KEEP OUR NHS PUBLICKEEP OUR NHS PUBLICNHS Cuts and the Health and NHS Cuts and the Health and

Social Care BillSocial Care Bill

Wendy Savage MBBCh(Cantab) FRCOG Wendy Savage MBBCh(Cantab) FRCOG MSc (Public Health) Hon DScMSc (Public Health) Hon DSc

Co-chair KONPCo-chair KONP

Sheffield 3.5.11Sheffield 3.5.11

KeepKeep OurOur NHS PublicNHS Public

Launched September 2005 by Launched September 2005 by

NHS Consultants Association NHS Consultants Association

NHS Support FederationNHS Support Federation

and Health Emergencyand Health EmergencyWebsite Website

www.keepournhspublic.com

Aims of KONPAims of KONP

To build a broad non-party political To build a broad non-party political coalition which will campaign to protect coalition which will campaign to protect the NHS from further privatisation and the NHS from further privatisation and fragmentation fragmentation To inform the media, public and MPs To inform the media, public and MPs about the government ‘reforms’about the government ‘reforms’To keep our NHS public which means To keep our NHS public which means publicly provided as well as fundedpublicly provided as well as funded

McKinsey 2009McKinsey 2009

Achieving World Class Productivity in the Achieving World Class Productivity in the NHS 2009/10 to 2013/14:NHS 2009/10 to 2013/14:

Detailing the Size of the OpportunityDetailing the Size of the Opportunitybasis for thebasis for the

Operating Framework 2010Operating Framework 2010andand

NHS 2010-2015: From Good to Great; NHS 2010-2015: From Good to Great; Preventative, Peoplecentred, Productive Preventative, Peoplecentred, Productive

Basis of figure of £15 to £20bn savingsBasis of figure of £15 to £20bn savings

McKinsey 2009McKinsey 2009

technical efficiency savings of £6.0 - 9.2bn found technical efficiency savings of £6.0 - 9.2bn found from provider costsfrom provider costsallocative efficiency savings of £4.7 - 6.6bn due allocative efficiency savings of £4.7 - 6.6bn due to no longer commissioning low value added to no longer commissioning low value added healthcare interventions and ensuring healthcare interventions and ensuring compliance with commissioners’ standardscompliance with commissioners’ standardssavings of £2.7 - 4.1bn from a shift in the savings of £2.7 - 4.1bn from a shift in the management of care away from hospitals management of care away from hospitals towards more cost effective out-of-hospital towards more cost effective out-of-hospital alternatives.alternatives.

Ring fenced increase for NHS?Ring fenced increase for NHS?

Planned 0.1% increase per year Planned 0.1% increase per year But But

Appleby says will be -0.25% because of inflation Appleby says will be -0.25% because of inflation higher than calculated at the timehigher than calculated at the timeinflation greater in NHS than RPI & CPIinflation greater in NHS than RPI & CPITransfer of £2.1bn over 5 years to local Transfer of £2.1bn over 5 years to local authorities to provide care for patients coming authorities to provide care for patients coming out of hospitals ie £0.4bn a year some stats £0.8 out of hospitals ie £0.4bn a year some stats £0.8 bn per yearbn per yearIncreased need as aging populationIncreased need as aging population

Their conclusionTheir conclusion

We recommend a nationally-enabled programme delivered through the SHAs and PCTs to drive through efficiency savings. The DH should take direct actions to capture some opportunities e.g. lowering tariffs. And should enable delivery by creating a compelling story, removing barriers, developing frameworks/tools and embedding the drive for efficiency gains within existing mechanisms e.g. WCC.

Fighting the H&SC BillFighting the H&SC Bill

Little media interest in a key factor Little media interest in a key factor which is to:which is to:

Transfer the responsibility for the NHS Transfer the responsibility for the NHS from the Secretary of State for Health from the Secretary of State for Health to a new NHS Commissioning Board. to a new NHS Commissioning Board.

He no longer has a He no longer has a duty to provideduty to provide a a comprehensive health service in comprehensive health service in England only England only to act with a view to to act with a view to securing the provision of servicessecuring the provision of services. .

Fighting the H&SC BillFighting the H&SC Bill

Strategically they have been cleverStrategically they have been clever

Reassuring languageReassuring language

Flawed consultationFlawed consultation

Implementing proposals before Bill Implementing proposals before Bill even reached parliamenteven reached parliament

Ignoring chorus of dissent Ignoring chorus of dissent butbut

Increasing ProtestsIncreasing Protests

TUC March 26TUC March 26thth & 1.4.11 Day of action & 1.4.11 Day of action

BMJ Dr Lansley’s Monster Lancet anti BMJ Dr Lansley’s Monster Lancet anti

BMA SRM voted to withdraw the BillBMA SRM voted to withdraw the Bill

RCN passed vote of no confidence 13.4RCN passed vote of no confidence 13.4

Think Tanks reservationsThink Tanks reservations

Lib Dems did not pass supportive motion Lib Dems did not pass supportive motion on 13.3.11 called for amendmentson 13.3.11 called for amendments

Some Tories have spoken out againstSome Tories have spoken out against

Unprecedented pause 4.4.11Unprecedented pause 4.4.11

Lansley announced on 4.4.11 that there Lansley announced on 4.4.11 that there would be a pause of two months to’listen would be a pause of two months to’listen reflect and engage’.reflect and engage’.

