Leader: The beginning of the end of the NHS

The coalition's reforms pave the way for the full-scale privatisation of the health service.

By Staff blogger Published 20 January 2011

It is a year since the Conservatives launched their pre-election campaign with a poster of an airbrushed David Cameron, bearing the legend "I'll cut the deficit, not the NHS". At that time, it seemed the party would adopt a safety-first approach to the National Health Service. We welcomed Mr Cameron's pledge to ring-fence spending and to stop the "top-down reorganisations of the NHS", a promise reaffirmed in the coalition agreement in May 2010. No one, from the Tory leadership downwards, hinted at the revolution the government is now preparing to unleash. Here, after the surprise decisions to triple university tuition fees, abolish universal child benefit and raise VAT, is yet another example of this coalition's calculated dishonesty.

Following the publication of the Health and Social Care Bill, alarm is beginning to spread over the biggest reforms to the NHS since its creation. If we are to believe Mr Cameron, the decision to abolish primary care trusts and hand over 80 per cent of England's health budget to GPs will reduce bureaucracy, improve efficiency and empower patients. In reality, it will empower the private sector, introduce an external market and bring about the end of the NHS in all but name.

The requirement for the new GPs' consortiums to commission services from "any willing provider" opens the way for full-scale privatisation of the health service. As our report on front-line Britain (starting on page 24) shows, few GPs feel ready to shoulder this responsibility. A doctor writes: "We have absolutely no idea how we're supposed to do it." In practice, many will transfer responsibility for commissioning to the private sector, creating a conflict of interest as the same private companies become both purchaser and provider. Little wonder that Kingsley Manning of the health firm Tribal has welcomed the reforms as the "denationalisation" of the NHS.

But it is the decision to open the health service to competition law that represents the most pernicious aspect of this bill. To avoid legal action by private firms, the consortiums will be obliged to put all contracts out to tender. Worse, the new NHS operating framework states that providers will be able to offer services to commissioners "at less than the published mandatory tariff price". In other words, the private sector has been given free rein to offer temporary loss leaders, undercutting the NHS. With the health service required to make unprecedented savings of between £15bn and £20bn by 2014, the danger is that GPs will prioritise cost over quality. The limited experiment with price competition during the Major government led to a decline in standards of care, according to research by economists at Imperial College London.

Opposition and scepticism towards the changes extend well beyond the ranks of the trade unions. Most GPs oppose the reforms, as do the Patients Association and the independent King's Fund think tank. Meanwhile, the Commons health select committee, chaired by the former Tory health secretary Stephen Dorrell, warns that the change of policy has not been "sufficiently explained" and the Conservative MP Sarah Wollaston, who was until last May a GP, likens the reforms to throwing a "grenade" into the system.

Since the government's plans were announced, Mr Cameron has struggled to explain them to the public. In the space of one radio interview on 17 January he described the reforms as "evolutionary" but also insisted that "fundamental changes" were needed. The detail has been left to the Health Secretary, Andrew Lansley. Mr Cameron is fond of presenting himself as a chairman rather than a chief executive, but it is he who will bear ultimate responsibility if the reforms precipitate the biggest crisis in the history of the health service.

Aware that its time in office may be short, the coalition is pushing through changes for which it has no mandate and at breakneck speed. We feel the onus is once more on the Liberal Democrats to halt or, at the very least, delay these reckless reforms. Should they fail to act, they will forfeit, as David Owen, one of the founders of the Social Democratic Party, writes on page 30, any claim to be "the heirs of Beveridge".

Special Offer: Get 12 issues of New Statesman magazine for just £12

9 comments

Thu, 2011-01-27 04:58 — Lenny (not verified)

My mother was unfortunate enough to b an inpatient at Chase Farm hospital. The care provided was disgusting, the nurses barely spoke English and were very dismissive and rude. Most of these nurses should not even be working for the NHS. The Doctors were unhelpful and arrogant. I wouldn’t take my dog to Chase Farm Hospital for treatment, let alone a family member. God help us all!!

Sun, 2011-01-23 17:48 — steve (not verified)

" As a frequent user of the NHS, I could not care less whether I am treated in a private or public hospital, in fact the private one would probably be better.

If private medicine is so bad, why to people bother to take out private medical insurance? At least you will be in a clean hospital.

Doctors will make decisions based on best clinical practice, just as they do in private medicine already. What's the problem?"

Zebigboss, your stupidity deserves the pain that is on your horizon. Come to the US where 46 million or so can't even afford the astronomical cost of health care, and those that do have insurance wonder if they're covered when they become sick. We're not talking nice little BUPA. We're talking a HUGE chunk of your pay packet. Money that will help pay for the incessant drug commercials played over and over again in homes, hospital and doctor waiting rooms. By the way, I am one of the lucky ones with relatively good insurance. It doesn't compare to my NHS treatment. The gloves are off. Be prepared!

Fri, 2011-01-21 17:39 — Luddite (not verified)

The coalition's reforms pave the way for full-scale privatisation of the health service.

No it will not, stop telling lies..

Sat, 2011-01-22 19:40 — Saltley Gates (not verified)

Labour paved the way for full scale NHS privatisations, not only paved the way but landscaped it planted bulbs, arranged the lighting to give Labours pals in the Private Health sector easier access.

