Thread by @docrussjackson

#THREAD on Sunak's "radical new plan" to "cut down on bureaucracy" (& further privatise the #NHS).

This "radical new plan has been around since at least the 1960s, when private landowners complained of "NHS bureaucracy" during Hospital site acquisition transactions....

The 2005 '#NHS Management & Administration Staffing & Expenditure in a National & International Context' report made clear that "Expenditure on management & administration, in the NHS & all other health care systems, is a means to an end: its purpose is to improve patient care."

"Relatively ill-informed & superficial debates around whole system ‘bureaucracy’ make little attempt to assess the value of management & administration in particular activities, or accept that some such expenditure is essential to ensure the appropriate & efficient care delivery"

"Historically, Beveridge-type systems like the ‘old’ (pre-1991) #NHS have been relatively inexpensive to manage & administer... a single payer, in conjunction with simple resource allocation mechanisms, has substantially limited the number of transactions needed"

"The purchaser-provider split, private finance, national tariffs & other policies aiming to stimulate efficiency in the system & create a mix of public & private finance & provision" means MORE bureaucracy is needed to make contracts, so "costs of providing care have increased".

And in true contradictory #neoliberal fashion, "At the same time, policy makers, focusing on better monitoring of performance, have also created a need for information systems &management to detect whether improvements in health care delivery are taking place."

So how did we get here?

Let's start with Margaret Thatcher, who in 1983 introduced competitive tendering to the #NHS to outsource ancillary services including cleaning, porters & kitchens to private companies.

yournhsneedsyou.com/timeline/

The internal market, devised by the Thatcher Govt in the late 1980s, was the most #NHS reform since its creation. It sought to replace a traditional model of planning & resource allocation with a ‘quasi-market’, in which NHS institutions took on the role of buyer & seller.

In 1988, Oliver Letwin, a banking privatisation expert, & John Redwood, wrote Britain’s Biggest Enterprise, a manual on how to privatise the #NHS through the introduction of trusts, private companies, charges, profits, & health insurance.

cps.org.uk/wp-content/upl…

Also in 1988, #TuftonStreet's free-market lobbying group the Adam Smith Institute, fleshed out the Britain’s Biggest Enterprise manual in their 'The Health of Nations: Solutions to the problem of finance in the health care sector” by Drs Pirie & Butler.

shibleyrahman.com/law/was-the-he…

In 1991 John Major brought in the #NHS & Community Care Act introducing a ‘purchaser-provider’ split, de-centralising the service by forming NHS trusts, adding a corporate management structure & the principle of competition.

In 1992 the TORIES introduced #PFIs, an unnecessary & expensive method of borrowing money for new hospitals designed to deliver attractive, risk-free returns for private investors, drain money out of the #NHS, lock the taxpayer into long-term debt & justify hospital closures.

In 1997 Tony Blair dumped @UKLabour’s tradition of support for public service & opted for privatisation & deregulation, funding 100 new #NHS hospitals with PFIs. In total, approximately £11 billion was borrowed, with repayments reaching approximately £88 billion.

Even when fully repaid, we the public won’t own the hospitals. PFIs enable a covert bed closure program to shrink #NHS capacity, & a future land grab. As the costs of paying off debts rise, NHS trusts will be forced to sell assets. Also in 1997, Oliver Letwin becomes a Tory MP.

In 2000, New @UKLabour’s #NHS Plan introduces private provision of medical services into the NHS for the first time to ‘modernise’ & ‘reform’ it. Routine surgery, diagnostic tests & procedures are contracted out to the private sector at greater cost than the same care on the NHS.

In 2003, New Labour allows #NHS trusts to apply to become Foundation Trusts (FTs), arms-length business entities independent of government control. This further embeds commercial priorities & leadership into the system.

In 2004, New Labour brings in Payment by Results. Providers are paid a fixed price per unit of completed health care. This helps the private sector to cherry-pick the easiest, most profitable treatments.

In 2009, Gordon Brown brings in the Unsustainable Provider Regime, the framework for using the PFI hospital debt burden to close & sell off publicly-owned #NHS land & property.

In 2012 Cameron & Clegg’s Health & Social Care Act abolishes the legal foundation of the #NHS & removes the Secretary of State for Health’s legal duty to provide healthcare for all, handing responsibility to quangos, & opening all major NHS contracts to the private sector.

This inevitably accelerates private involvement in the #NHS, further increasing the "NHS bureaucracy" that Sunak claims CUTTING is the only way to "Boost the NHS & Save Lives", & which, of course, increases administration costs substantially.

In 2013, the Tory/LibDem coalition Government replaces Primary Care Trusts with new, GP-run Clinical Commissioning Groups, transitional state-owned-and-run insurance pools based on American private Health Maintenance Organisations.

60% of #NHS budgets flow through CCGs.

In 2014, the coalition Government appoints Simon Stevens, former head of the global division of the American health insurance company UnitedHealth, as Chief Executive of #NHS England to manage the final stage of privatisation; the coalition continue to support his efforts.