Memo from DH reported 7.4.11 little Memo from DH reported 7.4.11 little change just some delay to Monitor 2012change just some delay to Monitor 2012

On 13.4.11 after RCN vote Lansley saidOn 13.4.11 after RCN vote Lansley said‘ ‘ I am sorry if what I’m setting out to do I am sorry if what I’m setting out to do

has not communicated itself’has not communicated itself’

This is a PR exerciseThis is a PR exercise

Has set up a ‘Futures Forum’ with about 50 Has set up a ‘Futures Forum’ with about 50 people chaired by Steve Field ex Chair of people chaired by Steve Field ex Chair of RCGPs and packed with ‘yes men’.RCGPs and packed with ‘yes men’.

On DH website there is yet another On DH website there is yet another consultation. consultation. http://healthcare.dh.gov.listening-exercise-how-to-get-involved

leading questions but do go and put your leading questions but do go and put your responses in responses in

Parliamentary arithmeticParliamentary arithmetic

• Amendments at Report StageAmendments at Report Stage• It is possible to defeat a bill at 3It is possible to defeat a bill at 3rdrd reading reading

and we need 48 coalition MPs to vote and we need 48 coalition MPs to vote against and all the small parties.against and all the small parties.

• 57 Lib Dems 21 have government 57 Lib Dems 21 have government positions but as proposals not in coalition positions but as proposals not in coalition agreement they can vote againstagreement they can vote against

• Some Tories have expressed concernsSome Tories have expressed concerns

House of LordsHouse of Lords

If the bill passes at 3If the bill passes at 3rdrd reading then it goes reading then it goes to the Lords.to the Lords.Considerable dissent, Robert Winston, Considerable dissent, Robert Winston, Jenny Tonge, David Owen, Nic Rea etcJenny Tonge, David Owen, Nic Rea etcAs most proposals were not in manifestos As most proposals were not in manifestos Commons must accept Lords Commons must accept Lords amendments. amendments. Cross benchers important Cross benchers important

The fight must continueThe fight must continue

These changes can be achieved without the BillThese changes can be achieved without the BillEvidence is that health care is an unsuitable service Evidence is that health care is an unsuitable service for market mechanismsfor market mechanismsIncreases inequityIncreases inequityAffects the elderly and other most vulnerableAffects the elderly and other most vulnerableEfficiency savings can be made by abolishing the Efficiency savings can be made by abolishing the marketmarketWhy should ordinary people pay for the bankers Why should ordinary people pay for the bankers excesses and failure of government regulation of the excesses and failure of government regulation of the financial markets? financial markets?

Nick Clegg 30.4.11Nick Clegg 30.4.11

Observer re NHS BillObserver re NHS Bill

‘‘Its got to have significant changes ‘Its got to have significant changes ‘

‘‘This will not pass parliament, I won’t This will not pass parliament, I won’t ask Liberal democrat MPs to pass ask Liberal democrat MPs to pass this legislation , until I am satisfied.’this legislation , until I am satisfied.’

What can we do?What can we do?

Let MPs know in every constituency that another Let MPs know in every constituency that another ‘re-disorganisation’ is the last thing we as citizens ‘re-disorganisation’ is the last thing we as citizens or the NHS staff want and it won’t save money.or the NHS staff want and it won’t save money.We do not want a market which is the underlying We do not want a market which is the underlying purpose of this Bill. Abolishing the regulated purpose of this Bill. Abolishing the regulated market (New Labour) and the purchaser-provider market (New Labour) and the purchaser-provider split introduced in 1989 by Kenneth Clarke would split introduced in 1989 by Kenneth Clarke would save at least £10 billion a yearsave at least £10 billion a yearJoin &/or donate to KONP so we can mobilize Join &/or donate to KONP so we can mobilize people via meetings website etcpeople via meetings website etc

Published 14.4.11Published 14.4.11

The Plot against the NHSThe Plot against the NHS

By Colin Leys and Stewart By Colin Leys and Stewart PlayerPlayer

Merlin PressMerlin Press

£12.95 or £10 from KONP£12.95 or £10 from KONP

Market-driven politicsMarket-driven politics

1.1. Real markets are deeply political-state Real markets are deeply political-state omnipresent-national politics and the state omnipresent-national politics and the state always targets-businesses want to enter NHSalways targets-businesses want to enter NHS

2.2. Convert services into commodities and Convert services into commodities and workforce into one orientated to profit and workforce into one orientated to profit and get government to underwrite risk.get government to underwrite risk.

3.3. Market competition transforms commoditiesMarket competition transforms commodities4.4. Consequences, inequality of provision, high Consequences, inequality of provision, high

costs and corruption (eg US health system)costs and corruption (eg US health system)

Further readingFurther readingColin Leys Market-driven politics (2001) Verso Colin Leys Market-driven politics (2001) Verso Allyson Pollock NHS-plc (2005) Verso Allyson Pollock NHS-plc (2005) Verso John Lister Health Policy Reform (2005) The NHS after John Lister Health Policy Reform (2005) The NHS after 60:for patients or profits? (2008) 60:for patients or profits? (2008) Stewart Player & Colin Leys Confuse and ConcealStewart Player & Colin Leys Confuse and Conceal

Merlin Press 2008Merlin Press 2008On the Brink Report for BMA London Regional Council On the Brink Report for BMA London Regional Council by John Lister January 2009by John Lister January 2009House of Commons Health Committee (2010) House of Commons Health Committee (2010) Commissioning. Fourth Report of session 2009-10Commissioning. Fourth Report of session 2009-10An NHS beyond the Market report of a round table An NHS beyond the Market report of a round table discussion download from www.bma.org.ukdiscussion download from www.bma.org.uk