NHS: what we’re up against

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Greg Dropkin, Keep Our NHS Public
Speech to Save Liverpool Women’s Hospital demo, 7 October 2023
First published labournet.net 9 October 2023

The NHS is being privatised. To illustrate how, I’ll focus on two companies: Optum and EMIS Health. The Competition and Markets Authority has just authorised their merger, with Optum buying EMIS. Optum is owned by the biggest US health insurance corporation, UnitedHealth, with an annual turnover of $324 billion.

UnitedHealth has been fined over $1.1 billion for 374 violations of US laws. Optum paid Ohio $15m for overcharging the Workers Compensation Board for generic drugs. California and Arkansas are suing Optum and other Pharmacy Benefit Managers and pharmaceutical companies for wildly inflating the price of insulin.

Here [in England], Optum has contracts with at least 19 Integrated Care Boards, and EMIS, formerly Egton Medical, has 30. Cheshire and Merseyside ICB pays Optum for prescribing software, and EMIS for primary care hardware and software. EMIS manages patient electronic records in GP surgeries, community and hospital pharmacies.

The merger means UnitedHealth subsidiaries will be active all across England, including in medicines management. The US parent could also gain information derived from patients’ confidential medical records.

Optum and EMIS are accredited under an NHS England scheme to fast-track firms to develop integrated care. Contracts can be dished out to pre-approved companies. Optum’s accreditations include ‘sharing structured medications data for uses such as population health management, medications reconciliation, and decision support’. That’s despite Optum being sued for rigging the price of insulin, and overcharging for generic drugs.

Meanwhile, the notorious management consultancy PwC with a string of fines for accounting fraud, advises Cheshire & Merseyside on how and what to cut. In their first year, Integrated Care Boards spent at least £6.4bn on private companies. NHS Trusts funded by ICBs have their own private contracts. In our region, around 27% of the ICB budget ends up with private firms, either directly or via the Trusts. North East and South East London are even worse.

How did we get here? Back in 2014, the Coalition Government appointed Simon Stevens as NHS England Chief Executive. With no mandate from Parliament, NHS England introduced Accountable Care Systems based on a US funding model promoted by health insurance firms and consultancies including UnitedHealth and PwC. In 2018 it rebranded them as Integrated Care Systems.

Last year, the Health and Care Act legalised what NHS England had already done. Systems have their own budgets, set using a Payment Scheme which can vary for different areas, providers, or types of patients. Private companies are consulted on the details. The national health service is broken into 42 pieces. By destroying the national NHS economy, this could threaten national pay, terms and conditions, or staffing levels.

Before Stevens was appointed to run the NHS, he was president of UnitedHealth Europe, CEO of its $30 billion Medicare business, and president of its global health businesses. Before working for UnitedHealth, he advised Blair.

We all want the end of this vicious Tory government. But where is Labour? From Thatcher onwards, all governments have damaged the NHS. Most PFI hospital schemes, including the Royal Liverpool, were signed off under Labour. Blair’s government changed the rules on ownership of GP surgeries, enabling UnitedHealth and later Centene to take them over. Independent Sector Treatment Centres were paid even if no treatment was given. Some clinical services went out to tender.

When the banks collapsed in 2008, Gordon Brown asked the US management consultancy McKinsey how to cut NHS spending. They said massive efficiency savings, dropping certain NHS treatments, and moving services out of hospital could save £15-20 billion per year. When Labour enacted their plan, the NHS funding crisis began.

Labour disowned Blair for invading Iraq, but never repudiated what Blair, Brown, Milburn, Reid, and Hewitt did to the NHS. With rare exceptions, Labour accepts or embraces the current fragmented and part-privatised landscape. But it’s a disaster, and it’s not what we want. We want the repeal of the Health and Care Act, and the NHS restored as a national health service. We want comprehensive, universal healthcare, publicly provided, publicly accountable, fully funded through progressive taxation, free at the point of need, with decisions on treatment taken on clinical grounds without regard to ability to pay. That’s what we want, but whether we get it depends entirely on whether patients, healthworkers and trade unions stand up to fight for it. I hope we’re ready.

Greg Dropkin, Keep Our NHS Public

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