The front cover of the public sector accountants' magazine Public Finance has spotted Milburn's game. (Left) Medical secretaries fight for fair pay. block contracts through which Labour curbed the hated and wasteful internal market system created under Thatcher.
Now a new system under which Trusts are once again "paid by results" on the basis of a national tariff of payments (fixed by the Department of Health) ensures that those Trusts which are now struggling to cope with local demand will lose money, and that extra cash flows to the best-resourced Trusts.
Hospital staff will face a new squeeze as managers try to force down their costs while some Trusts may pull out of providing services where they feel they cannot compete. Milburn's changes not only set NHS • •• hospitals in competition with each other, but also raise the prospect of private sector providers competing for "surplus" NHS work. A new system of "patient choice
This encourages patients waiting over 6 months for treatment to choose another hospital - with the money again following the patient. Once again in areas - such as much of London - where the NHS is under greatest pressure, with least spare capacity, this is likely to mean money being siphoned out of the NHS and into private hospitals And since the main constraint on NHS capacity is staff shortages, the transfer of work to the private sector will also mean more staff poached away from the NHS -triggering a spiral of decline. Franchising
Meanwhile the threat remains that management in "failing" Trusts which cannot cope in the new competitive NHS will be 'franchised' - the old bosses replaced by outsiders. It is now clear that where this happens the management is likely to be privatised, since none of the 3-star NHS hospital bosses have applied for this work.
Of course the private sector only runs very small hospitals, offering a restricted range of services: exactly why Milburn thinks these bosses can sort out busy general hospitals is a mystery. In another re-run of a failed Tory policy, the NHS is also headhunting other private sector managers. PFI
Another major component of Labour's privatisation drive in the NHS is of course the Private Finance Initiative (PFI) which has effectively replaced NHS capital funding for new hospitals and which is leading to the privatisation of the £21 billion NHS estate
Many more areas are now seeing a smaller-scale version of PFI, NHS LIFT, which is seeking profits from building health centres and other facilities for primary care services.
The plan is clear: to turn the NHS from an integrated public service into a cash cow purchasing care from private medicine, and a safety-net service covering the parts the private sector don't want.
But it's still free at point of use, right? Wel at the moment, maybe: but Tony Blair has already floated the notion of user-charges for more public services, and the prospect of "top-up fees" for treatment at the prestigious Foundation Hospitals is already being floated.
Fourteen years ago when Thatcher floated the Tory market reforms - timid in comparison to New Labour's onslaught - she triggered a wave of protest and high level opposition from the health unions and the BMA. There were broad campaigns against the first Trust opt-outs.
Today the same unions are equally opposed to foundation hospitals and market-style reforms. It's time they began to raise the stakes, while there is still a recog nisable NHS to defend