(September 6, 2011)
I’ve just returned from having my blood tested at Lewisham Hospital, and, as always when I use the NHS (the National Health Service, for readers outside the UK), I marvel that, because the entire system is paid for via taxation, no one asks me for any money upfront, and no one asks me for any money when I leave. This is a wonderful form of collective insurance, and I am perpetually grateful for the vision of the NHS’s founders, back in the 1940s. However, as the Tory-led coalition government tries for the third time to persuade the House of Commons to back its disgraceful Health and Social Care Bill, despite a much-touted “listening exercise” on the government’s part, it is clear that nothing has fundamentally changed, that it remains a bill dedicated to the privatisation of the NHS, and that MPs must do away with it once and for all.
In 2008, the NHS took up 8.3 percent of Britain’s Gross Domestic Product (GDP), compared to 15.3 percent of GDP in the US, where vast inequalities exist between the treatment of the rich and the poor. And yet, in Britain, under the Tories heading the coalition government, the most savage assault on the NHS is underway, in which that vision of care for all that was articulated and brought to life by the post-war Labour government will, if the Tories succeed with their plans, be replaced by an increasingly privatised system modelled on the US system, in which care for the rich will be prioritised over care for the poor (as Hamish Meldrum, the chairman of the British Medical Association, explained in an interview with the Guardian last week) and companies driven purely by their profit margins will be in charge of more and more of the health service.
If we’re lucky, the NHS will, for the most part, remain free at the point of entry, and at the point of exit, but it will certainly cost more than it does now (as all those private companies have shareholders to feed) and will result in savage inequalities of treatment. Moreover, as astute commentators have been pointing out since the government first presented its NHS reform bill at the start of the year, there is nothing to prevent the increase of inequality between the treatment of the rich and the poor if, as is intended, the government’s plans result in the health minister abdicating his own responsibility to provide or secure the provision of NHS services for everyone, which has existed since the founding of the NHS in 1948.
My visit to Lewisham Hospital today was part of what will be a lifelong relationship between myself and the NHS’s blood clinics, which began earlier this year, when I suffered a blood clot and nearly lost one or more of my toes. As a lifelong user of the blood-thinning drug Warfarin, I join many thousands of others around the country who are on the drug for life, to prevent life-threatening clots, and who have their coagulation levels tested on a regular basis.
Every time I visit the clinic I am reminded of how the cross-section of people I encounter represents just one microcosmic part of the NHS, replicated in Warfarin clinics up and down the country, and also in all the other regular services, helping to keep people alive, that pass largely unnoticed by those who have the good fortune not to be ill.
And while it’s good for waste in the NHS to be cut, and for there to be elements of competition in the provision of goods and services, what I see every time I use the NHS is something that is much bigger, and grander and more generous than anything that could be conceived by those in government, and in the companies and corporations meeting to discuss how to carve up the NHS and to profit from it, who are not part of the extraordinary vision that led to the creation of the NHS 63 years ago — ill people being treated equally, regardless of their income, or the contents of their wallets or their bank accounts.
Like everyone clamouring to destroy state ownership and the management of utilities, goods and services since Thatcher’s baleful revolution in the 1980s, the reformers in the government and their private sector friends care only about the profit of the few, at the expense of everyone else, but attempt to disguise this behind lies about choice, efficiency and, in the last year and a half, austerity.
Why the Tories are committed to the privatisation of the NHS
Anyone doubting that the Tories’ motives are, simply to privatise the NHS and to make sure that the rich receive preferential treatment and that their friends in private companies and in corporations can take as much of the British taxpayers’ money as possible should reflect on the information that was recently obtained by Spinwatch using freedom of information legislation in the UK, and on the advice that was obtained by the campaigning group 38 Degrees, from expert lawyers who were commissioned to give their legal opinions on two aspects of the Health and Social Care Bill: the removal of Secretary of State for Health’s Duty to provide or secure provision of NHS services and the impact of competition and procurement law on the NHS.
The results of the lawyers’ analysis, which can be found in detail on 38 Degrees’ website, were thoroughly alarming, and were summarised in the Guardian by Jacqueline Davis, a consultant radiologist in north London, the co-chair of the NHS Consultants’ Association, and a founder member of Keep Our NHS Public, who has been an astute critic of the government’s plans.
Back in July, she wrote an article, “This NHS U-turn was a fake,” in which she demolished claims that the government’s response to criticism of its health bill — the so-called “listening exercise” — had actually changed anything. Noting that critics had been taken in, she wrote that they were “the victims of a massive PR coup by the government,” and pointed out that the health minister Andrew Lansley had been “reassuring his backbenchers that the core principles of the bill remained in place and that no red lines had been crossed,” and that “he was quite right. Very little of significance had changed and the bill is still on course to achieve its underlying intention, accelerating the privatisation of the health service, turning the NHS into a kitemark attached to a ragbag of competing and largely private providers.”
All the mechanisms to do this are still in place. Private companies can still be involved in commissioning NHS services and these services will still be delivered by any “qualified” provider. Thus the commercial sector can still hold the budget and provide the care. Competition, the aspect of the reforms that most worries doctors, emerges almost intact.
Last Thursday, Jacqueline Davis turned her attention to the findings of the legal experts commissioned by 38 Degrees, noting first that, last week, “David Cameron claimed with astonishing chutzpah but complete lack of evidence that health professionals were on board with the health and social care bill,” even though this was not the case, as “a back of the envelope calculation suggests that the number of doctors who actively support it (as opposed to those who have had to get involved with it) is in single figures.” She added, “Surveys and conference motions show that the public and health professionals have no confidence in the bill and want it scrapped.”
