Anyone who knows what’s happening to the NHS should know that a large part of its budget is now controlled by CCGs, who are forced to offer NHS contracts up to private companies. You’d be forgiven for thinking that was the only form of privatisation taking place in the NHS. It’s not. Here are five forms of NHS privatisation that you really should know about.
1 – PropCo
NHS Property Services Ltd (PropCo) was launched in April 2013 and now owns £3 billion worth of NHS land and buildings. These assets were once held by the now-abolished Primary Care Trusts and Strategic Health Authorities; now PropCo is responsible for selling them off to property developers. Furthermore, while the government currently owns all of PropCo’s shares, the Act that created PropCo allows for private firms to buy the majority of these shares. Thus large swathes of NHS land could quickly pass into private hands.
2 – PFI/PF2
You’ve probably heard of the Private Finance Initiative and its sequel, PF2. You may think these are merely expensive loans with Wonga-style interest rates. Certainly these deals are bad value for the taxpayer and have pushed many hospitals into the red, but they’re more than just that. For at least the 25-30 year repayment period, the private firm providing the loan actually owns the hospital. Thus, more than a hundred NHS facilities are owned by banks and shell companies.
3 – Clinical Support Units
Although CCGs were created by the 2012 Act to decide where the money goes, it is the CSUs that provide the infrastructure. CSUs are there to run tenders, manage contracts, provide IT and HR services and other back-office admin functions. The Act created CSUs as part of the NHS structure, but from 2016 the CSUs will become independent businesses to be bought out by private firms. In fact, the sale of has already begun. If private firms take over the CSUs they will have a huge influence on the funding and rationing of healthcare in this country.
4 – Personal Health Budgets
Personal Health Budgets (PHBs) – in which an individual is allocated a limited amount of money to cover their healthcare needs – are already being introduced in England. While there is the obvious spectre of ‘top-up’ payments for those who exceed their allocated budget, there is another issue here. The classical pattern of funding in the NHS is that money is allocated to Trusts according to the amount of work they need to do. PHBs allow for a move to the private insurance model, where everyone pays in a premium (in this case their PHB) and the private firms then decide who gets treated/which claims to pay out on. You can just imagine the worried well opting to pay their PHB into a private insurer in return for cheaper gym membership and money off their holidays. Meanwhile, the genuinely-ill would end up paying top-ups to access increasingly rationed basic NHS treatment. Combine universal PHBs with privatised CSUs and you get an American-style health system.
5 – Foundation Trusts and Mutualisation
If the land, buildings, back office and budgets have all been privatised, what does that leave? That’s right, the NHS Trusts themselves. All hospital trusts now have a mandate to become independent businesses known as Foundation Trusts. These are standalone organisations which have to keep themselves in the black, and can do so by taking on as much private work as they want. As with the CSUs, the FTs are units ripe for privatisation, which in this case is dressed up as warm and fuzzy “mutualisation“. This means passing from public ownership into the hands of ‘stakeholders’ – that’s right, privatisation.

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What happens when politicians try to run an organisation they don’t understand

We are in a Kafka world.
• There is not enough money in the system and Trusts are punished if they overspend.
• They have to overspend to get staffing levels up to new ‘safe’ standards.
• As there are not enough staff in the system they have to go to agencies to buy-in the same staff they once employed in the NHS, now at twice the price.
• Many Docs and nurses don’t want to work in the system because being an agency staffer creates flexibility and freedom not found in the consolidated ranks who are pressured, shoved around and the butt of everyone’s ire.
Hospitals can’t find enough staff and the CQC spend a fortune (that could be used on patient care), turn up with 80 people (who could be working in the NHS providing care) and say; ‘You don’t have enough staff, therefore this place is dangerous and we want new leadership’.

New leaders are found who hire more staff and overspend. Monitor (who spend a fortune that could be spent on patient care) turn up with an army (who should be working in the NHS) and say you have overspent and we want new leadership.

New leaders are found who balance the books by cutting the staffing levels and the CQC turn up and say; ‘You don’t have enough staff, we want new leadership’. The old leader gets the sack and …. around we go again.