Don’t let markets kill the NHS!
by rhodri evans
The Government is on the road to converting the Health Service from a provider of health care into an insurance system. In the future, according to Blair and Brown, health care will be “bought in”, more and more of it from private hospitals and clinics, and the NHS will just be an insurance policy, providing cover for health care costs in return for our tax contributions.
Health minister Patricia Hewitt, vainly trying to stop the Labour Party conference condemning this privatisation policy, stated New Labour’s philosophy: “Haven’t we learned that profits are not a dirty word? They are part of a dynamic economy and they are helping build 100 new hospitals...”
The capitalist market is a cruel system in all its workings. It is doubly cruel in health care.
A market system will mean the better-off getting more health care (sometimes more than is good for them, with unnecessary but lucrative operations and treatments) and the worse-off being patched up with whatever is cheapest in the short run and gets them back on the streets quickest.
Competition between hospitals and clinics will lead them to drive down health workers’ wages and conditions, and skimp on unglamorous essentials while pumping resources into higher-profile “market-leader” activities. It will drive some hospitals and clinics out of “business”, disrupting their patients’ treatment.
Patients don’t and can’t have the information to choose “best buys”, even in the limited way we can for other goods and services.
Because it operates, and has to operate, without the “buyers” having much information, a market system involves huge administrative overheads. In the USA’s market-based health system, one quarter of all spending is administrative overheads. The NHS’s overheads used to be much lower. They are creeping up towards the US figure.
A market system might not be so bad if all health care were about who can deliver the slickest, quickest, cheapest appendectomy. But most of it is not. Some 70% of NHS resources are spent on long-term ailments, most of which cannot be cured, certainly not by quick ring-it-up-on-the-till procedures. Treating those ailments, making them controllable for the sufferers, requires cooperation, not competition.
Once the NHS shifts over into “insurance” mode, then, as with all insurance business, there will be constant pressure to limit the cover. Already the NHS has abandoned responsibility for long-term care for the over-70s. Next down the line will be the idea that less vital or smaller treatments should be paid for cash-in-hand rather than covered by the insurance. The current high prescription charges, introduced by the Tories and maintained by New Labour, are a first step there.
In July the Government announced that it would reduce the Primary Care Trusts to commissioning, rather than providing, treatment. Many of the 250,000 health workers now employed by Primary Care Trusts will lose their jobs.
Between now and 2008, the Government will push through a “second wave” of contracted-out medical treatment. By 2008, it expects private clinics to do 10% of NHS elective surgery. And private contractors will not be confined to elective care. Private companies are already being allowed to poach NHS doctors, nurses, and premises.
In anticipation, one entrepreneur, Ali Parsa, has already raised £100 million to build a chain of 20 private “health campuses” across England.
Where new NHS premises are being built, they are being done on the Private Finance Initiative, which means big money siphoned off to give profits to private contractors.
Our job now is to organise in the unions to make sure that they deliver action to match their leaders’ fiery talk against this destruction of the NHS.
www.keepournhspublic.com.
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nhs
It is a disgrace the way the nhs is being broken up.But at the same time you blame the uniona as well.Where were unison when agenda for change took place?Nurses are now worse off,and Dave Prentis supports this.It is wrong what has happend to the nhs,but the unions worked with Blair to do this.So unison are partly to blame,nurses have no support now,their is no union to help them now.
NHS and State Capitalism
Given the AWL's position on State Capitalism, why does the AWL seek to defend the NHS, which is a more clear example of state capitalism than was say the USSR? Given the definition of state capitalism as reactionary, and given the quote from Kautsky about the way the state is a far more oppressive employer than private capital surely the AWL should see the break up of the NHS as progressive, as it did with the break up of the Soviet Union.
Arthur Bough
Privatisation by Stealth
For 3 years up until May I was Vice Chair of Staffordshire County Council's Health Scrutiny Committee. County Council's were given the job of Health Scrutiny with the abolition of Community Health Council's. In fact the whole thing is a farce. The budget that formerly went to CHC's was to be divided up amongst Health Scrutiny Committees, and hte new PALS the patient watchdog. In fact the money seems to have disappeared, and given the mammoth task of scrutinising Health (which covers not just the NHS, but all aspects of health) Scrutiny Committees are woefully underfunded, and resourced - Staffordshire had just one full-time officer as Scrutiny Manager.
