The 1990 Health and Social Care Act, the brainchild of Margaret Thatcher, introduced an internal market into the NHS. It split the service into purchasers and providers. As long as this purchaser provider split is left in place the NHS is always prone to privatization. Private companies will always be ready to provide services to an NHS purchaser, particularly those services that are easy to perform with an attractive tariff.
The new legislation that came in in April merely extends what was already there. Even if a future Labour government repeals the Health and Social Care Act, it will not be enough, the danger of wholesale privatization remains. It may not be as quick, or as intense, and it may slow to a crawl, but the danger will still be there. Privatization of health services has been an ongoing affair under both Labour and Tory governments ever since the 1990 act began to bite
Despite Labour’s 1997 General Election commitment to ‘abolish the market in healthcare’, it didn’t happen. Some may argue, how could it? And point to the example of prominent Labour MP and former Health minister Alan Milburn sitting on the European Advisory Board of Bridgepoint along with disgraced banker Sir James Crosby and Lord Patten. Bridgepoint is an private equity group with extensive interests in private healthcare provision.
It is not, in my view, the fact that some senior Labour politicians were in bed with the private health sector but rather that many, particularly at senior levels in the party, felt that private companies could deliver better and more cheaply than the NHS itself. Hence there was no attempt or enthusiasm to honour the General Election pledge from amongst the Labour leadership.
This lack of confidence in public over private provision of healthcare flew in the face of the BMA’s advice and was in denial of the worldwide healthcare statistics which consistently showed that the NHS was not only one of the cheapest health services in the world, but also one that had better health outcomes than most,
So what we must do between now and the next General election is to convince the Labour party that repeal of the Health and Social Care Act, on its own is not enough? There must be a commitment to abolish the purchaser provider split. Until such time as that is done the NHS will always be open to being privatized..
We should not just oppose an internal market in healthcare because it was introduced by the Tories, although some may think that would be good enough reason, we should oppose it because as long as it remains we can’t have an integrated NHS. We need an NHS were all parts are working together and not in competition with each other, this can’t happen with an internal market. Integration between Health and Social Care will further enhance cooperation.
What do we do in the meantime?
As suggested by others we need to take full advantage of the limited opportunities available to us within the structures of the NHS.
We should put pressure on Clinical Commissioning Groups not to outsource to the private sector. Ensure that proper consultations takes place before any alteration in services. There is little opportunity for patient participation in the CCGs where, despite all the talk about ‘patients at the heart of everything’, there is but one patient representative, and if our CCG is anything to go by, that ’representative’ is appointed not elected.
Equally, the possibility of influencing the policy of Foundation Trust hospitals is very limited. Again, despite all the talk about local accountability FT hospitals are effectively run by unelected Boards of Directors, with the partly elected Boards of Governors meeting just four times a year. The membership of FT hospitals is extremely low, usually two per cent or so of the eligible population.
Given that the SHA is committed to ‘election rather than ‘selection’ we could campaign for the abolition of FT Boards of Directors and have the hospital’s run instead by the Boards of Governors.
We do elect local authorities which in many cases have smaller budgets than many FT hospitals. So this may be a popular demand. Elected bodies are invariably more professional that unelected ones.
The jury still seems to be out on Healthwatch. How democratic the local groups will be remains to be seen, as does the effectiveness of the new organization.
What we should do is join and support ‘Keep Our NHS Public’ which has been at the forefront of campaigning against the dismantling and privatization of the NHS.
We must campaign against the effects of the Health and Social Care Act of that there is no doubt, and we must campaign for its abolition. But for this socialist the key to permanent victory is the abolition of the internal market. Without that the NHS will always be threatened with privatization. If we want to safeguard an integrated health service for future generations Labour needs to bite the bullet and end the Thatcherite purchaser provider split.