The creation of the National Health Service is considered
by many people to be the greatest achievement of any British government. The
NHS was established in 1948 on the back of a landslide victory by the Labour
Party in 1945, who came to power on a programme that included the creation of
the cradle-to-grave welfare state, the mass construction of council housing,
and the nationalisation of transport and key industries. Aneurin Bevan, the
Labour Minister of Health who pushed for the creation of the NHS, famously said
that, “The NHS will last as long as there are folk left with the faith to fight
for it.” Now these words are being put to the test as the coalition government
seeks to introduce the most regressive changes to the NHS in its history.
The creation of the National Health Service is considered
by many people to be the greatest achievement of any British government. The
NHS was established in 1948 on the back of a landslide victory by the Labour
Party in 1945, who came to power on a programme that included the creation of
the cradle-to-grave welfare state, the mass construction of council housing,
and the nationalisation of transport and key industries. Aneurin Bevan, the
Labour Minister of Health who pushed for the creation of the NHS, famously said
that, “The NHS will last as long as there are folk left with the faith to fight
for it.” Now these words are being put to the test as the coalition government
seeks to introduce the most regressive changes to the NHS in its history.
The proposed NHS “reforms” (i.e. counter-reforms) have been
outlined in the policy paper “Equity and Excellence: Liberating the NHS” and
are currently under consideration in the form of the “Health and Social Care
Bill 2011”. From the content of the policy report and the bill, however, it is
clear that “liberating the NHS” is in fact a euphemism for “opening up the NHS
to privatisation”, since the proposals seek to introduce the market into the
NHS and allow private firms to have a greater influence and involvement in the
provision and management of health services.
In a paper entitled “English NHS Embarks on Controversial
and Risky Market-Style Reforms in Health Care”, Professor Martin Roland, the
Chair in Health Services Research at Cambridge University, states that, “The
scale of change envisaged is immense, creating major challenges in
implementation, with unpredictable implications as to how the reforms will
eventually alter front-line services and what effect they will have on quality
and cost.” In other words, the coalition government is not making these
proposals in the interests of patients.
Professor Roland goes on to say that, “The challenge is
compounded by a virtual freeze in NHS funding after several years of budget
increases of 6% per annum and by the need for £20 billion in real-term savings
over the next 5 years to accommodate inflation in the costs of medical products
and services.” Let us remember that the Tories promised to protect NHS funding
in their general election manifesto in 2010.
The NHS has not been
left unchanged since its inception in 1948. Both the Tories under Thatcher and
Major and then the New Labour government under Blair, sought to introduce the
market into the NHS in various guises. The most central part of the current
proposals – the intention to allow groups of GPs to manage part of the NHS
budget – was actually first proposed in a reduced format by the Major
government, but was quickly scrapped due to unpopularity and infeasibility. It
was Thatcher who introduced the “internal market” into the NHS in 1991, and
Blair who encouraged the outsourcing of medical services and support to the
private sector, including the use of Private Finance Initiatives (PFIs) that
allowed private companies to build and manage hospitals. The PFI schemes were
shown to be a complete farce by the credit crunch: as banks refused to lend,
private companies found that they couldn’t finance PFI projects, leaving
taxpayers to pour billions into the chasm of funding that emerged.
The most dramatic change that has been proposed is to allow
“consortia” or “commissioning groups” of GPs to manage upto 70% of the NHS
budget, a total of £80bn. The supposed aim of this measure is to eliminate
bureaucracy within the NHS and give control of the NHS budget over to staff.
However, Professor Roland concludes that, “Management support for general
practitioner commissioning groups will come either from the former staff of
primary care trusts [public bodies which currently manage the NHS budget] or
from a range of private-sector organisations. The risks of this are clear:
general practitioners don’t necessarily want to hold budgets, they may not have
the skills to manage budgets, and they will need extensive management support.”
In other words, one set of publically accountable bureaucrats is to be replaced
by a set of unaccountable private bureaucrats, many of whom will be the same
people! The proposal is clearly, therefore, simply a means to open up the NHS
to private companies, similar to the academies and “free schools” that are
being introduced in education.
It is undeniable that a layer of needless bureaucracy,
including a vast army of extremely well paid management consultants, exists
within the NHS and public services in general. It is also correct that NHS
staff should have a say in how the service is managed and run. For example, the
New Labour government too often set arbitrary targets for performance that were
imposed from above, not too dissimilar to the Stalinist “Five-Year Plans” or
Maoist “Great Leap Forward”. The solution is not, however, to introduce the
market and privatisation, or to simply hand over control of budgets to small,
elite sections of staff. Why should it be solely GPs that are given control of
the NHS? Why not include nurses, doctors, and all health care professionals –
the people who really understand how the NHS operates? And what about patients
and the public at large who must use these services? Instead of having
well-paid managers and consultants, the NHS should be run by the workers in the
hospitals, the trade unions in the health sector, and elected state
representatives.
The second big change to be introduced is that of health
care provision. The new policy aims to convert all hospitals into “foundation
trusts” – freestanding legal entities that are not centrally managed and that
have the freedom to raise public and private capital. In addition, the
proposals will allow “any willing provider” (i.e. any private company) to bid
for and deliver NHS services, provided they meet a certain standard of quality.
Allowing these providers to compete on the basis of price has not yet been
ruled out. The former hospital regulator “Monitor” will be expanded to become
an economic regulator by setting maximum pricing.
According to Professor Roland, “The hope of the new
government is that providing information on quality will ensure that market
forces drive up quality in the absence of centrally defined targets or price
signals.” He goes onto say, however, that, “The UK government is faced with the
paradox of wanting the health care market to be driven by a public that has not
been particularly interested in health care choice and using institutional
structures that in the past have proved ineffective in promoting markets.” The
message is clear: the vast majority of people are not interested in an abstract
idea of “choice”, and competition and privatisation will not help improve
either the cost or quality of health care.
The figures speak for themselves. In the UK, 82% of
healthcare funding is public, compared to 45% for the USA. In addition, the
total healthcare costs as a percentage of GDP are 8.4% for the UK, almost half
of the value for the USA. Despite these reduced costs, the life expectancy in
Britain is greater, the infant mortality rate is lower, and there is the same
number of physicians per population. In other words, thanks to our
nationalised, publically funded, universal health system, the UK provides
better healthcare at a lower cost than the privatised, insurance based US
system.
Far from needing more marketisation of the NHS, it is clear
that we need fewer markets and greater integration within (and between) public
services. It is the integration of the various sections of the healthcare
system that leads to improved efficiency, communication, and economies of
scale. Healthcare professionals already complain about not being able to gain
access to vital information and resources due to the breakup of the NHS and the
outsourcing of services to private companies.
In
addition, the costs of healthcare are currently driven up by the presence of
huge private monopolistic companies in key areas such as pharmaceuticals (e.g.
GlaxoSmithKline) and healthcare machinery (e.g. Siemens), which force the NHS
to purchase drugs and medical devices at vastly inflated costs. These private
monopolies should be brought into public ownership and put under democratic
control, along with the banks, infrastructure, and industry, so that a fully
integrated plan can be drawn up to run public services in the interest of
people not profit.
