'No NHS in England from 2013'. Is there anything we can do to save it?

[Solopower]

'In 2012, parliament in England passed a law effectively ending the NHS by abolishing the 60-year duty on the government to secure and provide healthcare for all. From 2013, there will be no National Health Service in England, and tax funding will increasingly flow to global healthcare corporations. In contrast, Scotland and Wales will continue to have a publicly accountable national health service.

NHS hospitals and services are being sold off or incorporated; land and buildings are being turned over to bankers and equity investors. RBS, Assura, Serco and Carillion, to name but a few, are raking in billions in taxpayer funds for leasing out and part-operating PFI hospitals, community clinics and GP surgeries that we once owned.'

Allyson Pollock in The Guardian.

Well I'm scared. Life is going to get so much harder for the vast majority of us. I'm grateful to people like Pollock and Dr Mark Porter for trying to alert us to what is happening, but what can we do about it?

www.guardian.co.uk/commentisfree/2012/aug/27/nhs-privatisation-toxic-world-healthcare

Things DID need to change. There was massive wastage and terrible management. The trouble is they are clueless about how to change it.

You could make a lot of savings by working together more closely and having a holistic approach, but they've gone in exactly the opposite and it will have exactly the opposite effect making the cuts even worse in the process.

If your local commissioning group, with management supplied by McKinsey's or some other big business, decides they don't want to do X or Y, they don't have to.

They will be statutory bodies of the NHS, edam. And held accountable by the NHS Commissioning Board (this must be true because the CB has been Tweeting to this effect ..). But they cannot, for example, arbitrarily decide that their patients don't need A&E services or that no-one will have diabetes this year. I'm not doubting that there is increased scope for the postcode lottery and bad commissioning decisions. It will also be possible for them to choose to commission all services of a certain type from private, rather than NHS providers, although this wouldn't prevent their patients from choosing the NHS anyway. But they will be publicly accountable bodies, and I would urge everyone with concerns to do all they can to hold their CCG to account.

Is there not a petition we can all sign to save the NHS?

That's another thing that worries me, Tribpot - accountabillity. I think one of the reasons the govt is doing this is so that no-one can blame them when things go wrong.

And, since you mention it, what is there to stop a group of private providers getting together and deciding that none of them will provide a particularly expensive treatment in a certain area? Will the NHS have to do it? How then will the NHS be able to be competitive if all their funds are being drained away by lengthy expensive treatments? In fact how will it be able to survive at all?

And how do you hold your CCG to account? You can't vote for them, can you?

These are genuine questions.

Some current petitions:

Protect our NHS, 38 degrees, hosts multiple campaigning issues.

NHS Support Federation, voluntary organisation campaigning in support of the NHS since 1989. Has more articles on NHS restructuring.

Op asked what we can do... We can all plan to go on the tuc anti austerity march 20 Oct and make mumsnet placards objecting ( in a witty and mumsnetty way) to the plan. Media loves mumsnet and we can get on telly and more debate will happen.

tribpot, yes, but the provision is there in the Act for commissioning groups to define what services are part of the NHS and what aren't. No-one, you hope, would be so stupid as to say 'we ain't doing A&E' - although it is clear some A&Es will close and plans have been announced to this effect in parts of the country - but anything less high-profile could be at risk. Speech and language therapy, perhaps. Or maybe cinderella services, the ones that don't grab the headlines, will just be rationed out of existence, with the criteria drawn so tight very few people qualify - as is already happening in social care, funded by councils.

And tribpot's question about accountability is an excellent one. At the moment, if you have a problem with the NHS, you can write to your MP, who can raise it with the Secretary of State. Under the new Act, the Secretary can say 'not my role' and ignore you.

Who is the NHS Commissioning Board accountable to, exactly? Certainly not the public.

Private companies are also not covered by the Freedom of Information act.

This has already come up wrt DWP testing of the sick and disabled, because the DWP outsource the testing to private company ATOS who just say, "Commercial confidentiality, mate, don't have to tell you a thing."

Yes, the NHS is safe in the Coalition's hands. Move along now, nothing to see here.

Accurate figures are hard to come by but between 1997 and now the NHS budget has at least doubled (in both cash terms and as a percentage of GDP). Whether the service now is twice as good as it was in 1997 is highly doubtful - there have, without question, been some improvements but could that progress have been made with fewer resources? The answer is almost certainly yes.

We would all like to see an even better system of healthcare and, if the current structure is limiting improvement by offering us less bang for our buck as we move forward, we should investigate different systems- especially those systems developed by our continental cousins which consistently outperform our NHS.

As the population grows and ages, we need more healthcare, so there are more demands on the health service every year. There's no way they can cut the money given to it. It will need to increase, year on year, in order to treat more people - unless the govt do something about population growth. Come to think about it, perhaps this is what it is all about. Survival of the fittest.

How do our continental cousins consistently outperform us, MrJP? By treating more customers? By fewer clients dying? Any figures on that?

I've visited people in hospital in Spain. The patients' families have to bring in their food and do some of their day to day care. But the service seemed fine, as did the hospital I went to in France. Just as good as the many hospitals I've been to here. Except that they have to pay for their treatment, and in the past, we haven't had to.

The alternative doesn't have to be American style health insurance. Here in Belgium, like in several other countries, a pa of your taxes/social security goes to the health service. Hoever, everyone must also sign up to a mutuelle (costs about ?35 a quarter, kids up to 18 are covered by their parents contributions and there are special arrangements for the unemployed). When you see a doctor, you pay the doctor up front and hen your mutuelle refunds you 85% of the costs, up to a maximum ceiling. The government sets the recommended prices for doctors, dentists, specialists etc, but doctors can charge more if they want.

