Reasons to Vote Yes: Privatisation and the NHS

Private businesses operating within the National Health Service must be pretty pleased with how policies pushed by successive governments at Westminster have allowed their interests to flourish. Why would they not be? Opportunities in this area of social provision are staggering and perfect to boost company profits. Shareholders must be drooling at the prospect.

There was a time when those responsible for safeguarding and running the NHS – politicians – were proud to declare it the best health service in the world  and one of the greatest achievements in history – and some still do though what they mean by this now is less clear. The NHS became something of a sacred cow – a marker for how civilised the UK was compared with other countries with their piecemeal services based on health insurance and unequal access to care.  

You don’t hear so much of that now – now that the NHS is steadily heading towards the American health care model – the steady incursion of private providers such as Serco and Circle increasingly managing aspects of public health care.  Serco’s expertise takes in everything from nuclear weapons to health. Circle, established by former banker Ali Parsa,  is run along mutual lines with doctors holding a stake in the business.  I should point out in passing that just last week Serco’s finance director of outsourcing was on the point of resigning over a financial scandal involving the government.

National Health Service

In 1948 the NHS was started as a comprehensive health and rehabilitation service for the prevention and cure of diseases  in response to the miserable health provision available to the majority of people in the UK. The NHS was established as free at the point of delivery and available to all, paid for by the people through public taxation.

We all know how successful the NHS proved to be, and rather than fewer people accessing its services the healthier the population became, the scale and variety of specialist care led to increasing numbers turning to the NHS with issues never envisaged at its initiation e.g. IVF treatment for fertility problems and gastric bypasses.

When a national health service was proposed opposition from some quarters, notably well-off doctors who feared a loss of income through restrictions on private practice, were well aired. For most ordinary people, however, the NHS was welcomed and proved a revelation. Lives were saved and improved enormously. It is not possible for any of us in the UK today who didn’t live through the years before 1948 to fully comprehend the awful misery inflicted on the poor having to make choices between paying out paltry earnings on keeping a roof over their heads, putting something in their bellies or paying for essential medical treatment.

Over the last half century the lives of people in the UK have been transformed by the opportunities for decent care provided by the National Health Service and life expectancy as a result has risen by around 10 years.

The cost of upkeep of the NHS has also risen year on year which is why Westminster governments have looked to ways of offsetting some of that financial burden  onto the private sector – outsourcing to private companies to manage aspects of care. The private sector is regarded by some as more efficient than the public. That efficiency does come at a price – private is more ruthless in regards to its employees but it is not per se any better at the job it does although it does bring in alternative means of funding such as raising cash through shareholders.

So where is the NHS heading?

I fear that in England there is little chance of what today we would recognise as the NHS still being around in another 10 to 15 years time with increasing numbers of health trusts outsourcing multi-million pound contracts on the open market for everything from mental health provision to tests and diagnosis. In Scotland things are a little different. Here there has been strong resistance to interfering with what is regarded as a vital system of health care.

But in England there is a different perspective, from government at least. A choice between direct infusion of funds into the NHS or outsourcing to the private sector has come down firmly in favour of private. Austerity measures drive this to an extent, it is argued, but that doesn’t wash in a country that supports Trident. Funding for the NHS is ideologically driven and pretty well shared by Labour, Conservative and Liberal Democrats.

England’s move into privatisation will no doubt lead to patients becoming clients and will be accompanied by the well-rehearsed refrain of those clients being provided with greater choices over their care. That  great myth of choice and the right to choose – such choices are always conditional in such circumstances.  The concept of choice so loved by rightwing commentators from both Labour and Conservative sides is not absolute – in some areas there will never be real choices of provision and moreover choice is mainly exercised by the wealthy and the middle classes creating gulfs in what was once a fairly equitable health service.  

A health care system operated by the markets will have as its number one goal, irrespective of claims from business people and politicians (sometimes the same people), the company’s profits.  Why would they not? That after all is their raison d’être.

Why are privately operated companies more likely to employ temporary rather than permanent employees? How does having transitory staff in hospitals fit in with putting the patients’ interests first?

Any private health care business will think carefully about where it operates to try to ensure success. Their bottom line is never going to be the service to be provided irrespective of cost. So what happens to the universal provision of care – does it become ghettoised? Like schools? Replacing the notion of universal care for competition at the heart of health planning has meant private providers are able to get more snouts into more troughs of readily available public cash.

In these so-called times of austerity NHS budgets are squeezed. Deciding that aspects of NHS care should be opened up to private companies is a political decision. It is dressed up as opportunities to improve care through competition therefore enabling ‘best value’ for patients or taxpayers or whoever – ie us. The slick, market-oriented operators breathing down the necks of cash-strapped health trusts are having a field day.

A second rate service provided by the state as a kind of safety net for the socially excluded and those not willing or capable of exercising their choices  will probably jog along for a time but the best service, the one that will be held up at election times as epitomising the best of British, will be that which is used by the better-off and the determined or pushy.

Of the billions of pounds paid out by UK taxpayers to provide essential services much will be siphoned off to pay for outsourced services from enterprising agencies and this is a national disgrace.  

