Who will save the NHS?
Lorna Finlayson
In his speech to the Conservative Party Conference, David Cameron vowed to protect current levels of health spending. He also stressed that ‘you can only have a strong NHS if you have a strong economy’ – something Labour 'will never understand'. In other words, the salvation of the NHS depends on a Conservative victory at the next election. That sentence has a strange ring to it. But everyone claims to be the saviour of the health service these days. Both camps in the Scottish independence debate claimed it. The Labour Party claims it. The Conservative Party claims it.
As it happens, Cameron’s commitment to maintain health spending in line with inflation would not be enough to avoid a funding gap of around £30 billion between now and 2021 because of ‘rising demand’ (a factor likely to be exacerbated by George Osborne’s planned £12 billion cut to the welfare budget). But the size of the budget is not the only issue. Privatisation reliably leads to worse services that cost more: the NHS is one of the most efficient health services; the US system is the worst in the developed world. A recent process to select among bidders for health services for the elderly in Cambridgeshire cost £1 million.
The fate of the NHS depends on whether or not certain proposed structural changes are allowed to proceed. And privatisation is exactly what those changes amount to. Cameron’s ‘reforms’ (the first rule of privatisation: don’t call it privatisation) will open up more health services to private bidders like Serco and Virgin, creating a two-tier, profit-oriented system on the promise of greater ‘efficiency’ and ‘choice’ – and the TTIP free trade agreement now being negotiated between the EU and the US threatens to make the changes irreversible.
Cameron claims that the current reforms to the health service are not about ‘ideology’ but about ‘what works’. All the evidence, however, shows that the NHS does work, that it is one of the most successful and cost-effective health systems in the world, and that privatisation never ‘works’ for the ordinary users of services, only for the stakeholders of certain corporations. The sell-off of hospital cleaning services has already shown the real effects of privatisation: apparent short-term savings at the expense of poorer hygiene, higher rates of hospital-acquired infection, the break-up of established ward teams and casualisation of the workforce.
The drive to privatise health provision is not new: the Tories are only finishing what New Labour began. There were protests from the start. In 2007, thousands of health workers marched against NHS reforms that would see services being sold off to private companies; in October 2011, around two thousand activists and health workers attended the Block the Bridge protest in London; in February 2012, demonstrations stopped traffic in Parliament Square, with protesters padlocking themselves outside the House of Lords; in May 2013, medical staff and union members marched from the South Bank to Whitehall; in September 2013, fifty thousand people marched against cuts and reforms.
In a speech to NHS staff in 2011, Cameron claimed that people were ‘on board’ with his plans: ‘It’s what patients expect. It’s what doctors and nurses want. And it’s what this government will deliver.’ A YouGov poll in February 2012 found that fewer than one person in five thought that increasing competition in the NHS would make services better; in the same month, an ICM poll found that a majority of voters believed the coalition should drop its plans to reform the NHS; and fewer than one NHS worker in ten thinks that the health service is ‘safe in the hands’ of the coalition government, according to a July 2013 poll conducted by 38 Degrees to mark the 65th anniversary of the NHS. The same poll reported that more than two-thirds of NHS staff think the government’s reforms have had a negative impact on patient care, with 83 per cent regarding the changes as motivated by a drive for privatisation.
Almost nobody believes what Cameron says. The problem is how to co-ordinate effective resistance. A number of organisations are trying to do just that. Alongside public sector unions such as Unison, which backed the recent Mothers’ March, there are groups like Keep Our NHS Public, which has branches all over the country and which anyone can join.
Comments
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4 October 2014
at
7:13am
SpinningHugo
says:
"Privatisation reliably leads to worse services that cost more: the NHS is one of the most efficient health services; the US system is the worst in the developed world. "
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6 October 2014
at
11:08am
Harry Stopes
says:
@
SpinningHugo
I don't think that the semantic difference is as clear, or as important, as you claim. As James Meek (for example) has made clear in several articles in this paper, privatisation has happened and continues to happen in a number of different ways. You suggest that the word only refers to the sale of physical assets or enterprises. As Meek makes clear, privatisation more fundamentally is the provision by private enterprise of services formally provided by the state. Whether that provision occurs on the basis of a sale of an asset, or the sale of a contract ("outsourcing") isn't the most important question, when the end result is that private companies become involved in the provision of public services and extract a profit for shareholders by doing so.