Turning to the findings of the lawyers, she noted that they are “essential reading and are completely at odds with the government’s bland reassurances,” and stated:
They [the legal experts] found that the bill does indeed “remove the duty of the secretary of state to provide or secure the provision of health services which has been a common and critical feature of all previous NHS legislation since 1946″. Furthermore, a “hands-off clause” will “severely curtail the secretary of state’s ability to influence the delivery of NHS care to ensure everyone receives the best healthcare possible”. They conclude the government can now wash its hands of the NHS, while the likelihood of a postcode lottery increases and local accountability decreases.
They also conclude that the bill “will increase competition within the NHS at the expense of collaboration and integration and/or make it almost inevitable that UK and EU competition law will apply as if it were a utility like gas or telecoms”. So despite the coalition’s repeated denials, this legal opinion believes that “these plans will lead to a system geared heavily in favour of private companies”.
This was confirmed in the documents obtained by Spinwatch, which, as the Observer explained on Sunday, “reveal a series of meetings focused on ‘potential opportunities in London’ between officials from the Department of Health, the NHS, the management consultant McKinsey and one of the largest German private hospital chains, Helios,” and “show the Department of Health secretly plans to hand over the running of up to 20 NHS hospitals to foreign firms, despite the prime minister’s pledge that there will be ‘no privatisation of the NHS.’”
Alarmingly, as the Observer also noted, if the government has its way and EU competition law applies to the NHS, “there would be no barrier to handing over the running of NHS hospitals to non-British firms,” allowing opportunities for companies like Helios, who are already being groomed to take over aspects of the NHS, even though, as the Observer also noted, “Helios has a record of turning around failing hospitals, largely by cutting staff or wage levels,” and “Local politicians have accused it of being motivated more by revenues than by patient care.”
In the documents obtained by Spinwatch, it was also noted that the consultants from McKinsey “warned the department not to bundle off all the hospitals to the private sector at once — and instead start ‘from a mindset [of] one at a time,’” and that they also “told officials to be mindful of the ‘various political constraints’ associated with privatisation.” The documents also reveal that “international hospital provider groups” are looking for £500 million in revenue to run hospitals, stipulating that they need to have “a free hand on staff management,” but that the NHS can “keep real estate and pensions.”
The Observer also noted that, to date, the Department of Health “has only given approval for one NHS hospital, Hinchingbrooke in Cambridgeshire, to be handed over to a private company, Circle Health, which is backed by two Tory donors — financiers Paul Ruddock and Crispin Odey.”
Why MPs must oppose the bill
As the House of Commons prepares to vote on the bill, prior to its perusal by the House of Lords, it is imperative that those who care about the integrity of the NHS act to prevent the passage of this damaging piece of legislation. And central to this are the Liberal Democrats, who should learn from their unacceptable failure to oppose the university funding bill last December by refusing to pass this latest monstrosity. According to the Observer, sources close to Nick Clegg “said the leadership had already ‘used up a lot of political capital’ by halting and then recasting the bill earlier this year.” One source said, “We expect MPs to vote with the government. Otherwise we won’t last very long [in power].”
Rebels abound in the Lib Dem ranks, however, and to my mind saving the NHS could be a defining moment for the party, which has been badly damaged by its role in the coalition government.
As the Observer explained:
Key rebels — such as the Lib Dem MP Andrew George and John Pugh, co-chairman of the Lib Dem backbench health committee — have tabled a dozen changes to the bill, almost all seeking to roll back the “competition and choice” agenda of the health secretary, Andrew Lansley.
George calls for the restoration of the health secretary’s “duty to provide or secure” services, to elevate GPs’ duties to tackle health inequalities above those that promote choice, remove “all references to promoting competition directly or indirectly” from the remit of the regulator Monitor and to keep the cap limiting the proportion of total income hospitals can earn from the paying sick.
George said: “We are on the slippery slope in the direction of a US-style insurance system and have to stop patient choice being used as a crowbar to lever in the marketisation of the NHS.”
Pugh’s amendments would also close a loophole that would allow private companies to “wholly or mainly” run the new GP commissioning groups set up to buy treatments for patients.
As the Observer also explained, John Healey, Labour’s health spokesman, called on Lib Dems to “join with Labour this week to put a stop to David Cameron’s damaging plans for the NHS”. He said it looked like there was “a well-worked secret plan for privatising hospitals,” adding, “Cameron promises one thing on NHS privatisation in public, while at the same time his government attends secret meetings with those ready to take advantage of the prime minister’s market-driven plans for our health service.”
What you can do
To ask your MP to vote against the bill, please visit the 38 Degrees website here, and enter your postcode. You will then get the phone number for your MP, and a list of some of the questions you might like to ask. As 38 Degrees ask:
Can you phone your MP today? MPs don’t usually get a lot of phone calls from voters — if they hear from thousands of us today, they will realise just how strongly the public feels about the NHS. That could help tip the balance in the the run up to the crunch vote this week.
For further information, see my previous articles about the NHS reforms: Battle for Britain: Resisting the Privatization of the NHS and the Loss of 100,000 Jobs, Save the NHS! Will the BMA Do the Right Thing, and Reject the Coalition Government’s Privatization Bill?, BMA Emergency Meeting Calls on Government to Drop NHS Privatization and Act Now to Save the NHS, as Government Advisor Claims Reforms Will Show “No Mercy” and Allow “Big Opportunity” for Profiteering.