Such a trend has meant ‘putting multinational companies in the driving seat of the NHS,’ according to former health secretary Frank Dobson. He was talking about the Labour government’s push to contract out to private and third sector providers.

Health care in England is being transformed and unlike the public body that is the NHS private enterprise does not have a duty to provide a comprehensive range of services only ‘such services or facilities as it considers appropriate.’

 

Who then is making decisions about health priorities in the UK?

Circle’s profits have risen from £170.3million to £192.7million encouraging the company to build more private hospitals in England. It and Capita (the UK’s biggest outsourcing company which earns half its turnover from the public sector) expect to continue to pick up contracts from NHS trusts whose incomes are stretched to breaking point. Privatisation in England is there to stay – hospitals and clinics springing up in Cambridgeshire, Manchester, Birmingham, Bedfordshire, Nuneaton, Bath, Reading – anywhere and everywhere.

For those who judge the NHS by the state of its waiting rooms and chipped paint corridors such rampant privatisation will be just what the doctor ordered. For those who recognise that each time a contract is put out to tender and won by a company operating for profit another part of the NHS is being undermined. At some point the whole edifice will go in all but name with implications for staff as well as patients. Actually the terminology has already changed from National Health Service with all that suggests to healthcare market.

Health care is devolved thank goodness. In Scotland at present the SNP government is adamant that the structure of the NHS is safe and there are no moves into the kind of health privatisation happening in England.

I don’t think we should be complacent however. Scotland has seen examples of reckless behaviour from Holyrood. In 2005 when Scottish Labour was in coalition with the Scottish Liberal Democrats Andy Kerr then Minister for Health and Community Care announced a Scottish Regional Treatment Centre pilot at Stracathro funded under PPI which was duly opened in a blaze of publicity in 2007 by Jack McConnell then First Minister. The white elephant of the Golden Jubilee National hospital in Clydebank also established under New Labour had to be bought by the NHS.

While both the Scottish National Party and the Green Party in Holyrood have stated opposition to any privatisation of clinical services in Scotland’s NHS  there must be a question mark over what will happen in the future if Scottish Labour and the Liberal Democrats and Tories (those two in coalition presumably) get back into power.

 http://www.keepournhspublic.com/pdf/SRTCshort.pdf

Scottish Labour and the Scottish Liberal Democrats  have been criticised for their underhand methods when it comes to privatising health care – omitting mention of it in their election manifestos.  The Labour Party, very keen on Public Private Initiates, did include references to mixing private and public health care in its Westminster manifesto of 2005 – all in the guise of providing better, ‘more quality healthcare’ to ‘expand provision’ and ‘reduce waiting times’ but there was nothing in its Scottish manifesto before setting up the pilot at Stracathro and the National Waiting Times Centre later renamed Golden Jubilee National hospital –  all £180million of it built in 1994 and having consequently failed, bought by the public purse as an NHS hospital in 2002.

John Reid one-time Health Secretary at Westminster under Tony Blair tried to persuade Scots the ‘the medical market place’ was the way to go. Reid would no doubt welcome chief executive of LaingBusiness (a so-called healthcare intelligence company) William Laing’s observation that Circle’s success is ‘significant for all private sector providers to the NHS.

There doesn’t seem any way back for the NHS in England but here in Scotland we have a chance to hold onto what has proved an excellent provision for the past 60 plus years. Voting no in the referendum will put Scotland’s NHS at risk of going the way of England’s. It’s time for people to wake up to the real danger of losing this brilliant health service.

A positive vote for independence is the only chance we have to retain our universal health service, free at the point of use. Use your vote well.

3 Comments to “Reasons to Vote Yes: Privatisation and the NHS”

  1. For some more on the history of the NHS and its workings in England (pre-Coalition), readers may like to have a look at “The NHS Is 60: undervalued, underfunded undermined” published by the Radical History Network of North East London in May 2008: 64-page pamphlet, pdf at https://drive.google.com/file/d/0B3YbS5W6XetQRGVUbWotMzRBQ28/edit?usp=sharing

  2. You only have to walk round any old graveyard to see the horrors of life pre-NHS. They are there to be seen in a mass of headstones on which the names of young children are engraved for posterity. Children who never had the opportunity to grow to adulthood because of diseases we regard as almost trivial nowadays with modern medicine. Then there are the others who never even saw the light of day because women could not afford pre-natal care, and the many women who died in childbirth. We women have much to thank the NHS for. As has the country. Without children, without a new generation, we all face increasing financial problems.

    To me our NHS is a mark of a civilised and caring society, a society that wants the best for people irrespective of their immediate ability to pay, for over the years society will reap its payment many times over in increasing prosperity and a happier, more content population. So, yes, let’s protect our NHS and our society on 18th September.

    • Women and children have been huge beneficiaries of the NHS. Because younger generations have grown up with it I wonder if many don’t fully comprehend the dangers of sleepwalking into a situation where the universal service free at point of delivery provision will become more and more withdrawn until widespread privatisation/expensive health insurance replaces it. By then realisation of what they’ve let go will hit – too late.

      Thanks for your comments.

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