The new coalition government white paper Liberating the NHS could reduce the National Health Service in England from one of Europe’s largest single employers, with around 1 million staff, to near zero by the time of the next general election.

Tens of thousands would face redundancy through wholesale cuts in “bureaucracy” or lose their jobs through so-called “efficiency savings.”

Hundreds of thousands more could find themselves effectively privatised and transferred to non-NHS employers in the biggest shake-up ever to hit this popular public service.

The NHS itself, which currently spends £105 billion, will remain in name only as a “brand,” transformed from a major public service into little more than a central fund drawn from general taxation.

This cash mountain would be used to commission a variety of services delivered by non-NHS organisations in a competitive health-care “market” in which a growing number of private providers, including multinational corporations, would be encouraged to operate.

Continued central funding would ensure that patients would mostly not be required to pay for services at point of use, preserving the illusion of continuity of the NHS, while even more non-profit and profit-seeking providers slice off lucrative portions from the public budget.

At present the NHS is divided internally into three sectors.

“Commissioners” of services operate locally through 152 primary care trusts and 10 strategic health authorities. These hold or allocate budgets for the various sectors of health care.

“Providers,” a network of local NHS trusts covering acute, mental health, community care and ambulance services, together with local community services agencies

129 free-standing NHS foundation trusts. These work outside the main NHS management structure and are accountable to an independent regulator, Monitor.

The majority of staff working in all these organisations are NHS employees, enjoying nationally negotiated pay scales and terms and conditions including sick pay and pension entitlements.

In addition around 60,000 family doctors, general practitioners (GPs), work largely as independent contractors to primary are trusts, delivering primary care to a defined list of patients. They work with teams of nursing and other staff, some of whom are employed directly by the GP practice and some through PCTs.

Several years of efforts by the new Labour government have failed so far to persuade more than a small minority of GPs to take on the responsibility of “practice-based commissioning,” in which they would shape the policies and spending decisions of their local primary care trust.

The new white paper would completely reorganise this structure. The “commissioning” bodies (PCTs and SHAs) are to be scrapped altogether with the loss of tens of thousands of managerial and administrative jobs.

The public health function of PCTs is to be hived off to local government and the Department of Health itself would be reduced to a small rump organisation.

The commissioning role is instead to be taken over by GPs, who will be obliged to participate, working through local consortia of GPs and, if necessary, forcibly incorporated into a consortium.

It is clear that these consortia would need to enlist substantial additional expertise and administrative assistance, either from former PCT or SHA staff or from private-sector management consultants who in many PCTs have been playing an increasingly influential role for some time.

But while NHS employment among commissioners is set for near-extinction by 2013, the providers too will increasingly be forced out of the NHS.

Foundation trusts, already detached from the mainstream NHS, are to be pushed even further by the white paper proposals to become “social enterprises.”

They would be encouraged to set their own pay scales and lift restrictions so they could expand provision of private medicine and their links with the for-profit private sector, “regulated the same way as any other providers.”

Health Secretary Andrew Lansley is also known to favour shifting foundation trusts “off balance sheet” from the NHS and allowing them to run as normal companies, regulated by Monitor.

This raises the prospect that new staff recruited to foundation trusts would be employed outside the NHS, its pensions and terms and conditions. Existing staff would initially have their terms and conditions protected, but there is little doubt that growing numbers of trusts would soon set about changing these contracts.

There is no escape for NHS employees. The white paper stipulates that all remaining NHS trusts are either to become foundation trusts, or be taken over by foundation trusts, by 2013, when their current legal status will be repealed.

Community health and primary care services, currently run at “arm’s length” from PCTs, would also be systematically put out to tender and either reorganised as “social enterprises” outside the NHS, taken over by foundation trusts or by “any willing provider,” whether for-profit or not.

This would be imposed on staff from above. We already know that virtually every sector of the workforce that has been allowed to vote on whether or not to join in a social enterprise has voted by 90 per cent or more to reject the idea. The hostility to private companies would be even greater.

All of these moves to whittle down the NHS to a bare minimum handful of employees will also take place in the context of the fastest and largest spending cuts in history.

