Coming to an SHA near you – CATS, ICATS, ISCATS…how long till the NHS disappears in your region?

Prof Janet Wilson, Consultant ENT surgeon in Newcastle upon Tyne, contemplates the reconfiguration from NHS to NHI – national Health Insurers

Enjoy the freedom to read this missive, comrades – such commentary from NHS employees could soon be a thing of the past. Not, of course, that free speech is under threat, merely the NHS. It does remain rather mysterious to me, (q Edinburgh, 1979) that so much privatisation has been achieved by the good comrades, with so little protest. I should have been warned, however, that the death of the NHS would not elicit calls of protest – far less a state funeral. I should have better understood the lack of interest – far less protest – when comrade Reid advised that the poor should be allowed to smoke, having so little else. I should have registered when comrade Hewitt sanctioned the totally private management of the Lymington New Forest Hospital by the Partnership Health Group. I should have read more carefully the KONP booklet – ‘The Patchwork Privatisation of our Health Service: a Users’ Guide’.

But I did not comrade, I did not. Last autumn, we asked is it too late to save the NHS? Now, there remains only one question: Do we still have a National Health Service? Sadly, thanks to the tireless efforts of the DoH comrades, in some areas the answer must be no. But if you are reading in an area of healthcare provision not yet effectively ‘reconfigured’ – it may not be too late. Especially if your Party representative is one of those cabinet comrades who object to reconfiguration of their local compound. We salute woman comrade Blears whose protest is an altruistic act of faith on behalf of her constituents (quite unrelated to her job security). Women are indeed useful in this regard, as we are in general higher users of healthcare services, live longer and have more need of elderly care. We are also, conveniently, less politically active, allowing the leading Department of Health citizens to focus on targets for the more able male voter. The rapid disuse atrophy of voting and the imminent demise of democracy itself will allow the Party full, unopposed privatisation as chief citizen Cameron wants to ditch NHS provision just as much as President Blair.

Thus while ‘depoliticisation’ was once the great hope of NHS workers, now, too late, we realise that beyond Party headquarters lies not Narnia, but that weary tundra of Netcare landscape. Is the gift of the NHS cash cow to the South African Netcare a public act of reparation by President Blair for the wholesale poaching of a continent’s nurses?

What does it all mean for UK healthcare?


The sums passed into private hands are stratospheric to mere directorate budget holders. The desperation to shrug off the NHS as a service provider and metamorphose into mere service purchaser is so great that tens of billions of pounds have been spent on PFI initiatives, inducements, choose and book, IT, all well documented in the recent KONP publication. The impact of competitor services is not just direct revenue loss, but also mammoth bleeding of resources into these underpinning developments. David Nunn, consultant orthopaedic surgeon at Guy’s and St Thomas’s has broken cover on the hopelessness surrounding the NHS tariffs, which so undercut operational costs as to represent the most obvious destructive weapon as the DoH guns down the NHS. Doubly demoralised, NHS workers are left not just short of equipment, beds, drugs and operating slots, but ridiculed by Party members for taking oodles more money for far less activity. Of course, the Party is not going to all this trouble just to humiliate us. Why on earth would it bother? Rather, it has proved vital to create this cash crisis, which can act as a systems amplifier, and justify calls by lead privatiser Nicholson, for managers not to ‘shy away from major service changes that address financial difficulties.’ [While secretary Hewitt stands on the sidelines, like the mother of the recently celebrated 14 stone eight year old, quoted ‘Well, I must love him, mustn’t I, because I am giving him all this food…’]

Service provision

The North West model of ICATS covers Carlisle, Barrow, Lancaster, Blackpool, Birmingham and Burnley. Manchester’s central teaching hospitals are very likely to survive, but for much of the population we seem to be moving back to a system uneasily close to the GP tonsillectomists of yore. The general public has not been slow to assimilate some of the implications of gifting the NHS cash cow to Netcare. Secretary Hewitt was challenged recently by the decision to set up an ISTC in Bristol, and the lack of consultation. The patient, Rebecca Fudge, who made the challenge is obviously an ‘old democrat’ Party member and does not yet understand the new labour regime, where consultation after a contract has already been sponsored and agreed by the DoH is the norm. Also, any such consultation , as in the North west of England must be completed in days, if at all possible, not weeks. After all, since many – if not most – of the public have abandoned the habit of voting, democracy too can be reconfigured to meet the goals of the minority. Ms Fudge must await judgement on 27th March as to whether this case will proceed – let us hope that citizen Goldsmith, does not destroy his minimal residual credibility by directing the judge to find against her.

