Mutually Assured Destruction: The Future of the NHS
In August 2014, as the first experiment of a totally privatised NHS hospital was grinding to a disastrous end, the Coalition quietly initiated the first phase of their latest wheeze to privatise our NHS.
In order to remove hospitals from central Government control (the wet dream of our political establishment), the Coalition unveiled plans to
make invite individual NHS organisations to become mutuals. Instead of being publicly-owned, the NHS organisation would be owned and run by its ‘members’, ie staff.
Under these plans, once removed from Government control, the staff of each organisation would take on the benefits and risk of ownership. This reorganisation would then allow the hospitals’ new owners to buy in services from private healthcare providers.
As a result, the creation of mutuals would lock in three vital, damaging consequences:
- A return to pre-NHS provision of health services, when a patchwork of mutuals provided varying levels of quality and services, depending on the part of the country and wealth of the business/service provider. Local communities will suffer from having less wealthy or profitable hospitals as their main healthcare provider.
- The financial benefits of owning a hospital are uncertain at best, but the risks of owning a traditional loss-making business are enormous. To reduce financial losses (and maximise profit) that they would be liable for from their business, staff/owners would be likely to buy in cheaper healthcare services from the private sector. In order to reduce costs and compete competitively for tenders, these private healthcare companies will naturally exploit the usual targets; staff wages reduced, terms and conditions minimised, cheap material and equipment used etc. Think about your local train company. Then think about the equivalent looking after your mum in hospital. Exactly.
- Most health trusts are under serious financial pressure, and many rely on occasional bailouts from Central Government to keep them afloat. A mutual would no longer be in the public sector and therefore it could not receive Government financial support in the same way. It is likely that a mutual, just like an NHS Trust no, will come under financial pressure, and without Government protection there is a real threat of a complete private sector takeover. And with that, all employee terms and conditions would be up for grabs.
So far, nine Trusts have signed up a £1 million ‘Pathfinder’ programme to access ‘technical, legal and consultancy support to help them a) understand what mutualisation means to them and b) find solutions to practical barriers to becoming mutual organisations.’
The Pathfinder Trusts are due to report back in March. If the reports are positive, and I’m willing to put a few sheckles on them being positive, then expect this to become a cornerstone of Tory health policy at the General Election.
Mutuals In Healthcare, ie staff-owned NHS services, will, of course, be spun by the Government as being good for local communities, good for NHS staff, and good for patients. A review on Staff Engagement & Empowerment in the NHS from the King’s Fund found that NHS organisations with high levels of staff engagement – where staff are engaged in decision making – deliver better quality care.
But make no mistake. This is a Trojan Horse for dismantling our NHS and selling it off to the private sector. It is up to all progressives who value our NHS as a publicly-owned institution to fight these plans while they are still on the drawing board. We need our NHS assets to be owned by everybody – because the NHS is for everybody that needs it.
The nine Pathfinder Trusts are
- Cheshire and Wirral Partnership Foundation Trust
- Liverpool Heart and Chest Hospital Foundation Trust
- Moorfields Eye Hospital Foundation Trust
- Norfolk and Norwich University Hospitals Foundation Trust
- Norfolk & Suffolk Foundation Trust
- Oxleas Foundation Trust
- Surrey and Sussex Healthcare Trust
- Tameside Hospital Foundation Trust
- University Hospitals of Leicester Trust