Government proposals in the White Paper, 'Liberating the NHS', will bring the NHS in England much closer to a fully privatised healthcare system.
Under this Health Bill, Strategic Health Authorities and Primary Care Trusts will be abolished. PCTs are currently responsible for spending 80% of the NHS budget. GPs themselves will now directly take on that spending role, become commissioners of all healthcare services; Foundation Trusts will be autonomous institutions that will be allowed to provide private care. The NHS will become little more than a fund, overseen by GPs (or more likely private companies employed by GPs), that buy healthcare services from various private providers.
International private health companies are already salivating at the prospect of winning lucrative NHS contracts.
The end of PCTs and SHAs will result in thousands of job losses (45% of management positions will be axed). Necessary administrative support will now be filled (inadequately) by businesses like Humana, Aetna and United Health. In consultative roles they will provide advice to GPs on where to access the best services. They will also be vying for business as health care providers. The plan is that they will “facilitate” staff in health care centres set up like John Lewis style mutual associations.
Despite the promise of real terms spending increases the Lib/Tory government wants to claw back a £20 billion budget deficit by 2014 (a year earlier than previously planned).
Foundation Trusts (groups of hospitals and community services) will be able to raise money by external means. The most obvious way is by increasing the number of private beds. Other ways are allowing women to pay for further fertility treatment in an NHS centre when they have used up the number of IVF cycles available on the NHS and building facilities where treatment is more likely to be financed by insurance companies — e.g. traffic accident trauma centres.
Crucially, Foundation Trusts (there are currently 130 in England, about a third of the total) will now be able to opt out of national bargaining with the trade unions.
The government wants to see the NHS in England turned into the “biggest social enterprise in the world”. Nothing new here though — workers are being asked to oversee and step up their own exploitation.
Like New Labour, the new government justifies privatisation by claiming they are serving “patient choice”. “Patient choice” is in fact embedded in traditional medical ethics, as the principle of “informed consent”. Patients must be told as much as possible about their condition and their treatment options in order to get the most informed consent possible. Short of training every patient in the finer points of medical science, consent and choice will remain limited, but it is a goal that most healthcare professionals aspire towards.
However “patient choice” has now become part of a post-modernist trend that champions patients rather than trained professionals as the experts.
We know confidence in the authority of doctors and other healthcare providers plays an important role in a patient’s recovery. Despite scientific advance, good quality healthcare remains rooted in human relationships and trust between healthworkers and patients. In recent years, both New Labour and the Tories have sought to undermine that trust.
New Labour attempted to introduce outcome measures and targets across the public sector and asked the public to put their trust in their bureaucratic facts and figures. The Tories wish to take this a step further by asking us to place our confidence in the market — competition between service providers will produce the best outcome for you!
New Labour believed in a “managed market” whereas the Tories are for “liberating” the NHS from any management. If a service does not receive enough referrals, or it is not performing well in the League Tables, then it will go bust. Health Secretary Andrew Lansley has already signalled that “failing” hospitals, GP surgeries and other providers will receive no bailout.
The advocates of free markets argue that state-run healthcare is unnecessarily bureaucratic. But the administration costs of privatised healthcare are many times more than the old-style, bureaucratically-planned NHS. Why?
Health is not very easily commodified. While for example a hip replacement can be easily costed up and sold, treatment for schizophrenia is less easy to measure and package. In many such cases a market in health can only be maintained artificially by a massive bureaucracy which exists to attach arbitrary cash sums to uncommodifiable aspects of health.
For the same reasons marketised health care distorts the services, priorities and values of the health service. When all the most profitable contracts (a quick hip op here, a sports injury there) will have been taken by the private firms, the rump NHS will be left to administer all the least profitable services (the unquantifiable chronic illnesses like schizophrenia).
As cuts begin to be felt, those who can afford to will top-up their care (e.g. get the better state of the art drugs or a fast track operation) and drive down the availability or standard of free care on the NHS.
Eventually the whole principle of free state-of-the-art healthcare will be undermined.
Although it reeks of hypocrisy, Labour’s Shadow Health Minister Andy Burnham has already raised the alarm about this White Paper and pledged to mobilise a campaign against the proposals. Whilst the Lib/Tory proposals are an extension of New Labour’s, the Labour machine may be forced to take a turn towards the trade unions and the grassroots of the movement to defend the NHS as a healthcare provider.
Socialists need to be involved in campaigns to fight a defensive action to save the NHS and to assert a positive alternative vision. This vision should cut against both the old bureaucratic state-run service and the market-driven system and assert workers’ and patients’ control. “[Healthcare] run from the bottom up, with ownership and decision-making in the hands of professionals and patients” will only be possible with a fully nationalised, state-funded NHS and through a movement to defend the NHS drawing on the expertise, creativity and knowledge of people who work inside it.