Lansley opens the door to full-scale NHS privatisation (Updated: no, he doesn't)

The 49% cap on private work done by NHS trusts will be abolished.

Update 2: Just to clarify, this piece was based on a Financial Times story, which the Department of Health has told us is incorrect. The FT has silently changed the headline, standfirst and content of its story. However, we have decided to leave this piece online, with the relevant correction.

Update: The Department of Health has been in touch to say that the cap is not being removed, rather that the planned 49% limit will be introduced from 1 October 2012.

The spokesman added: "Services for NHS patients will still be protected as the Health and Social Care Act 2012 sets out that foundation trusts still have a core legal duty to provide services to them.  The majority of their income must also come from NHS sources.  Income from non-NHS sources will also be reinvested back into wider hospital services, to benefit NHS patients."

When the government unveils a policy change on a Friday it's a sure sign that it doesn't want you to notice. Today, Andrew Lansley will announce that the 49% cap on private work done by NHS hospitals, which his bill introduced, will be abolished. In other words, the Health Secretary has just opened the door to the full-scale privatisation of the NHS, with hospitals able to raise 100% of their income from private healthcare.

Sue Slipman, the chief executive of the NHS Foundation Trust Network, describes the removal of the cap as "a really creative way of bringing more money into the health service". What she doesn't say is that foundation trusts, in pursuit of profit, will likely prioritise the treatment and care of private patients over NHS ones. Since the most profitable procedures are usually the simplest, those requiring more complex treatment will be pushed to the back of the queue. As Howard Catton, head policy at the Royal College of Nursing, has previously warned: "NHS patients may feel a subtle pressure to reach for the credit card." Since all of the remaining 113 NHS trusts are required to become self-governing foundation trusts by April 2014, the removal of the cap will apply to all NHS services - hospitals, ambulances, mental health, community services and clinics.

What makes this change so unexpected is that Lansley's original plan to place no ceiling on private treatment was rejected under trade union and Liberal Democrat pressure. There are two possible explanations: either the Lib Dems signed off on the policy or they weren't told. Either is disastrous for their credibility.

Health Secretary Andrew Lansley plans to allow NHS trusts to raise 100% of their income from private treatments. Photograph: Getty Images.

George Eaton is political editor of the New Statesman.

Photo: Getty Images
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Autumn Statement 2015: whatever you hear, don't forget - there is an alternative

The goverment's programme of cuts is a choice, not a certainty, says Jolyon Maugham.

Later today you will hear George Osborne say there is no alternative to his plan to slash a further £20bn from lean public services by 2020-21. He will also say that there is no alternative to £9bn cuts to tax credits, cuts that will hit the poorest hardest, cuts of thousands of pounds per annum to the incomes of millions of households.

But there is.

As I outlined here the Conservatives plan future tax cuts which benefit, disproportionately or exclusively, the wealthy. Suspending those future tax cuts for the wealthy would say, by 2020-21, £9.3bn per annum.

I also explained here that a mere 50 of our 1,156 tax reliefs cost us over £100bn per annum. We don't know how much the other 1,106 reliefs cost us - because Government doesn't monitor them. And we don't know what public benefit they deliver - because Government doesn't check.

What we do know, as I explained here, is that they disproportionately and regressively benefit the wealthy: an average of £190,400 per annum for the wealthiest.

And we know, too, that they include (amongst the more than 1,000 uncosted reliefs) the £1bn plus “Rights for Shares Scheme” - badged by the Chancellor as for workers but identified by a leading law firm as designed for the wealthiest.

Simply by asking a question that the Chancellor chooses to ignore - do these 1,156 reliefs deliver value for money - it is entirely possible that £10bn or more extra in taxes could be collected without any loss of  public benefit

To this £19bn, we might add the indiscriminate provision - both direct and indirect - of public money to wealthy pensioners.

Those above basic state pension age enjoy a tax subsidy of up to 12% on earned income.

Moreover, this Office for National Statistics data (see Table 18) reveals that the 10% of wealthiest retired households - some 714,000 households - have gross pre-tax and pre-benefit private income of on average £43,983. Yet still they enjoy average cash benefits from government of £11,500 per annum.

Means testing benefits to exclude that top 10 per cent of retired households would save £8.2bn per annum. And why, you might wonder aloud, should means testing be thought by the government appropriate for the working age population, yet a heresy for retired households?

Add in abolition of that unprincipled tax subsidy and you'll save even more. 

So there are alternatives. Clear alternatives. Good alternatives. Alternatives that enable those with the broadest shoulders to bear some share of the pain. Don't allow yourself to be persuaded otherwise.

Jolyon Maugham is a barrister who advised Ed Miliband on tax policy. He blogs at Waiting for Tax, and writes for the NS on tax and legal issues.