British Doctor Opposes Corporate Healthcare in UK
Privatisation of the NHS is accelerating
Both patients and staff can resist the creeping corporate takeover
By Allyson Pollock
Tuesday May 24, 2005
The Guardian
When Malcolm Glazer took over Manchester United, fans reacted with horror. Some wore black at the FA Cup final, while others are boycotting the club’s merchandising and demanding the resignation of those board members they hold responsible.
Glazer took over United on May 10 - the day the Adam Smith Institute hosted a conference in the Commons for 100 of the country’s most senior NHS and private healthcare executives. Patricia Hewitt was represented by Stephen O’Brien, the NHS strategy director, who used to run the corporation that owns B&Q, and the Texan Ken Anderson, the NHS commercial director and formerly an employee of Amey, a PFI company that specialises in private finance initiatiatives.
“We created a market place,” a senior NHS official told the gathering. “It’s up to you now … Together we’ve created a new era of healthcare provision which can only get wider.”
Much has been made of the fact that the Department of Health has set aside £3bn to buy 1.7m operations from the private sector over the next five years; the emphasis has been on patient choice and extra capacity. But corporate representatives at the meeting were given a frank account of New Labour’s plans to privatise NHS services.
A transfer market is now emerging in doctors, clinical services and even patients (healthier ones are worth more than sick ones). As in football, there will be a premier league of foundation trusts and independent sector treatment centres (ISTCs) lording it over the rest. And as in football, commercial interests will prevail over all others.
Consider first the ISTCs, which will cream off £3bn of taxpayers’ money. At present the Department of Health does not require the same level of training for doctors working in ISTCs as in NHS units. Six surgeons working for the private sector on NHS cases have already been suspended for what are termed serious surgical errors.
ISTCs create incentives to direct care to the comparatively well at the expense of the comparatively less well. There have been reductions in waiting times for cataract surgery, but there have been dramatic increases for chronic eye conditions such as glaucoma, diabetic eye disease and age-related macular degeneration. Easy, cheap operations such as cataract procedures are what the ISTCs want to focus on. If the easy cases and trained NHS staff get swallowed up by the private sector then the market will indeed get “wider”, as more and more NHS providers get squeezed out by rising costs.
As for primary care, Department of Health officials told the businessmen on May 10 that private-sector involvement in elective surgery - the diagnostic and treatment centres - was “very much the starting point for the direction we now want to travel in primary care”. Under the Health and Social Care Act 2003, primary care trusts can contract out all aspects of primary medical services: from cancer screening and family planning to maternity services and minor surgery. By the end of 2005, 55% of GP out-of-hours services are expected to be delivered by companies like GP Plus and Asda.
Meanwhile, the government is creating opportunities to hand over services for multiple sclerosis, alcohol and drug misuse and depression, intermediate care, diagnostics and radiology. Much of this will be accomplished through local improvement finance trusts (Lifts) - the counterpart of PFI in primary care. According to the department: “Lifts transfer ownership of primary care premises from the public sector or GP practices to private investors.” At present Lift partnerships own only GP premises, but health corporations are being encouraged to find new medical-service niche markets to link into Lifts. A Department of Health official reassured the industry that it would be “ringfencing 10% of primary care trust budgets for innovative programmes”. Drawing a parallel with the BBC’s requirement to commission around 20% of its programming from independent producers, the official said this would promote creativity across the NHS.
Doctors are now being offered golden hellos of several hundred thousand pounds to abandon their patients and leave the NHS for life as a salaried employee of a transnational healthcare corporation.
If this were football, the media would full of it. But, to paraphrase Bill Shankly, it’s only life and death. Supporters of the NHS should take a leaf out of the Manchester United fans’ book. Patients should insist on being treated in NHS hospitals; NHS staff should refuse to work in the newly privatised sector; journalists and academics should monitor the impact of the private sector on entitlements to healthcare. And they should be willing to depose the board members - such as Blair and Hewitt - who brought in the hundreds of Malcolm Glazers who will bestride British healthcare like colossi.
Allyson Pollock is professor of public health policy at University College London and the author of NHS plc