Lansley’s white paper makes clear that the £20 billion target for “efficiency savings” is to be achieved by 2014, two years earlier than previously planned.

Such a massive and unprecedented squeeze on spending could only be carried through by axing tens of thousands of staff, closing beds, wards and hospitals, and massively increasing the workload of the staff remaining.

However it’s by no means certain that things will go the way Lansley expects. His apparent master stroke of handing commissioning to GPs is itself highly controversial even within the government.

The Treasury in particular attempted to prevent the plan to hand £70 billion in commissioning budgets to GPs with no managerial or commissioning training or experience.

The department’s fear is that GPs in many areas will take the line of least resistance, avoiding making unpopular cuts and closures which might antagonise their own patients – making it almost impossible for cutbacks to hit the £20 billion target.

In addition the previous track record of GP commissioning, when the previous Tory government imposed the controversial system of “GP Fundholding” in the early 1990s, was that many GPs did precisely that.

Under that system GPs held back £1 for every £6 they were allocated for patient care, leaving millions unspent. Administrative costs elsewhere in the NHS were forced sharply upwards, with an estimated £500m of additional bureaucracy as each trust was obliged to negotiate one by one with a variety of fundholding practices.

And even the new white paper admits that under fundholding the varying priorities from one GP practice to another brought a “postcode lottery” for patients, with widely varying access to health-care.

Despite this, the system is set be made even more arbitrary by the scrapping of any form of planning, along with many performance targets and any incentive to co-operate, collaborate and share best practice.

Now, as then, the apparent power given to GPs is being backed up with a blunt threat that they have to drive the cuts and rationalisation and stay within financial limits, warning that any GPs or providers that go bust will be allowed to fail in a ruthless, competitive marketplace.

On top of this threatened workload is the introduction of patient “choice,” backed up by voluminous information which will no doubt delight some of the sharp-elbowed middle classes, but will confuse and irritate many other less confident and articulate patients. Most just want to be able to access good quality care from their local NHS provider.

But it is far from clear that GPs, even if they want to, would have the time to work through the exhaustive process of offering each patient this choice of not only which hospital or provider to use but which consultant to see, let alone provide detailed studies to back it.

In London and elsewhere the pressure for “efficiencies” in primary care has been for GPs to spend less time, not more with each patient. The white paper makes this almost impossible to achieve.

Will GPs be persuaded to take on this work, which ministers have made clear would not be rewarded by any extra pay? The British Medical Association has waged a strong campaign against a market in health-care, but with GPs themselves divided on the issue it is not clear how it will respond.

The other big question is how strongly the TUC health unions will resist this root and branch attack on the jobs, pay and conditions of their members and the dismemberment of the NHS as a public service, which builds on all the worst aspects of Labour’s “reforms.”

One thing is clear. If the white paper is carried through, the new system will eviscerate the NHS, wiping out much if not all public-sector provision, and installing the untrammelled competitive market in place of any form of planning, co-operation or collaboration.

It will offer a bonanza for private providers and ring the death knell for any serious attempts to implement policies aimed at reducing inequalities in health.

It can and must be stopped.

From the Morning Star

The outgoing Labour Government instigated cuts of £20 billion in the NHS which the ConDem Government is continuing to implement. More is to come in the autumn public spending review. At the same time huge chunks of the NHS funding cake is being devoured by the privatisation juggernaut.

• The cuts will mean the loss of thousands of hospital beds, while the budgets for nursing, medical and support staff are to be slashed, implying thousands of jobs will go.
• Rental costs from ballooning PFI projects are running at £2 billion a year. £11 billion of new hospitals will cost taxpayers £62 billion; the private Independent Sector Treatment Centres are siphoning off cherry-picked work from the NHS; and primary and community care services – GP practices, district nurses, health visitors, elderly care – are being put out to tender.

