By Alex Scott-Samuel
POGH blog (U.K.), July 17, 2016
I want to give a broad political overview of what’s happening in the NHS in England and of the background to the current situation.
As you’ll know, the English NHS is in a bad way, with practically every part of the country in financial deficit. Many hospitals and many services are being closed down, cut back or rationed. At the same time, many long term contracts for the provision of NHS services are being awarded to private sector companies – though often people are unaware of this because the likes of Virgin, Carillion and SpecSavers are allowed to operate under the NHS logo.
By definition, these arrangements are wasteful, because private companies have a duty to make profits and to give those profits to their shareholders. That means that public money is haemorrhaging out of the NHS – whereas when a public provider of NHS services makes a surplus it is reinvested in the NHS.
There is also a substantial legacy of (mainly Labour initiated) private finance initiative (PFI) funded hospitals, whose exorbitant loan interest payments have to be made before NHS funds can be spent on routine services. And it’s no coincidence that people’s inboxes are filling up with adverts for health insurance, with their invitations to jump the NHS queues. Everything I’ve described forms part of what in my view is an intentional strategy by the Conservative government to create financial, managerial, professional and public chaos throughout the NHS, so that private provision of NHS services, alternative private health services, health insurance, and NHS co-payments and ultimately charges will be seen as inevitable.
This ‘cultural revolution’ takes many different and apparently unrelated forms whose destructive nature is denied by the government – which continues to assert that it has the public interest at heart and that it is factors like the ongoing impact of the credit crash, the increasing costs of drugs and medical equipment, the ageing population and our unhealthy lifestyles which are the true problems facing the NHS. The building blocks for privatisation to which I have referred currently include: the aforementioned awarding of NHS contracts to private bidders – often asset strippers who provide poor quality services, fragment and undermine the cohesive public ethos of the NHS; the creation by the Treasury of NHS deficits and of regulations which forbid them; enforced rationing of services to extend waiting lists and encourage patients to seek private alternatives; manufactured confrontations with doctors and other members of the NHS workforce; the imposition of ‘new models of care’ which undermine NHS hospitals and create community based healthcare structures ripe for privatisation; personal health budgets, designed to link with health insurance. There are many more and I can provide documented evidence for all of them. It is a national scandal.
I’m not usually a conspiracy theorist; the reasons I feel confident in making these claims are because my and other people’s researches over the last decade have revealed a series of papers and reports going back to the 1970s, in which the eventual privatisation of the NHS is laid out. Their sources include the Conservative Research Department, the Central Policy Review Staff, the Adam Smith Institute and the Centre for Policy Studies.
A few names occur recurrently – most notably Oliver Letwin, who helped plan many of Thatcher’s privatisations of public goods and services and who until July this year was a senior minister in the government. It was Letwin, not just Secretary of State Andrew Lansley, who had a major role in ensuring that the Health and Social Care Act 2012 passed into law. The monumental 350 page H&SCA – drafted by corporate lawyers – constitutes the complete enabling legislation for full privatisation of the English NHS.
What is to be done? Until we have a government committed to tackling and reversing this appalling onslaught on our beloved NHS, we must continue to expose what is happening, to challenge it and to campaign loudly and widely in order to increase public awareness and action. And even the opposition can draft legislation and campaign around it: the NHS Bill, first tabled in the previous parliament as a cross-party bill by Green MP Caroline Lucas, with support from Jeremy Corbyn and John McDonnell, was reintroduced as a Ten Minute Rule bill by Labour’s Margaret Greenwood on July 13 2016; it will have its second reading on November 4. Drafted by Professor Allyson Pollock and barrister Peter Roderick, it would reintroduce the Secretary of State’s duty – abolished by the 2012 H&SCA – to provide a universal, nationalised NHS in England. We must do everything in our power to support these aims.
Jacky Davis and Raymond Tallis, eds. NHS SOS. How the NHS was betrayed – and how we can save it. Oneworld, 2013.
Jacky Davis, John Lister and David Wrigley. NHS For Sale. Myths, lies and deception. Merlin Press, 2015.
Youssef El- Gingihy. How to Dismantle the NHS in 10 Easy Steps. Zero Books, 2015.
Dr. Alex Scott-Samuel MB, ChB, MCommH, FFPH, is senior lecturer (clinical) in public health at the University of Liverpool.