The State of the NHS
On 5th July we start together, the new National Health Service. It has not had an altogether trouble-free gestation! There have been understandable anxieties, inevitable in so great and novel an undertaking. Nor will there be overnight any miraculous removal of our more serious shortages of nurses and others and of modern replanned buildings and equipment. But the sooner we start, the sooner we can try together to see to these things and to secure the improvements we all want . . . My job is to give you all the facilities, resources and help I can, and then to leave you alone as professional men and women to use your skill and judgement without hindrance. Let us try to develop that partnership from now on.
Aneurin Bevan in a message to the medical profession, 1948.
The National Health Service (NHS) first opened its doors to the general public on 5th July 1948. Spearheaded by the Labour Minister for Health, Aneurin Bevan, it was based on principles unlike anything seen before in health care the world over. Financed almost entirely from central taxation, with contributions based on how much each individual could afford to give, the NHS provided the same level of care for everyone no matter what their socio-economic status. Anyone could be referred to any hospital in the country, whether it be local or more distant. Crucially it was entirely free at the point of access. It was a fantastic socialist experiment that few countries outside of the Soviet bloc have since tried to copy.
Sadly some concessions were made over the following years, such as charging for dental and eye care. Surgeons and doctors were also still permitted to work privately outside of their normal working hours, a policy that has come back to bite us in the behind today with NHS surgeons working in the private sector, making them unavailable for overtime within the NHS.
Prior to its establishment, health care in the UK was very hit and miss and the level of care a person received was largely down to where they lived and more importantly, how much money they had in the bank.
The previous century had seen an increasingly popular argument in favour of health care being a basic right for all people and not something that should be dependent on wealth or the whims of charity. There was also a belief among junior medical professionals that there was a better way of doing things and that the disjointed, disorganised infrastructure of existing health care was neither sufficiently competent nor adequately available to suit the needs of an optimistic post-war society.
On the appointed day 1,143 voluntary hospitals with some 90,000 beds and 1,545 municipal hospitals with about 390,000 beds were taken over by the NHS in England and Wales. That day didn’t bring with it one extra doctor or nurse but what it did do was change the way in which people could obtain and pay for care. They ceased to pay for medical attention when they needed it, and paid instead, as taxpayers, collectively. This is a principle that should be defended to the very end to ensure the most vulnerable in society can always access the health care they require.
Over the years treatments and techniques improved, people started to live longer and needed better and more frequent medical attention and so obviously costs started to increase. As the 1980’s beckoned there were the first signs that the health service was being underfunded by central government, coinciding with the winter of discontent, the oil crisis and the election of the Tory Witch.
By 1987 health authorities throughout the country were in debt, waiting lists were growing and hospital wards were being closed. Neither the public nor the health care professions were satisfied and the service was increasingly subjected to scrutiny in the media. There was a huge lack of funding which was carried on throughout successive governments. A 2001 report concluded that Britain had spent £267 billion less on health care than the European average between 1972 and 1998.
Instead of investment, in 1989 the Tory government introduced the idea of the internal market to the NHS. It was designed to “increase the responsiveness of the service to the consumer, to foster innovation and to challenge the monopolistic influence of the hospitals on a health service in which community based services were increasingly important.”
What it actually led to was a deteriorating service for patients as hospitals had to compete against each other and ensure they were as profitable as possible. Far from leading to innovation, competition led to unnecessary duplication of services and the deepening of a two-tier system. It saw the humble beginnings of the postcode lottery, with the less profitable health authorities not being able to offer the same range of services as those provided in more profitable areas of the country.
New Labour swept to power in 1997, promising to abolish the internal market and return the NHS to something more resemblant of Bevan’s original idea. They did increase the NHS budget but this was coupled with the increase in privatisation meaning net spend wasn’t much different. The internal market expanded from 2001 onwards and privatisation was rampant. (More on that later).
