As NHS and care system face Covid crisis – Tories secretly plan fresh attacks

- Protest 5 July

By Mike Forster, Socialist Alternative Political Committee

As the debate around relaxing the lockdown continues, secret documents have come to light around the kind of NHS the government is planning for us. The campaigning NHS journal, the Lowdown, has revealed secret letters from NHS England’s London Regional Director Sir David Sloman, sent out internally on 29 April but not published, requiring Integrated Care System (ICS) Chairs and Senior Responsible Officers to take “urgent action” on system plans for London that “fundamentally change the way we deliver health and care.” Each ICS is ordered to supply a “revised ICS plan” immediately spelling out a 12-point list of issues on which bureaucrats in each area are supposed to devise new policy, on the hoof, for a “Recovery Board” meeting this month.

These plans are being hatched during the current crisis, with an explicit aspiration to keep public engagement ‘to a minimum’. The provisional plan recommends mergers of admin and clinical support services, a rapid increase in ‘virtual’ appointments, a very slow start to elective surgery and increasing reliance on the private sector to deliver care. These plans will result in job losses and a dilution of patient contact with NHS professionals.

The secret leaked documents have to be set in the context of Tory government plans for the NHS for the last 10 years. In 2016, they proposed pushing the oversight of NHS care into Sustainability and Transformation Areas, creating just over 40 mega management bodies across the country. These were then renamed Integration Care Bodies, but with the same objective. Each body has been allocated a smaller budget and with a brief to concentrate and centralise NHS Services into large cities or conurbations. This has been accompanied by creeping mergers of GP practices into larger Primary Care ‘Hubs’ resulting in widespread closures of local GP Practices.

All this has left NHS services totally unprepared for the pandemic which has swept the country. Many are now questioning the centralised model of NHS organisation which has totally failed to take into account of local needs and requirements. There remain in place half implemented plans to downgrade or close hospital provision across the whole country which they will no doubt return to once the current crisis recedes.

As these leaked letters reveal, none of this has happened with any democratic oversight or public consultation. The Tories have got away with this by removing responsibility for the NHS away from the government and putting it into the hands of unelected quangos like Public Health England and NHS England after they pushed through the Health and Social Care Act back in 2012. No new legislation has therefore been necessary to reorganise the NHS and the only legal recourse campaigners have had to challenge cuts to NHS provision has been through the courts.

The Health and Social Care Act also hugely exposed the NHS to privatisation which has continued apace. During the pandemic, the Tories have awarded contracts to private companies to provide equipment and services completely bypassing the usual tendering process.

The Guardian revealed that 177 firms have been awarded just over £1 billion in state contracts to provide services from face masks to free school meals vouchers. Needless to say, almost every contract has created huge problems and profiteering. This is only the tip of the iceberg since the government will not reveal the full list of contracts awarded despite its own guidelines stating any awarded contract must be published within 30 days.

Among the firms benefiting from this taxpayer funded process are Price Waterhouse Cooper and Ernst and Young, accountancy firms with no background or expertise in Healthcare! The contract for providing free school meals to feed more then a million schoolchildren was awarded to a French company, Edenred. They have rightly been accused of ‘woeful’ preparation causing children to go hungry and parents humiliated, and forcing food banks and charities to step in and deliver food parcels to those most in need.

Serco and G4S, have both reportedly been awarded the contract for contact tracing and already have contracts for testing centres. In 2019, Serco was fined £19.2m and had to pay £3.7 million in costs by the Serious Fraud Office over an electronic tagging scandal. Both Serco and G4S were accused of charging the government for electronically monitoring people who were either dead, in jail, or had left the country.

Within healthcare, Serco is best known for the scandal of the out-of-hours contract in Cornwall, which included falsifying data and not employing enough qualified staff.

A major winner of this rush to outsource work has been the giant accountancy firm, Deloitte, which was recruited in March by the Department of Health and Social Care to help create a network of up to 50 virus testing centres around the UK and by the Cabinet Office to assist with the procurement of personal protective equipment (PPE) for frontline NHS staff. Deloitte then appointed several other companies to run the testing centres at a regional level, including Serco, G4S, Mitie, and Sodexo, and the pharmacy chain Boots.

The farce will continue with the contact tracing app which will be a centralised arrangement relying on the employment of over 20,000 professional contact tracers. This work has traditionally been undertaken by local council public health bodies which had vast experience tracing outbreaks of food poisoning, for example. However, years of cuts have left these departments stripped of the expertise and the contract for developing the app and employing the staff has once again gone to the private sector. Johnson has promised a ‘world class’ service within 10 days. The performance of the private sector has so far demonstrated this aspiration is unlikely to be fulfilled, and new recruits are already complaining they have no work to do and lack the required training.

This farce has been tragically played out in the residential and home care sector. More than 22,000 care home residents are officially estimated to have died in England and Wales, although the Financial Times suggests the figure is a lot higher. Excess deaths in care homes, for example, are running three times higher than the previous comparable data for the last 5 years, leaving some experts to estimate that the figure is well over 30,000! Johnson has been forced to acknowledge that the sector has faced an “appalling epidemic.” Hancock tried to brush off these figures by suggesting that this meant 50% of care homes have avoided infection!

A report by Public Health England found that homes have been forced to take on agency staff who are travelling between care homes and unwittingly spreading the disease. Ministers were warned about the potential of cross infection last month but failed to pass on the information to care home managers or Directors of Public Health.

This situation has been exacerbated by the ongoing lack of PPE in care homes for the staff and persistent problems in securing the necessary testing regime which would massively assist in the control of the pandemic. All this work continues to be provided by the private sector, now backed up by the armed forces.

Yet, Prof Terry Lum, the Head of social care policy in Hong Kong told a recent parliamentary committee that they have had no deaths in care homes there. He puts this down to rigorous testing, quarantine measures and training for staff. Yet the same committee were told by the chief executive of Care England that patients and residents with symptoms of the virus were being discharged from hospitals to free up beds and so spreading Covid-19. No wonder we have rightly claimed that the Tories have blood on their hands.

Socialist Alternative has already commented on residential and home care but this whole situation has once again ignited a debate about the provision of social care in this country. There is no doubt that the elderly, infirm and frail population has been cast aside and left to the staff and care companies to cope with without proper due care or attention. This is a huge scandal which has to be addressed urgently.

With further cuts potentially coming down the line in local government, inevitably impacting on the already hugely underfunded social care sector, Labour councils should refuse to continue passing on brutal austerity and instead refuse to implement any further cuts. The rebellion by some council leaders over school reopening, under pressure from teachers’ unions and the wider community, shows the potential that exists for councils to defy the government. We need an end to cuts and privatisation in health and social care and the establishment of a fully funded, publicly owned and democratically run service providing free and high quality care to all who need it.

We have often heard the phrase; we cannot return to the ‘old normal’. This is especially the case with our NHS and Social Care. Health Campaigns Together and Keep our NHS Public are working together to demand a different kind of NHS for the future. We will be calling for public protests on the 72nd anniversary of the NHS on 5th July in local areas and preparing a larger national mobilisation in September around the state opening of parliament. These plans will very soon be announced. In Huddersfield, we have already put in place a socially distanced protest around our hospital for Sunday 5th July. These protests must be organised around clear and unequivocal demands:

  • Proper public funding for our NHS now

  • Kick out the profiteering private companies and end the scandal of Private Finance Initiative

  • Bring Social care back into the public sector

  • A decent and immediate pay rise for ALL NHS and social care staff

  • End the discriminatory and unfair migrant charges now

  • End all hospital cuts and closures