Remember the Foundation Trusts, PFIs, the return of the Tories Internal Market?
Remember NHS Logistics flogged off without debate, Remember how Labour abolished our Community Health Councils and all subsquent Democratic scrutiny.

Remember Labour allowing victimisation of Union reps who spoke out against privatisation like Helen Reissman?

Remember Labours encouragement of bullying managers in Trusts?

Remember Labour attacking NHS pay , conditions and pensions whiole stuffing the Medics mouth with gold again

Remember all that cod Partnership Working that the Unions fell for

Remember Labours sham consultations and Labours fatuous NHS Constituition not even useful to wipe your arse on.

Then there were the influential Labour Private Health Care donors Lord this and Lady that selling the NHS for a pair of ermine knickers

Then the massive influence of privatisers and marketeers like Julian Le Grand and that Corpoarte propaganda arm of the Corpoarte Health privateers the King Fund

Then we had Milburn and Hewitt pimping the NHS to the highest bidders in the private sectors as Ministers and Consultants

Remember Burnham talking about privatisation until the loss of NHS workers support before the election made him change his tune but not his belief. Remember Burnham was preparing GP Comissioning himself.

Labour and its spineless members should be ashamed of their role in NHS Privatisation and the cringeing opposition they have put up to the privatisation.

We will remember Labours privatisation and break up of our NHS and we remember what Foundation Trusts led to Mid Staffs, bullying gagging management culture and dead or neglected patients

Labour a pathetic gutless party that rats on the poor, elderly and disabled.

Fri, 2011-01-21 18:09 — zebigboss

As a frequent user of the NHS, I could not care less whether I am treated in a private or public hospital, in fact the private one would probably be better.
If private medicine is so bad, why to people bother to take out private medical insurance? At least you will be in a clean hospital.
Doctors will make decisions based on best clinical practice, just as they do in private medicine already. What's the problem?

Fri, 2011-01-21 03:18 — the pinkpostman

The same could well happen here in NZ if the National (Conservative ) Government is returned. Im afraid privatisation is in their DNA,, However its the working people who put them in and thats the big problem

Thu, 2011-01-27 16:12 — Jakka

The recent Commonwealth Fund Survey of the healthcare systems of 11 richest nations ranks the NHS top for efficiency and cost effectiveness. The NHS came 2nd overall (Netherlands came top) and is the only system where access to treatment is not linked to wealth. The US comes bottom, despite paying double per head, has the highest number of people who go without treatment because of cost, and the highest rate of disputes with insurers refusing to pay. The NHS score highly for quality of care and patient satisfaction.

Sun, 2011-01-23 14:13 — Red Mantis (not verified)

The Plot against the NHS

By Colin Leys and Stewart Player

Colin Leys is an emeritus professor at Queen’s University Canada and an honorary professor at Goldsmiths College London. His most recent books are The Rise and Fall of Development Theory, Market-Driven Politics, and Total Capitalism. He has been studying and writing about the NHS since the late 1990s.

Stewart Player is a public policy analyst with extensive experience of studying the NHS. He is the co-author with Colin Leys of Confuse and Conceal: The NHS and Independent Treatment Centres, and author or co-author of numerous articles on the NHS.
with CARTOONS BY Julian Tudor-Hart

Do the coalition government’s plans for the NHS really mean a big change of policy? Or do they just bring into the open what New Labour was already doing?

This book shows what has really been going on:

The plot: how a small ‘policy community’ inside and outside the Dept. of Health have schemed for ten years to replace the NHS with a US-style healthcare market – without telling parliament or the public.

The template: how the close links established after 2000 between the Department of Health and the US health maintenance organisation Kaiser Permanente led to the American market model becoming the lode-star of government policy

The players: the insiders of the policy community – the corporate heavies, the mercenaries (management consultants), the think-tankers and the freelancers (some academics and doctors), and the ‘revolving door’ that lets private company representatives into jobs in the Department of Health, and ex-ministers and officials into lucrative positions in private health companies

The interests served: the private health industry and its drive to take over from NHS hospitals and GPs – the companies involved, their lobby, their businesses, their fortunes – and in some cases, their crimes

How it has been done: key elements in the strategy – the provision of openings for the private sector at every stage of ‘reform’; so-called ‘pilot’ schemes that are never evaluated but promptly ‘rolled out’ across the country; buying off or denigrating critics; divide and rule in the NHS workforce; constant spin

The victims – us: the shape of the emerging healthcare market and how it is already driving costs up, and the availability and quality of care down, as revealed in real-life accounts by NHS patients and doctors; with high-quality care increasingly having to be paid for – by those who can afford it.

Keywords: Health policy, Health economics, Politics, NHS, Privatisation, UK. Bic: MBN,KCQ, JP, JPP, 1DBK

Pbk ISBN 978 0 85036 679 2 GB Pounds 12.95
——-

THE MERLIN PRESS LTD. [Editorial +44 [0]20 8533 5800]
Order books from www.merlinpress.co.uk
6 Crane Street Chambers, Crane Street, Pontypool NP4 6ND, Wales Tel 01495 764 100