It doesn’t have to happen

We are making a film, called Wake-Up Call, which tells our side of the story, one that counters the arguments that there is no alternative to the cuts and that privatisation is value for money and improves services while offering greater “patient choice”. It is intended for use by campaigning organisations and by trade unions. Popular opposition can stop them, as the campaigns to save the Whittington in North London and the Horton in Banbury showed. PFI schemes could be nationalized as many are owned by the same banks that we are the majority shareholders of. We need to keep the NHS as a service of care and co-operation, publicly owned, funded and run.

Who is involved in the production?

Dr John Lister, consultant on the film, is Information Director for London Health Emergency; Anne-Marie Sweeney is a professional documentary film-maker. Among the reviews of her films are: “A moving and inspirational account….. A must for anyone thinking trade unionism is an outmoded concept” (Margaret Prosser National Women’s Secretary, TGWU on ‘Amazon Sisters’ and ‘Needs Must’) and “I loved it! A marvellous film“ (Tony Benn on ‘Amazon Sisters’ and ‘Needs Must’); Peter Cann is a journalist and Chair of the Oxford and District branch of the NUJ; Alice Berkeley is a graduate of Ravensbourne College in London in broadcasting studies and has worked for the BBC and Channel 4; Daniella Clark has worked on documentaries and outside broadcasts.

What do we need to make this film?

To make a professional film will cost money for production costs, equipment hire, travel and specialist crew so we will need financial contributions. So far we have raised more than £2,000, with support coming in from unions. But even with much of the crew and research time donated for free we will still need to raise at least £5,000 to cover costs. We hope that your union branch recognises the importance of this film project and will contribute to its success.

Cheques should be made payable to Wake-Up Call and sent to: Wake-Up Call, c/o 111 Cornwallis Rd, Oxford OX4 3NH

Or money can be paid into this account: sort code 08-92-99 account no 65400742

PLEASE SUPPORT THIS FILM

Contact: Peter Cann on 01865 773158 or emt

111 Cornwallis Road, Oxford OX4 3NH.

GMB has written to all the 26 head teachers in Hertfordshire whose schools have been identified as having registered interest in making their school into an academy, under the government’s new school scheme as early as September this year.

GMB is seeking assurances from all these head teachers that the existing pay conditions and Pensions of GMB members who work as teaching assistants, caretakers, cleaners, lunchtime supervisors, school secretaries, laboratory assistants and in many other support roles, will be remain unchanged. It has sent copies of this letter to all our members who would be affected by any such change in school status.

Warren Kenny, GMB Senior Organiser in Hertfordshire said, “Initially the government had withheld the names of the schools which had expressed an interest in academy status but following GMB pressure we now know which these are. In all the schools which may be made academies GMB has taken immediate action to ensure that GMB members who work as school support staff will not suffer jobs, pay, hours, conditions or pension cuts as a result of their head teacher moving the school to be an academy.

It is absolutely clear that support staff, parents and governors seem to have been left out of the discussions when considering the future of their schools. We have personally requested full consultation takes place so that everyone involved can make an informed decision about what this could mean for them in the long term. Equally as important is the potential damage this could do to the educational standards in schools as any new academy will be given the option to withdraw from adhering to the national curriculum.

GMB has sent TUPE (see notes) transfer letters to all head teachers in the 26 outstanding schools targeted for fast tracking by the government with another letter to all our school based members providing them with a copy of the letter we’ve sent their head teacher. This should provide support staff with the opportunity to express their opinions too and not sidelined as initially intended.

School support staff will do the same excellent job that they have always done regardless of whether or not their school is called an academy however, setting up a competitive culture within our educational system is divisive and will inevitably create a two tier educational system. The biggest losers will be our hard working school support staff, teachers and the educational needs of our children which must always be our priority.”

The NHS white paper is an ‘untested, expensive exercise in political dogma’ that will herald greater privatisation of the health service, Unite, the largest union in the country, said today.

Unite accused the health secretary, Andrew Lansley, of backtracking on a Conservative pre-election pledge that there would be no more major reorganisations of the health service, as the white paper was unveiled.

The white paper sets out plans to handover £80 billion of the NHS budget to GPs who will decide whether the patient is treated at a NHS hospital; a private company, such as Bupa; or a charity with specialist knowledge, such as Marie Curie.

