Margaret Ridley was born in 1948 – the same year as the NHS. At the age of 18, she went to medical school in Leeds, qualified as a doctor in her early twenties and became a consultant psychiatrist in 1985 – a job for life which she kept until she retired eight years ago.
Here in her own words she explains her experience of working in the NHS, privatisation, PFI, Hinchingbrooke Hospital and the future of the Nation Health Service.
“I’m a retired hospital doctor. I would like to discuss what has happened to the NHS since I first started working in it over 40 years ago and I would also like to discuss Hinchingbrooke Hospital.
I was born in 1948 the same year the NHS came into being. Although the post-war government had enormous financial debts it managed not only to introduce a publically funded, publically provided and publically accountable NHS but it also introduced social housing and nationalised the railways and mines.
In 1971 I qualified and started working in the National Health Service. The management structure for the NHS then was the same as that from 1948. The Secretary of State for Health was responsible to Parliament and had a duty to secure and provide a health service for all. The Department of Health managed the 14 regional health authorities which in turn managed the 160 District Health Authorities. There were clear geographic lines of accountability and money was allocated to the regions on the basis of their population health needs.
According to Kenneth Clark MP, the former Prime Minister, Margaret Thatcher did discuss in cabinet privatising the NHS and introducing an American style insurance system. However, it was decided that doing this in one fell swoop would be very unpopular and so they introduced privatisation a little at a time but later under the Blair Labour government they continued the privatisation process. The long term care of elderly patients was transferred from hospitals to private care and nursing homes. The internal market was introduced and hospitals were expected to compete with each other for patients and funds. Hospitals were encouraged to become Foundation Trusts and become independent of ministerial control allowing them to generate money from private patients and commercial backers. The Conservative government introduced the Private Finance Initiative (PFI) in which private companies funded the building of hospitals and then leased the hospital back to the hospital trust at an exorbitant rent. Initially there was reluctance on the part of major investors to get involved because they feared that if the hospital became bankrupt they would not be repaid. However, the Blair government passed legislation to protect the private investors and ensure that the taxpayer would foot the bill. The cost of building Peterborough City Hospital is £300 million and the PFI debt to be paid back is three times this. The private companies involved are often hedge funds based in off-shore tax havens.
When the Coalition government came into power in May 2010 they rapidly introduced what was to become the Health and Social Care Act of 2012. Oliver Letwin MP for West Dover author of a very helpful book “How to Privatise the World” was involved in its planning together with Andrew Lansley MP for South Cambridgeshire and former Secretary of State for Health. In the Act Andrew Lansley absolved himself of any responsibility to provide a comprehensive health service for all, by changing a duty to “provide” to a duty to “promote” health. All contracts within the health service, when they come up for renewal, have to be open to competitive tender to whoever wants to bid for them which now includes private, for profit companies. The bidding process involves a vast amount of staff time in drawing up the bids, etc. and NHS staff are at a disadvantage in all this because they are often competing against multinational companies. In 2015 a contract for Older Peoples and Adults for the Cambridgeshire and Peterborough area costed the Cambridgeshire & Peterborough Clinical Commissioning Group over £1 million pounds. The cost of the contract collapsing after only just 8 months later costed the Cambridgeshire & Peterborough CCG £12 million and then in addition to this there is the cost incurred by the other organisations involved. The first duty for private, for profit, companies is to make a profit for their shareholders. The largest cost in the health service is staff wages and so in order to make a profit from a NHS contract they inevitably reduce the number of staff, worsen their terms and conditions of service and end up converting a once skilled work force into minimum wage carers.
In 2014, Simon Stevens was appointed Chief Executive of NHS England. He had previously worked with the Labour Government introducing Foundation Trusts and promoting PFIs. In 2004 he moved to America and worked there for 10 years as vice-president for United Health, the biggest health insurance firm in the USA. One of his roles was to introduce American health insurance into other countries and he has been quoted in a newspaper article as saying that even in poorer countries there is an expanding middle class who will be able to pay for health insurance. United Health has now moved into NHS England and into the market for supplying administration services for general practice. Simon Stevens very soon introduced his 5 Year Forward View and the Sustainability and Transformation Plan (STP) which is another complete reorganisation of NHS England. It does not apply to Scotland, Wales or Northern Ireland because these countries have rejected a lot of the privatisation so far and for example do not have Foundation Trust hospitals. NHS England is now to be divided into 44 STP areas called footprints and these areas have to reduce the amount of money spent on healthcare. Hospital based care is to be reduced and care is to be provided in the community. There is not enough community based care at the moment let alone when more hospital beds are closed. Cambridgeshire and Peterborough are one of those footprints. The Health Service Journal reported that of all these 44 areas, the area which has the greatest deficit in their budget is Cambridgeshire and Peterborough. The deficit is said to be 13% of the running costs. I attended a meeting organised by the Cambridgeshire and Peterborough Clinical Commissioning Group in Huntingdon last year when we were told that hospitals were draining money out of the NHS and that Cambridgeshire and Peterborough did not have the money to fund 3 hospitals. The speaker did not say which hospital was under threat.
