Privatisation: changing the ethos of health care delivery

15/03/2011 Comments Off on Privatisation: changing the ethos of health care delivery

RHM is about promoting sexual and reproductive health and rights globally, but sometimes it’s important to focus on what’s happening at home.

First, though, I need to acknowledge the heartbreaking devastation in Japan and say that this shouldn’t be seen as an isolated natural disaster. It (and the floods in Australia and the tsunami in Thailand before that, among others) is just the beginning of the global environmental disaster we are continually being warned about. If we don’t take heed soon, our children and grandchildren will inherit a far more frightening world to live in than we can imagine now.

And now, to the news in the UK, where a movement is growing both among health professionals and at the grassroots to stop passage of a Government bill that would dismantle and privatise our National Health Service in England. Today, at 11:45am, a special session of the British Medical Association voted “overwhelmingly” to call on the Government to withdraw the bill in its entirety. This is a major victory in an ongoing struggle to stop the privatisation of health care in the UK, which has been going on since 1992 under the last Conservative government, and which this bill would have finalised under the coalition Government in office since last May.

Privatisation means many things. First, it means changing the ethos of health care delivery from being for patients into being for consumers. Some years back, we thought it would be good to stop using the word “patient” for people such as those seeking contraception, who weren’t ill. However, the term everyone has substituted, “client”, is applied across the board and ignores the fact that most health service users are ill and may have a life-threatening condition, such as obstetric complications or breast cancer, or chronic problems, such as fistula or infertility.

A paper RHM will be publishing in May looks at why maternal morbidity is higher among immigrant women in the Netherlands than among native Dutch women. In it, the authors talk about a consumer-centred care model that is being promoted by the Dutch government, which sounds similar to what the UK government is promoting as well with their bill. They claim on both sides of the North Sea that the aim is to improve the quality of care by giving people more “choices” over the care they receive. But as this paper observes, women with a life-threatening condition such as pre-eclampsia need competent diagnosis and decisive action by health professionals – not a “choice” of where to get that help or patient-centred participation in the decision of what kind of help it is, in the consumer sense.

This distortion of the concept of “choice”, at least over here, is about turning health care provision more and more into a marketplace, where publicly funded GPs, primary care and specialist services such as mental health services, and hospitals as well, must all become independent bodies and compete with each other as regards which services they provide, what they charge for them, and also for referral of patients to them. That’s privatised medicine, I don’t care how you dress it up.

Under European Union-wide policy, if a service is not almost wholly provided by the state, as the health service in the UK here currently still is, then the rules of competition that apply to free trade would also apply to health care provision. This could potentially bankrupt publicly-funded hospitals and services. Anyone – whether a public or private health care provider – would be allowed to compete for patients and undercut each other in their efforts to do so. This is called allowing in “any willing provider” in the language of the current Government bill. Its effect would be to destroy the ethos of cooperation in the health system.

It is incredibly heartening to see so many health professionals in this country rejecting privatisation, since many of them could benefit enormously at a personal level by “going private”. The UK was recently found in a survey to be one of the most equitable health systems in the developed world. The USA, in contrast, was among the worst.

Why should we be trying to emulate and copy a model that is among the worst of its kind? Because large, private profit-making health corporations in both the USA and Europe-wide are fiercely lobbying our politicians to “let them in” and word has it that they have close contacts inside our Department of Health and give a lot of money to the campaigns of politicians in more than one of our main political parties who will support their invasion of our much-loved, publicly-funded, publicly provided NHS.

Does it need improving? Oh yes! Constantly. Is privatisation the way forward? Definitely, resoundingly not.

And now, I need to get back to editing the next journal, which has more articles on privatisation and commercialisation of sexual and reproductive health services.

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