Thatcher's health service dream realised?

Submitted by cathy n on 19 May, 2011 - 2:46

Stuart Jordan interviewed David Price, Senior Research Fellow at the Centre for Health Sciences, Barts and The London School of Medicine and Dentistry.


You have said previously that the Health and Social Care Bill means handing £100 billion of NHS money to the private sector. Could you explain how this would work?

The public planning system, which ensures that resources are allocated according to health needs in geographical areas, will be broken up. We will see increasing private sector control over the allocation of resources or allocation driven by financial incentives.

At the moment Primary Care Trusts have are required to provide comprehensive universal healthcare for geographic populations. GP commissioning consortia will not have this statutory duty. The Bill says consortia will represent specific geographical areas but their duties to the whole population are not specified and in fact the consortias can form from GP practices anywhere in the country. So consortia will be able to choose which patients they want to take responsibility for.

On top of this, the Bill will allow GP consortia to choose which services they charge for. At the moment, this power lie solely with the Secretary of State. The new legislation will allow consortia to decide which services are part of the NHS and which are chargeable.

Across the country the "healthcare basket" — the range of services and treatments that are available on the NHS — will start to vary depending on the decisions of individual consortia.

Private companies are also coming in and choosing which patients they want to treat. So instead of a publicly owned system which plans for the provision of universal healthcare, we will have a private planning system, which obviously involves a whole different set of priorities involving selection not inclusiveness.

What have you made of the latest announcements coming out of the listening exercise?

There are a lot of confusing messages. A week ago it was positively stated that Andrew Lansley would be sacked from his role as health minister. Days later he was sat on the front bench surrounded by Tory Ministers.

I believe that Steve Field [chair of the government-appointed advice body overseeing the "listening exercise"] originally supported the reforms set out in the White Paper but is now more critical. Like many he sees threats to integrated care and the hospital infrastructure as companies come in and cherry-pick services. However, his criticism does not address all the issues and there are some who say that the Bill is unamendable.

Do you think that Royal Colleges, the BMA and other groups in opposition will be convinced by the listening exercise and changes to the Bill?

I am not sure whether they will be convinced. I think that the Royal College of General Practitioners is leading the charge on challenging the Bill and is doing extremely well. Among other things they are calling for the Bill to restore the principle that the Secretary of State has a duty to provide or secure the provision of a comprehensive service that consortia have geographic responsibilities and that only the Minister has a statutory power to impose charges on services currently provided by the NHS.They are also fighting hard against fragmentation of the service.

Some critics say that the Bill was unnecessary and that even without legislative reform the government can push ahead with privatisation. We already see that private sector management is coming in, wards are closing down and staff are being sacked. We are witnessing a general reduction in NHS capacity, which gives potential for the private sector to grow.

To some extent therefore, the Bill is a red herring.

But the Bill is still significant. It is a political mechanism to remove responsibility for providing universal healthcare from the Secretary of State in order that a different financing system can be introduced. By giving consortia power to charge and the power to decide what constitutes the NHS, the door is opened to user charges and co-insurance.
Of course it was widely reported recently that Mark Britnell, former Head of NHS Commissioning and now working for the KPMG and the Prime Minister's Kitchen Cabinet on health care believes that is exactly what should happen. We also know that supplementary health insurance is the reform path of choice in a number of OECD countries, so it is definitely a fashion.

Seventeen years ago Julian Tudor-Hart unearthed similar objectives formulated by Margaret Thatcher in the 1980s. He called it "the project" because it had been the undisclosed goal for so many years. If there is a project it is now nearly completed.

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