Is this the end of the National Health Service? It is certainly the end of Aneurin Bevan’s vision for a national health service. Strategic service provision and standards will fade away as decisions devolve to doctors for whom profit will become an ever-increasing factor in patient care. The notion of a publicly owned service will also be whittled away by ravenous private finance interests gorging on the great feast that has been placed at their feet.
Nye Bevan’s hardest fight in creating the NHS was with the doctors, who, through the representation of the British Medical Association, saw their medical supremacy threatened and wanted little to do with it. Now they are to be given a power that they never even dreamed of before the NHS was born – direct control of £80 billion of NHS publicly funded cash. But this is no belated revenge. The BMA has expressed alarm at the likely expansion of private firms within the GP and hospital services. Rightly so.
The supremacy of the medics is in danger of being overtaken by the supremacy of the market. It is even going to be overseen by its own market regulator along the lines of Ofcom or Ofgem with a brief to ensure corporate investors are attracted into the NHS.
Some doctors’ consortia may try to protect their operations from the effects of the market but it will be difficult to work in isolation and foundation hospitals – which will be all hospitals – will have little protection after the lifting of the cap on private work.
Kingsley Manning, business development director of health support services Tribal, succinctly described the likely effect of the reforms: “[they] could lead to the denationalisation of healthcare services in England”.
As Jill Palmer observes on page 19: “…what will stop patients’ suspicions that they are being offered the cheapest rather than the best treatment in order to save the GPs money? …And it will not stop one group of GPs deciding to purchase one type of care which another group refuses to fund”. The line of accountability is also unclear, with patients apparently the first and last line of regulator but with the blunt instrument of having more power to vote with their feet.
The NHS reforms are a giant and unexpected political experiment, a gamble with no prior consultation, no empirical evidence to support the proposals and with nothing but uncertainty. Safe in their hands?
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Chancellor George Osborne and his coalition allies insisted they had to announce deep public spending cuts in order to placate the jittery markets so that Britain would not go the way of Greece. At a Downing Street reception, Nick Clegg told journalists that if the coalition hadn’t done so, the markets would have gone into nosedive and the Government would have forced into a position of constant crisis management from week two. So what is the markets’ verdict? Not good enough, they say. Britain’s credit rating remains on the critical list. Well done, George, David and Nick. You give them blood and it’s still not enough.
