On 1 February, the first National Health Service hospital to be handed to private management, Hinchingbrooke Hospital in Cambridgeshire, went over to its new bosses.
The Government’s Health and Social Care Bill will push the NHS into radically more privatisation and marketisation. Health minister Lord Howe told a conference of private healthcare operators in London, in September 2011, that they would have “huge opportunities” once the Bill was through.
The next several weeks are crucial. The Government has taken the Bill to its last stages in the House of Lords, after which it will have to return to the House of Commons to harmonise amendments. But as the Bill reaches those last parliamentary stages, opposition is rising.
The Government hastily drafted 137 amendments at the start of February to try to stave off the opposition. But the next day Royal College of General Practitioners joined the British Medical Association, the Royal College of Nurses, the Royal College of Midwives, and the Chartered Society of Physiotherapists, in calling for the Bill to be withdrawn.
The British Medical Journal, Nursing Times, and the Health Service Journal have published a joint editorial denouncing the Bill as an “unholy mess”.
On 5 February Labour Party leader Ed Miliband called for a campaign against the Bill, saying that we have “three months to save the NHS”. The TUC has called a rally to oppose the Bill at Central Hall, Westminster, for 7 March. We should organise to demand that Labour and the unions mobilise a full-scale storm of protest.
Opposition and discontent has been bubbling ever since the Government published the White Paper outlining the Bill in July 2010.
The labour movement, preoccupied with the public-sector pension changes and direct service and job cuts, has done only a fraction of the mobilisation it should have done. But dissent from the public and from health specialists has been strong enough to push the Government into a three-month “pause” on the proposals, last year, and now its 137 last-minute amendments.
The health specialists, the sort of people who would instinctively seek to nudge the Government rather than flatly to oppose it, have become increasingly convinced that the Bill threatens the very basics of the NHS.
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 clinical commissioning groups, but the ground is prepared for a switch to private purchasing-power with, as in many countries, a “social insurance” back-up.
The GP commissioning groups 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, where they are not put under private bosses outright, as at Hinchingbrooke. 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.
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.
The National Health Service replaced a system where health care depended on the ability to pay, with a backstop of chancy charity provision. For the first time it recognised health care as a human right. To adapt Karl Marx’s words for a different measure, it signified that in one important though partial domain, “the blind rule of the supply and demand laws which form the political economy of the middle class” succumbed to “social provision controlled by social foresight, which forms the political economy of the working class”.
The NHS has been under constant attack since the end of the 1970s, with the rise of neo-liberalism and its reassertion of those “supply and demand laws which form the political economy of the middle class”. Multinational private profiteers have grabbed at “the healthcare market”.
Grievous blows have been struck. Also at the start of February, even this government felt obliged to put together a £1.5 billion “emergency fund” to bail out seven NHS trusts which would otherwise go bust because of extortionate payments to private contractors who financed rebuilding under the New Labour government’s “Private Finance Initiative” (PFI) scheme.
But the NHS is still there, damaged but still a public service. Maybe some activists have been stunned by the years into thinking that attacks on the NHS always go through, and yet, somehow, whatever happens, the NHS will always be there.
Both resignation and complacency are out of place. The Government can be forced into abandoning the Bill. But if it isn’t, then we lurch a vast distance towards the future sketched by Government adviser Mark Britnell: “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”.
The labour movement should mobilise. As well as withdrawal of the Bill, we should demand:
• Reversal of the coalition Government’s cuts to the NHS (nominally $20 billion “savings”, in fact more);
• A complete end to the drain of PFI payments from the NHS;
• Reversing the partial privatisation already carried out in the NHS, and its reintegration into a single comprehensive public service.