. The health risks of noise and air pollution from fifty lorries a day for ten years, plus the traffic congestion, accident and spillage risks in narrow country lanes are obvious. Bath and North East Somerset (BANES) only reclaims a thousand tonnes of asbestos a year, so allowing 64,500 tonnes a year – half of which would be asbestos –  would necessitate importing asbestos from all over the UK.

The long term risks are hard to quantify. The asbestos would be dumped in a shallow, quarry, raised up into a mound and covered in topsoil. At much smaller dumps in Somerset and Derbyshire, shoddy disposal has allowed asbestos fibres to escape into the air. As mesothelioma, the lung cancer caused by asbestos, takes up to 40 years to develop the consequences cannot be known. Bristol Water strongly opposed an initial successful application, because of the risk of soluble hazardous waste reaching the reservoir, but the planning application was overturned due to a failure by BANES council to advertise it properly.

The reapplication was sprung on residents on March 28, with just 21 calendar days to mount objections and with no legal or expert support from BANES. The applicant, Larry Edmunds, has no evident expertise in the disposal of hazardous waste and has once again failed to consult with local residents prior to application. He is, however, under intense pressure from Barclays Bank, who have lent him £1.6 million and are doubtless petrified they won’t get their money back. If successful, Edmunds and his partners Mark Foley and Arthur Bristow could make up to £20 million by selling the contract on. Barclays Bank’s ‘Sustainability Team’ has thus far failed to reply to a December 6 letter asking why the bank has loaned money to a venture that could be so hazardous to the health of Chew Valley residents (including myself) www.stopstoweyquarry.co.uk

Please sign the petition

http://www.gopetition.com/petitions/stop-stowey-quarry-2012.html