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7 October 2014
at
12:02pm
semitone
says:
@
SpinningHugo
It's also annoying to read things like "we were told that the Health and Social care Act 2012 would leave the NHS a smoking ruin (when in fact almost all that it did did not require primary legislation at all)."
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7 October 2014
at
2:00pm
Harry Stopes
says:
@
SpinningHugo
"But as the UK’s relative performance has improved under the last two governments, that seems somewhat inconsistent with the claim that the NHS is being run into the ground by the Blairite/Tory privatisation (sic) agenda."
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4 October 2014
at
9:39am
streetsj
says:
You make me feel less alone on these pages, spinninghugo
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9 October 2014
at
6:45pm
John Hobbs
says:
For many who suffer autism the NHS is already lost.
Read moreThere are so many things wring with this lazy claim that it is difficult to know where to start.
First, the meaning of the word privatisation. Privatisation means the selling off of part of the State to the private sector, whether it is property or an enterprise. Nobody is proposing doing that with the NHS.
What the writer seems to mean by privatisation is outsourcing: a different thing. I expect a Labour politician to conflate the two: that is their job. A philosophy lecturer? Not so much.
Second, it is claimed both that State run health care systems have better outcomes and that they cost less.
The first claim is usually supported by this study by the King's Fund
http://www.theguardian.com/society/2014/jun/17/nhs-health
But as the UK's relative performance has improved under the last two governments, that seems somewhat inconsistent with the claim that the NHS is being run into the ground by the Blairite/Tory privatisation (sic) agenda.
If we look at outcomes (cancer survival, infant mortality etc etc) the NHS looks much less impressive. Better than the US certainly, but not than France, Germany, Canada, Australia etc.
The reason the NHS is relatively cheap is that it is illiberal. Other healthcare systems is modern western states permit patients to pay a premium for a better service. To take a simple example, if you want a room and not to be on a ward, you can pay for it. This ability to 'top up' the basics leads to a higher spend. In the UK your only options are the NHS or, if you want better, to go entirely private. No wonder it is cheaper.
No party at all is proposing a return to the world before the introduction of the internal market in the NHS. All governments have pursued the same agenda on this since the 1990 National Health Service and Community Care Act. Just as then, we were told that the Health and Social care Act 2012 would leave the NHS a smoking ruin (when in fact almost all that it did did not require primary legislation at all).
Labour will probably win in 2015, and that will be a good thing not because they will reverse the Tory's agenda but because they can take it further. only Nixon could go to China, and only Labour can reform the NHS.
This is a clear non-sequiteur: the amount of good or ill caused by a policy has no direct relationship to the quantity of primary legislation it requires. Similarly, comparing health outcomes against countries like Australia (which has a nationalised health service remarkably like the NHS) without comparing what they cost is lazy at best. Perhaps Hugo you would be more comfortable back in the shallow end of CiF?
It's also important to note that from 97/8 up until 2010 there were very large (in historical terms) real terms increases in spending on the NHS every year. So if you want to imply that health outcomes have been unaffected, or even improved, by outsourcing, you need to grapple with the confounding influence of that extremely important variable.
And "so many things wring" is somehow just perfect.
My view is that the NHS needs breaking up. Nothing to do with state ownership (or outsourcing) but simply because it's too big to manage. And because it's impossible to manage no good managers will get involved.
Doctors are to be sent on Autism Awareness courses. With 600,000 sufferers and children joining this epidemic at the rate of 1 in 50 it would seem reasonable that the NHS would support doctors examining these people and having the results of those examinations, together with sufferers experiences, on a database. No chance, the M of Health watch as autism becomes the most common cause of permanent disability at an estimated cost of £32 bn per year.
Who will save our children ?