Unite’s national officer for health, David Fleming, said: ”This is an untested, expensive Trojan Horse in political dogma that will give private companies an even greater stake in the NHS – this way of operating has already happened in the USA.”

Unite said there were a number of questions that needed to be answered:

• What experience have England’s 35,000 family doctors got to undertake this vast commissioning exercise? And do they want to?
• What training and equipment will they be given when this new system – the biggest shake-up of the NHS since foundation in 1948 – is imposed on them?
• What will the increased transactional costs – both billing and invoicing – cost the health service?

David Fleming said that already GPs surgeries and health centres have contracts with third sector organisations and private companies. This could mean that private companies getting their hands on even more NHS money.

Said David: ”Billions of pounds – estimated to be £20 billion annually in England  – are already being squandered on the so-called transaction costs of the market; money that could be much better spent on frontline services.

Unite has serious concerns about the White Paper and there should be a public debate on the implications of these market-driven reforms. Why is the NHS always just one reorganisation away from perfection?

Before the election, the Tories promised no major reorganisation of the health service – within three months that pledge to the British people, the majority of whom did not vote for further privatisation of the NHS – has been broken. So much for the new politics.”

TUBE UNION RMT today secured a massive victory for low paid workers as it was confirmed today that all tube cleaners will be paid the London Living Wage of £7.85 per hour backdated to the 1st of July.

RMT has mounted a long and hard campaign for the cleaners to be paid the London minimum and the final group, the Tube Lines cleaners working for ISS, will at last join their colleagues on a decent rate of pay from this month.

RMT General Secretary Bob Crow said:

“This is a massive and historic victory for RMT and our London Underground cleaners and will come as a boost for other low paid workers right across the city. It shows very clearly that if you join a union, get organised and stand up and fight then you can win major improvements to your rate of pay.

For years we have mobilised the cleaners and mounted demonstrations – often in the teeth of the most outrageous intimidation – and today we see the culmination of that industrial and political pressure with this ground-breaking agreement on pay.

It is a tribute to the solidarity, bravery and resilience of our members and their reps that they have stood firm and won this truly inspirational victory.

We will now focus our energy on the fight for decent working conditions and facilities for the tube cleaners. With this victory on pay chalked up we move on to our demand for working conditions to match it.”

The general policy-ie. not specific to the CWU Executive Council-was overwhelmingly passed at Saturday’s South West TUC Regional Council, in a motion moved by the RMT and seconded by Bridgwater TUC. Please see the text of this after the CWU Bristol motion below.

In your trade union branch, could you use the terms and format of either motion to help us get this invitation withdrawn?

Thanks,

Dave Chapple

Bristol and District Amalgamated CWU motion:

“This Central Committee supports the motion overwhelmingly passed at the meeting of the South West Region TUC on 3rd July, which calls upon the TUC General Council to rescind its recent decision to invite David Cameron to this year’s TUC Congress.

We resolve to write to the CWU President and General Secretary, calling upon the CWU National Executive Council to rescind any endorsement of the decision of the CWU TUC General Council representative(s) to support the decision to invite David Cameron.

If the NEC hasn’t yet discussed this subject, then we ask that the decision of the TUC General Council representative(s) be NOT endorsed.

Further, that the CWU writes to the TUC General Secretary, asking that the General Council decision be re-considered as a matter of urgency.”

South West Region TUC motion:

“The South West Region TUC deplores the recent decision of the TUC general Council to invite David Cameron to address TUC Congress 2010, and asks the General Council, in the urgent interests of trade union unity against this government’s austerity measures, to reverse this invitation.”

The Communication Workers Union today (Monday) is disappointed to have to cancel the notice for the industrial action ballot in BT.

The ballot has been cancelled following legal advice which clearly outlined that under the notoriously restrictive trade union laws in the UK certain technical breaches would potentially invalidate the ballot. CWU has today received an offer from BT to meet for further negotiations and the union will take up that offer whilst taking all necessary steps to allow a re-ballot as soon as practically possible if negotiations are unsuccessful.

