Restricted McKinsey paper portrays grim future for health service

A set of restricted-circulation papers prepared by private health consultants McKinsey in 2010 for the NHS in Northern Ireland includes measures that depict a grim future for the NHS’ founding principle of healthcare ‘free at the point of need’. The measures offer a glimpse into the way that government and private consultants see the future of our NHS in Northern Ireland – and, most likely, in the rest of the UK.

The documents are marked

This document is solely for the use of personnel in the Health and Social Care Board and Public Health Agency of Northern Ireland. No part of it may be circulated, quoted, or reproduced for distribution outside the HSCB or PHA without prior written approval.

However, they are stored on a publicly-accessible area of Northern Ireland’s Department of Health, Social Services and Public Safety (DHSSPS) website, and are therefore in the public domain – perhaps either through oversight or hubris.

The documents can be accessed by entering a specific page address, or by doing a site search for ‘McKinsey’ – but no links to them appear to be available on any of the site index pages. It seems likely, therefore, that they were stored on the site for ease of access by remote personnel in the expectation – ill-founded, as it turns out, that no one else would notice their presence.

The documents are extensive, and heavy going in many parts. However, some sections are very clear. The first, under a heading that says:

begins with a preliminary paragraph warning that the measures about to be suggested would

challenge the principle that the NHS is free at the point of delivery

but that the report’s content

suggests that such options may need to be considered.

So, what are these measures that will challenge the founding principle of the NHS that treatment should be free at the point of need, but that McKinsey’s report suggests are necessary? The first may not seem so bad to those of us who live in England:

We could generate revenue through co-payment by the service user, an opportunity estimated to be worth £0.1 billion -£0.3 billion p.a. by 2014/15.

– Bringing co-payment protocols into line with the rest of the UK could be worth ~£50-80 million by 2014/15.

Co-payment means requiring the patient (‘service user’ in the more commercial jargon) to pay part of the cost of treatment, such as prescription charges or dental treatment tariffs. Since people in England already have to pay such costs, it might not seem unreasonable to impose the same regime in Northern Ireland. However, McKinsey don’t stop there:

In addition to this, other co-payments such as are used in other European countries – or beyond that – could potentially be introduced, if there was need and will. For example, people could pay for attending A&E (as in Republic of Ireland); for access to primary care (as in Germany); for inpatient stays (as in France).

The introduction of any of these measures would do far more than challenge ‘free at the point of use’ as an NHS principle – any one of them would mean its immediate end, and a massive burden on people at their most vulnerable moments.

A careful reading of the figures indicated by the report show that the underlying intent is to implement the wider range of ‘co-payments’, and not just to bring Northern Ireland into line with the system in England.

The report indicates that merely bringing NI into line with England would save between £50m and £80m. But the introduction to the section outlines an ‘opportunity’ of £100-300 million per year. The aim is clearly to save the higher amount – which would mean the complete destruction of the founding principle – and a massive theft of an entitlement which we rightly regard as an essential element of British life.

McKinsey’s recommendations go further still. The report outlines the ‘opportunities’ for reductions in staffing numbers as follows:

• a reduction in the number of consultants by 234
• a reduction in non-clinical staff of 4,300
• 12,600 fewer staff overall (clincal and non-clinical) compared to previously-expected 2015 requirements

Not only does the report recommend reducing staff numbers, but advises a saving of £100m per year by 2014/15 by freezing staff pay.

The grim news isn’t finished yet. The report outlines some of the likely results of having to achieve ‘further savings’ – which will certainly be required as government continues to squeeze funding:

If further reductions in funding were to prove necessary, beyond the identified improvements in productivity and quality, and the changes to income and staff costs described above, then..We would need to restrict access to services and treatments, for example by:

– Enforcing tougher eligibility criteria for treatments, e.g., hip replacements only for the over 80s, social care packages only for the acutely-ill, asking people who need it to buy their own equipment
– Introducing means-testing, i.e., making people pay for care if they can afford to
– Denying treatments that are high cost per Quality-Adjusted Life Year (QALY), e.g., high-cost end of life treatments such as chemotherapy
– Reducing funding of services seen as ‘non-core’, e.g., voluntary and community groups – which currently substitute and/or prevent need for statutory care.

Such actions would ..involve further bed closures and workforce reductions, of ~150 beds and ~1,200 staff per £0.1 billion further reduction in 2014/15 funding.

And, just in case we still need ‘icing on the cake’, the report recommends (but doesn’t quantify, that I can see), the closure of whole hospital sites and of large parts of others.

It’s no surprise that the NHS in Northern Ireland didn’t want these papers in general circulation – and quite a slip to put them into the public domain.

We should be thankful that they did slip. This report gives a frank view of the future of our NHS under this coalition government that robs the poor to enrich the wealthy, and which admits in private, no matter what the public pronouncements say, that the Tories’ long-term aim is not just to privatise the NHS but to eradicate all public services.

This particular document may only pertain expressly to Northern Ireland, but without question the cost-cutting, staff-cutting, service-cutting measures it recommends reveal the nightmare vision that this Tory-led government has for the NHS – one of the greatest achievements of our society.

It has to be resisted, its progress stopped – and the damage reversed by the next Labour government, no matter what it takes.