Arguments for top up fees started to emerge, with British Medical Association suggesting certain expensive treatments would have to incur a fee. This would have opened up the opportunity for US style health insurance companies though fortunately it wasn’t implemented. Those of you who have seen the Michael Moore documentary Sicko will know the consequences for people who can’t afford health insurance under such a system.
An example of the problems of an underfunded NHS can be seen in the cancer drug Herceptin. Some local health authorities were refusing to offer the potentially life saving drug as at £30,000 per course of treatment, it was deemed too expensive. Thankfully the high court ruled in favour of the patient and the drug was made available.
By 2000 there were over a million people waiting for treatment on the NHS. New Labour had pledged to cut waiting lists by 100,00 when they came to power in the late 90’s but in reality the lists increased rather than decreased.
Around this time the number of patients being treated on the NHS in private hospitals was also on the increase at additional costs to the taxpayer due to the inability of the public service to fulfil the demands placed on it.
Private Finance Initiatives
Since the mid-90’s we’ve also seen the rise of Private Finance Initiatives (PFI), whereby private sector money is used to build hospitals and other buildings in an attempt to cut public sector spending. These privately funded hospitals so far have 28% fewer beds than the ones they replaced and are estimated to cost the general public half a billion pounds more per year than public funded builds.
Of the 133 new hospitals built since New Labour came to power, 101 were financed under PFI. There are 149 PFI hospitals in Britain, valued at £12.27 billion. But a recent report by University of Edinburgh academics shows that the NHS will pay £70.5 billion for them. That’s a huge waste of nearly £60 billion which has found its way from the public to the private sector. Costs for building a private hospital are estimated to be up to 4% higher due to the additional cost of borrowing for the contractor at higher interest rates as opposed to borrowing from public funds.
Repaying the debt of PFI financing eats up well over £8 out of every £100 of a hospital’s budget in London, as against a 5.8% debt rate for conventionally built hospitals. Half the larger PFI-financed hospitals are in financial difficulties compared with a quarter of non-PFI hospitals.
Health and Social Care Bill
Seumas Milne, writing in the Guardian, summed up the proposals: “From a major public service with a million employees, [the NHS] will have become a central fund with a minimal workforce, commissioning services from a string of private companies in a fully-fledged healthcare market.” He reported that Kingsley Manning of the health firm Tribal is looking forward to the “denationalisation of healthcare services in England”. I don’t think it’s unfair to suggest he is more excited by the potential increase in his company’s profit margin than he is in any potential improvement to the provision of health for the working class.
When the Con-Dem government came to power last year we were told that savings had to be made in the NHS and that the necessary reforms will bring power to the people with control switching to “family” doctors. £20 billion was said to be needed to be shaved off the budget by 2015.
Andrew Lansley’s (Minister for Health) Health and Social Care Bill see’s the abolition of the Primary Care Trusts (PCT’s) and see’s senior managers being made redundant (it is true that the NHS has become too bureaucratic, but the costs of several large redundancy fee’s must be taken into account).
“Choice is an illusion created by people to sell you something”
What we will see with Lansley’s Bill is the transfer of the majority of power to private health care corporations. It proposes that 80% of the NHS budget be controlled by consortia of GP’s and is using the fact that the general public trust their family doctor to sell the idea.
The reality is that GP’s don’t have the experience or the time to be deciding how to spend billions of pounds and being primarily concerned with seeing patients, will likely turn to the private sector and corporations such as BUPA for advice. Private health care companies are the same as any capitalist organisation in that their primary goal is to make a profit. This is in direct conflict with the true primary aim of any health care provider, which should be the treatment of patients.
Private interference in the health care system will lead to a service that only provides treatments with the highest profits, a service where staff are overworked and underpaid and above all, a service that is ran for profit rather than for the needs of society. If you can’t pay, you can’t get treatment.
