This book is written in the classic muck-raking style. But then, there’s a great deal of muck to be raked. It deals with the introduction of Independent Sector Treatment Centres into the NHS. ISTCs are capitalist firms operating for profit. It was a New Labour brainwave for them to be given NHS surgical procedures to perform. The argument was that harnessing the private sector would help do away with the horribly long hospital waiting lists left after 18 years of Tory penny pinching. Actually we never needed them. As Player and Leys point out it was later admitted that, “cutting out waiting times for elective care – was being eliminated by the increased funding going to the NHS after 2000.” (p. 73)

So why were they brought in? There was certainly a great deal of secrecy about the contracts. How dare Labour Health Ministers claim ‘commercial confidentiality’ when they were spending £5.6bn of our money on the first two wave of ISTCs alone! The stated aims of ISTC involvement were:

·        Increasing capacity

·        Innovation and best practice

·        Increased choice

·        Value for money.

Did they provide more hospital beds? The situation is shrouded in secrecy. The Healthcare Commission inflated the number of diagnostic procedures by 420% - 73,000 rather than 234,000 were carried out. Stalin’s planners would have been proud of them.

The authors comment, “As of February 2007 approximately 25% of all work carried out by Wave 1 ISTCs was not additional work but ‘transferred activity’; work that would have been carried out by NHS trusts but was instead given to ISTCs and performed by NHS staff. Meanwhile, so far from being short of capacity, some NHS Treatment Centres had actually been closed for lack of demand.” (p. 29)

Did they provide skilled staff? No, they poached them from the NHS. At Waltham Forest ISTC 83% of staff were seconded from the NHS.

Did they provide more hospital space? No, the secretive contracts demand that they get first bite of the cherry on hip operations etc, since they are paid for the contracted number of procedures whether they perform them or not (Take or Pay). They get a guaranteed throughput of patients. Yet, according to the House of Commons Health Committee, “It is far from obvious that the capacity provided by the ISTCs was needed in all areas where Phase 1 ISTC’s have been built.” (p. 31) Meanwhile NHS wards and hospitals are closed. This is madness.

Do they stimulate quality? Again silence and subterfuge prevail. The Committee found that, “after more than three years there was still no data on clinical outcomes that could be compared with those of NHS hospitals and treatment centres.” (p. 46).

Professor Wallace of the British Medical Journal has hazarded an assessment. “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.” (p. 44) Thanks a lot, New Labour.

Here’s what else could happen to you (pp. 61-2). “The NHS patient was at Haslar (Gosport) in November 2004 to have an arthoscopy on his left knee and the removal of a cyst on his right knee. On waking from anaesthesia he discovered that surgeons had performed arthoscopies on both knees. During the subsequent journey back to Plymouth – some 200 miles – the ambulance driver stopped at a service station and the patient was invited out. He was on crutches and, due to the driver’s failure to assist him, he stumbled and fell. Later the ambulance driver explained that she wasn’t qualified to help him because she was only driving the ambulance for extra cash. Her main job was working for Plymouth aquarium.”

But surely the risk-loving entrepreneurs at least cough up when they screw up? No, it’s us that pay the bill. The NHS pays the indemnity for private sector failure.

What about choice? “The Health Committee noted that where the establishment of an ISTC led to the closure of NHS facilities, patients would have no more choice than before. It also noted that in the absence of clinical outcome data, patients – and GPs – could not make an informed choice of elective care providers.” (p. 48)

How about value for money? Despite the secrecy, we have a result. The Committee heard that prices paid to ISTCs were upwards of 40% over reference costs (now the NHS tariff)” (p. 51) 40% more!

Somebody is determined we should continue to pay for proven failure. When West Oxfordshire PCT decided to award the local contract to the well-rated Oxford Eye Hospital rather than an ISTC, Ms. Hanna told the Committee, “All the non-executive directors were called by the chair of the PCT and were told that he had been told that John Reid (the Secretary of State for Health) wanted a reversal of the decision on his desk by 12 o’clock on the Monday...we all understood that our positions as non-executive directors were under threat.” (p. 50) of course Reid’s only known skill was bullying.

What about the rest of New Labour’s Health Ministers? Alan Milburn resigned in 2003 to spend more time with his family. He might have mentioned he wanted more quality time with his money. Alan Milburn took a post for £30,000 a year as an adviser to Bridgepoint Capital, a venture capital firm heavily involved in financing private health care firms moving into the NHS, including Alliance Medical, Match Group, Medica and Robina Care Group.

What about Patricia Hewitt? What caused her enthusiasm for private health provision? Well, now she’s a ‘special consultant’ to Alliance Boots and a ‘special adviser’ to Cinven (who own BUPA’s hospitals). Civil servant Matthew Swindells (an apt name?), who was Hewitt’s chief executive at the NHS, has with indecent haste become head of health for Tribal, the private sector consultancy and service company. Tribal is, of course, bidding for some of the contracts that Swindells was, until recently, responsible for setting up. Surely a conflict of interests? A long list of other civil servants and New Labour crawlers who have gone through the revolving door from administering a public health system to profiting from private provision are given on page 96. Cuckoos in the nest!

The Health Committee smelled a rat, but the health professionals were working full time to lead them up the garden path. The Committee reported, “It has become clear that the level of capacity required by the local NHS does not justify new ISTC schemes....It is not clear whether this represents a failure coherently to articulate the situation or a more profound incoherence in terms of policy.” (p. 64) In fact policy was quite coherent. It was to break up the NHS into bite-sized pieces ready for privatisation

The National Health Service is the most popular institution in Britain. It is Labour’s supreme political achievement. Even the Tories say they accept it is here to stay. Now it is being dismantled bit by bit by the corroding acid of money by stealth. Don’t let it happen.