PRN reviews this hard-hitting documentary featuring a group of prominent NHS doctors who are desperate to let the public know what is happening to our health service. Directed by film maker Peter Bach, Sell-Off is a not -for-profit project which is currently raising funds on StartJoin in order to cover costs and continue campaigning to defend the NHS.
Most people I know won’t have watched Sell-Off: The Abolition of your NHS. This isn’t because the subject matter is not hugely important, or the narrative is not compelling enough. Nor is it because it won’t be relevant to them if they live in England, or because it is mere speculation - if only this were the case.
It is simply because most of them won’t have heard of it.
Eerily, this is also one of the major themes of the documentary itself: the NHS is being privatised right under our noses, yet most people are still largely unaware.
Writer, Producer and Director Peter Bach could count himself as one of those who was unaware, or in his words “ignorant as they come”, before being invited to a meeting one snowy night with a group of doctors who had something on their minds. He has spoken about being initially unsure as to why he was approached, as his previous work has been mainly about foreign affairs, hostile environments and the arts. However, he listened to what the doctors had to say, and took the project on.
The resulting film is a nightmarish vision of the future, a trawl through the building blocks of the past that are enabling the demolition of the NHS, and a call to arms. The style is intimate - like a consultation with your GP who happens to be diagnosing England with a potentially fatal illness. This sickness comes in the form of the ‘quiet bang’ of privatisation, as previously described by Dr Lucy Reynolds, a Health Policy Analyst, in her excellent explanation of the Health and Social Care Act of 2012. Dr Reynolds also appears in Sell-Off, alongside well respected and experienced professionals such as Dr Clive Peedell, Professor Allyson Pollock, Dr Bob Gill and Dr Clare Gerada amongst others.
I asked Peter Bach if it was important to the doctors that he was an outsider to the healthcare industry, he told me; “ I think it was very important to be an outsider. One of the points I made during that first meeting was that, yes, I would need to make my own mind up, which might be a risk for them, in the event I didn’t agree with the argument, but that in-so-doing I would at least be the equivalent of a member of the public discovering this for the very first time”.
The film focuses on ten different elements that each in part and as a whole have contributed to the abolition of the NHS, and takes us on a journey from the crippling Private Finance Initiatives (PFI’s), introduced by New Labour in 1992, to the Health and Social Care Act of 2012 conceived by the Conservatives and brought to life by the Coalition in April 2013. It is this Act that some argue has finally driven the nail into the coffin of the NHS. This is because amongst the 457 pages of legal jargon, one of the purposes of the Act was to abolish the duty of the secretary of state for health to provide comprehensive healthcare for all on the basis of need. Barrister Peter Roderick, who alongside Professor of Global Health Allyson Pollock worked to decipher the meaning of the Health and Social Care Act, comments in the film that the removal of this legal duty effectively “untethered the health service from the government”. This clearly goes against the founding principles of the NHS, and to my recollection, was kept pretty quiet by both the government and the media at the time of the Bill.
As the film goes on to tell us, the structure now in place takes the form of Clinical Commissioning Groups (CCGs). CCGs are made up of groups of GPs who hold the responsibility for commissioning services in their local area, and collectively hold an annual budget of £88 billion. This sounds good on paper, as who better to provide services for their patients than GPs? It appears that that the reality is quite different.
CCGs are modelled on the US style of insurance funds and put services out to tender, which means they are open to the private as well as public sector - or in the jargon of the Health and Social Care Act - ‘any qualified provider’. Prior to the Health and Social Care Act it was difficult for a non-NHS provider to win a contract to provide a service if an existing NHS service was already providing that care. Now, however, ’any qualified provider’ can win contracts from the NHS if they can meet the same need at a lower cost. CCGs are actively encouraged to promote competition and drive the market, overseen by Monitor - a government body who regulates health services in England and whose role includes preventing ‘anti-competitive behaviour’.
