The new coalition Government has announced that it plans to give more “voice” to patients, reduce health inequalities?and put?clinicians in control of the National Health Service. It is to press ahead with Conservative plans to create an independent board in order to reduce politicians’ day-to-day involvement in the NHS. The board will take responsibility for resources, and oversee the commissioning of NHS care.
Health provision will be out of the public accountability loop. Crucial decisions about what is provided where, when, and how will not lie with local communities, the Department of Health or parliament. The board will do little to address a service that professes equality as a core value but implements policies which contribute to widening inequality. To have an independent, non-elected quango responsible for £110 billion of public money is cynical at best and at worst a smokescreen to extend the commercialisation of the NHS. The board’s real purpose may even be to prepare the way for full-scale privatisation.
The coalition remains wedded to the dogma that efficiency in healthcare is best achieved by promoting competition and commercialisation and encouraging?the private sector to provide services. Slogans about giving power to health service professionals and users are misleading. For the past two decades, the professionalism of doctors?has been?undermined by ideological reforms, built on commercialism, competition, patronage and fear for survival – compounded by orchestrated adverse media publicity.
The real culprit?has been?the malignant control-freakery over clinically irrelevant targets. There has been grotesque waste on an unstoppable quangocracy and an almost manic dependence on organisational restructuring as a substitute for clear thinking on public health priorities. This has been coupled with an obsession with information technology and management consultants, profligate waste on the “choice” agenda that few patients want or need and a virtually pathological dread of trusting clinicians. These are among the reasons why the huge increase in NHS spending has largely missed its intended target – the health of the nation.
For the past 62 years, various political leaders have insisted the NHS is safe in their hands and that they can deliver healthcare more efficiently. In reality, services have been continuously destabilised in order to establish a competitive market system with a plurality of for-profit providers, for the double-edged sword of patient choice. Now, the coalition intends once again to put commercial values at the heart of the NHS.
The previous administration already introduced charges for healthcare (co-payments and top-ups), altering the NHS funding base. New Health Secretary Andrew Lansley would like to extend that principle. Deputy Prime Minister Nick Clegg has even called for the NHS to be “broken up”.
The risk is that with continuing commercialisation and a cash squeeze, public support for the principles of the NHS could erode, opening the way to extending charges, introducing widespread top-up fees, co-payments and, by implication, private insurance. The danger is that this would see the NHS increasingly become an insurance system rather than a provider of healthcare.
If the founding principles of the NHS –?universality, equity and quality – are to survive, the prescription must be to abolish the purchaser-provider split and reintegrate services. This would save on transaction costs, marketing, billing and invoicing. The abolition of foundation trusts and the independent monitor would allow the reintegration of the health service and bring it back under direct parliamentary accountability.
It is also vital to bring back needs-based planning for geographic populations and allocate resources on the basis of need and equity. The budget for the prevention of ill-health needs to be strengthened. What the NHS needs is an evidence-based plan for reducing unacceptable variations in access and quality through geographically-based integrated services led by general practitioners and secondary care clinical leaders. No more money should be spent on unnecessary reorganisation. The professionalism, community and integrity of the NHS must be preserved. What it does not need is another wave of commercialisation that throws away what it fundamentally ought to be – a model of successful healthcare.
The new government has pledged to ring-fence NHS spending, although there will be cuts in real terms. We have an infinite demand for healthcare and a finite budget. A?rapidly ageing population, escalating obesity and alcohol-related illnesses, and growing health inequalities will continue to put increasing pressures on the health service. These will be difficult to overcome even without the future budgetary restraints. Lansley should concentrate on transforming the NHS from being a sickness service that diagnoses and treats into one that also promotes health and pre-empts sickness. All the main political parties need to rethink their policies on the role of the market in the NHS in England. The universal healthcare provided by the NHS –?once the envy of the world– is in serious danger of becoming unsustainable.
Kailash Chand was a GP for 25 years and is chairman of Tameside and Glossop PCT
