The city has been on the front line of some of the most radical and, many argue, damaging reforms to the NHS since its creation. The Nottingham We Deserve investigates.
by Benedict Cooper and Zenn Athar
When five of the UK’s leading dermatologists quit the QMC in December, Nottingham was thrust into the middle of a gathering storm of political debate. To many their departure was the latest symbol of a health service breaking down, and a workforce under increasing pressure.The doctors wouldn’t be drawn on the issue, but sources quoted deep discomfort about a big decision that had quietly happened away from the public’s eye: the unit was to be run by Circle, a private company.
Unite head of health Rachael Maskell says the case in Nottingham was a key moment for many campaigning against the growing influence of private healthcare companies like Circle in the service.
“It showed the strength of feeling people have towards the NHS,” she says. “It’s not just an ideological step they took, it’s also a clinical point of view. The consultants were willing to forfeit their careers to protect care in Nottingham”.
So why the strength of feeling? And what made the doctors quit? As activists in Nottingham and further afield know, the QMC case is just the tip of the iceberg.
Everywhere you go, services are being taken over by private companies operating under the NHS logo; big business is moving in.
This is nothing particularly new, but one thing alone has caused a major acceleration of the takeover of NHS services by profit drive companies. In 2012 the government passed a major piece of legislation, the Health and Social Care Act.
Somewhere buried deep within this long and involved document was an innocuous sounding but incendiary new rule: NHS trusts would be required to go through competitive tendering for all new contracts.
In short, NHS trusts would be forced to pay private companies to run their services, and pay for the administration of the whole bidding process – with taxpayer money.
In this new rule, lies the root of the Queens dermatology row, and dozens more like it up and down the country. Private companies are picking up NHS contracts, paid for by taxpayer money, with one thing in mind: turning a profit.
And how do they do this? By treating the whole thing as a business; by taking aim on the lucrative contracts and leaving the risky ones well alone; by slashing staffing costs through staff redundancies, leaving the rest on cheaper, often zero- hour contracts.
It’s whole new business culture in health that former QMC psychiatrist Dr Arun Chopra, speaking to Nottingham We Deserve in January, claims is slowly eroding services. “So much time goes into creating business models now,” he said.
“We’re seeing services competing with each other, services pitted against each other. I’m spending more and more time and tax-payer money dealing with bureaucracy; it’s not what I wanted to do”.
It’s a growing trend, which Ben Clements, a community mental health nurse in Nottingham and member of campaign group Keep Our NHS Public (KONP) says is having a direct effect on services and working conditions in the city.
He says: “Already our NHS mental health beds are being reduced, and private companies are stepping in to fill the inevitable gap. It’s not a business, it never has been; it’s a public service, and we shouldn’t forget the unique values that brings. People don’t want the glossy brochures and the spin.
“They don’t want lawyers fighting over contracts for who does what. They want decent care”.In Nottingham there has been a spate of alarming changes to care not least the planned closure of two mental health wards at the QMC. And when the crisis in A&E services in England first became apparent back in January, Nottingham was sadly back in the news once again.
Which GP and NHS campaigner Dr Bob Gill says could well continue as more contracts go to companies like private equity owned Circle – which itself hit the news in January when it walked away from a whole hospital contract, unable to turn a profit.
He says: “The NHS is being turned into a corporate structure modelled on the private sector, in Nottingham and across the country. A&E is not profitable, it’s very high risk. A&E units are being shut across the country to focus on the profitable services”.
So what can be done? Many fear that with the passing of the Health and Social Care Act, any significant change is irreversible.
Labour has pledged to repeal the controversial Act, as has the Green Party, but with almost a half of all new contracts going to private companies since it came into effect, whoever wins in May will be running a service drastically altered since the last election.
But there is a growing swell of activists in Nottingham and nationally, fighting for a change of government, and a change of direction.
Many are turning to single-issue campaign groups like KONP, the National Health Action Party, and the People’s Assembly, for alternatives to mainstream of politics.
It’s a crucial time, perhaps the last ditch, to save the NHS as we know it. As Sarah Hallett, a junior doctor in Nottingham says: “The only conclusion that can be drawn is that if we lose the NHS, my patientswill suffer the consequences.
I cannot stand by and watch that happen without protesting”.