As Professor Allyson Pollock has pointed out, however, one of the things CCGs don’t have to do is provide healthcare for all. This means that people who are not registered with a GP in their area, or who have complex care needs or long term conditions - such as many of the elderly - may slip through the cracks. Private providers tend to have less interest in services that don’t stand to make them much of a profit, and instead will ‘cherry-pick’ lucrative services. Ultimately, as many of the doctors in Sell-Off fear, this means that the doctor-patient relationship could be in danger. Patients may begin to wonder if what their GP suggests is in their best interests or the best interests of the GP, or the private provider behind the services. As Dr Clive Peedell says; “ Right at the heart of what I want to do is patient care, and you cannot do your best for patients in the market-driven, private providing healthcare system”.
Further more, GPs are realising that while they may be excellent clinicians, they do not necessarily have the time or expertise to fulfil the role required of CCGs. Conversely, when doctors are forced to bid for a service they are currently providing successfully, they are taken away from precious time with patients. In Dr Steve Taylor’s justifiably frustrated and insightful piece ‘ Why Privatisation is Killing the NHS’ for the Huffington Post in September 2014, he describes the demoralising experience of being forced to bid for the tender of the specialist HIV service he and his colleagues have been providing for years. Upon sending the bid the ‘size of my PhD thesis’ he writes of his colleagues; “They are waiting for the council's consideration, to see whether they might be good enough to deliver a service they have trained all their lives to provide. The reason that they are doing it at all, of course, is that they truly and deeply care about a service they have spent years putting everything into: they care about patients, they care about the NHS, and they don't want to see their service asset-stripped and cherry-picked, colleagues made redundant and patient care suffering.”
Concerns about the uneasy relationship between public and private healthcare provision as voiced by the clinicians in Sell-Off, are already proving themselves to be correct . In December 2014, Nottingham University Hospital Trust faced a blow when five of their eight consultants left the dermatology services rather than work for private provider Circle. In January of this year, Circle were once again in the news when it was announced that they intended to pull of their contract to run Hinchingbrooke hospital in Cambridgeshire as it was ‘no longer sustainable’. Circle have been running Hinchingbrooke since 2012 in a flagship contract as the first private provider to manage an NHS hospital. Chief Executive Steve Melton cites a combination of insufficient funding, increased pressure on A&E, a lack of care places for patients to be discharged to, and an ‘inadequate’ rating from the CQC as the reasons for the decision. It appears that now the going has got tough, Circle have got going - out of the contract.
It would seem that now more than ever, as the cracks are beginning to show and we heading towards a general election, people need to be aware of the implications of privatisation . So why is there such little mainstream publicity for Sell-Off? I asked Peter Bach this question; “It has been mentioned in The Independent and New Statesman and Evening Standard. But the major networks haven’t touched it, though I have done a handful of interviews about it on Russia Today, both with Max Keiser and George Galloway. The truth is, I have had more success in the past with films about artists. An incisive look at what is being done with £110 billion of public money without the knowledge of its public is not deemed newsworthy by a mainstream media besotted with Punch and Judy politics”.
As much as the mainstream media may under-report what is happening, there are many other people who have the faith left to fight for our National Health Service. As shown in Sell-Off, Professor Allyson Pollock and Lord David Owen are currently campaigning to return the NHS to a public service with the NHS Reinstatement Bill. This Bill aims to reverse the changes put in place by the Health and Social Care Act of 2012 which has opened the NHS up to private providers who stand to make a profit from once-public services. The SNP announced it’s support for the NHS Reinstatement Bill in January 2015, and the Bill’s campaigners are asking parliamentary candidates who want their vote to publicly state their support for the Bill in the Queen’s Speech after the general election in 2015.
Dr Clive Peedell is standing for the National Health Action Party against David Cameron’s seat in Witney, Oxfordshire, in the coming general election. The National Health Action Party has several doctors standing as candidates including Dr Bob Gill and Dr Louise Irvine who is standing against Jeremy Hunt. The NHA was launched in 2012 with the defence of the NHS and it’s values at it’s heart. It is a testament to the strength of feeling for the NHS by the doctors who formed the NHA that they continue to juggle clinical commitments with their new found political careers.
People are fighting for an institution that prides itself on providing healthcare for all, without profit for a small few. Sell-Off is not a film you should watch in in a few months, or a couple of years: it will be too late by then. If you care about what happens to our NHS, watch it now.
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