In practice, what it means is that a trip to the doctor costs me about ?8 but I can always, always, always get a same day appointment and an annual dentist visit (plus scale and polish) costs about ?80 (but again, no problem finding a dentist). Prescription medicines usually end up costing anything from ?2/3 to ?5/6 each. Most employers also give free hospitalisation insurance to their employees and their families (costs about ?100/year per family) which will cover 100% of any hospital stay.

While I really respect the idea behind founding the NHS, I just don't see how it can remain to fucnction as is. The system here hardly costs me anything, apart from the charges to see doctors etc, but I can always get an appointment when needed, hospitals don't have stupidly long waiting lists (when DS had a kidney problem he was referred and seen within 2 days!), people get the treatment they need and deserve (my Dad's cancer was treated in France with a drug that the NHS would have refused to cover), but neither are doctor's surgeries full up with time wasters.

Solopower

"How do our continental cousins consistently outperform us, MrJP? By treating more customers? By fewer clients dying? Any figures on that?"

Cancer survival rates, deaths from respiratory disease, hospital acquired infections, diabetes care, lower cost of prescriptions, less waste and duplications in procurement etc, etc, etc.

Belgium spends 10.9% of its GDP on healthcare rather than the UK's 9.8%, which works out at US$3946 rather than US$3487 per person, 13% more than the UK. (2009 OECD figures at purchasing power parity)

So it's not clear shorter Belgium waiting lists are to do with the structure rather than the more generous funding.

And if the NHS supposedly takes up to much of UK GDP, emulating Belgium will make this worse.

One would expect more duplication in procurement - and other areas - under a fragmented system than a unified one.

One of the NHS's great current strengths is its ability to negotiate good prices for drugs, because it buys in such immense bulk. Even Mark Britnell, architect of the restructuring, acknowledges smaller fragments won't be able to get the same low prices.

"One would expect more duplication in procurement "

I would have thought so too but it is clear that the NHS is failing to take advantage of economies of scale at the moment. Take this story as an example.

As for bulk buying of drugs, it all very much depends on how the privatisation is arranged and which bits are sold off and to whom. The state has a dreadful record when it comes to privatisation and has often managed to make a complete dogs breakfast out of even the simplest sell off (see Royal Mail, British Rail, Corus etc - I'll admit that the runes don't look too good) but, if competition can be created where competition works best - driving up standards and practices for consumers - then there are bits that it makes some sense to retain within a nationalised monopoly. Drug procurement is one, funding of the system through National Insurance is another. As I say, it all depends on how the privatisation takes place.

Conversely, the NHS itself acts as a block on the use of cheaper drugs. It runs a system whereby each drug must be registered to be used to treat various ailments. If drug A has been registered to be used against a given ailment, drug B, which may be used to treat the same ailment (more successfully and at a lower cost) elsewhere in the world cannot be used on an NHS patient until it is trialled and registered as safe to do so. These stories here and here will, no doubt, explain the problem more clearly.

Yep, they clearly don't always leverage economies of scale to the max.

But as that article points out, once fragmented it will be even harder to do. And the £300,000 that trust saved by bulk procurement may be lost again.

And those articles don't support your claim that the NHS is acting as a block on cheaper drugs.

For safety reasons, many countries (including the US) require drugs to be registered to treat given ailments. In this case the manufacturer, Novartis, has refused to submit a cheap drug for registration because it has an expensive drug already registered, and would like the UK to carry on using the expensive one. The NHS is attempting to use the cheaper drug and Novartis is suing them for it. Not sure how you got "NHS blocks cheap drugs" out of that.

Amyboo, the health service you are describing is the health service I recognise as being the one I have always used in the UK. Same day appointments, no long waits, excellent treatment, excellent care ... Only I never had to pay for it (except with my taxes).

However, I understand this is not the experience of everyone here. The problems get a lot of publicity, and the NHS is being deprived of funds, so it's very likely to get worse.

But we had a wonderful system that I used to boast about to my friends from overseas. Built on the soundest of principles: that those who are lucky enough to be healthy and well and can work for a living, pay for those who are vulnerable and ill. What on earth is wrong with that?? Especially when we will all be old one day, we hope.

Thanks for the links MrJP. I'm no expert on interpreting figures, but they don't look good, do they?

But - that's why we need to focus on improving health care, rather than providing opportunities for private companies to make a killing.

Terrifying. I have had renal failure twice needing transplant and all of this has left me with a damaged heart. I could never pay for what I need

Some drug companies seem to be entirely without scruples, and far far too powerful.

Well, Noddy, maybe you'll be lucky enough to live in an area where the changes are brought in gradually and aren't too drastic. I hope so.

And I hope we will be allowed to exercise our democratic rights and shout about this until we are heard and listened to.

National insurance doesn't fund the NHS any more than any other tax does. The NHS is funded out of general taxation.

Your own NI contributions are taken into account when you claim the state pension, or certain contributory benefits. Nothing to do with the NHS. And it would be madness to try to link them - who knows whether they will be run over tomorrow, or develop cancer, or have an unexpected pregnancy (maternity care is v. costly)... there's no way of knowing how much healthcare you will need, except that you will probably need quite a bit if you are lucky enough to live to old age.