From Newsletter #3 Spring 2011

Rich Moth provides an analysis of the Health and Social Care Bill and outlines the growing opposition to the reforms

The establishment of the NHS in Britain in 1948 was a landmark for equality and justice. Covering the entire population and offering treatment on the basis of need and not ability to pay, the NHS was the first public healthcare system of its kind and has since been copied by many other countries. It soon came to be seen as the ‘jewel in the crown’ of the welfare state by citizens who were at last freed from fear of exorbitant bills if they or their family became ill. It only requires a glance across the Atlantic to the U.S. and the iniquity of a private insurance system which leaves 55 million without healthcare in the richest country on the planet to appreciate why the NHS is so valued by ordinary working people.

However, the NHS is now facing the most serious threat to its existence in 60 years. The Con-Dem government’s Health and Social Care Bill will enormously accelerate the free market reforms that its New Labour predecessor embraced. Its proposals will lead to the dismantling of the NHS as we know it, with Con-Dem Health Secretary Lansley, “looking to a world where the Department of Health does not own hospitals”. Instead the health service will be run as a market, with the NHS budget of £80 billion handed over to GP consortia and an increased role for the private sector in supporting GPs with purchasing care for patients. The care itself will be bought from ‘any willing provider’ with all NHS hospitals and services being broken up into independent ‘social enterprises’ and forced to compete for healthcare contracts with for-profit companies such as Bupa and the American UnitedHealth Group. These private healthcare corporations are confident of benefiting from a large and growing share of this NHS market.

Introducing the profit motive into the NHS means that public money for health ends up in the pockets of shareholders rather than being spent on patient care. Free market advocates justify this with claims that the private sector is more efficient, but the opposite is in fact true with the introduction of the market into the NHS leading to a significant increase in management costs (up from 6 to 12% when the internal market was introduced and even higher now). The market means NHS money spent on billing, marketing, management consultancy fees and more senior managers instead of patients’ needs. The Private Finance Initiative (PFI) is symptomatic of this, with NHS Trusts tied into expensive 30 year-plus contracts with private companies for building and running hospitals that have been compared to buying a hospital on a high-interest credit card.

The reforms also have serious implications for equal access to healthcare. GP practices will receive incentives to take on their new purchasing role, with each local GP consortium having its own budget and financially rewarded for working within it. As people on low incomes have higher rates of sickness than the rich GP practices in wealthy areas will tend to have less pressure on budgets and therefore be able to afford more expensive treatments for their patients. Though the government claim that they will weight funding according to deprivation levels there is real concern this will be inadequate and lead to the return of the postcode lottery.

However GPs have expressed concern about their ability to take on this new role. They acknowledge that many do not have the expertise in specialist areas such as mental health. Many also recognise that by taking on this purchasing role they will be expected to deliver the £20 billion cuts to the NHS that the Con-Dem government is demanding, which will result in them rather than the government taking the blame for unpopular changes in service provision such as closing local hospitals and services.

There is also concern about the way these plans force hospitals and GPs to compete with each other rather than work in cooperation, as well as the loss of a public service ethos that has until now freed NHS staff from the need to consider their patients’ ability to pay thereby enabling them to concentrate solely on the task of caring.

The proposed reforms have provoked anger amongst NHS workers and the public. Health unions, the BMA and the Royal Colleges have come out against the plans, with Lansley set to face an unprecedented vote of no confidence at the Royal College of Nursing conference as Dispatches went to press. More significantly, that opposition is now starting to turn into action. On ‘Day X for the NHS’ last month in London over a thousand health staff and supporters marched against NHS cuts and the Health Bill, with the protest led by medical and nursing students in scrubs and white coats chanting ‘our NHS is not for sale’. This was the first demonstration by London NHS workers in over a decade. There were also large health worker contingents on the TUC March for the Alternative, followed by All Together protests around the UK.

Meanwhile, there is growing public disquiet about the Bill.  For instance, grime MC NxtGen’s ‘Lansley rap’ critique of the proposals has become a youtube phenomenon. As a result of this opposition, Lansley recently announced an unprecedented two-month ‘pause’ to consider amendments to the plans. However, if this is to be more than just an opportunity for the Coalition to repackage the proposals, health workers and campaigners need to build the momentum of the resistance to these reforms with protests and strike action.

Con-Dem plans to turn our NHS into a market, where the interests of shareholders will come before the needs of patients should be totally rejected. Instead we need a different kind of healthcare system that returns to the founding principles of the NHS but also goes beyond them to deliver a truly equitable, democratic and universal service. NHS founder Aneurin Bevan once said, “the NHS will last as long as there are folk left with the faith to fight for it.”  We are those folk and we have to fight!

A version of this article appears in the Right to Work pamphlet ‘Defending the Welfare State’ available from: righttowork.org.uk

For more NHS campaigning information: keepournhspublic.com