I fear that Ed Miliband could not be more wrong in his warning that there will be huge public protests over National Health Service reform. The simple reason is the public does not understand the internal workings and management complexities of the NHS. Of course, there was an outcry over the selling off of forests because that was an easy issue to follow. Public forests would be sold to private buyers. Just as water, electricity and gas have been in the past. Although, thankfully, the Government did a U-turn and this time it will not be happening. Of course, there is an outcry about raising university fees because that is an easy issue to follow. The cost of going to university is getting more expensive.
However, the difference between the health service budgets being held by primary care trusts or by GPs is not an easy issue to follow. The NHS is not being sold off to private buyers – not yet at least, although this appears to be on the cards for the future. The cost of healthcare is not going to get more expensive, it will still be free at point of delivery – at least for the time being. It is internal restructuring. And how many voters understand the internal structuring of the NHS? In any case, it has changed so much over recent years that it is difficult to keep up with the alterations. So however ill-conceived and dangerous the plans, however much a threat they are to the future of the NHS, however much Labour politicians try to push them into the headlines, they are not going to grab the public’s attention or prompt mass protests.
It may be the biggest shake-up in the NHS since it was founded and may be roundly condemned by doctors, nurses and even management. Everyone involved in the NHS understands the damage the changes are going to do; everyone with any knowledge of how the NHS works knows it is happening at the wrong time, when the health service is facing unprecedented cutbacks. But for those who use the NHS there will, on the surface, be hardly any change. It will not be until GPs are forced to refuse certain drugs, deny certain treatments and offer a poorer quality service because of budget constraints that people will understand what is going on. And by then the changes will have been put in place and it will be too late.
Still, there is some good news. The Government has backtracked on its controversial plans to introduce full-scale competition in the NHS and allow private providers to undercut state-run hospitals (who have to abide by the national tariff) and even compete with each other to offer discount surgery. It has admitted, via NHS chief executive Sir David Nicholson, who will head the new NHS Commissioning Board, that competition will not be allowed to hinder GPs and consultants working together and there is “no question” of introducing price competition price into the NHS and that services must always be based on quality of care.
But don’t let this U-turn persuade us that ministers might be having serious second thoughts about their strategy to sneak the private sector into the health service. David Cameron has said he intends to “release public services from the grip of state control”. A white paper due to be published soon will set out the automatic right for the private sector to bid for public work. We could see many aspects of the NHS being run by private companies – and eventually a privately run NHS. Be afraid, be very afraid.
