The privatisation of the National Health Service has moved from the back door to the front door. Profits before patients is the agenda for hospitals, now that the coalition Government is in control. No discreet sneaking in the alley way and creeping through the back door, as in Labour’s day. No such embarrassment about its intentions for this Government. The coalition is bold and brazen about its objectives. Every hospital must become a profit-making business and encouraged to make as much money as possible. The slippery slope to privatisation begun by the last Government has suddenly become a whole lot steeper and speedier. It will not be long before all our hospitals are turned into private enterprises with just a few beds and facilities left for NHS patients.
Every hospital is now being forced to become an independent self-governing business with financial freedom from central government, operating in a competitive and commercial NHS. When foundation trust status was introduced in 2004, it was optional. Now it is to be compulsory. What if a hospital does not want to join in this reorganisation? Tough. There is no choice. If you can’t or don’t want to join the market, you will have to be merged into another foundation trust. Legislation being introduced this autumn includes “the abolition of the NHS trust model”, which means non-foundation trust hospitals – of which there are many – will disappear. Legally, they will not be able to exist.
There does need to be some hospital reconfiguration. The NHS cannot afford so many hospitals. It is not sensible that parallel hospitals should provide the same services and compete for the same patients. Certain specialisms should be centralised and smaller units closed. As the inquiry into the Bristol heart scandal 10 years ago showed, and as was recently highlighted at the John Radcliffe Hospital in Oxford, big is best when it comes to complex conditions. Increased volume equals improved outcomes. Most patients would always opt to travel for specialist excellence rather than have doorstep mediocrity.
Closing any hospital is always controversial and a political vote-loser. According to Professor Leslie Hamilton, the immediate past president of the Society for Cardiothoracic Surgery, it was a lack of political will that stopped the Bristol inquiry recommendations that children’s heart surgery should be centralised in specialist units that treat hundreds of cases a year being implemented. “There are not many votes to be won in closing children’s heart centres”, he said. “It is just that it takes courage.” However, it is going to have to be done, especially if the NHS has to deliver significant financial savings and the best care for patients. But forcing hospitals to merge or close should not be at the whim of the money markets. It should be a well-thought-out and much-discussed decision made by clinicians. Hospitals should not be threatened to choose between foundation status or extinction.
Will this reorganisation really improve the health service? There is little evidence that changes and reforms have produced much improvement in the past. What about the transitional costs of reconfiguration? Closing down, restructuring or merging hospitals produces extensive unseen costs that are rarely publicised, whether it be new stationery, new hospital signage or redundancies, early retirements and redeployment.
But the real proof that the NHS is being privatised is not the issues of foundation trusts or primary care trusts or GP commissioning. It is the more sinister shake-up of scrapping the cap on how much money hospitals can earn from private, paying patients.There used to be a cap on the percentage of private income that a hospital could make. No longer. This limit is being scrapped. In future, hospitals will be able to earn as much private income as they want. They will be able to concentrate on paying patients at the expense of NHS patients. There will be a strong incentive to compete in the private healthcare market as well as the NHS market. Private wings will become the cash cow of the NHS.
Now the money-led ethos that persuaded many hospitals to become foundation trusts in the first place will become even more cash-obsessed. Can we believe the Department of Health’s insistence that scrapping the private income quotas will not turn hospitals into profit-driven bodies but into “social enterprises”?
Many NHS hospitals already operate their own private wings, although most of these only bring in small amounts of income. But this could all change. The new private income free-for-all will only encourage services to be based on how much money they earn and not on the basis of medical need. Any surplus made from private patients will simply be ploughed back into the hospital’s private facilities rather than benefiting NHS patients.
Diagnostic facilities, operating theatres and doctors’ time will be diverted away from NHS to private patients. Healthcare will become a two-tier service with private patients getting the best and NHS patients having to put up with the rest. It will be easy in these budget-slashing days of recession for a hospital to choose between upgrading a dilapidated NHS ward or redecorating a private patient wing and attracting wealthy, paying foreign patients. It will be easy to cherry-pick patients who are willing to pay for quick and simple procedures and discard those on the NHS who have complex and chronic illnesses.
Abolishing the private income rules pushes foundation trusts further away from the public sector and into the private market. It is a fundamentally flawed policy that will replace co-operation with competition as hospitals fight for lucrative private contracts. It will divide and destroy the NHS as we know and love it.
