Don’t let GP services go the way of hospital cleaners!

Two stories on health, both significant, the latter having implications across England (and reinforcing my view that this country desperately needs a parliament and a fair electoral system so that the privatisation of the NHS can be better resisted).

Whilst cleaners working for private contractors are usually conscientious and hard-working individuals, they are not part of a team within the hospital and this means there’s a lack of accountability. So from the people on the ground, we have a reality check – cleanliness is a medical concern in hospitals, and should not a source of profit for big business:

Nurses have called for hospital cleaning to be brought back in-house to tackle hospital infections.

The Royal College of Nursing conference overwhelmingly voted for a motion proposing an end to contracting out cleaning to private firms.

Cleaning contracts have been outsourced since the 1980s and about 40% of hospitals now use the private sector.

Nurses at the Bournemouth conference said it had led to a drop in standards and a rise in infections.

The government has made cleaning one of its highest priorities to tackle infections such as MRSA and Clostridium difficile.

It recently oversaw a deep cleaning programme of all hospitals in England and its infection strategy published in January said good quality cleaning was essential.

MRSA rates have been falling since early 2006 with the NHS on course to halve the number of infections this year based on a 2004 baseline.

But nurses still maintained infections was a pressing issue that was not being helped by the contracting out of cleaning, something which has been particularly popular in England.

No public sector ethos

May McCreaddie, a nurse from Glasgow, said: “There has been an increase in hospital infections and decline in cleanliness. It is quite simple.”

She said private cleaning firms did not have the public sector ethos of in-house teams and there was higher staff turnover which contributed to poorer performance.

“We know what works we have been there before, we have had them. They are called ward domestics, they are an integral part of the team.”

Sheila Dunbar, a nurse from Liverpool, added: “The increase in hospital infections is a big issue. NHS trusts in north west England have started to come back in-house to have cleaner wards.”

But Derek Blackshaw, from Salisbury, said as well as bringing cleaning back in-house, it was important nurses on the wards were given responsibility for overseeing cleaning.

“It is not enough to bring it back in-house if you still need to deal with a chain of authority.”

The delegates also heard from a number of nurses who described how in-house cleaners were much more part of the NHS family.

Dominic Walsh, a nurse from London who works on an intensive care ward, said he was proud to work on a ward where the cleaners employed by the hospital.

“I can say to Monica and Arnie ‘you are coming to our Christmas party aren’t you? You’re an essential part of our team’.”

George Monbiot writes in the Guardian today of the threat of GP services – and the entire NHS in England – being privatised:

Everything is getting bigger and further away. Hospitals, post offices, schools and prisons are being “rationalised” and “consolidated”. The government says this process improves efficiency. Instead, it outsources inefficiency: we must travel further to use public services. This is bad for the environment, bad for community life, and bad for universal provision. But we haven’t seen anything yet. We are about to be confronted with the biggest shutdown of all: the government has started the process of closing England’s network of doctors’ surgeries.

If you know nothing of this, don’t blame yourself. The announcement was buried in an interim report published last October by a junior health minister. The report was 52 pages long, and the policy was explained in a single paragraph on pages 25 and 26. Rather than being brought before parliament, it was released four days before MPs returned from their recess. Since then there has been no further public announcement. But in December, the Department of Health sent a letter to all the strategic health authorities in England, demanding that the policy be implemented immediately. The greatest transformation in the history of the NHS is taking place without public debate, public consent or formal consultation.

The government’s policy is to consolidate doctors’ surgeries into a series of giant health centres, or polyclinics. Thousands of small practices will be closed and patients will be processed in buildings containing up to 50 GPs. The new clinics will also house some services at present provided by hospitals, which allows the government to claim that it is bringing healthcare “closer to home”. The net effect will be a massive reduction in convenience.

