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The Great NHS Sell Off

Recently released figures show the staggering extent of NHS privatisation - with £15 billion worth of contracts outsourced to private companies since 2015 alone.

The Tories’ are promising this election that “the NHS is not for sale – and it never will be,” but their record in government reveals another story. A recently released study from Tussell, commissioned by the GMB union, reveals a staggering pattern of NHS privatisation in recent years, amounting to £15 billion of outsourcing since 2015.

In 2010, despite promising no top-down re-organisation of the NHS, the Tories and the Liberal Democrats introduced the Health and Social Care Act – a catalyst to privatise the service. Since this act became law in 2012, NHS privatisation has risen exponentially. Tussell’s research shows NHS contracts given to private companies in 2018 skyrocketed by 90% when compared to 2015. Over the past three years, nearly two-thirds of NHS contracts have been put into private hands. Private companies and social enterprises won £1.9bn of NHS contracts in 2015, rising to £3bn in 2016 and again to £3.6bn in 2018. In 2019, non-NHS companies have already secured contracts worth £3.3bn. 

Most contracts were awarded to for-profit companies, with Care UK securing seventeen contracts. Virgin Care, a company with form for taking legal action against the NHS, has been a key beneficiary of privatisation, winning thirteen contracts worth £579 million. But the social enterprise Sirona Health and Care was awarded the single most valuable contract, paying £1.09bn to provide adult community health services in the Bristol, North Somerset and South Gloucestershire areas over the next ten years.

A spokesperson for Social Enterprises UK argued that it was unfair to bunch Sirona Health and Care with companies like Virgin Care, as social enterprises are not profit-orientated and deliver a social mission. But NHS staff are not immune to the intricacies and anxieties of the TUPE regulations when their contracts are relinquished to social enterprises. Staff providing NHS community healthcare services in West Yorkshire lost the benefits of an NHS pension when Locala Community Partnerships, a social enterprise took over the service.

The competitive tendering process incrementally erodes labour rights as services switch providers over time. Earlier this year, when Locala Community Partnerships’ emergency dental services contract was awarded to Night Dental, some workers were told that their contracts were not eligible for TUPE, and hence they would no longer be needed. Some of the staff had worked for the service for over a decade, and yet the news came with just two weeks’ notice. 

Under the new arrangements, teams working at Night Dental are expected to see more patients as well as take on additional duties for less pay. Since it is not possible for companies to simultaneously make profits and undercut NHS Trusts, private companies resort to cutting corners, reducing the quality of patient care and severely undermining the working conditions of NHS staff.

This situation was summed up by Rehana Azim, GMB National Secretary, who said “outsourcing is bad news for patients and NHS staff. Time and time again, we have seen private providers fail to deliver while our members’ terms and conditions and the NHS national agreement have been undermined.” 

With 1.7 million staff, the NHS is the UK’s biggest employer making the welfare of workers crucial to the economy as well as standards of care. But the Tories have shown consistent contempt for the labour rights of NHS staff. During their time in office, this government has presided over the first junior doctors’ general strike across the NHS in over 40 years. Meanwhile, waiting lists are at record levels, staff shortages amount to 100,000 and nearly half of all doctors in the NHS have considered quitting.

This culture of more for less and privatisation is becoming pervasive. Faced with stiff competition from the private sector even NHS Trusts are creating subsidiary private companies to save money –known as ‘subcos.’ NHS Trusts claim that subcos allow them to save money by exploiting a VAT loophole. But UNISON trade union made clear what the real savings are: employing new staff on non-NHS terms and conditions.

The Office of National Statistics data shows that despite the Tory cuts there is increased productivity within the NHS – rising three times faster than the rest of the economy. NHS England rightly described this as “a remarkable tribute to our hard-working NHS staff” who are delivering in the face of stagnant wages, tough working conditions and constrained budgets.

