The more one learns about the plans to ‘transform’ the NHS the more the whole NHS ‘crisis’ appears a gigantic scam for which most of us are going to pay a heavy price. I don’t say it so bluntly in our just completed submissions to TV commissioners for funding of my GROUNDSWELL documentary project. Here’s how I’ve put it to them.
A Brief History Of NHS Privatisation: Tory grandee Nicholas Ridley’s 1977 report to his party’s Economic Reconstruction Group declared that “A frontal attack (on nationalised industries) is not recommended. Instead the group recommends preparing the industries for partial return to the private sector, more or less by stealth. First we should destroy the statutory monopolies; second we should break them up into smaller units; and third we should apply a whole series of techniques to try and edge them back into the private sector.”
For the NHS this process was started in 1986 with the privatisation of hospital cleaning services. Under Labour as well as Tory governments competition was then introduced into the NHS in the 1990’s with the development of the ‘internal market’ and establishment of hospital ‘trusts’ to operate as commercial entities. The trusts in turn entered into partnerships with private sector operators who undertook responsibility for the building and maintenance of hospitals as Private Finance Initiatives (PFI’s).
The floodgates for finally converting the tax-funded NHS to a public/private US-style enterprise were opened by the 2012 Health and Social Care Act. This lifted the cap on private earnings for NHS Hospital Trusts to 49% of their budget income. Hospitals could use the public’s ‘brand loyalty’ to the NHS to attract patients to their private services. Swindon’s Great Western Hospital could advertise; “We are in the unique position of being able to offer high quality healthcare in a premium environment, alongside the safety of the specialist services associated with the NHS.” Patients at the private facility would enjoy shorter waiting times.
In 2014 NHS England’s new CEO Simon Stevens (a former CEO of US healthcare provider/health insurance giant United Health) launched plans, drawn up with mega US business consultants like McKinsey and United Health subsidiary Optum, to ‘reconfigure’ the NHS by 2020.
Reducing the public’s hospital usage is the plans’ central aim. This underlies the planned reductions of 144 Accident & Emergency units to just 40-70, the substantial reductions in hospital beds for public patients, and the promotion of family and community-dependent homecare and at-home online consultations.
GP services, with their long-term, personal doctor/patient relationships, are being reduced and replaced by cheaper, semi-qualified, impersonal US-style ‘physician assistants’ and pharmacists. Rationing GP and publicly available services adds to the increasing delays and accessibility in treatment for public patients and creates an NHS ‘crisis’ such as the much-publicised ‘bed blocking’.
All this pressures the public to accept privatisation and to use expensive private providers and private health insurance companies.
Hi-tech ‘solutions’ using apps and online appointments services are now offered to provide speedy but costly medical attention and treatment from private sector GP’s. GP family practices are merging into business federations to be taken over by large private groups like Virgin Healthcare. GPs will move from the family practice model to a system of commercially-driven super-clinics called Multi-Speciality Community Providers (a US import).
The running and provision of public health services will be undertaken by private companies selected by Accountable Care Organisations (also a US import) comprised of NHS and public bodies partnered with the private sector.
The NHS’ fragmentation, as envisaged by Ridley, and the deliberate underfunding and squeezing of NHS and GP services – by 2020 the cuts will amount to over £30 billion – makes the NHS appear ‘unworkable’. This is central to justifying the dismantling of what was once the cheapest and most cost-effective public healthcare system in the developed world.
And it’s central to the drive for then ‘reconfiguring’ our public healthcare as a US-style 2-tier public/private system – an accessible one for the better off and another less accessible one for the worse off.
The Ridley report said that privatisation had to be enacted ‘by stealth’ because of the strong opposition it would face. It was delivered privately to Tory colleagues and only came to light by being leaked to The Economist. Hidden behind its cherished logo the NHS’ privatisation continues to be enacted with considerable stealth, obfuscation and lack of transparency.
This is aided by the national media who mouthpiece the privateers’ patter about an ‘unworkable’ and ‘unaffordable’ NHS in irretrievable ‘crisis’ and who conspicuously fail to properly question it.
Why is it happening? The NHS is the 5th largest ‘business’ in the world and healthcare is a dream business. Patients are never in short supply and the government will act as the back stop when it comes to payment for the least well off, or will pick up services which the private sector drops if the profits don’t match expectations.
Who stands to profit? Major private stakeholders in the $7.6 trillion global healthcare sector, including US healthcare services/health insurance behemoth Kaiser Permanente (originator of the Accountable Care Organisations model), are looking to expand in global markets through massive trade agreements, like the mooted Trump/UK one, which remove protections from public services and open them to market predators. Only 10% of the UK population have private health insurance, leaving a lucrative market to be tapped.
Who stands to lose? Most of us are dependent on the tax-funded, publicly-provided, publicly-accountable NHS. But the true costs of its increasingly privatised sectors are impossible to obtain as the implicated private companies are protected by commercial confidentiality laws. Informed guesstimates suggest that the public are already paying some £8 billion a year for the costs involved in privatisation.
Privately-provided services, with their bank loan costs, dividend payments and ‘management fees’, cost far more than State-funded ones. And the administration of privatisation, with all the consultants, lawyers, accountants, billing agents etc involved in franchising NHS services, is hugely expensive.
Getting rid of privatisation would actually cover the lion’s share of the costs of the extra demands facing the NHS (eg the ageing population) which are blamed for making the NHS ‘unaffordable’.
Instead the public are being confronted with having to pay the substantial additional costs of privately-provided services out of their own pockets and/or by resorting to ever increasing private health insurance premiums as they get older or suffer illness – in addition to the taxes they are already paying.
Health insurance involves all kinds of exclusions and limitations leading to patients having to make substantial additional payments for their healthcare – healthcare costs are the biggest cause of personal bankruptcy in the US.
Denial of treatment, unnecessary operations and serious misconduct – United Health is currently the subject of a multi-million dollar lawsuit from the Justice Department for defrauding the US healthcare system – are a feature of the US profits-driven system.
In my film GROUNDSWELL: THE GRASSROOTS BATTLE FOR THE NHS doctors testify how the Government’s drive to complete the major steps of converting our tax-based model to a public/private enterprise by 2020 is already seeing the development of a US-style 2-tier system and a further widening of the gap between rich and poor produced by the unfettered free market.
The June 2017 General Election marked a turning point in public revulsion at the free marketeers who have dominated our lives over the last 30+ years. The NHS Reinstatement Bill provides the key practical and legislative means for getting rid of their hold over the NHS. But the Labour Party remains way off committing itself to the Bill because of the bulk of its MPs’ continued swallowing of the privateers’ patter.
It took me a long time to get my head around the idea that the NHS might be being taken down the notorious American way of public health. But the elucidations of very well-informed researchers like Professor Allyson Pollock (see her powerful 18-minute TED talk) and Deborah Harrington (to whom this blog owes a great deal – see The Americanisation Of The NHS in her incisive new blog Public Matters) have made the unthinkable thinkable.
Campaigners feel that there is a limited window of opportunity to save the NHS. Seize the time!