Current government proposals to reverse the 2012 Health and Social Care Act have been hailed by some quarters as a shift away from the marketisation of the NHS; but doctor and author Youssef El-Gingihy says the proposals likely to represent the next step towards further privatisation of the health service.
Dr Youssef El-Gingihy, who works in a GP surgery in Oxfordshire, having transferred from Tower Hamlets after a decade of practice in London, authored the book How to Dismantle the NHS in 10 Easy Steps: The Blueprint That The Government Does Not Want You To See. Dr El-Ghingihy reviewed the UK Government’s White Paper on proposed changes to the NHS for Sputnik and explained that he doesn’t see a “massive U-turn” from the policies of prior governments but rather a continuation of the steady process of privatisation.
Sputnik: Briefly explain the key aspects of the proposals in the White Paper, in respective of changes to the NHS, that has been published by the current Tory government, including plans to reverse Health and Social Care Act 2012.
Dr Youssef El-Gingihy: So, I think that the key proposals are, as you pointed out, reversing the competition element of the Health and Social Care Act and presenting the Health Social Care Act as a failure, essentially. On the surface, that seems quite attractive.
I mean, there’s the introduction of integrated care, but that’s something that we’ll come to later, it’s been in the pipeline for some time now. Integrated care, superficially, nominally, would mean that various parts of the NHS or social care or councils, local government, would basically work together in an integrated or coordinated way. That’s what it’s been sold as. So, who can argue with that, right?
Sputnik: Is there anything else beyond that?
Dr Youssef El-Gingihy: Other aspects in terms of reversing the Health and Social Care Act, they would presumably abolish the clause about how previously the Health Secretary had a duty to provide and promote NHS services and that was abolished by the Health and Social Care Act and devolved to the quangos such as NHS, England. Which is why someone like Sir Simon Stevens, chief executive of NHS England, had a lot more power than perhaps previous heads of the NHS.
Sputnik: So this would reverse that?
Dr Youssef El-Gingihy: Well, they’re saying that yeah, the government now and the Health Secretary will therefore have a lot more power to be able to directly manage the NHS day-to-day. So that, basically, would supposedly return you to pre-2013 [before the Health and Social Care Act came into force], essentially.
I mean they’re thinking about weakening foundation trusts. So, I haven’t quite got to the bottom of what that means really, it’s a bit odd, because foundation trusts are something that has been pushed for the past 15 years or so.
Sputnik: The foundation trusts were introduced by Tony Blair’s Labour government?
Dr Youssef El-Gingihy: Yeah, yeah, by New Labour. So, that basically meant turning hospitals or NHS trusts into semi-independent businesses, with the ability to make partnerships, to make ventures, to kind of go global. So you now have Moorfields Eye Hospital in Dubai, [for example].
Sputnik: And the proposals speak about perhaps scaling back the power of foundation trusts?
Dr Youssef El-Gingihy: Yeah. That’s what I understand. I’d have to go into a little bit detail on that [and investigate further]. One of the things they’re talking about is also capitated pay budgets. So putting a ceiling on how much the budget would be, presumably, for a foundation trust or for another NHS trust.
Sputnik: As opposed to what is it currently?
Dr Youssef El-Gingihy: Yeah, it’s a good question. I mean, I guess with 10 years of austerity, it’s hard to say how different that is, but I guess previously the idea would have been that you would try to provide a budget according to, – certainly in terms of the original concept of the NHS – the needs of the people, according to the health and social care needs of the population. So by basically putting a limit on the budget and you’re saying that regardless of the needs of this population, that will be the budget.
Sputnik: So, originally with NHS each region, there’s a formula that would be used, and that was a formula that was agreed by government, it looked at the population size and the needs of that particular population and fund an area accordingly. Is that right?
Dr Youssef El-Gingihy: Yes.
Sputnik: But the point is, instead of basing it purely on the formula, this White Paper is saying that actually there would be a cap regardless of the needs of a region?
Dr Youssef El-Gingihy: I’d have to say, my expertise doesn’t extend to understanding exactly how they would, and perhaps they haven’t really fleshed this out, how they would actually calculate this now. But the implication is, which they’ve been talking about for some time, that you would put a cap. Yeah. I imagine there still would be differences in funding for each area, depending on the age of the population, levels of deprivation, etc.
Sputnik: If these proposals are implemented, as far as we understand them at the current stage, what are some of the kinds of practical changes we could expect be they positive or negative?
Dr Youssef El-Gingihy: I think kind of the changes that will happen will be what’s called integrated care. I think the key point here is that integrated care is being sold as integration, but it’s really a US healthcare concept and it’s also known as accountable care and managed care. So in the US this is about getting various groups or organisations to work together, supposedly by coordinating together, that incentivises them to make savings, they call it savings. But I guess really another way of describing that is profits, which you get to keep, presumably, if you’re United Health or whatever. So that’s kind of where the two concepts crossover, in other words, what they’re selling it as and what the reality will be.