Andy Kerr, CWU deputy general secretary, said: “We’re bitterly disappointed that this ballot has had to be cancelled. It’s devastating for our members and for trade union rights in the UK and of course it doesn’t help to resolve the outstanding issues over pay which we have with BT.

“The legal technicalities on which this ballot has been cancelled again raise questions over the right to strike and the extremely restrictive trade union laws that exist in the UK. The law, in our view, appears to be outdated when it comes to the provision of information.

We will take all necessary steps to allow us to re-ballot our members as soon as is practically possible. In the meantime we will also be taking up an offer from BT for a meeting to see if there is a way to resolve this dispute without the need for industrial action.”

CWU has received a series of letters from BT over the past few weeks which effectively amount to a legal challenge. On taking legal advice regarding the questions put to the union by BT the decision to cancel the ballot was taken on Monday 5^th July.

We raised the need to build resistance to these polices and called for support for the launch of our Anti Cuts Committee on 29^th July, on the initiative of our trade union branch. This call was supported by the hospital workers representative from the platform. So far we have support for our meeting from the local Labour Party, Reading Shop Stewards Network (which includes trade unionists from the RMT, Unison, National Union of Teachers, and the IWW), UNITE, GMB, Greens, Socialist Party and the Campaign for a New Workers Party, as well as numerous individuals. The anger of the community activists at this meeting is an early sign that people will fight the cuts; we must ensure that we have an organisation in place to carry this fight forward.

At another recent meeting in Bracknell organised by the Socialist Party we saw more evidence of the rising tide of anger. Although fairly small in numbers it included a prominent local Liberal Democrat who was spitting blood at his Party going into coalition with the Tories and promised to support our campaign against the cuts. This Liberal Democrat asked “where are the socialists in the Labour Party”. We explained that most of them are now outside the Labour Party, fighting to build a fighting socialist alternative. There were also two workers at this meeting keen to find out how they could help to fight the cuts. One of them remembered us from the Anti Poll Tax struggles of the past. The policies of the Government have spurred them to be once again involved in struggle. I think we will see many more workers galvanised into action as the full horror of the Tory/Lib.Dem attacks on our Welfare State begin to unfold.

At the weekend I (Terry) attended the Annual Conference of the National Shop Stewards Network in London, this conference comes at an opportune time as the fight back against the Coalition Government is beginning. Speakers from Greece, Spain and Ireland gave reports of the massive movements of workers taking place around the world. The comrade from Ireland painted a picture of the future facing British workers if we do not fight. With a right wing Government slashing public sector jobs and welfare with the tacit agreement of the trade union bosses, we must beware in the UK the potential treachery of our trade union tops. The speakers from Greece and Spain reported on the strikes and demonstrations in their countries which are more advanced than in the UK at present. Calls for international solidarity were made by these comrades.

Today it was announced that 600,000 Public Sector jobs would go over the next 5 years and that unemployment could rise by 1. 5million over this period. In the Guardian of 29/6/10 Paul Krugman, Nobel prize winner, declares, “We are now in the early stages of a third depression…The cost – to the world economy and the millions of lives blighted by the absence of jobs – will be immense”. He also likened it to the long depression of the 1870′s that dragged on more than a decade, more severe than the Great Depression.

In the UK the Coalition Government are rushing into punitive attacks on the working class, slashing welfare, butchering housing subsidies for the low paid, increasing VAT from 17.5% to 20% hitting the poorest in our community at the same time giving the greedy bankers an easy ride. Not only are they threatening the feeble recovery of the economy but they are quite prepared to return the working class to Dickensian conditions, all this with the support of the treacherous Liberal Democrats.

In Bracknell as elsewhere in the UK, the work to build resistance to the cuts is a crucial necessity, it is no longer a theoretical consideration; we have no choice. As someone said the other day if we do not resist they will run all over us. We can build a movement of resistance similar to the great anti-poll tax campaign of the past, except that this time the fight will be many faceted, fought out on the picket lines and in the communities, involving many people new to politics. If we can build a fighting campaign in Bracknell, a Tory dominated Town, then such campaigns can be build in every corner of the country.

Val and Terry Pearce, Members UNITE the Trade Union, Bracknell Branch.