NHS: sold to the lowest bidder!

Submitted by cathy n on 20 July, 2010 - 3:30 Author: Todd Hamer

The Government’s White Paper Liberating the NHS sets out the Tories plans for extending the role of the private sector in healthcare. Under the proposals (which will be included in the Health Bill going through parliament in October), GPs will take on the role of commissioning services and foundation Trusts will be autonomous institutions that will be allowed to provide private care.

In effect these reforms will transform the NHS from a public service delivering healthcare, to a fund that commissions healthcare services from various private providers. Although the Con-Dem government affirms its commitment to “free healthcare at the point of need”, the new proposals take us several steps closer to a fully privatised healthcare system.

International private health giants are already salivating at the prospect of lucrative NHS contracts. The end of the PCTs will not only result in thousands of job losses, but it will also leave a big deficit of administrative support that can be filled by businesses like Humana, Aetna and United Health. These companies also hope to take on various consultative roles, providing advice to GPs on where to access the best services. They will also be vying for business as providers and setting up John Lewis style mutual associations.

The White Paper also extends greater freedom to Foundation Trusts (groups of hospitals and community services) to raise money by external means. The most obvious means of doing this is to increase the number of private beds, creating a two-tier system within our current hospitals that goes far beyond top-up payments introduced by New Labour.

Foundation Trusts will also be able to opt out of national bargaining with the trade unions. In fact, the White Paper wants to see the NHS turned into the “biggest social enterprise in the world”. Social enterprises are supposed to be replacing public sector employment. Professionals are being asked to step out of the public sector and set up their own social enterprise in the hope of siphoning off business from the NHS. This is all part of the effort to “empower” David Cameron’s “Big Society”. Public sector workers should see it for what it is – a good way to get workers to exploit themselves.

The increase in private providers and social enterprises will mean that many NHS staff will be forced into the private sector where terms and conditions staff have won over many years of struggle will be destroyed. Added to this 45% of management positions are set to be axed, with the closure of the PCTs and SHAs and the privatisation of their essential services. Also, despite the promise of real terms spending increases (to be detailed in the October Spending Review), the Con-Dems want to claw back a £20 billion budget deficit by 2014 (a year than previously planned).

The White Paper argues that these proposals will improve the NHS and hand power and control back to patients and professionals. The vision set out in the foreword sounds almost like socialist policy: “Healthcare will be run from the bottom up, with ownership and decision-making in the hands of professionals and patients.” However, the free market ideology that lies behind this policy stands at odds with this aim.

Like New Labour, the new government justifies privatisation by claiming they are serving “patient choice”. “Patient choice” is not a new idea and is in fact embedded in traditional medical ethics as the principle of “informed consent”. Patients must be told as much as possible about their condition and their treatment options in order to get the most informed consent possible. Short of training every patient in the finer points of medical science, consent and choice will remain limited but it is goal that most healthcare professionals aspire towards.

In its latest guise, “patient choice” it is part of a post-modernist trend that champions patients rather than trained professionals as the experts. This doctrine has had a progressive effect in challenging the medical hierarchy, especially in areas such as childbirth and psychiatry. However, it is also potentially reactionary in its devaluing of science and because of the way it is used by bourgeois politicians.

As we know from various experiments with placebos, confidence in the authority of doctors and other healthcare providers plays an important role in a patient’s recovery. Apart from all the innovative scientific advances, quality healthcare is rooted in human relationships and trust between healthworkers and patients. In recent years, both New Labour and the Tories have sought to undermine that trust. New Labour attempted to introduce outcome measures and targets across the public sector and asked the public to put their trust in their bureaucratic facts and figures. The Tories wish to take this a step further by asking us to place our confidence in the Market.

Behind the choice agenda lies the belief that free markets rather than social planning is the most efficient way to provide health services. New Labour believed in a “managed market” whereas the Tories are for “liberating” the NHS from such management. They believe the market alone can maintain quality services. If a service does not receive enough referrals, or it is not performing well in the league tables, then it will go bust. Health Secretary, Andrew Lansley has already signalled that “failing” hospitals, GP surgeries and other providers will receive no bailout.

The advocates of free markets argue that state-run healthcare is unnecessarily bureaucratic. However, the administration costs of privatised healthcare are many times more than the old-style bureaucratically planned NHS. Health is not very easily commodified. So whilst a hip replacement can be costed up and sold, treatment of schizophrenia, for example, is less easy to define, measure and package. In such cases, a market can only be maintained artificially by a massive bureaucracy which attaches cash sums to uncommodifiable aspects of health.

The market and its bureaucratic add-ons then distorts the services, priorities and value of the health service. When all the most profitable contracts have been taken by the private firms, the rump NHS will be left to administer all the least profitable services. As cuts begin to be felt, those who can afford to will top-up their care and drive down the standard of free care on the NHS. Ideologically this will call into question the whole principle of free state-of-the-art healthcare.

Although it wreaks of hypocrisy, Labour’s Shadow Health Minister, Andy Burnham has already raised the alarm about this White Paper and pledged to mobilise a campaign against these proposals. Whilst many of the Con-Dem proposals are similar to New Labour’s, the Labour machine may take a turn towards the trade unions and the grassroots of the movement to defend the NHS as a healthcare provider.

Socialists need to be involved in these campaigns to both fight a defensive action to save the NHS and to assert a positive alternative vision. This vision should cut against the old bureaucratic state-run service and the market-driven system and assert workers and patients control. “[Healthcare] run from the bottom up, with ownership and decision-making in the hands of professionals and patients” will only be possible with a fully nationalised, state-funded NHS and through a movement to defend the NHS drawing on its expertise, creativity and knowledge.

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