Monday, April 1, 2013

NHS 2013: Please Don't Cry!

It is a common practice for politicians to ignore professional advice. Sometimes they might get away with it; sometimes it led to failure, gross failure as in the case of the French attempt at building the Panama Canal.

So, please don’t cry!
© Am Ang Zhang 2012

Lith Style Photographic work.

No Public Accountability:
………As for public accountability, there is none. Commercial contracts are redacted so that crucial financial information is not in the public domain. Government departments and companies refuse to release the necessary information on the grounds of commercial confidentiality and allow companies to sequester their profits in offshore tax havens. NHS staff transferred from the public to the private sector see their wages and benefits eroded. But all this is nothing compared with what is in store for patients.

In the new world it will no longer be possible to measure coverage or fairness. Former NHS hospitals, free to generate half their income from private patients, will dedicate their staff and facilities to that end, making it impossible to monitor what is public and what people are paying for.

Market Concept:
The belief that markets distribute resources more efficiently is the basis of regional economic agreements like the European Union as well as policies imposed on developing countries by the World Bank and IMF. Britain led the way, starting with gas, water, telecoms and railways. By 2004, the whole of Whitehall was committed to putting corporations in control of what had formerly been publicly administered services. This year it is the turn of the NHS.

Loss of public control means higher cost and fewer services, as we have learned from the toxic record of the US corporations which are now part of England's new healthcare market and helped design it. Billing, invoicing, marketing and advertising will add between 30% and 50% to costs compared with 6% in the former NHS bureaucracy.

Fraudulent Billing & Embezzlement:
Patient charges will become commonplace. Fraudulent billing and embezzlement will become endemic. Take HCA, one of the largest and most profitable US chains and controlled by private equity firms including Mitt Romney's Bain Capital. In 2006 HCA International described its first joint venture with the NHS, the PFI University College London Hospital (UCLH), as "the establishment of Harley Street at UCLH".

HCA-UCLH provides cancer treatment to those who can pay from the 15th floor of the hospital. But currently some of HCA's American hospitals are under investigation for refusing care and performing unnecessary investigations and treatment, including cardiac surgery. A decade ago it paid the federal government $1.7bn to settle fraud charges, while former chief executive Rick Scott – now the Republican governor of Florida – managed to avoid prosecution.

This is the pattern elsewhere. Unitedhealth, which is currently providing services to the NHS, paid hundreds of millions of dollars in settlement of mischarging allegations in the US; Medtronic paid $23.5m for paying illegal kickbacks to physicians to induce them to implant the company's pacemakers and defibrillators; GlaxoSmithKline and Abbott paid $4.5bn in fines relating to improper marketing and coercion of physicians to prescribe antidepressants and antidementia drugs respectively. Novartis, AstraZeneca, Pfizer and Eli Lilly have all paid large fines for regulatory breaches.

The list is not exhaustive. In the absence of information and strong laws to prevent corporate crime and tax evasion, England's business-friendly environment is rapidly becoming a banana republic. Franchising is not an easy win for the public. It is a profit opportunity for big business in whose interests healthcare is increasingly being run both at home and abroad.

On PFI: 

Strangled by PFI debts and funding cuts, NHS foundation trusts compound their problems by entering into joint ventures. The great NHS divestiture, which began in 1990 with the introduction of the internal market and accelerated under the PFI programme, now takes the form of franchising, management buyout and corporate takeovers of our public hospitals. 

Virgin has been awarded £630m to provide services to vulnerable people and children in Surrey and Devon. 

Circle has been given the franchise for NHS hospital Hinchingbrooke and is now struggling to contain its debts. London teaching hospitals are merging to give them greater leverage for borrowing and cuts.

First Emperor, Animal Farm & Allyson Pollock

"Since it was Pollock's views on the PFI that so upset its proponents, it is worth summarising them briefly. Costs are now intrinsically higher, because of capital borrowing at higher rates than those available to government, because of cash hungry consultancies and the vast transactional and monitoring costs of countless contracts, and because—for the first time on a large scale in the NHS—commercial profits must be made. To accommodate all these new costs clinical services have been scaled down, while matching assumptions about increased efficiency are only variably delivered. All this, along with the rigidity of a trust based strategy for building hospitals and the locking in effect of contracts fixed for decades, seems to Pollock and many others at best a bad bargain, at worst a naive betrayal that opens the NHS to piecemeal destruction and the eventual abandonment of its founding principles. And all over the country PFIs—greedy, noisy, alien cuckoos in the NHS nest—gobble up its finances and will do so for the next 30 years.”

Next 30 years!

Ernst & Young was paid £33m for handling the administration of Metronet, the company which left the maintenance of two thirds of the London Underground in limbo when it collapsed.

The failure cost the taxpayer up to £410m, the National Audit Office also disclosed in a highly-critical report released today.

'The taxpayer has borne some of the direct costs of Metronet’s failure, including the unexpected upfront payment of £1.7bn. We estimate there has been a direct loss to the taxpayer of between £170m and £410m,' the NAO said.

The government had to shell out the £1.7bn to cover Metronet's debt obligations to its lenders, which would have been paid back over the course of the 30-year contract if the company had not collapsed.

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