on 12 July 2007
Our National Health Service used to plan and fund to meet patient needs, providing free and fair access for all. But things are very different now, as Dr Alison Talbot-Smith, a specialist registrar in respiratory medicine, and Professor Allyson Pollock, head of the Centre for International Public Health Policy at the University of Edinburgh, explain in this excellent book.
They have provided a careful and scholarly survey of the NHS's current workings. It follows Professor Pollock's NHS plc: the privatisation of our health care (Verso, 2004), in which she destroyed the government's rationales for its anti-NHS policy.
They write, "The NHS is being radically transformed. It was originally conceived and built up as a tax-funded, centrally-planned, publicly-owned and accountable service, available everywhere to everyone equally, like schools or police services. The new NHS is to be a market, in which patients choose particular hospitals or clinics and in which doctors and hospitals compete for business, both with each other and with for-profit healthcare corporations."
Until 2000, the government claimed that it would not privatise clinical services but The NHS Plan of 2000 proved this to be a lie. The NHS was to become a holding company, `franchising' health services out to various providers. The government has destroyed the mechanisms for ensuring greater equity of resource allocation and service distribution.
Privatisation means extra costs: setting up new bodies to regulate, monitor, inspect and audit; marketing services to attract patients; billing and invoicing; paying huge fees to unnecessary management consultants and lawyers; and, for the private providers, the overriding imperative of paying dividends. For example, surgery performed in private hospitals costs 40% more than in NHS hospitals, because of higher costs and the need to return a profit to the shareholders.
The government imposed external regulation on the health professions, reducing the roles of the professions' own bodies. New contracts for GPs and consultants give the government more powers over how doctors work. The government's Medical Training Application Service for junior doctors is a disaster. The government has also tried to impose more `flexibility' on all NHS staff's conditions. But the government has succeeded in one area - it has created 70% more managers. Public trust in NHS workers' service ethos is being replaced by litigiousness, fostered by private law and legally binding contracts.
Most of the increased amounts of public money that the government boasts about putting into the NHS go straight through the NHS and out the other side to private companies. The total value of PFI-financed hospital schemes approved by the Labour government is £17 billion. PFI accounts for 98% (by value) of building schemes in the NHS hospital and community health services. Private borrowing is dearer, but the public sector runs the risks. In 2004, Labour lifted the ceiling on health administration costs, which had already doubled, cutting clinical care budgets so that there are fewer beds in PFI hospitals. PFI's spiralling costs and corruptions are obvious to everyone but the scheme's godfather, Gordon Brown.
Many NHS trusts have large financial deficits, causing them to suspend or delay treatment or even close services. Community hospitals are being closed; there are major cuts in mental health services, palliative care, pain relief and speech and occupational therapy services. And now Brown proclaims that he wants to end all district general hospitals!
Labour has forced local authorities to divest themselves of all their social service assets, including long-term care for the elderly, ending equal access to equal quality of care for older people. Much social care and long-term care is now charged for. All these cuts are worsening health inequalities. Patients' entitlements to NHS care are being curtailed. The NHS no longer provides comprehensive care.
`User fees', `top-up fees', `co-payments' and vouchers are undermining the NHS's goals. `Choice' of service provider swiftly becomes `choice' of level of service, a choice determined by ability to pay, not by need.
Labour's `reforms' are not producing a better or more cost-effective NHS. As the authors note, "The outsourcing of ancillary services, like hospital cleaning and catering, has yet to provide evidence that the profit motive leads to better service, or lower costs." In sum, Labour is destroying our National Health Service, one of Britain's greatest achievements.