The policy was launched by Ara Darzi, a colorectal surgeon who has been raised to the peerage and made an undersecretary of state for health. He wrote his interim report in three months, during which he claims to have spoken to thousands of people. But it contains no record of who they are, how they were selected, or what their answers were: he reveals only that “their views have helped shape this interim report”. His final report will not be published until June, but the Department of Health has instructed England’s primary care trusts to advertise for bidders for the new polyclinics by May 2008: the first notices have already been posted in the Health Service Journal.

During a parliamentary debate launched by the Conservatives last week, health secretary Alan Johnson claimed three times that this policy is not being imposed on PCTs. “There is no national policy for replacing traditional GP surgeries with health centres or, indeed, polyclinics”; “we are not specifying polyclinics as any part of the exercise”; “[the Tories say] we are imposing a system of polyclinics throughout the country. We are not.” Three times, in other words, he misled the House. The letter sent by the Department of Health in December ordered that “each PCT will be expected to complete procurements during 2008/09”. In a parliamentary answer in February, health minister Ben Bradshaw confirmed that “every PCT in the country will be procuring a new … health centre during 2008-09”. A press release published by the Labour party on April 15 confirmed that the new centres would be built “in every town and city”. I hope MPs demand that Alan Johnson apologise to parliament.

Lord Darzi insists that polyclinics will offer “a more personalised service”. This is nonsense: in the enormous new centres we are less likely to be able to see the same GP, and more likely to get lost in the system. A recent paper in the British Medical Journal reveals that “patients in small practices rate their care more highly in terms of both access and continuity”, and that small practices “achieved slightly higher levels of clinical quality than larger practices”. The centres will be built not where they are most convenient for patients but – as Darzi revealed to the Commons health committee – where the NHS happens to own land. If you live in a village or a distant suburb and depend on public transport, as many elderly and sick people do, visiting the doctor could take all day. Ara Darzi is the new Dr Beeching, shutting down the branchlines of our primary health service.

So why is this happening? In seeking to surreptitiously privatise healthcare, the government has a problem. Primary care is already in private hands – GPs run their own practices. But they are the wrong hands: the corporations demanding guaranteed streams of income from the taxpayer can’t play in this field. Polyclinics are perfectly designed to let them in, while preventing doctors from competing.

It’s not just that GPs can’t raise the capital; because the contracts are much bigger than ordinary practices’ and involve many different services, the tendering process is expensive and fiendishly complex. The big service companies can produce the same bid for any number of clinics: they need spend their money only once. The Department of Health says that PCTs should use a type of contract called Alternative Provider Medical Services, which is designed to allow corporations to bid. This is not a public-private partnership: it is the outright privatisation of primary healthcare.

Do I need to explain the implications? The American health system, which the British government seems determined to emulate, is both more expensive and less efficient; those who can’t afford to pay are either excluded or treated like battery pigs. The independent sector treatment centres (ISTCs) – private clinics which carry out routine NHS operations – have been a costly disaster since being introduced in England in 2003. Private companies receive their money regardless of whether they carry out the work they are contracted to do. The government refuses to release comparative figures, but the little evidence we have suggests that their costs are much higher than the public sector’s.

The risks have been transferred back to the taxpayer, and the standards of treatment are sometimes appalling. In 2006 Angus Wallace, professor of orthopaedic and accident surgery at Nottingham University, told the Guardian: “We expect failures of hip replacements at approximately 1% a year and knees at about 1.5% a year. But we have got some of the ISTCs that are looking at 20% failure rates.” Because they put profits first, companies that run these centres have generated a stack of litigation claims and a huge NHS bill for repairing the damage they have caused. Far from reversing its policy in the light of this evidence, the government is setting up a competition panel to ensure that the health service never discriminates in favour of the public sector when awarding contracts.

Did any of us ask for this? Are there crowds on the streets demanding the privatisation of the NHS? Even the Tories have come out against it: David Cameron’s speech last week placed them to the left of Labour. Why, after the 60-odd quarters of consecutive growth that Gordon Brown keeps boasting about, can he not maintain a public service founded in the midst of poverty and rationing? What mysterious hold on policy do the corporations possess, that they can persuade this government to wreck Labour’s finest achievement and damage its chances of re-election?

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