Privatising the NHS can bring down a government

02/06/2011 Comments Off on Privatising the NHS can bring down a government


I am writing to urge you to call on the Prime Minister and the Secretary of State for Health to withdraw the NHS Bill, as recommended by the British Medical Association and many others with expertise in health care and health systems. This Bill is the wrong response at the wrong time. It is far too complicated, with potentially costly and negative consequences, to be amended piecemeal.

Everyone recognises that the cost of health care is a major issue, particularly with an ageing population. However, this Bill does not address the costs of an ageing population. Indeed, it says nothing about it.

Instead, it removes the responsibility for health care from the Government altogether. It does this by handing over the responsibility to a body independent of Government, called Monitor. It shuts down the only remaining Government bodies responsible at regional and local level (Strategic Health Authorities and Primary Care Trusts) for managing health care spending and ensuring national standards are met. It places their role in the hands of GPs, who will be forced to create the equivalent of these same bodies, but not in the public sector. And it requires all hospitals to become independent trusts, thereby forcing them to take independent responsibility for balancing their books and leaving them on their own to sink or swim.

Lansley’s Bill also takes away most of the powers of NICE, a body whose contribution to standard-setting and control of costs, such as drug costs (crucial with an ageing population), based on public health expertise and scientific and clinical evidence, has been absolutely essential. This will be a fatal blow to control of spending on drugs and quality of care.

All of this is privatisation of the NHS. The upshot will be fragmentation from within – the postcode lottery instituted as the basis of policy, dressed in deceptive language about “choice” and “local control”.

You will say perhaps that the last Labour government started this process, as if that were justification enough to go so much further. It is not. The Thatcher and Major governments “started it” and Labour certainly took it further, no one disputes this. Under their jurisdiction, since 1990, an internal market was created in the NHS, which led to massive growth in managerial spending.  Whole sections of the NHS were moved out of the public sector – GPs became independent; so too did dentistry, optometry, ambulance services in many places, and much more. Private medicine also grew, e.g. for cosmetic surgery. And private companies came in, offering Strategic Health Authorities and Primary Care Trusts their services (for a profit) in a myriad ways, such as handling hospital appointments and sending reminders to come for screening. Moreover, through private finance initiatives, many hospitals were committed to taking out and paying back expensive private loans to support badly needed modernisation, as the whole system was falling behind, precisely because it had been starved of funds prior to 1997.

What Labour did right was to inject the funds and push modernisation. It set standards of care and targets to ensure those standards were reached. And the reason why the Labour government was able to make so many needed improvements was because the system as a whole was still under the control of the very public bodies that the Lansley Bill will close down – the Ministry and Department of Health, Strategic Health Authorities and Primary Care Trusts.

So, yes, previous Governments started it. Some of what they did turned out to have been a very good thing, but not all of it. Not all by far. The internal market is the main reason why bureaucracy has grown so much, and it and private finance initiatives have increased costs greatly. The question is, does the Lansley Bill address the real problems? Unfortunately, it does not. It is likely to exacerbate them.

Privatisation takes many forms. Lansley’s Bill does it first and foremost by moving all the remaining parts of the NHS in the public sector out of the public sector. At the same time, it opens the door even wider to private health companies and service providers. How? Under European trade regulations, the bulk of the NHS will be independent of government, so it will be required to allow competitive tendering – from which only the public sector is exempt. Thus, the replacements for Primary Care Trusts (set up by GPs), GPs themselves and all foundation trust hospitals will have to open themselves to competition – privatising the NHS in all but name.

It is a false assurance by the Secretary of State that competition will not be permitted. If he does not know this, his competence must be questioned, and if he does know it, then he is trying to pull the wool over our eyes.

The Conservative Party supports privatisation of public services. It would therefore be disingenuous of Conservative MPs to pretend that, unlike all the other reforms they are pushing through at breakneck speed, the Lansley Bill does not aim to privatise the NHS, and radically.

Labour and the Liberal Democrats have tried to have it both ways for too long It would be disingenuous to think that mere amendments could remove the profound effects this Bill will have. The time has come for both parties to take a stand against privatisation of public services. Together, you have the power to force the withdrawal of Lansley’s Bill. The fact is –  as has been shown in country after country – that the public will soon be paying user fees for health care in one form or another as a result of these reforms, as we already do for dentistry. The poor, the disabled and the elderly will be especially hard hit.

Every medical professional body and health trade union has expressed opposition to and/or grave concerns about this Bill. The public do not fully understand how this Bill privatises the NHS, but they have taken on board the message that it does. Week after week on Question Time they have shown it. Some 420,000 voters have signed the 38 Degrees petition against the Bill as I write. That’s a lot of votes.

“Protecting the NHS” is a vote winner, yes. But privatising it can also bring down a Government.

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