This year is shaping up to be the battle for the future of the National Health Service. Among the raft of cutbacks and reforms, it has gone largely unnoticed that the future of the NHS has been compromised by Andrew Lansley’s plans published last year.
Already the Tories’ election pledge to protect the health service is starting to unravel. In my constituency, 350 health workers will lose their jobs over the next three years as the NHS tries to save between £15 billion and £20 billion from its national budget.
The past 13 years have seen clear and visible progress in former coalfield communities such as Wigan where the health legacies from the mining industry remain stark. Life expectancy remains low, many people live for decades with chronic illness and heart disease is a major problem.
The investment made over the past decade had started to turn that around. The gap in health outcomes with the rest of the country was starting to narrow, often as a consequence of new buildings and staff. Yet the Health Select Committee reports that the NHS needs an increase of 3 per cent a year just to remain as it is. With such a huge loss of staff and resources, the fear is people will start to get sick earlier and die younger.
But while the pledge to protect the NHS financially is increasingly exposed as false, health experts and campaigners are struggling to draw public attention to the reforms in Lansley’s white paper. They warn that these reforms amount to privatisation by stealth on an unprecedented scale and potentially mean the end of the NHS.
The use of private companies to deliver health services is nothing new and there are parallel moves in the education system to hand over public provision to companies and charities with clear, vested interests.
Over the past 10 years, concerns have repeatedly been raised about the reliance on private providers. The high profile Private Finance Initiative- built hospitals will cost the NHS £2.3 billion a year by 2013-14. And by then, the total amount to be repaid by the NHS will be more than £90 billion. Routine operations were awarded to private sector-run independent treatment centres, which were paid to deliver operations regardless of whether they were performed. A range of primary and secondary care services were awarded to the private sector.
Patient choice was supposed to help to control quality, but choice in some areas – notably rural ones – has never existed. The majority of visitors to my constituency surgery say they want good quality care near to their home. For some of them, at a time of illness, choice is a burden not a freedom.
The past decade serves as a warning about the reliance on private providers in terms of spiralling costs and patient care, and should sound caution about untested reforms. Yet Lansley’s plans are on a whole new scale in terms of their radical nature and their consequences.
Competition will no longer be an option in the NHS but a compulsion. The “preferred provider” policy of the last Government will be scrapped and every NHS activity must involve competition or face court action. For GPs, this means going through a tendering exercise or facing legal action.
Devolving commissioning to GPs has raised concerns from the British Medical Association to backbench Tory MPs. Some GPs have welcomed the move, but as the Conservative MP and former GP Sarah Wollas has pointed out, it allows private companies in through the back door and gives them a potentially breathtaking degree of influence. Many GPs, concerned about the amount of time it would take to deliver in a management and commissioning role, will see no option but to turn to the private sector. Some already have.
Health professionals have also raised concerns that private companies could advise GP consortiums to commission services from sister companies. How this conflict of interest will be resolved is unclear. It is more troubling because, at a time when GPs have been asked to take on such a large role, primary care trusts are losing staff. It is difficult to see who will be there within the NHS to assist them, forcing many to rely on private sector firms only too keen to get a foothold in the NHS.
Unions have warned that this has strong potential to lead to rising costs, longer waiting lists and a postcode lottery in health services. That means untreated illness, preventable deaths and a growing gulf between rich and poor.
Between £1.7 billion and £3 billion is being spent on reforms that could bring about the end of the NHS as we know it. The challenge is to ensure people realise the implications before it is too late. Allowing competitive forces to dictate the quality of our public sector will entrench division and inequality. We can look to United States for the example of the charter schools or their beleaguered health insurance system to understand that.
On March 26, the TUC will take to London’s streets in support of the NHS and all our public services. The unions will need the public behind them if they are to succeed.
Lisa Nandy is Labour MP for Wigan
