In 1948 all the Tory MPs in the House of Commons dutifully voted against the setting up of the National Health Service. For more than sixty years since, the NHS has been one of our most loved institutions, relied on by millions of people to look after their health. The Tories have publicly regretted their stance and pledged that, “the NHS is safe in our hands.” We now see that was a lie. If new Health Secretary Andrew Lansley’s plans, called ‘Liberating the NHS’, goes through the NHS will be in tatters in five years time.
The NHS is Britain’s biggest employer, providing jobs to more than a million workers. As Tony Benn often says, “It’s the most socialist thing we (Labour) have ever done, and the most popular.” The basic principle is that treatment is free at the point of use to all and is paid for from general taxation.
It is a standing reproach to right wing ideologues, and to profit hungry corporations, that the NHS does its job impervious to market forces. For decades ‘reformers’ have plotted ways to inject a market (or rather a pseudo-market) into health provision.
If Lansley gets his way the NHS will no longer be an organisation; it will just be a fund. £80bn, of the more than £100bn presently spent on healthcare in the country, will be disbursed directly to General Practitioners, who will commission health services on behalf of their patients. Lansley presents this as an attack on ‘bureaucracy’ and a case of bringing health care closer to the individual patient. Without apparent irony he refers to “Labour’s old command and control” regime as if the NHS were a Stalinist state.
Let’s be clear: this reorganisation is just a way to soften up the health service for cuts. Paradoxically NHS chief Sir David Nicholson reckons that just implementing Lansley’s plan will cost £1.5bn.
Ten Strategic Health Authorities and 150 Primary Care Trusts will be abolished. That means 30,000 jobs will go. What will happen to the workers? Will their expertise be lost to the NHS? Lansley neither knows nor cares. Their abolition goes contrary to the Coalition Agreement which pledged only weeks before that PCTs would stay. Nobody voted for these proposals.
Even the British Medical Association, the organisation of family doctors, is divided on the plan. Though doctors initially resisted the setting up of the NHS, most have become reconciled to socialised healthcare, which after all provides them with a decent living. The 35,000 GPs are not up to the task of organising all health care in England. For instance, most GPs admit they are not experts on mental health. It is feared that many will just dish out tranquillisers to those who ask for help. Many have said they want to be doctors, not accountants. They don’t have the expertise to handle large sums of money. It is assumed that GPs will form consortia and farm out the administrative side of the business.
Fortunately there are firms that can help them! The giant private healthcare and insurance companies, mainly American owned, are salivating at the prospect of getting their foot in the door of the NHS. No wonder Kingsley Manning of the health firm Tribal is looking forward to the "denationalisation of healthcare services in England".
These are the same companies that have fought like tigers to prevent Obama’s modest plan for universal health insurance passing in the USA. They are part of a system where healthcare costs nearly twice as much as a proportion of national income as in Britain (15.2% as against 7.8% here); yet 50 million Americans have no health insurance and millions more are bankrupted by the medical bills incurred by long periods of illness. The US health system is also dogged by vast frauds by the same healthcare firms that want to make their fortune at our expense. For instance UnitedHealth has been caught using a dodgy database to set charges and its California subsidiary was fined for mishandling claims in the same year. These firms are not welcome here.
Commissioning for primary healthcare is currently the job of 165 PCTS. Nobody knows how many GP consortia will replace them – figures between 300 and 600 have been mentioned as possible. That sounds like more bureaucracy, not less. GPs may imagine they can just sign cosy little deals with the firm they know down the road. As a form of public sector contracting, their arrangements will be open to the full scrutiny of EU competition law. That means that tenders have to be advertised internationally. That is not only very bureaucratic, it has proved to be a crowbar for big capitalist corporations to make money out of public provision all over Europe.
What if your local hospital goes bust as a result of this bidding war? Lansley has no answer. But most hospital operations are linked to strokes, heart attacks and other mishaps. ‘Choice’ is not the issue – staying alive is more important to patients! – and for that you need a hospital local to you.
Lansley has played the populist card that front line services need to be preserved at the expense of ‘bureaucratic’ jobs. Our health service workers do need backup. Medical records have to be kept. Appointments have to be organised. PCTs have built up teams of ancillary workers such as physios. They try to provide holistic treatment.
PCTs are also co-operating with local authorities on public health. A genuine criticism of the NHS is that it is a ‘national illness service.’ But prevention is better than cure. All these links in a unified service would be at risk under the governmenta proposals and of course the coalition is slashing local authority budgets as well. National standards will go by the board. Cameron has already admitted he can’t guarantee that a cancer patient will get to see a specialist within a fortnight.
Unison’s head of health, Karen Jennings notes, “Specialist services could disappear altogether in areas where there is little demand for them. But that could be catastrophic for those patients suffering from life-threatening diseases who are unable to get treatment near to where they live. The profit motive is not a panacea and we think standards of patient care could deteriorate.”
The argument about cutting back layers of ‘bureaucracy’ is very convenient when the coalition government is going to take an axe to public service provision. 14% of the £105bn NHS bill (that’s £15.4bn) goes on management and administration. This figure has soared since the first attempt to introduce an internal market to the NHS in 1991 by the Tories. The attempt to introduce ‘market reforms’ into the NHS unfailingly leads to the development of new layers of bureaucracy!
The 1991 reorganisation was called GP fundholding. It was voluntary and did not cover hospital care, emergencies and maternity services. The current proposals go much further. They are the exact equivalent of the ‘shock therapy’ privatisation that destroyed much of Russian industry and ruined so many lives in the 1990s. For Russia it was all shock and no therapy. This will be the same – if they get away with it.
Any attempt to introduce ‘market reforms’ is really a pretext for privatisation. It is a case of opening the door to the big private health companies. Previous Labour health ministers Patricial Hewitt, Alan Milburn and Lord Warner are all on the payroll of such firms, lobbying vigorously for the NHS to be opened up to the businesses they work for.
Lansley argues that the proposals would offer more ‘choice’ to patients. That is highly unlikely. It will be the GPs who will hold the cheque book and therefore make the choice, They will pass on the administrative side to the healthcare giants to take commissioning decisions. Their ‘choice’ will be profit–driven – no doubt about it. If GP budgets are constrained, as is bound to be the case with this government determined on cuts, they will try to cut costs and send patients to the cheapest provider, come what may.
Lansley says choice will be informed by publicising health information. Some health information is publicly available, such as the prevalance of MRSA in hospitals. (We know that MRSA and other infections have become a big problem since the privatisation of hospital cleaning.) But information about the performance of GPs is not always in the public domain, and would be difficult to assess in any case.
The NHS unions are up in arms at the proposals. Karen Jennings, said: "Handing over £80bn to untried, untested and probably private sector-led consortia is reckless. How will they be held accountable for that money? Far from liberating the NHS, these proposals will tie it up in knots for years to come. They are a recipe for more privatisation and less stability."
These proposals are being rushed through. They are a huge gamble with people’s health and lives. It makes it easier to push through waves of cuts in a fragmented health service. Make no mistake. This is a proposal to destroy the NHS, which millions of working class people regard as the biggest single reform we have ever wrung out of the capitalist system. The labour movement must mobilise all its forces to stop Lansley and the coalition in their tracks.
