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By Alex Scott-SamuelThe BMJ, August 5, 2016

July 2016 saw the very quiet publication of two key documents charting the route to the privatisation of the NHS in England. Firstly, from NHS England, came Strengthening Financial Performance and Accountability in 2016-17. This is the latest set of instructions on the implementation of NHS chief executive Simon Stevens’s Five Year Forward View (5YFV). The 5YFV is increasingly coming to resemble one of Stalin’s Five Year Plans from the 1950s. As the new guidance makes clear, Stevens’s latest collectivisation strategy, the Sustainability and Transformation Plans (STPs), is being rigidly imposed across England.

The Health and Social Care Bill has just passed through Parliament. A huge step towards privatising the NHS has been taken. The most cherished of UK public institutions is being dismantled and large private providers are already signing contracts. All this is against the wishes of a large majority of the public and an even larger majority of health-care professionals.

The Department of Health had already been infiltrated by McKinseys consultants under New Labour (see Player and Leys, 2011 ↑ ).

Professional opposition was widespread. Keep Our NHS Public ↑ , 38 Degrees ↑ , Spinwatch ↑ and others began scrutinising the bill and campaigning at an early stage. New local BMA groups sprang up all over the country in an attempt to force their leadership to engage with its ordinary members about their concerns. Numerous articles and blogs appeared, written by health professionals who had scrutinised the bill in far more detail than politicians or journalists[i]. Public meetings took place regularly - and across the UK, not limited to England. Many demonstrations took place. Marathons were run. Barely any of this was reported

The political economy of health care (Second Edition) Where the NHS came from and where it could lead

With a foreword by Tony Benn.Drawing on clinical experience dating from the birth of the NHS in 1948, Julian Tudor Hart, a politically active GP in a Welsh coal mining community, charts the progress of the NHS from its 19th century origins in workers' mutual aid societies, to its current forced return to the market. His starting point is a detailed analysis of how clinical decisions are made. He explores the changing social relationships in the NHS as a gift economy, how these may be affected by reducing care to commodity status, and the new directions they might take if the NHS resumed progress independently from the market.This new edition of this bestselling book has been entirely rewritten with two new chapters, and includes new material on resistance to that world-wide process. The essential principle in the book is that patients need to develop as active citizens and co-producers of health gain in a humanising society and the author's aim is to promote it wherever people recognise that pursuit of profit may be a brake on rational progress.

The biggest shake-up of the NHS in 60 years represents a "hazardous journey" with a "real danger of failures in quality of care or finances", said the body representing the health service establishment

Andrew Lansley, the health secretary, unveiled a radical pro-market agenda for the health service in England in July that would permit hospitals to leave public ownership to become "not for profit" companies, hand more consumer powers to patients and allow failing medical centres to go bust.

As part of the plan, England's 35,000 GPs will be handed £80bn of taxpayers' money and be forced to form consortiums by 2013.

So the government’s attempt to deny privatisation of the NHS by claiming that NHS services will remain publicly funded and free at the point of delivery does not escape the WHO definition if services are delivered by non-governmental actors, such as private and third sector (voluntary and community) organisations. This is clearly a stated objective of the reforms.

Changes to the NHS in England have created an "unholy mess", the editors of three leading journals have said.

suggests an independent commission be set up to oversee changes in the future

the major NHS unions have called for the bill underpinning the changes to be scrapped

A leaked version of the final draft of a Consortium consultation into pay and conditions for NHS Staff in the South West of England (here) shows that without any consultation, and despite the opposition of all 15 health Trade Union & professional bodies in England, the Department of Health have pushed on with imposed pay and conditions cuts for the NHS in the South West of England. As a matter of fact, these punitive measures will be rolled out across the northern and midland parts of England in time.

over and above the already 2 year pay freeze (to 1%) that has been suffered by NHS staff

28,610 NHS Staff have been sacked with a projected total number of 72,000 NHS job losses on the way

The NHS Trust that runs the hospital says the PFI deal has caused problems

03 June 2015

Britain’s first NHS hospital financed and built by private capital is a “major” fire safety risk, fire fighters have said. The Cumberland Infirmary in Carlisle was first opened in 2000 under the controversial “private finance initiative” which sees the NHS pay a private company rent-like payments to make use of facilities.An independent report commissioned by the NHS trust that manages the hospital found that fire proofing materials installed by the private company did not meet the required protection standard to allow for save evacuation and prevent a fire from spreading across the building.

destruction by market forces Allyson Pollock 14 April 2015

As politicians squabble over NHS funding figures, the British Medical Association's Council has backed the principles of radical legislation which would get the costly 'market' out of the NHS.

The stated policies of the British Medical Association are to end the market in health care, oppose the purchaser provider split, and to reinstate the Secretary of State’s duty to provide universal health care throughout England. 

Doctors and senior NHS managers have accused health officials of trying to make it more difficult for hospitals to publically admit they are reaching breaking point

28 Jan 2015

Health officials have issued new guidance on hospital “major incidents” amid accusations they are trying to hide the scale of the NHS winter crisis. Accident & Emergency doctors accused NHS England of attempting to “dampen down” publicity over the problems hospitals are experiencing by making it more difficult to declare that they are unable to cope.