What we’re looking at is basically large, 10-year, regional multi-billion [pound] health and social care contracts to run the NHS. Previously we had 211 CCGs (Clinical Commissioning Groups) from the Health and Social Care Act, right? So these are being consolidated into these 44 STPs (Sustainability and Transformation Partnerships). In other words, in each region where there used to be multiple CCGs, what we’re going to have then is one organisation which will be responsible for running the health and social care in that region. Right?
So the whole of England would have 44 of these and then they will obviously then subcontract to other parties. This is the White Paper so we will have to wait for the actual legislation. But thus far, with the integrated care proposals that were previously put forward, the worry was that there was going to be no legislation, that this was just going to be implemented by fiat and without parliamentary scrutiny and without statutory protections that would state whether organisations having to run these regions would have to be NHS.
So it could easily be that you’d handed over this 10-year, multi-billion contract to Virgin or United Health. In fact, in bringing about this transitional phase, not quite the finished product, but the transition, to integrated care, some of those contracts were handed to private companies. So, [US health insurance company] Centene and Capita bring about that transition towards integrated care in Nottingham. You probably have read about the recent story of how a whole train GPS in London have been sold to Centene. So this is all happening, you know, by stealth, isn’t it?
Sputnik: You mentioned eliminating the competition introduced under the Health and Social Care Act, is there a positive aspect within these proposals?
Dr Youssef El-Gingihy: That’s very important point. What the Health and Social Care Act did, it obligated the CCG’s to effectively tender out contracts when they expired. Maybe not all, but significant numbers, if not most, services. So we saw a doubling of private sector outsourcing for frontline services as a result of the Health and Social Care Act from about four to eight per cent. I think that under emphasises the extent of privatisation a little bit still it’s still a significant amount, isn’t it?
But when they’re talking about reversing competition, I guess one of the concerns would be that those contracts would just be awarded, there wouldn’t be a competitive tendering process. So when you say, ‘Oh, we’re reversing competition, isn’t that wonderful, that sounds like it’s the reverse of marketisation’, actually, from my point of view, you could argue that’s a consolidation of privatisation because you’re suddenly going to award a contract for South London or Southeast London, and is there gonna be a tendering process?
Is there going to be competition? It doesn’t sound like it. Unless there is something in the legislation that specifically states that the NHS would be the preferred provider, which would obviously be preferable to the status quo. It still wouldn’t be perfect, but it would be a step in the right direction. But I don’t see that happening.
I think this isn’t some new, massive U-turn, that’s just PR. This is something that they’ve been talking about [for quite some time]. When I wrote my book How to Dismantle the NHS in Ten Easy Steps, in the new edition in 2018, there’s a whole chapter on all of this stuff. So this isn’t anything new. If we want to ask ‘why now?’ the answer would probably be that things, under the cover of a crisis, that would otherwise not be palatable, can be rammed through whilst NHS staff and others are perhaps more busy than ever.
Sputnik: Is it possible that difficulties in dealing with the pandemic has caused the government to think differently about the way to go forward in terms of healthcare?
Dr Youssef El-Gingihy: No, no. I don’t think there’s any indication that they are thinking differently. I don’t see anything from the behaviour of [Health Secretary Matt] Hancock, Johnson, Stevens, or any of the interests behind them to indicate that. Not when we’ve had a 22 billion pounds, Test and Trace fiasco that’s gone to Deloitte and then subcontracted to Serco and Sodexo and all those people. You could say, ‘Oh, well, they’ve learned the lesson from that’.
I doubt it because that kind of massive outsourcing has been going on for several decades. We’ve had the same with the kind of massive NHS IT supercomputer fiasco. Again, it was a management consultants fiasco, that was 10 years ago. So, we’ve had it with PFI. We’ve had it with Carilion. We’ve had loads of outsourcing scandals, in GP out-of-hours contracts with Serco and Virgin.
I don’t see how a bunch of individuals, but more importantly, institutions and corporations, whose very existence depends on being signed up to do deregulated free market capitalism, [are suddenly going to be the] conduits [for a radical shift in policy]. Boris Johnson, Matt Hancock these are all completely signed up to this ideology.
Marketisation and privatisation has been a cross-party programme running for decades, by Conservative, New Labour and Lib Dem governments, enforced since the 80s. This is just the latest manifestation to accelerate it. It’s not about a single person, be it Boris Johnson or anyone else. The only person who broke from that consensus was [former Labour Party leader Jeremy] Corbyn.
*This interview has been edited for concision and clarity