Is all lost for the provider NHS? Ironically the Party is a victim of its own targets at this critical time, when all is said and done. As the new private consortia come on line, they are exposed by the prior meeting of said targets by existing NHS providers. It is a great credit to the application and persistence of the NHS that it could manage, against the swells of bureaucracy, to beat an ISTC. Red stars to the University Hospital of North Staffordshire NHS Trust. Pity poor Graham Urwin, whose Stoke PCT is thirled to Nations Healthcare for another three years. For the same University hospital is now so impoverished that its plastic and reconstructive surgery patients must wait for 20 weeks, despite idle theatres and surgeons. Colleagues elsewhere report MRI machines at a standstill, while the radiology waiting room throngs with patients using the department as a passageway to the Alliance portacabin out in the back

For most trusts, therefore, the loss of business to CATS, ICATS and ISTCs, coupled with spiralling bureaucracy has led to under-funding of front line services. Sadly, so complete has been the indoctrination that even those expressing horror at the speed of privatisation, like the chair of Cumbria’s Health Scrutiny committee, see it as a ‘quick-fix solution’. But to what problem precisely, did Lancashire GP, David Wrigley see privatisation as the answer? His comment – it ‘hasn’t been a level playing field’ hardly does justice to the process.


While the NHS engaged a flexible culture of interdisciplinary working, the replenishment of service providers, be they physicians, surgeons, surgeons assistants, nurse endoscopists or physiological measurement technicians, is critically dependent on a strong and progressive national training network. The loss of high volume activity from the remaining few major hospitals leaves a residue of complex cases totally unsuitable for training all but the most superspecialised minority. How dire is the Party record on the organisation of health education!

As part of the modernisation agency – now disbanded, in 2003, it launched the NHS University –with an annual budget of tens of millions (£38m from DoH; £37m parliamentary funding). The next year, more than £150 million later, the NHSU was axed. Many even in the NHS had never even heard of it. Little wonder ‘extra money’ has achieved less than hoped for in service delivery!!

Undaunted? unheeding? uncaring? – the Party plans, nonetheless, to train at the barefoot doctor level – i.e. capable of implementing Party protocols, and has set up a model institute in South West England. Strangely, while the public seem more extended about the influence of Tesco on the High Street, and Parliament about the privatisation of the probation service.

However, the Party does not concern itself much with training as it is a longer term exercise than the length of any one parliament. A very expensive exercise, better outsourced to the EEC. If the trainee numbers should swamp the limited training options offered by CATS / ICATS – the push of a single button will delete the whole lot from MTAS and no-one will be any the wiser. Meanwhile the trainees themselves will undertake an old Labour-style historical protest pageant on 17th March from the RCSEng

An estimated 3200 accredited medical specialists will have no consultant post by 2008-11. Already in ENT, a small speciality with fewer than 500 consultants, over 20 accredited surgeons are without a consultant post. The intention is to force down employment conditions, drive out staff to the private companies, and take the pressure off the NHS pensions bill. Many of this highly intelligent young cohort may opt for fully independent practice in chambers. Not one of David Nunn’s orthopaedic Guy’s and Thomas’s CCT holders has a consultant post – and no doubt they will survive very well in the private sector, serving those well enough off to afford to pay private healthcare insurance as well as their NI contributions.

Should the public accept this double billing? Or will they soon realise once the NHS has fully mutated into NHI – National Health Insurance, once all that is left of is a consortium of entrepreneurs, purchasers, and no providers, they would be better off ditching the middle men and going for a fully private system? That would be good news for the Party, good news for the orthopaedic SpRs, and good news for those leasing chambers in Harley Street. Not quite so good for Netcare, admittedly – but no doubt they will reconfigure marvellously from their privileged position. No losers then………….

And the dissenters? Well, they should have thought about that when they forgot to vote, shouldn’t they? The passing of the NHS could only have followed the death of democracy itself. Mourn not for Barbara Castle – she is long gone, , and Diane Abbott sits cosy on the couch, touching arms with Michael Portillo.

But let’s not dramatise. Most folk will be all right. Well – the poor, the chronically sick, those whose illness needs major research developments, the elderly. They might be losers. Yes, it osers. Yes, be any of us one day. Yes, we did all come in to the NHS to help them. But the NHS – well, that no longer exists.

2007 – President Blair’s final tableau from a life dedicated to the Law of Unintended Consequences – NHS RIP. Long live NHI.


Consultant ENT Surgeonant ENT Surgeon

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