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Dear Supporter

The privatisation of the NHS is accelerating: 2017 is going to be a year of hard campaigning on all fronts. We hope that many of you will stand as councillors where you have local elections on 4 May. There will be a major demonstration in London on 4 March and other events. We will keep you updated throughout the year.

We thought it was time to review the many ways that privatisation is being implemented, break it down into sections, including the ways that might not be so well known. We hope this will help campaigners understand the complex issues facing us all when reading the Sustainability & Transformation Plans which will form the context for all our campaigning.

The focus of this newsletter is the commercial exploitation of the NHS 'brand' and the private patient income the hospitals are generating. We include a Freedom of Information request which we would very much like you to send to your Trust or Foundation Trust then forward the response to us at contact@nhaparty.org. It will help us build a more accurate picture of what is going on in the NHS which becomes more obscured the more it is privatised.

Thank you

Deborah & Jessica
NHA Campaign Team


Will you send a Freedom of Information request to your local Trust(s) to help us develop a picture of the extent of these changes detailed below? You simply write by email or post to your local trust using the following letter template. Make sure you include your name and address. 

Dear (name)


Freedom of Information Request

The Health and Social Care Act (2012) section 164 allows Trusts to earn up to 49% of their total income from non-NHS sources, including private patients. If your Trust provides private patient services, please supply the following information.
  • 1a How many beds did the Trust have for NHS services in 2012?
  • 1b How many beds does the Trust have for NHS services in 2017?
  • 2a How many beds did the Trust have for private patients in 2012?
  • 2b How many beds does the Trust have for private patients in 2017
Thank you

Yours sincerely,

etc

Privatisation #1 How private patient income is expanding in NHS Trusts

An article in The Times on New Year's Day 'NHS in dash for private cash' reported that the Royal Marsden in London will earn 45% of its income from private patients and other non-NHS sources this financial year and wants to raise its income from private patients to £100m.

The Coalition's Health and Social Care Act (2012) removed the limitations on private patient income previously imposed on Trusts, but in order to soothe Liberal Democrat fears about the clear expansion of privatisation they created Section 164.

"An NHS foundation trust does not fulfil its principal purpose unless, in each financial year, its total income from the provision of goods and services for the purposes of the health service in England is greater than its total income from the provision of goods and services for any other purposes."

This is the '49%' rule which means that almost half of an NHS Trusts' income can be earned through the private patients and non-NHS sources referred to in The Times article. The 'dash'  is very uneven, with some Trusts generating large amounts and others none, or seemingly none, in some cases.

In August 2014, a little over a year on from the implementation of the Act The Guardian reported that private patient income was increasing in what was seen as 'creeping privatisation'.

Here are the comparisons given in that article with an update from the accounts for the year end March 2016:

Trust        2010-11       2013-14    2015-16

UCL         £7.3m         £10.3m       £21.4m
Moorfields £16.1m     £21.3m       £23m
Papworth  £4.9m        £6.4m        £7.45m
Royal Surrey £3.6m    £4.6m       £4.9m
C'sea & Westm'r £10.7m £13m   £17.4m

Some of the largest private patient incomes shown in the March 2016 accounts are in London Hospitals; the Royal Brompton is just over £39m, Moorfields is £23m as above, Great Ormond Street is £47.88m and the Royal Marsden is £83.1m.

Some Foundation Trusts have set up their own private companies within the Trusts, which compete with the traditional private sector for their clients, often boasting that their service benefits from its close working relationship with the established NHS hospital with which it is associated.

The Westminster Unit of Guys and St Thomas' Private Healthcare, for example, starts the introduction to its services with "The Westminster Unit is available to private patients, assuring them of expert clinical care in comfortable surroundings, secure in the knowledge that all the technical expertise of Guy’s and St Thomas’ NHS Foundation Trust is available should it be required." (our emphasis).

Almost all of the Trusts which offer private healthcare claim that the income from their private patients is used to support their NHS services. But it seems likely that the reverse is true, as Trusts must divert resources towards those who can pay.

One trust which shows no private patient income on the March 2016 accounts is The Christie in Manchester. The Christie set up a joint venture in September 2010 with Health Care of America (HCA) which means that the income the Trust receives is shown as profit share rather than income from private patients.

The Christie is also one of two specialist cancer centres which will run proton beam therapy units. These are paid for from government funding of £250m with an additional £20m in charity fundraising. This raises the question of whether the Christie/HCA private patients will also have access to this treatment. And if so, how will it be accounted for? What are the true costs to the NHS of offering these expanded private services?

With increasing waiting lists for treatments across hospitals in England, with the double shock last week of the deaths in the Worcestershire Royal Infirmary and the Red Cross being called in to respond to the 'humanitarian crisis' in the NHS, these are questions which need urgent answers. It isn't just about the money received - it is a question of the use of resources. Doctors, nurses and other clinical staff are required for these expanding private facilities whilst the NHS services literally next door in most cases struggle to fill their rotas.

NHS England proposes to give preferential access to capital funding to those trusts that beat their financial targets. We think it likely that the Trusts which are most successful at expanding their non-NHS income will then, paradoxically, become eligible for the most additional public funding - through Transformation and capital funding.
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If you wish to see the full list of accounts published by NHS England for the year end to March 2016, you can download the excel spreadsheet here.
The BBC broadcast 'Inside Out London' yesterday at 6pm which focused on the NHS. It was disappointing to see Dr Ranj Singh - who many parents will know from Cbeebies - say 'is a revenue stream now generating nearly £300m a year in London alone actually an essential asset for an institution calling out for money, or will it, as others fear, lead to a two tier system where those who can't pay are increasingly left behind?'

He also discusses the private income streams with Prof. Allyson Pollock and points out that the Homerton in East London has doubled its private income in 5 years from £500,000 to £1m. Prof Pollock points out that it is the resources needed to staff and maintain the private provision that is draining the NHS, which is not compensated for by the private income stream. 

The images that accompany this section of the programme do include a shot of the Royal Marsden - but surely it is the Marsden and Great Ormond Street which will bring the shock of these figures home to the viewing public, so why not use them?

Inside Out London, 16/01/2017: www.bbc.co.uk/iplayer/episode/b088p2n5 via @bbciplayer
Have you heard about Healthcare UK the 'International' NHS? Not the sarcastic name which is used by those who believe health tourism is undermining the NHS but the real thing. The NHS is now a global competitor, selling its 'trusted brand' across the world, in selected markets. It is sickening to read its publicity brochure and annual reports extolling the virtues and success of the famous NHS model of health whist we have patients dying on trolleys, being denied care according to a postcode lottery and the 'transformation' to a US style system well under way.

Here is a quote from the blog of the CEO of Healthcare UK, the global marketing arm of the NHS, about last year's International Expo "We hope to show not just why an NHS organisation, be it a large acute hospital or a small community care provider, should consider international work, but exactly how they might go about it and learn from others already out there and doing it. One good example of this is the joint session between the Department of Health and NHS Improvement, which will look at how the NHS is already generating commercial income and how the centre can best support others to do the same."

All these steps making the NHS commercial, a global competitor, earning private income to subsidise the public sector end inevitably in the creation of a two or three tier service. This is the return to the pre-1948 concept of healthcare for the poor as charity. The NHA is fighting against this. The NHS should be for all, equity is its foundation stone, not charity. An ideological commitment to a publicly funded NHS does not require private income streams.
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