The End of the NHS

From Punch 6/2/02

Having closed 13,000 NHS beds and services since 1997, Labour is now moving rapidly, under the direction of Health Secretary Alan Milburn, to privatise NHS care provision, contracting for services in the independent foreign and domestic markets. The first tranche of hand-picked NHS patients has gone to France for cataract and joint surgery and in the south-east the government is contracting with a small private hospital for 5,000 operations.

Accordingly, the NHS becomes a purchaser, not a provider of services. Public funds flow into the Department of Health and out to the private sector via service contracts. Doctors and nurses will follow the more lucrative contracts and the handpicked, low-risk patients into the private sector, creating an irreversible drain of money, middleclass patients and NHS staff. The NHS will become a rump service for the sick, the poor, the old and emergency care.

But the private sector is no panacea. Private-sector contracts remain commercial and confidential. Accountability for public money is increasingly obscured, as parliamentary committees have found. How do we measure patients in the luxurious hotel-like private hospitals having convalescence extended to three weeks at public expense against patients stuck in NHS hospitals, suffering rapid discharge policies and called “bed blockers”?

The use of the private sector and its small hospitals has been sold as expediency, an interim measure to shorten waiting lists. But the policy overturns medical practice and highlights the huge dangers and risks to patients of not having integrated care systems and access to specialist opinions for, say, renal failure.

The government is overturning its own policy of NHS hospital closure and centralisation. Clinical quality it said then, necessitates closing popular, local NHS hospitals. Hospitals with more than 400 beds are being closed as clinically unviable by a government which hives off ever more elective surgery to private hospitals, most with fewer than 100 beds.

With the National Audit Office reporting that 40 per cent of NHS hospitals are in financial deficit, what becomes of them as money leaks out to the private sector? NHS hospitals simply do not have enough money to care for patients and pay for staff. The financial crisis is compounded by servicing the enormous debts incurred from using private finance. It is met by closing NHS beds and services.

For New Labour, so despising the public sector and anyone stupid enough to work in it, this is part of the master plan. It has drawn up a draconian performance framework for the NHS, from which the private sector is exempt, although the latter is motivated by profits, not care.

Using performance league tables, hospitals are ranked into four categories, from zero to three-star. The tests do not measure care or access, just the ability of the NHS to deflect political discomfort away from government. As the Audit Commission has revealed, three-star NHS hospitals achieve their status by focusing not on quality but on the tests themselves. To address the waiting lists, many hospitals fraudulently remove patients and massage the statistics.

NHS hospitals daring to reveal how badly underfunding affects their services will be taken over by private management – the same private management that has contributed to the destruction of the railways, falling BBC standards, and the Passport Office and National Insurance fiascos.

However, if NHS hospitals deliver the political targets, they win three-star status and “foundation hospital status”. Foundation hospitals get entrepreneurial freedoms, including the ability to dispose of national assets as their own, increased freedom from inspections, and money-making rights exploiting patient services, illness and research into these for profit.

Moreover, the government has also provided new eligibility criteria, the first in NHS history limiting intermediate NHS care to six weeks, allowing hospitals to introduce user charges after redefining some NHS care as personal care.

Foundation hospitals are simply an extension of the internal market, which the Conservatives introduced in 1991 when establishing hospitals as NHS trusts. They take us back to the situation pre-1948, with teaching hospitals as great beasts in a lawless jungle where survival not planned health care, is what counts. And, as hospitals become responsible for their own revenue and investment, they will be driven back on to the wealth and charity of local communities. The areas with maximum political clout will thus be silenced.

Cross-subsidisation is the key mechanism for low-cost universal access. But cross-subsidisation is a barrier to the marketplace and to trade in health services – hence the creation of the internal market as a necessary prelude to the private finance initiative and private hospital contracts. But the trade in services exposes the NHS to threats from the large US corporations and transnationals. Little-understood EU and World Trade Organisation trade agreements will be triggered, making it a requirement for the UK to open up all aspects of its health services to the market place.

No country provides universal health care on the back of for profit providers. The government is now awash in unkeepable promises. It cannot provide a universal NHS free at delivery when it has undone the efficiencies of cross-subsidisation, bulk purchasing, and monopolist provision. But, instead of public debate, the government confuses us with “diversity”, “choice”, and “decentralisation”. Thus does Milburn strip the principles of the NHS and devolve political responsibility for them.

Allyson Pollock