Mark Britnell, recruited by the government as an adviser on the changes it will force through in the Health Service (Nursing Times, 3 May), has said:
“In the future, the NHS will be a state insurance provider, not a state deliverer [...] The NHS will be shown no mercy and the best time to take advantage of this will be in the next couple of years” (Guardian, 14 May).
In the Health Service Journal (11 May), Britnell proposes Singapore as a model: “the government [...] provide people with a sort of individual savings account that enables them to take greater personal responsibility. The central provident fund enables people to pay for their own housing, pensions, healthcare and even their children’s tertiary education”.
He also suggests “co-payment”, whereby people would pay part of the price of care and medicine, while a public fund pays the rest.
Lib Dem bigwig Shirley Williams has publicly challenged David Cameron to “dismiss Britnell and specifically reject [Britnell’s] predictions for the future of the NHS.”
Otherwise, says Williams, Cameron’s denials that “his party intends to privatise the NHS” lack all credibility (Guardian, 16 May).
Cameron has failed to respond, other than via a government statement insisting disengenuously that Britnell is not a government adviser (he is on a volunteer panel).
Professor Steve Field, chair of another panel of advisers, the NHS Future Forum, has said Britnell is “wrong”, but then Field already criticises the government’s proposals as “unworkable” and “destabilising” and wants to change them at the edges.
Even with the “listening exercise” pause (announced early April, and due to run to early June) the process of NHS privatisation is driving ahead. The driver right now is the £20 billion “efficiency savings” the government wants to claw back by 2014-15.
• Across the country wards and services are closing down.
• Many non-urgent elective treatments are no longer available.
• Queen Mary's hospital in South East London has temporarily closed its A&E department and maternity services, a move that potentially spells the closure of the entire 430-bed district hospital.
Many lost NHS services will be replaced by pared down versions provided by the private sector (using NHS money). For example, in April 2011 the Tees, Wear and Esk Valley NHS Trust shut down its operation in the local prison service and that was replaced by Care UK. The commissioning board admitted that Care UK would provide an inferior service but that they had chosen it because they were cheaper.
Though it seems some core services will be protected from competitive tendering, profitable services will be hived off and high risk, high cost areas will remain in the NHS.
Running down the NHS service creates a market for private healthcare. As the free service becomes increasingly limited and sub-standard those who can afford to, will choose to pay.
There are a number of mechanisms which will make expansion of private health care easier, including lifting the cap on the number of private beds in NHS hospitals and introducing top-up payments. Private providers, running NHS contracts, will always find ways to make money directly from their patients. Early indications from the NHS Future Forum indicate these mechanisms will remain.
The final result of the cuts will be to create a “reserve army” of unemployed healthcare professionals. By pushing health workers onto the dole the government is making a gift of highly-skilled (and desperate) workers to the incoming private health corporations.
Even a substantially revised Bill will include GP commissioning, and that will introduce market forces and bureaucratic obstacles at every level of the health service.
For the last 60 years, medical decisions were, for the most part, based on clinical judgement. We are now seeing some treatments being denied for financial reasons. This trend will increase.
The logical end is a US-style fully privatised system, where people die of curable diseases because they cannot fight the faceless market-driven bureaucracies of their private health insurers. As US medic Dr Linda Peeno (former employee of Humana health corporation) explains:
“In the spring of 1987, as a physician, I denied a man a necessary operation that would have saved his life, and thus caused his death. No person, and no group has held me accountable for this, because in fact, what I did was I saved a company a half a million dollars.”
The old NHS, based on state-planning and risk-sharing, had a “bureaucracy” of 6% of total health spending. Despite its inadequacies, there was a constant, conscious organisational aim of levelling up health provision across the UK. With the introduction of internal markets and outsourcing, the NHS bureaucracy is now 15% of total health spending. It attaches price labels to treatments and manages the exchange of money.
GPs do not have the time or expertise to provide commissioning services and will buy-in help from the private sector. The result — an enormous, fragmented, privatised bureaucracy — will produce nothing of any benefit except profit for various private interests.
If the Tories make enough concessions, middle-class pressure groups like the BMA may drop their opposition. If that happens then there is a danger that the health unions and the Labour Party, which have so far failed to set out a clear ideological defence of socialised healthcare, will fail to mobilise their forces to reverse the privatisation juggernaut.
We need to make the political arguments to build a mass opposition. That means arguments against markets and in favour of human decision-making processes. We need to assert that health needs, not profit, comes first.
When the market comes to govern over healthcare, it dictates matters of life and death. It is an expansionary force that will only be stopped by our intervention.
We need a working-class movement with clear political aims. We need a workers’ government that serves our class interests with the same dedication that the current coalition serves capitalism.