David Cameron has intervened in Libya in order to uphold the values of democracy, but the way this Bill – designed to turn the NHS into a market, despite the evidence that healthcare is unsuitable for market mechanisms – has been managed is anything but democratic.
In June there was a ten week “listening exercise” with a view to reviewing the Bill after considerable opposition from the press and the general public. Sadly YouGov research suggested nobody had a clue how to have their voices heard when the MP’s were apparently listening with only 5% of the population saying they knew how to be involved in the forum. It was also revealed that the discussion group set up to hear the concerns, the Futures Forum, had no union representation or any of the GP’s who remained critical of the proposals. Experts were appointed to the forum on the basis of them being supporters of the idea.
As you can imagine this listening exercise was originally hailed as a retreat by the Con-Dem government but the truth is that the proposed waves of privatisation were still in place. Token gesture were made, such as deadlines being extended and more involvement from front line staff but a clearer idea of the effectiveness of the listening period can be gleamed from the fact that during the 10 weeks, three psychiatric hospital’s closed in Liverpool.
Within weeks the Bill passed through the commons with a majority of 65. The Liberal Democrats, who were trying to prove they weren’t just the poor, neglected younger sibling of the coalition and squeaked a few objections to the Bill, voted en masse in support. Only 4 of them stuck to their principles to defy their leader and voted against.
The Bill then passed to the House of Lords. There was some form of a fight back from Lords Owen and Hennesey who said they would like the third part of the Bill, the bit relating to competition, to be sent to a select committee for further consideration. This could have derailed the Bill and led to it being thrown out. There was also justifiable discussion in the Lords around the fact that neither the Conservatives nor the Liberal Democrats had such drastic measures in their manifesto’s and so it was their duty to block the Bill. Sadly any opposition was defeated and the Bill passed through this second phase unchallenged. Maybe it was foolish to believe that a group of over-privileged, unelected career politicians would be the ones to stand up for the general public after their elected peers chose to sell us down the river.
Public outrage at the decision was seen through protests that closed Westminster Bridge last Sunday and a petition set up by the website 38 degrees urging the Lords to throw out the Bill, which collected 160,000 signatures in just 36 hours. 250 Health Experts also wrote to the Lords to warn of the impact of the cuts presenting more cases like that of Baby P who “died because too many unco-ordinated and fragmented services, staffed by too few and inexpert staff, were involved in his care. The current proposals, designed to increase provider plurality, will amplify these deficits,” the letter said. “Children and young people are especially susceptible to the heightened degree of commercialisation and marketisation ushered in by this bill.”
Andrew Lansley’s office has received donations from private health care companies during his time as the Shadow Health Secretary. Care UK alone donated £21,000. Surely there is a conflict of interest in the changes he is trying to steamroller through. Can the judgement of a man who has employed the help of Pepsi, McDonalds, KFS, Mars, Unilever and Diageo to write policies on obesity, alcohol and diet related diseases really be trusted?
We have already had a taste of the type of problems a private health care system will bring us with the recent demise of Southern Cross and the problems caused to residents of their care homes when it went into administration. Do you want to live in a country where the most needy and vulnerable amongst us are no longer able to access our health services? Where certain treatments that could greatly benefit you and your family are not provided as they are too expensive? Where money that should be going into funding services is instead channelled into the bank accounts of the rich elite? I know I certainly don’t.
- Bring the NHS into public ownership. Rebuild it as a publicly funded service, free at the point of use, with immediate cash to end the underfunding crisis.
- Bring all trusts and foundation hospitals into a democratically run NHS.
- Representatives of NHS workers, trade unions and health service users should make decisions about how the NHS is run and what its priorities are.
- A living wage and good working conditions for all NHS workers.
- Abolish the internal market. Abandon the Private Finance Initiative. All new hospitals to be built with public funding, not for private profit.
- Nationalise the pharmaceutical industry under democratic working-class control and management.
- A socialist programme to eliminate poverty – the biggest killer and cause of ill-health.