Colin Leys – co-author of ‘The Plot Against the NHS’ – has an article at Opendemocracy.
In voting for the third reading of Andrew Lansley’s Health and Social Care Bill last week MPs voted to replace the NHS as a public service with a system of competing businesses – foundation trusts, social enterprises and for-profit corporations.
The government’s claim that the Bill does not mean privatisation is plainly specious: the truth of the matter is to be found in what Lansley’s health minister, Lord Howe, told a meeting of private health businessmen on the day the Bill was approved. He said it presented ‘huge opportunities’ for the private sector, and noted that commissioners of health care would be barred from favouring NHS providers. The truth is also to be found in the government’s leaked plans to hand over the management of NHS hospitals to private companies, and in the current and promised large-scale opening up of NHS work to ‘any qualified provider’.
- Conservative election poster 2010
Lord Howe reiterated Tony Blair’s dictum that it doesn’t matter who provides care, so long as it is free to the patient. What this does is to treat as irrelevant everything that follows from introducing market dynamics. The basic fact about health care is that high quality care depends on a sufficient ratio of skilled staff to patients, whereas in the long run profits can only be made by reducing the skill-mix (to lower the wage bill) and cutting staff ratios. The resulting decline in care quality is already evident in privatised long term care and home care, and is now beginning to be seen in community health services and GP services. Once NHS trusts have to compete with for-profit companies they will be forced to follow suit.
The erosion of quality will be reinforced by two other powerful factors: a) the cuts being imposed in the NHS budget, leading to the withdrawal of some services and the scaling back of others; and b) rising costs due to marketisation.
The costs of market-based health care – from making and monitoring multiple and complex contracts, to advertising, billing, auditing, legal disputes, multi-million pound executive salaries, dividends, fraud, and numerous layers of regulation – will eventually consume 20 per cent or more of the health budget, as they do in the US. Neither the Care Quality Commission nor NHS Protect (the former NHS Counter-Fraud Unit) is remotely resourced enough, or empowered enough, to prevent the decline of care quality or the scale of financial fraud that the Bill will introduce.
The effect will be that people with limited means will be offered a narrowing range of free services of declining quality, and will once again face lengthening waits for elective care. To get high quality and more comprehensive care people will have to pay for private insurance and private care, if they can afford to. More and more NHS hospital beds will be occupied by private patients, further reducing the resources available for free care. Fixed personal budgets, like those already given to people for social care, are to be introduced for a growing range of chronic conditions, allowing those with resources to top up their allocations while leaving the rest to make do with ‘basic’ NHS provision.
None of this is wild speculation. It is either already happening or announced or readily foreseeable on the basis of current policy. To deny that the Bill means privatisation and the end of the NHS as a comprehensive service equally available to all is like denying that the earth is round.
The fact that MPs have nonetheless endorsed the Bill reveals something more serious than an ideological blind spot. It shows that they don’t really care that they are flouting the wishes of the electorate. Cameron promised categorically that there would be no further top-down reorganisation of the NHS, but is pushing through a reorganisation that amounts to a destruction of it, against the known wishes of a large majority of voters. Governments, we are told, must often take unpopular decisions. But this is not some incidental measure. We are talking about something fundamental to what, for more than half a century, has played a key part in making Britons equal citizens, and Britain a civilised and humane country. If democracy doesn’t mean that governments have to respect public opinion on something as important as this, what does it mean?
It is no less depressing that the Department of Health has been reduced to peddling more and more brazen lies, such as its ‘Department of Health Myth Buster’ document, published to coincide with the Third Reading debate. The principle seems to be that that if an official lie – such as that the Health Bill does not mean privatisation – is repeated often enough, most people will feel it must be true. Democracy depends on voters having trustworthy information. If we cannot trust departments of state, run by public servants, to tell the truth, who can we trust?