At the current moment only 7% of our GDP is spent on the NHS. The UK now ranks 13th out of the 15 original members of the European Union as far as health spending is concerned. France and Germany spend 11% of their GDP on their health service and so have more doctors, nurses and hospital beds.
Dr John Lister is a health journalist who has been following the fortunes of Hinchingbrooke Hospital for several years. He says that in the mid 2000s Hinchingbrooke was a successful hospital providing routine operations at below average cost. Then the way hospitals were reimbursed for operations changed to a payment by results method that should have resulted in the hospital being paid more for the work it was doing. However Cambridgeshire Primary Care Trust, who at that time had control of the budget, then started diverting patients away from Hinchingbrooke in order to reduce the budget back to its previous level. This financially destabilised the hospital and in 2011 the East of England Strategic Health Authority saw this as an opportunity to privatise the hospital. Circle Health took over the running of the hospital in 2013 which already run two private hospitals of 30 beds but they only accepted patients that were going to have straightforward operations because they did not have any intensive care units, as these are expensive. They also did not have Accident & Emergency departments again because these are also expensive to run. Circle’s contract at Hinchingbrooke was based on achieving massive year on year cost savings. The National Audit Office was critical of the contract but did not intervene. Circle had built into their contract from the beginning that they were entitled to terminate their contract if they spent more than £5 million pounds of their own money on Hinchingbrooke and it was clear for several months beforehand that this limit was being approached. They announced the termination of the contract in 2015 a few hours before the adverse Care Quality Commission report was announced which detailed the hospital as inadequate. In 2016, the hospital come back under NHS control, although still under Care Quality Commission special measures, and the Hospital Board are making progress with improvements.
Johnathon Djanogly MP for Huntingdon who has also only recently campaigned for Hinchingbrooke is concerned that the possible collaborative working between Hinchingbrooke and Peterborough City Hospital is the prelude to a merger and then the possible downgrading of Hinchingbrooke with the loss of the maternity and A&E departments. At the moment the managers of the two hospitals are discussing shared back office functions and operational services to deliver reduced costs and sustainable services. There has already been some collaborative working. We have been attending the Hinchingbrooke Trust Board meetings and have heard that the hospital has had a very high staff turnover. A human resources manager has been seconded from Peterborough and this has helped Hinchingbrooke to tackle this problem. I personally think that there are benefits to collaborative working although the marketization and competition ethos of “market reforms” make collaboration difficult. Although the managers may want to cooperate to help both hospitals, it may be that the Government has a hidden agenda to downgrade Hinchingbrooke Hospital in the future to reduce Peterborough’s enormous PFI debt.
However, there are two immediate threats to the viability of Hinchingbrooke Hospital:
The first affects other hospitals as there is a national shortage of nurses because in 2010 the Coalition Government reduced the nurse training places. There’s also a shortage of medical staff and this is resulting in the piecemeal closures of beds, wards and departments throughout the country because they do not have the staff for the departments to run. Currently at Addenbrooke’s there are only half the number of consultant cardiologists needed to run the department and so patient referrals have been reduced and a neurology ward has been closed because they don’t have enough specialised nurses. Is something similar going to happen at Hinchingbrooke? The Government’s dispute with junior doctors has resulted in doctors leaving to train and work abroad. There are apparently 300 vacancies across the country for first year junior doctor posts for the 1st of August whereas previously there would have been none.
The second threat as I have already mentioned is that Cambridgeshire and Peterborough CCG have not been given enough money to continue funding the existing services. The CCG has to come up with a STP plan by June 2016 on how to reduce the cost of the health service and will inevitably cut services. I have heard from two sources that part of the STP plan is that Hinchingbrooke Hospital will be downgraded. Throughout England, hospitals are being threatened with downgrading or even closure. The residents of Shropshire were told that they had to lose either the A&E department in Telford or Shrewsbury. They successfully opposed this closure and said that they needed both A&E departments to remain open. We need to gather support from local people to say that we want to retain all clinical services at Hinchingbrooke Hospital.”
Margaret Ridley
Retired Hospital Doctor