Fears that health reforms could lead to a privatised NHS in Norfolk

It is the largest piece of health legislation since the National Health Service was created but campaigners are warning that the Health and Social Care Bill could 'end the NHS as we know it'.

The bill has been criticised for its complexity, length and vagueness, meaning it has been difficult for many people, even health professionals, to understand its implications.

So campaigners came together at the inuagural meeting of the Norfolk branch of Keep Our NHS Public (KONP) this week to discuss its implications and gather opposition to the reforms.

And perhaps no-one did more to underline just how important the changes are, and just how angry they are making people, than Mark Harrison, chief executive of the Norfolk Coalition of Disabled People.

'These are life and death questions,' he said at the meeting. 'There are people in our coalition with enduring health problems committing suicide because services are being whittled away. We need to plan some very real actions and shake this Coalition Government to its roots.'

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The growing opposition has already forced the Government to launch a 'listening exercise' but cynics say this is unlikely to lead to significant amendments of the reforms, which were described at the meeting as 'an ideological attack' that would erode the founding principles of the NHS.

Former Norwich North MP Ian Gibson, who chaired the meeting, said campaigners should try to gain the support of patients' groups and by coming together at this grassroots level they would have more 'clout'.

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People were also encouraged to lobby their MPs and to join the Norfolk branch of KONP.

Norfolk KONP will be giving out leaflets and talking to members of the public before the next Norwich City home game at Carrow Road, meeting near to the Riverside Leisure Centre at 6.30pm on Friday April 15.

A May Day event around the theme 'Save our NHS' will also be taking place from midday to 3pm on Monday, May 2, in Chapelfield Gardens, Norwich.

To join the Norfolk branch of Keep Our NHS Public, email konpnorfolk@gmail.com.

• GP Consortia

The NHS reforms include handing over the majority of the NHS budget from the existing primary care trusts to consortia of GPs.

The government argues that GPs are best-placed to design services and commission care for their patients.

But with most GPs busy doing the day job, critics argue the consortia will end up being run by the very same managers made redundant at great cost from primary care trusts and who end up being employed by the consortia, or by private management consultants who win contracts with the consortia.

Harry Seddon, of Unison's branch at the Norfolk and Norwich University Hospital, said it was ludicrous the bill would allow for GPs to pay themselves bonuses for making efficiencies, and given that the NHS had to make �20bn of efficiencies over four years we could see 'rationing' of services.

He said: 'The miracle of the NHS is that it divorces the financial considerations from the doctors' consideration of what's care for you clinically.

'By giving them the challenge of being in charge of the budgets, Andrew Lansley has polluted that. This situation will force them them to think not about your clinical condition as a patient but how to manage the budget at the end of the year.'

There are also worries that the consortia is focused solely on GPs, and they should involve other clinicians too, such as nurses and hospital consultants.

Opponents also say the consortia will be unaccountable and it amounts to handing over budgets to private organisations, as GPs are effectively private businesses.

• Competition

The bill is aimed at increasing competition within the health service, with ministers arguing it will lead to the best value services.

GP consortia will put services out to tender to not-for-profit social enterprises, like the one NHS Great Yarmouth and Waveney wants to set up to run community health services in its area, and also to for-profit companies.

While it is thought that many GPs will want to buy services from their local hospitals, this is something that could be legally challenged by private companies if they put in a lower bid and do not win.

And if a private company which provides healthcare goes under, then it could be a case of the public purse picking up the pieces.

The Government has promised to make amendments to the bill to stop private companies 'cherry-picking' the easiest, and most profitable, patients - but how this will be done effectively remains to be seen.

All remaining NHS trusts have already been told they need to become foundation trusts, which gives them more independence from the NHS, including being able to move away from nationally-agreed terms and conditions for their staff.

Opponents say the proposed reforms also mean that many current NHS staff could end up finding themselves instead working for a social enterprise or private organisations, being offered inferior pay and terms.

The fear is that price competition in clinical services will lead to a 'disastrous race to the bottom', and it is likely to lead to hospitals acting more like private hospitals and closing down any services which do not make a surplus. With all limits on the amount of income foundation trusts can raise from private practice to be removed by the bill, this could lead to these trusts expanding income from private patients in a bid to ease the cash squeeze.

A speech therapist at the meeting this week also raised concerns that as organisations will want to protect their own contracts, it could put an end to the sharing of 'best practice' within the NHS.

Wendy Savage, founder of Keep Our NHS Public, said it was likely the competitive market created by the bill would actually lead to huge administration and bureacracy costs. She said the Department of Health had not been forthcoming about the estimated cost of putting contracts out to tender, but independent estimates put it at as much as �10bn.

She added: 'The primary duty of private companies is to their share-holders. NHS care needs co-operation, not competition.'

• Openess and accountability

NHS trusts have to hold their board meetings in public so that it is clear how they are spending public money and how they are making decisions. But foundation trusts do not have to hold their board meetings in public, and as more non-NHS organisations run services, it will become harder to see how they are spending the public money that they receive in return for providing healthcare. With NHS bodies, social enterprises and private health companies all competing for contracts, it is likely the 'commercially sensitive' argument will mean the public are kept in the dark over how public money is spent, and how much contracts are worth. This is already prevalent and is likely to get worse - NHS Norfolk recently refused to say exactly how much it spends on GP out-of-hours care in the county because the East of England Ambulance Service, which provides the out-of-hours care, is having to compete against private healthcare firms and therefore the information is considered 'commercially sensitive'.

As it stands there will also be no statutory right for the public to know what is being discussed by the GP consortia and there could be a conflict of interest if GPs who are also on the payroll of private health firms stand to benefit from some of the decisions they are helping to make.

Professor Savage said the bill would also transfer the responsibility for the NHS from the secretary of state to a new NHS Commissioning Board.

The Government wants to put in place Health and Wellbeing boards, but many of the organisations that need to be scrutinised will have representatives on the boards and there is a fear that this will mean they are not being held to account properly. Local Healthwatch bodies are planned to provide the independent scrutiny, but critics say they will be 'ineffective advice and information bodies' with little clout.

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