On 11 October the Health and Social Care Bill has its second reading in the House of Lords. The Bill went through the House of Commons between January and September 2011, slower than usual because of a two-month “pause” allowed by the Government midway, but is now being pushed full speed ahead.
Even this late public pressure can push crossbench or Lib-Dem members of the House of Lords into voting through amendments which will block the Bill, or cause problems for the Government when the Bill comes back to the Commons for consideration of amendments (as it must), and thwart this drive to undermine the National Health Service.
Many doctors and health experts oppose the Bill. On 11 October, more than sixty leading doctors published a protest letter. On 4 October, nearly 400 public health experts made a similar statement. The usually-conservative British Medical Association is still calling for the Bill to be withdrawn.
As yet the labour movement has been slow on this issue. There seem to be two reasons. One: that activists have their hands full with pension cuts and service and job cuts which are already under way. Two: that the Tory/ Lib-Dem Bill builds on a long series of marketising changes already pushed through under New Labour, and the movement has become inured to defeats and setbacks on health issues.
But this is an issue as big as any in the Government’s plans.
The Bill abolishes the NHS as a coordinated public service, and replaces it by a health market. For now the main purchasing-power for the market will come from Government funds channelled through GP commissioning consortia (now renamed clinical commissioning groups).
The GP commissioning consortia will mostly, in practice, be run by private contractors with whom the GPs cut commercial bargains.
Those contractors, in turn, will cut commercial bargains with hospitals and other treatment centres. NHS hospitals will all be transformed into businesses operating independently in the market, by being made foundation trusts or going through management buy-outs.
They will compete against new private-profit health-care outfits for “business” (treating patients).
The Bill abolishes strategic health authorities and Primary Care Trusts, and sets up an almost-independent quango to dispense the NHS budget.
Health minister Lord Howe told a conference of private healthcare operators in London, in September, that they will have “huge opportunities” once the Bill is through.
The “private patient cap” which now limits the proportion of income which NHS hospitals can draw from private patients will be abolished. NHS hospitals will be able to treat any number of private patients they like, even if that is to the detriment of NHS patients. And, of course, if the private patients pay well, they will have an incentive to take more.
Many hospitals will be financially crippled by PFI deals imposed on them by the New Labour governments, under which, for a long time into the future, they have to pay over a large slice of their income to provide profit to private companies who put cash into rebuilding schemes.
If the Bill is pushed through, then a further push to scrap NHS principles altogether, and instead have a “social insurance” system, will be easy. At that stage health care would become entirely, in its basics, a market run for profit. The rich could buy the best. For the poor, the harshness would be tempered by government-organised “insurance” under which we could claim back some costs of treatment. (For example, in Australia, an average visit to a GP will cost you $70. You can claim back $34.90 from the government insurance scheme, Medicare).
David Cameron protests, for now, that he wants to keep health care free at the point of use, but some Tory advisers are forthright.
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 has proposed 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”.
At the same time, the Government demands that the NHS make £20 billion “efficiency savings” by 2015.
With more NHS money finding its way into private hands and being squandered on reorganisation and on the overhead costs of complex market mechanisms, that will mean real cuts in care.
• For more about campaigning to save the NHS: www.keepournhspublic.com