In a late-night session on 24 April, Lords voted through secondary legislation that will drive forward NHS privatisation.
The “section 75 regulations” provide the detail on how the new Clinical Commissioning Groups will sell the NHS to the private sector. Health academic Lucy Reynolds explains: “The Health and Social Care Bill was passed in a form as if it were an aeroplane without any jet engines. The structure was there but [...] they couldn’t find the thing in it to accomplish the privatisation. The regulations provide the jet engines and will make that privatisation go ahead.”
Prior to this legislation, GPs thought they would be able to choose which parts of the NHS to put out to the competitive tendering. But the Lords vote will mean that all NHS services will have to go head to head with the private sector.
This runs contrary to Andrew Lansley’s promises when he was moving the Health and Social Care Bill through Parliament. Then he gave assurances: “”I know many of you have read that you will be forced to fragment services, or put them to tender. This is absolutely not the case. It is a fundamental principle of the Bill that you as commissioners, not the Secretary of State and not regulators — should decide when and how competition should be used to serve your patients’ interests.”
Health economist Allyson Pollock estimates that 20-30% of the NHS budget could be wasted administering this system.
Competitively tendering all health services will put the NHS under significant financial strain. At the moment, NHS providers are paid for every procedure they perform. Some of these procedures are very costly and some are relatively cheap. Generally, low-risk routine procedures, like cataract operations, are cheap and hospitals can make some money on them. High-risk procedures, like emergency surgery, often involve spiralling costs and hospitals may perform them at a loss.
With a single NHS the costs balance out. The extra money from the low-risk procedures subsidises the more costly treatments. But if all services are being put out to tender, then the NHS could lose the low-risk work. Health sector capitalists will be looking to win as many contracts as possible in the low-risk category as this is where the profit is found. So long as the service is funded by the taxpayer, these providers will be allowed to use the NHS logo. Patients will not even know that someone is making a profit from their care. NHS hospitals will be left doing all the expensive treatments but without the subsidies they used to get from low-risk treatments.
Instead of risk and costs being shared throughout a single organisation, the health service will be split between a profit-making private sector and a loss-making public sector. Over time the public NHS will wither away and its reputation will deteriorate as it fails to meet public expectations. At this point, the private sector firms, which have built up their capacity using the NHS brand, can take off the NHS logo and start offering services directly to the public through private insurance schemes.
Many of the individuals who pushed through this legislation will personally gain from this vote.
According to the Social Investigations website, 142 peers have present or recent financial connections with the private health firms. Labour peer Lord Warner even broke the whip to vote in line with his private sector interests.
Only a tiny minority of people support NHS privatisation.
Most of them will personally profit from a booming private health sector. Unfortunately for us, a high concentration of such people work in Westminster. The representatives of private health companies, sitting in Parliament, have ignored the evidence, and scorned professional opinion. They have told the public outright lies, hiding their true intentions with obscure legislative processes.
There is a widening chasm opening up between these people and the majority who believe in a publically owned and controlled NHS. Unlike the sale of British Telecom in the 1980s, NHS privatisation will not happen overnight. The private sector will slowly strangle the life out of the NHS until there is nothing left.
Standing in the way of this future is a growing movement of people who understand the importance of a publicly owned, publicly accountable health service and are willing to fight on the streets, in our workplaces and at the ballot box for the working-class alternative.