1. KEEP OUR NHS PUBLIC NHS Cuts and the Health and Social Care Bill Wendy Savage MBBCh(Cantab) FRCOG MSc (Public Health) Hon DSc Co-chair KONP Sheffield 3.5.11

2. Keep Our NHS Public Launched September 2005 by NHS Consultants Association NHS Support Federation and Health Emergency and Health EmergencyWebsite www.keepournhspublic.com www.keepournhspublic.comwww.keepournhspublic.com

3. Aims of KONP To build a broad non-party political coalition which will campaign to protect the NHS from further privatisation and fragmentation To inform the media, public and MPs about the government ‘reforms’ To keep our NHS public which means publicly provided as well as funded

4. McKinsey 2009 Achieving World Class Productivity in the NHS 2009/10 to 2013/14: Achieving World Class Productivity in the NHS 2009/10 to 2013/14: Detailing the Size of the Opportunity Detailing the Size of the Opportunity basis for the Operating Framework 2010 and NHS 2010-2015: From Good to Great; Preventative, Peoplecentred, Productive NHS 2010-2015: From Good to Great; Preventative, Peoplecentred, Productive Basis of figure of £15 to £20bn savings Basis of figure of £15 to £20bn savings

5. McKinsey 2009 technical efficiency savings of £6.0 - 9.2bn found from provider costs allocative efficiency savings of £4.7 - 6.6bn due to no longer commissioning low value added healthcare interventions and ensuring compliance with commissioners’ standards savings of £2.7 - 4.1bn from a shift in the management of care away from hospitals towards more cost effective out-of-hospital alternatives.

6. Ring fenced increase for NHS? Planned 0.1% increase per year But Appleby says will be -0.25% because of inflation higher than calculated at the time inflation greater in NHS than RPI & CPI Transfer of £2.1bn over 5 years to local authorities to provide care for patients coming out of hospitals ie £0.4bn a year some stats £0.8 bn per year Increased need as aging population

7. Their conclusion We recommend a nationally-enabled programme delivered through the SHAs and PCTs to drive through efficiency savings. The DH should take direct actions to capture some opportunities e.g. lowering tariffs. And should enable delivery by creating a compelling story, removing barriers, developing frameworks/tools and embedding the drive for efficiency gains within existing mechanisms e.g. WCC.

8. Fighting the H&SC Bill Little media interest in a key factor which is to: Transfer the responsibility for the NHS from the Secretary of State for Health to a new NHS Commissioning Board. He no longer has a duty to provide a comprehensive health service in England only to act with a view to securing the provision of services.

9. Fighting the H&SC Bill Strategically they have been clever Reassuring language Flawed consultation Implementing proposals before Bill even reached parliament Ignoring chorus of dissent but

10. Increasing Protests TUC March 26 th & 1.4.11 Day of action BMJ Dr Lansley’s Monster Lancet anti BMA SRM voted to withdraw the Bill RCN passed vote of no confidence 13.4 Think Tanks reservations Lib Dems did not pass supportive motion on 13.3.11 called for amendments Some Tories have spoken out against

11. Unprecedented pause 4.4.11 Lansley announced on 4.4.11 that there would be a pause of two months to’listen reflect and engage’. Memo from DH reported 7.4.11 little change just some delay to Monitor 2012 On 13.4.11 after RCN vote Lansley said ‘ I am sorry if what I’m setting out to do has not communicated itself’

12. This is a PR exercise Has set up a ‘Futures Forum’ with about 50 people chaired by Steve Field ex Chair of RCGPs and packed with ‘yes men’. On DH website there is yet another consultation. http://healthcare.dh.gov.listening- exercise-how-to-get-involved http://healthcare.dh.gov.listening- exercise-how-to-get-involved http://healthcare.dh.gov.listening- exercise-how-to-get-involved leading questions but do go and put your responses in leading questions but do go and put your responses in

13. Parliamentary arithmetic Amendments at Report Stage Amendments at Report Stage It is possible to defeat a bill at 3 rd reading and we need 48 coalition MPs to vote against and all the small parties. It is possible to defeat a bill at 3 rd reading and we need 48 coalition MPs to vote against and all the small parties. 57 Lib Dems 21 have government positions but as proposals not in coalition agreement they can vote against 57 Lib Dems 21 have government positions but as proposals not in coalition agreement they can vote against Some Tories have expressed concerns Some Tories have expressed concerns

14. House of Lords If the bill passes at 3 rd reading then it goes to the Lords. Considerable dissent, Robert Winston, Jenny Tonge, David Owen, Nic Rea etc As most proposals were not in manifestos Commons must accept Lords amendments. Cross benchers important

15. The fight must continue These changes can be achieved without the Bill Evidence is that health care is an unsuitable service for market mechanisms Increases inequity Affects the elderly and other most vulnerable Efficiency savings can be made by abolishing the market Why should ordinary people pay for the bankers excesses and failure of government regulation of the financial markets?

16. Nick Clegg 30.4.11 Observer re NHS Bill ‘Its got to have significant changes ‘ ‘This will not pass parliament, I won’t ask Liberal democrat MPs to pass this legislation, until I am satisfied.’

17. What can we do? Let MPs know in every constituency that another ‘re-disorganisation’ is the last thing we as citizens or the NHS staff want and it won’t save money. We do not want a market which is the underlying purpose of this Bill. Abolishing the regulated market (New Labour) and the purchaser-provider split introduced in 1989 by Kenneth Clarke would save at least £10 billion a year Join &/or donate to KONP so we can mobilize people via meetings website etc

18. Published 14.4.11 The Plot against the NHS By Colin Leys and Stewart Player Merlin Press £12.95 or £10 from KONP

19. Market-driven politics 1. Real markets are deeply political-state omnipresent-national politics and the state always targets-businesses want to enter NHS 2. Convert services into commodities and workforce into one orientated to profit and get government to underwrite risk. 3. Market competition transforms commodities 4. Consequences, inequality of provision, high costs and corruption (eg US health system)

20. Further reading Colin Leys Market-driven politics (2001) Verso Allyson Pollock NHS-plc (2005) Verso John Lister Health Policy Reform (2005) The NHS after 60:for patients or profits? (2008) Stewart Player & Colin Leys Confuse and Conceal Merlin Press 2008 Merlin Press 2008 On the Brink Report for BMA London Regional Council by John Lister January 2009 House of Commons Health Committee (2010) Commissioning. Fourth Report of session 2009-10 An NHS beyond the Market report of a round table discussion download from www.bma.org.uk