Stevens spends £millions embedding UnitedHealth’s UK subsidiary Optum & US ‘managed care’ in England: Optum software, algorithms, personnel, practices, & the training of local council leaders to replicate American Medicare will reduce England’s #NHS to a funding stream & a logo.

Stevens publishes his Five Year Forward View introducing Sustainability & Transformation Plans & New Models of Care, creating the impression that these are #NHS sanctioned policy. The narrative of ‘integration’ points to the American private insurance industry-devised model.

Steven's plan is to:

Reduce the number of full A&E hospitals from 140 (in 2013) to between 70 & 40

Reduce the number of GP surgeries from 7500 to 1500 “superhubs”

Close smaller hospitals to produce economies of scale & cut future private sector costs

Shrink provision of expensive, high risk, unprofitable healthcare to the sickest patients

Consolidate lower risk routine planned healthcare ahead of outsourcing

During 2015-17, Stevens rolls out STPs, dividing #NHS England into 44 regions or Footprints to be run by ACOs.

In 2016, Exercise Alice, a dry-run of how the #NHS would respond to a coronavirus-like pandemic, identifies the need for more trained NHS personnel, beds & Personal Protective Equipment (PPE) as well as the need to maintain contact tracing & patient isolation capacity.

Both Theresa May’s government & Simon Stevens fail to implement these recommendations.

And we all know the consequences of that - hundreds of thousands of largely avoidable deaths, followed by endless PPE profiteering scandals to the tune of £billions.

In 2017, the Naylor Review report by global accounting consultant Deloitte & Robert Naylor, & Project Phoenix, create incentives for Hospital Trusts to sell land & assets as the only option to raise funds to buy, improve & maintain hospitals, equipment & #NHS properties.

In 2018, the Commissioning Capabilities Programme run by UnitedHealth/Optum in partnership with global accounting consultant Price Waterhouse Cooper (PwC), is an exercise setting out the curriculum & all the design functions for both advanced & aspiring ICSs.

In 201, a major new contract for GPs means they're grouped together to form Primary Care Networks (PCNs), which form the foundation of American-style Integrated Care. Managers & computer software (rather than doctors) determine ‘care pathways’ for patients & decide on treatments.

The British Medical Association, the doctors’ union, wave through the contract binding GPs in to PCNs, with hardly any debate & no vote of GPs.

In 2020, Johnson, #NHS privatisation, the decision by May & Stevens not to prepare for pandemics, & #Covid19 create a perfect storm.

Hospitals become emergency Covid treatment centres. GPs are instructed by NHS England (NHSE) to replace face-to-face appointments with phone consultations, making it almost impossible to see your GP—a taste of what’s to come under American ‘managed care’.

More than 1,500 health & care staff quickly die from Covid due to the lack of PPE, the unofficial Tory ‘herd immunity’ policy, delayed lockdowns, Boris Johnson's absence of attention to detail, incompetent Ministers more concerned with the culture war than the #NHS etc.

The Tories pay two corporations with ZERO expertise in public health—global accounting consultant Deloitte & outsourcing giant Serco—£37 billion to set up Test & Trace, which makes ‘no measurable difference’.

David King, former Govt Chief Scientific Officer, estimates that more than 100,000 UK Covid deaths could have been avoided.

From 2021, each ICS board is made to serve private corporate interests, control all spending & decide what treatments to allow patients in their region.

As with US ‘managed care’, the more private corporations cut & deny care, the more profit they’ll make.

The Health & Social Care Bill allows private companies to be awarded £multi-billion contracts behind closed doors without competition, normalising PPE/Test & Trace scandals.

In 2022, the Health and Care Act puts ICSs on a legal footing. From July 1st, ICSs start operating throughout England, effectively denationalising the English #NHS.

Waiting lists top 7 million, the highest since records began.

#NHS wage stagnation, the #CostOfLivingCrisis & rampant inflation lead hospital trusts to open food banks for staff which, together with a new round of #austerity imposed by Rishi Sunak, leads nurses to vote to strike for the first time in their history.

https://twitter.com/docrussjackson/status/1471979226714755080?s=20&t=KSAYknD9HnnbF0jatD2uOQ

And now Sunak has appointed Bill Morgan, a private healthcare lobbyist & founding partner of PR & lobbying firm Evoke Incisive Health, with links to controversial clients, to advise him in Downing St, to drive through further privatisation within the #NHS.
theguardian.com/society/2022/n…

This magnificent timeline of #NHS privatisation was put together by the excellent @YourNHS2021, who request we share their #KeyDemands on social media, & support their #Actions to build the movement to reverse Americanisation, & Renationalise our NHS.

yournhsneedsyou.com

A late entry revealing how the unhinged Libertarian free-market extremist plan to destroy one of the world's greatest humanitarian institutions, our #NHS, & replace it with profit-hungry private insurance, has been kicking around for at least forty years:

https://twitter.com/TweetForTheMany/status/1305515293515698177?s=20&t=ubsFn4_MOEu3UnRVRmFzwA