The Conservative Party’s antipathy towards the National Health Service has always been its major political vulnerability. But David Cameron’s leadership seemed to represent an about-turn – anxious as he was to reassure the public about his own love for the NHS by drawing on family experience. The opinion polls showed that this tactic was working and health was not a big issue at the 2010 general election.
This made the Health and Social Care Bill something of a surprise, even an enigma. In opposition, the Tories could not have been clearer that they were not in the business of big re-organisation. In November 2009, Cameron said: “With the Conservatives, there will be no more of the tiresome, meddlesome, top-down restructures that have dominated the last decade of the NHS”. Earlier, in July 2007, Andrew Lansley had said much the same.
Fast forward to government and, enter stage right, a bill aimed at delivering the most fundamental shake-up of the health service since it was set up by Clement Attlee’s Labour Government. This will include the abolition of primary care trusts. The Tory-led coalition is intent on handing over the running of the NHS, in very large part, to local GPs who will become commissioners of hospital care and other key health services. This is no mere reshuffling of bureaucratic deckchairs. It is far more fundamental and far more worrying.
Notwithstanding the debate so far, there are urgent concerns and questions that ministers have yet to address adequately.
How will the Health and Social Care Bill impact on the values and underlying principles of the NHS, the most important one being that treatment is based on need, not income or wealth? This is why
Bevan called the idea of the health service “pure socialism”.
Yet the bill proposes to remove any limit on the use of NHS beds and staff to treat privately-paying patients. Unless the Government somehow envisages surplus hospital resources, spare staff and empty beds – a far-fetched proposition – more private patients will surely mean longer waiting times for NHS patients and inferior care.
By abolishing PCTs and introducing GP commissioning, the bill kicks the NHS door wide open to private companies out to make a profit. This raises the question of how the new regime will work in practice. As GPs are trained to be doctors and clinicians, not entrepreneurs and finance directors, it is likely that healthcare in future will effectively be delegated to – and organised by – others. Some GP consortia might employ former PCT staff to do the job, but others would be free to hand over the task to private corporations, including companies based in the United States. Other private firms will be awarded contracts to provide health services. A new economic regulator will be put in place to encourage competition.
So what is to stop companies competing on price in relatively straightforward areas, perhaps initially cherry-picking some things as a loss leader, while leaving NHS hospitals with more difficult medical procedures?
What proportion of the NHS budget might effectively be in private hands? Of the £80 billion annual expenditure, what sums might end up as profits for private shareholders?
The legislation allows for the new commissioning board to make payments to a GP commissioning consortium, if performance is good. What exactly happens to that payment? Who benefits from it? Does it go to improved patient care, which is fine, or does it form bonuses for those working in the consortia?
There are further questions about accountability and parliamentary oversight. In this brave new world of competition, profits and privatisation, where does the NHS buck stop? Is the Secretary of State still responsible, still accountable to Parliament?
What about the relationship between patients and GPs? The Secretary of State and his colleagues wax lyrical about how decisions will now be taken by GPs and patients. What exactly does that mean? How will patients be involved in commissioning?
Moreover, will GP commissioners meet in public, like PCTs? If not, why not? Where is the accountability? If a patient wishes to complain about services, to whom do they complain – to their own GP, who does the commissioning? Where is the patient’s complaint procedure in all this?
The bill amounts to something between a relapse into market ideology and an untried, untested leap in the dark. For the NHS, it is a fearful time. The bill will also be shown to be a leap in the dark for the Conservatives, just when they had been making some headway in convincing the British public that the NHS might be safe in their hands.
How should Labour respond? The status quo in British healthcare is no serious option. Improving the NHS is a continuing challenge – not least because of our ageing population, increasing medical costs in many sectors and rising public expectations, which are sometimes fuelled by information on the internet. If we add to the mix the new public health agenda and the need to bring health and social care into better alignment, we can see the scale of the challenge. This must be Labour’s agenda – a radical one, in stark contrast to the Conservatives’ recipe for decline and privatisation.
Malcolm Wicks is Labour MP for Croydon North and a former minister in the last Labour Government