Despite that the Committee did some useful work and produced reports on a number of important areas of health - available from the County Council. One report done by one of our working groups looked at Health Care for Children at Risk. The findings were appalling. To give one example, it was found that at least 5,000 children many as young as 8, were involved in providing care. In most cases these children had no support, and their own health - let alone education and welfare - was jeopardised. In fact the figure is much larger, as these were only the children that had been identified - usually by accident as a result of visits to the doctor, or the investigations of Welfare Officers. At the other end of the age spectrum Social Sevices Officers reported on one occasion that they did not know how many old people there were in the County who might need support, and they did not want to go out of their way to find out because the resources to meet their needs were not available.
This is part of a move to take responsibility for care out of public provision, and to put it back on the individual. Considerable effort has been made to ensure that people are taken out of the healthcare system and put into the realm of social care - Councils can now be fined if people are left in hospital beds for whom it is deemed they should be in social care. But in Social Care emphasis is now placed on keeping people in their own homes. It is argued that this is because that is what people want, and it allows them to retain some dignity and independence.
This argument is a sham. Many of the old people sent home are not capable of properly looking after themselves, and those that can often end up with a poor quality of life. Its okay if you live in some leafy middle class area, but life for many old people living in run down areas, afraid to go out of the door for fear of being mugged, and often with nothing to go out for is not much fun. There are some good developments such as retirement villages run by Local Authorities where people can have their own bungalow or flat, in a secure environment, and with the benefit of a community, and with the kind of organised activities that old people need to keep them active. One such in Stoke even organises absailing for some of its residents!!!
If people were offered these kinds of facilities at reasonable cost I think few old people would choose to live in their old, damp terraced houses, or high rise flats. But, these kinds of developments are few and far between.
During the time a couple of hospitals appied to become Foundation Hospitals, and the Scrutiny Committee had to be consulted. The Scrutiny Committee made a number of objections.
1. That the supposed democratic structure of the Hospital Board, although at first glance appearing to be a step forward by giving local people more control over the running of the hospital, would in fact simply lead to the same middle class overrepresntation, and in any case the hospital management would be able to dominate the Board.
2. Foundation Status would lead to a drain of resources including staff from other hospitals within the County as staff could be attracted by higher salaries and better conditions, and the higher investment through borrowing of the Foundation hospital would mean it could do more procedures, which in turn would bring in more revenue. Its improvement would come at the cost of deteriorating provisoin elsewhere.
3. Given the introduction of fixed price funding the likelihood was that the hospital would icnreasingly specialise in particular areas of medicine where it had a cost advantage. There would necessarily be a tendency for the hospital to be a provider not of general health services, but of speicalised medicine, and consequently other hospitals would end up taking on the less profitable work. (This is a likely consequence of fixed price funding - whereby each hospital gets the same price for doing a particular type of operation -throughout the NHS. The supposed increased choice given to patients will in fact become not the choice of going to the hospital that has the best record, but the necessity of going to the hospital that specialises in that operation wherever in the country it is.)
4. The financial arrangements did not seem very clear. Hospitals which prospered udner the arrangements could reward their managements with higher salaries, but hospitals that made big mistakes and ended up in financial difficulties faced no penalties. The Board could simply walk away, and leave the state to pick up the bill.
But we need not have bothered raising any objections because whent he first hospital produced its report on consultation it did not even mention that the County Council had raised them. The second hospital pulled out of the process because it went from being a five star hospital to a two star hospital after it suddenly had financial problems - problems which it did not mention a couple of months before when it made its presentation to the Committee.
It appears to me that the changes being introduced such as fixed price funding, and Foundation hospitals are designed to break the NHS up into manageable units, with different sections becoming specialist providers. Such a process also lays the groundwork for breaking up national pay bargaining - who could object to workers in a Foundation Hospital being paid MORE money? At the same time the break-up of Health Authoroties and the establishment of first Primary Care Groups and now Primary Care Trusts - dominated by the managemnts and doctors, dentists etc. - provide the basis for these organisations becoming private enterprises.
Some of these proposals could be positive if they were given independent working class content. For example, taking hospitals out of the control of the state and bureuacratic NHS Management could be positive, if instead of the proposal for Foundation Hospitals what we had was hospitals whose boards were directly elected by patients, the local community, and NHS workers. Breaking up the Health Authorities and establishing local community control over Primary Healthcare could be positive, if the membership of the TRust was directly elected by the local Community, or if the TRusts functions were transferred to reinvigorated local democratic structures such as Town or Parish Councils.
The Left has to provide not just a fight to defend the progressive elements of the bureaucratic, state capitalist NHS against the reintroduction of private capitalism, but has to present a vision of a socialised healthcare system that truly reflects the ideals of socialism. A healthcare system which not only aspires to provide healthcare free at the point of use, but a system based upon the fullest democratic control by workers and patients.
Arthur Bough