But things are at breaking point with over 100,000 vacancies across the NHS. Despite the government promise of an extra 5,000 GPs by 2020, GP numbers are falling. GPs are increasingly choosing to take early retirement, with the numbers doing so rising threefold over the past decade. The mental toll of workloads is such that the government introduced a mental health support service for doctors and dentists – but on the flip-side, they have cut 6,000 mental health nurses across the NHS.

Subcontracting practices by private companies, commercial sensitivity protections and NHS cuts and staff shortages leave little capacity to monitor the quality of patient care outsourced to private companies. Although privatisation can save money in the short-term, academic research suggests it is a false economy. Analysis has shown that NHS hospitals that outsource cleaning to private companies have nearly 50% higher rates of the MRSA superbug infection. This poses health risks to staff, patients and the wider population by sabotaging the NHS’s fight against antibiotic resistance.

The World Health Organisation (WHO) defines healthcare privatisation as the increasing financing and/or provision of healthcare by non-governmental actors. With over 500 provider bodies that include private companies, social enterprises, NHS subsidiary companies, and charities, it is clear from the WHO’s terms that the NHS is already being privatised. This privatisation has not necessarily impacted individual patients in terms of charges, but as well as healthcare services it has involved the takeover of property, portering, cleaning, catering and patient transport. And this is big business. Last year, the second most valuable contract was a PFI extension by St Helens and Knowsley Teaching Hospitals NHS Trust which was worth half a billion pounds.

Some have argued that private provision does not matter so long as we’re not asked to pay. However, with the Immigration Act of 2014, a key plank of the hostile environment, the Tories introduced charging for the use of the NHS by migrants. Furthermore, with the Health and Social Care Act, the Tories with their Liberal Democrat coalition partners removed the government’s responsibility for healthcare. As a consequence, the NHS has no legal obligation to provide any treatments beyond emergency care.

Last year the NHS announced cuts to seventeen procedures including routine treatments like tonsil removal and varicose vein surgery. Furthermore, a new wave of 34 cutbacks have just been disclosed that include simple blood tests, scans and treatments. These NHS reduced and removed lists of tests and treatments have created a market for care for those who can afford to pay, with the NHS providing these treatments privately.

Migrant charges and private ‘NHS’ patients have created the business processes and billing systems within the NHS to charge for healthcare. In this system, NHS patient care is already becoming the lower tier in a two-tier system. The Health and Social Care Act 2012 has removed the legislative protection to deliver comprehensive healthcare. That, along with the infrastructure to charge, means there are no legal guarantees that the NHS will remain universal and free at the point of need under the next government.

The Tussell data once again unveils the scale of NHS privatisation we have seen in the last decade. Last week, Jeremy Corbyn revealed unredacted documents in which ‘full market access’ to the NHS in the event of the post-Brexit UK-US Trade Deal was discussed between senior UK-US trade officials. A Trump deal could increase the NHS drugs bill by £500 million per week, while also granting American healthcare companies easier access to provide more NHS services. And it would not stop there. The costs for medical devices such as pacemakers and prosthetics could increase, NHS legal bills could soar, and our data in the NHS, worth billions of dollars, could be up for grabs. 

Our data could be a further market created inside the NHS, and one with particularly concerning implications. The NHS database holds the health records of 65 million people. The expanding digitisation of our healthcare notes is attracting the attention of big tech firms like Google, as well as smaller healthcare app developing companies.

Last year, the 100,000 Genomes Project, led by Genomics England in partnership with NHS England, reached its goal of sequencing 100,000 whole genomes from NHS patients making the UK the first nation in the world to apply whole genome sequencing at scale in direct healthcare. This data, in addition to the real-life records of our medications, vaccinations and their impacts on our health outcomes, side effects and allergies will be a prized jewel for Big Pharma. Despite repeated government assertions that the NHS is not for sale, it’s plain to see that the NHS is already being carved up and sold. The question remains: what will the Tories sell next?