It is a devastating indictment of 13 years of Labour rule. But the privatisation of the National Health Service is now stronger than ever and the NHS looks certain to move even more dramatically and rapidly into the market place.
While Scotland and Wales are reverting back to decisions that protect the public NHS, England continues to promote the mishmash of public and private and it seems highly unlikely that the coalition Government will reverse this trend.
The internal market was introduced into the NHS by the Tories in 1988, splitting purchasers and providers, replacing co-operation with competition. Labour, which objected strongly to this when it was in opposition, adopted and even strengthened it when in government.
The Private Finance Initiative mortgaged the future of the NHS and passed on a legacy of debt for the future. It allowed the private sector to finance and build hospitals and lease them back to the government at heavy rates of interest. It encouraged the privatisation of ancillary staff, catering, cleaning and laundry.
Over the years, it has rolled out the market even further. Hospitals were encouraged to become foundation trusts, which, despite being non-profit-making, are still commercial concerns. Although GPs remain part of the NHS, they have been encouraged to use “alternative” private sector providers for many of their services.
Long-term care was hit hardest by the introduction of the private sector into the NHS. A staggering 400,000 beds for long-term care are now being run by multinational private companies. Yet there is no evidence they offer value for money or that they are more efficient or effective than the public sector. And obviously they are in business to make a profit.
Even more disgraceful is the soaring use of management consultants. The latest figures show the NHS paid £350 million to management consultants in England last year – the bulk of it going to supporting bids for foundation status by NHS trusts, helping to draw up private finance initiatives and increasing competition in the health service.
Some of the worst excesses in outsourced costs are in IT and drugs purchasing. Between them, the Department of Health, its IT programme, Connecting for Health, and the NHS Purchasing and Supplies Agency spent £470 million on management consultants in the three years from 2005-06 to 2007-08.
Yet so far New Health Secretary Andrew Lansley and his team have remained cautiously quiet about these extravagances, which could easily be resolved. It is fine talking about removing centrally-decreed directives, initiatives and strategies. It is fine talking about ending the culture of managerialism. It is excellent talking about improving motivation and morale.
But the only way to save billions of pounds and ensure economic efficiency in the NHS is to get rid of the for-profit providers. The Government should step in and take the NHS back into public ownership – 100 per cent public ownership. The last Labour Government failed to do so. Since Labour founded the NHS, it would be ironic if a Tory Liberal Democrat coalition restored the NHS to its rightful public ownership. Patient choice was another flagship NHS policy – and one that Lansley has already announced is here to stay and even be strengthened.
Since January 2006, patients requiring a referral to a specialist have been entitled to a choice off four or five doctors. From April 2008, that choice was extended to any eligible NHS or private sector provider in England.
The aim was to create competition between doctors and hospitals and so encourage higher quality of care. Yet a report by the independent King’s Fund think tank has found that most patients ignore all that. They don’t want to research their options and find their way through a maze of information, weighing up distance, parking charges and the relative merits of league tables.
In truth, only 4 per cent of people used NHS Choices, the Department of Health website that provides information about hospital services. They would rather depend on their GP in deciding where to go to hospital.
Surprise, surprise – people simply want a local hospital that is good enough to attend and trust. Surprise, surprise – doctors and hospitals would rather co-operate and collaborate than be in competition with one another.
Yet large sums of money are being invested in choice. The Department of Health spent £27.9 million on developing and running the NHS Choices website during 2008 to 2009. The total cost of NHS Choices is expected to reach £21.3 million in the period 2009 to 2010. This is in addition to the much-criticised electronic booking system Choose and Book. Is this a cost-effective way of using scarce NHS funds? Do the benefits of choice outweigh the cost?
I hate repeating myself, but none of this would be necessary if every local hospital was as good as each other, all offering gold standard care and if the only time patients had to travel was for specialist care at a specialist centre.
But that can only happen when the NHS is once again a truly national health service: when the standard of care is universal, when primary and secondary care, long-term and social care, all work together for one ideal – the benefit of the patient. And that will never happen with the current unacceptable alliance of private and public providers, competing against one another for every patient and every penny.
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Brilliant analysis and proposed solutions.Is anybody listening?
I agree that the privatisation of the NHS is a bad thing. Looking at the problems faced by the US shows what happens in a totally private healthcare system.
However, to attack NHS Choices without revealing how much it saves and how useful it is to the public is unfair. The Health Service Journal HSJ recently published an article showing that NHS Choices saves £45m a year, over twice its running costs, and that’s only what can be easily measured in the primary care setting.
The figure of 4% general public utilisation is also misleading. It’s true that a survey showed that only 4% of the population know what NHS Choices is but far more than 4% actually use it, they just don’t know that it’s called NHS Choices because the brand hasn’t been well marketed. Far more people know about NHS Direct and yet much of it is the same website. It’s very unlikely that a website that receives an average of eight million visitors a month is used by such a small number of people.
NHS Choices is far more than a hospital ratings system. It has information about many health conditions and treatments, visitors can find their local GPs, dentists, opticians and other medical practitioners, it shows details about hospitals such as car parking and directions and the services offered and it gives patients the ability to comment on their treatment.
Finally, showing what strengths and weaknesses a hospital has helps to drive standards up by showing where best practice occurs and where help is needed. I agree that we’d all like a good health service on our doorstep but the reality is that we will not get that without highlighting where standards are failing and then voting with our feet.
I give up look it’s simple if the people do not want the NHS sold off they will tell the Tories, if they cannot be bothered then sorry but tuff luck.
I’m sick of marching during the 1960/1970/1980 for the NHS and the people just carried on without a thought, we were even called hippies for demanding the NHS staff within public domain, it seems the people are happy for labour to sell it off or hock it into debt with PFI, so now we will see, but my marching days are over.