The democratic and legal basis for the NHS in England was abolished by the Health and Social Care Act 2012. The impact of this fundamental change is already being felt, ahead of the shift to the new market system in April 2013. 

The Act ended the Secretary of State’s duty to secure or provide health services throughout the country, a duty that had been in force since 1948.

This briefing explains what the government is doing and why an urgent bill to reinstate the NHS in England is required. 

BMJ 2016; 353 doi: http://dx.doi.org/10.1136/bmj.i2232 (Published 19 April 2016) Cite this as: BMJ 2016;353:i2232

Adrian O’Dowd

Two thirds of doctors are uncomfortable with “privatisation” of the NHS in England and the growing role of independent sector organisations in providing NHS services, a BMA survey has found.In a report published on 18 April the BMA examined how much NHS money was being spent on independent providers, the effects of independent providers taking over NHS services, and the opinions of around 500 doctors on these issues.1

The doctors fear the fact that ‘private companies that have advised the Government on how to dismantle the old system stand to derive commercial benefits from the new one’.

A Mail on Sunday investigation, based on hundreds of official documents disclosed under the Freedom of Information Act, has revealed the full extent of McKinsey’s myriad links to the controversial reforms

Many of the Bill’s proposals were drawn up by McKinsey and included in the legislation wholesale. One document says the firm has used its privileged access to ‘share information’ with its corporate clients – which include the world’s biggest private hospital firms – who are now set to bid for health service work.

the NHS Confederation, the organisation that represents NHS managers

believes that at least 25% of patients in hospital beds could be looked after by NHS staff at home

The task of shifting public and political opinion on moving more care out of hospital is one of five key challenges for the NHS that Mr Farrar has identified for 2012. The others are: increasing efficiency and minimising rises in waiting times during the unprecedented financial pressures, dealing with concerns about the quality of care particularly of older people, resolving how to fund social care in the long term, and minimising distractions from reconfiguration and implementation of the government’s health reforms.

Health Secretary dismisses Royal College of Nursing as "grandstanding" after it warns of possible walkout at David Cameron's NHS plans

18 May 2015

Jeremy Hunt has attacked the Royal College of Nursing for its "ridiculous" threat to strike over David Cameron's plans for a seven-day NHS. The health secretary accused the nursing union of "grandstanding" after its general secretary threatened industrial action if ministers tried to cut nurses' pay for working antisocial hours in order to deliver the plans.

BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h3971 (Published 21 July 2015) Cite this as: BMJ 2015;351:h3971

ngrid Torjesen

The Department of Health for England is considering an inquiry to look at how the NHS should be funded to ensure its future sustainability, which some doctors fear could put in jeopardy a founding principle of the NHS: that it is free at the point of use.The inquiry was suggested during a House of Lords debate on the “sustainability of the National Health Service as a public service free at the point of need,” which took place on 9 July. At the end of the debate the parliamentary undersecretary of state for NHS productivity, David Prior, said that he was interested in meeting Narendra Patel, who moved the Lords debate, and “two or three others” to discuss how an independent inquiry looking into the long term sustainability of the health service might be framed. He did not think that the inquiry would need to …

Jeremy Corbyn has called for a fund to bailout NHS trusts with PFI schemes.

Corbyn has called for a fund to be established to bailout NHS trusts saddled with PFI schemes. In 2012 Lansley gave seven NHS trusts whose PFI deals were unaffordable access to a £1.5bn fund. All the deals had been negotiated under the Labour government.

Watch as a 91-year-old war veteran upstages Ed Miliband at Labour's conference with a speech that has the crowd in tears.

A 91-year-old Second World War veteran has upstaged Ed Miliband at the Labour Party conference with a passionate and tear-jerking speech on the health service. Harry Smith moved audience members to tears as he made a passionate case for the NHS and warned David Cameron: "Keep your mitts off my NHS."

BMJ 2016; 352 doi: http://dx.doi.org/10.1136/bmj.i1510 (Published 17 March 2016) Cite this as: BMJ 2016;352:i1510

Gareth Iacobucci, news reporter, The BMJgiacobucci@bmj.comWith experts assessing that the NHS is in the grip of the biggest crisis in its history, The BMJ hosted a roundtable discussion during the Nuffield Trust health policy summit this month to discuss whether today’s medical workforce is fit for the future needs of the health service. Gareth Iacobucci reports

What will you be doing on strike day? I will be the sole doctor covering the department (usually eight doctors). How do you feel about junior doctors staging a full walkout? They are fighting for a dying NHS and reasonable working conditions. This is the culmination of years of abuse. My take home salary is 10% lower than it was in 2004 but I have moved from being an senior house officer to a consultant. My contracted hours are exactly the same. Juniors today are so poorly paid they can’t hope to pay off their medical school debts for many years and buying a home is utter fantasy in London.