Friday, 26 April 2013

NHS Commissioning: Why You Should Care

One of the reasons the government have had an easy ride over its plans for the systematic looting of the NHS by Tory-friendly private health companies is the sheer complexity of their restructuring. Unlike, say, the Department for Work and Pensions, where there is a single bureaucracy responsible for administering a particular public service and a clear line of accountability stretching from the job centre complaint form to the Secretary of State. It's not a perfect set up by any means, far from it. But to use a well-trodden phrase, you know where you stand. The NHS on the other hand was transformed into a patchwork of semi-autonomous, competitive trusts and hospitals under the Blair/Brown governments. As of the beginning of the month, matters have taken an even more retrograde step. The trusts have gone and in their stead are hundreds of GP-led Clinical Commissioning Groups. It is the role of these organisations to buy in (commission) NHS services from any number of public and private providers. So, while treatment is free at the point of need in the vast majority of cases - for the moment - a new health market underpinned by the taxpayer is the mechanism for its delivery.

The idea on paper isn't entirely without merit. As a socialist who would like to see more democratic decision-making in the NHS led by patients and staff, the devolution of budgetary responsibility to CCGs theoretically brings resource allocation closer to the public. And more opportunities exist to link NHS spend to the public health strategies of local authorities to address the particular needs of their areas. But that's as far as the commendation goes. Because in North Staffordshire we have seen where letting the market in could leave NHS services, and it isn't pretty.

I doubt many readers will have heard of Turning Point. They are a self-described social enterprise run by Lord Victor Adebowale, who was gonged in 2000 and ennobled the following year for his work among the unemployed and the homeless. Reflecting his record, Turning Point, which he has led for the last 12 years, specialises in assisting recovering alcoholics and drug addicts, the mentally ill, and vulnerable people with complex needs. Exactly the sort of worthy-sounding not-for-profit I think most people, whether they like the CCG commissioning model or not, would be relaxed about providing NHS services.

Unfortunately, amid the beaming faces and success stories plastered all over their website a reader will find nothing on today's strike action by their Stoke-on-Trent and North Staffordshire employees, nor the bitter dispute it has foisted in its 2,600 staff. Under the previous system of commissioning, Turning Point were contracted to run residential services for patients with severe learning difficulties and other complex needs. But, as John Gray notes, Turning Point are determined to make sure the workers they "inherited" from the NHS are re-engaged on far worse terms and conditions. The employer seems determined to trample all over transfer of undertaking (TUPE) protections, including redundancy rights. They are refusing to negotiate with their nominated representatives from Unison, despite their role being one of the protections backed by the law via TUPE. I have also been told the original decision by the dearly departed commissioning body awarded Turning Point the contract on the understanding existing provisions would be honoured.

The terms Turning Point want to impose include cuts to overtime pay, out-of-office payments (sleep-ins, on-calls), the removal of enhanced redundancy terms, end to unsociable hours’ payments and the disregarding of existing pay agreements and incremental structures. In sum, a number of workers could be out of pocket to the tune of £10,000/year. Quite how a charity with a 50 year track record of helping the most vulnerable thinks it can deliver a responsive, sensitive and professional service by treating its staff so despicably is beyond me.

Without a clutch of shareholders to satisfy and a very healthy turnover (£70m in 2010), you have to ask why a charity is hell-bent on bulldozing workers' rights? It is worth noting last year Lord Adebowale was paid £165,000, and his three assistants shared between them £473,000. For some, charity really does begin at home. What's going on? Is Turning Point accumulating capital so it can splurge on CCG contracts? The truth will out.

While this contract was granted before the Tory reforms, the proliferation of CCGs means the exponential multiplication of disputes of this kind. Collectively, hundreds of thousands of workers presently employed by NHS organisations could see their pay and job security peeled back. You don't need me to spell out what this could do to staff morale, patient care, service quality and workers' collective spending power. And, of course, taxpayers' money released from providers chopping into staff this way will not be returned to the CCG - it will go into the service provider's pockets. It's horrifying.

On the upside, the government will be able to pretend it's created more private sector jobs.

If Turning Point get away with raiding their staff this way, other providers will follow suit with all the consequences that entails. They must be stopped.

Messages of support can be sent to There is also a video from today's Turning Point strike rally at their Manchester HQ here.

1 comment:

Anonymous said...

This is the second part of the transition to private health care, a multi-tiered system. The wealthy are well cared for and the poor are shafted. The first transition was under New Labour. A much neglected fact is that parts of the health service, those that affect the poorest the most, have been brought into Local Authority control from the NHS. Why? So governments can more easily cut these services, because cutting local authority spend does not grab the headlines that cutting the NHS does. And even while cutting health provision they can claim to be increasing it!