The abolition of the NHS. That’s what is happening.

In unscripted remarks, the UK Prime Minister revealed his true agenda: he wants to turn our universal health care system into “a fantastic business”. Not patient choice but choice of patient will be the order of the day.

In a speech on exports and growth on 10th November 2011, David Cameron went “off-script” and revealed his government’s true agenda for the NHS. Standing in front of a Union Jack banner and the slogan “START UP BRITAIN” the Prime Minister told his audience of small and medium enterprise people at the BFI on London’s South Bank: “We have a growth review, led by the Chancellor and the business secretary, which ensures that every minister has to come to the table with proposals to cut regulation in their departments and come up with ways of helping business in their sector, helping them to grow.” Then he said: “From the Health Secretary, I don’t just want to know about waiting times. I want to know how we drive the NHS to be a fantastic business for Britain.”

He really said that. It’s here on video: “I want to know how we drive the NHS to be a fantastic business for Britain.”

That same week Hinchingbrooke Hospital became the first NHS Hospital to be franchised to a large for profit health care company — Circle.

The NHS is already big business and some of the costs are there for everyone to see.  (Much is hidden). The NHS is haemorrhaging public funds to hundreds of companies through a range of services, legal, accountancy, catering cleaning, PFI and health care.

For the last two decades government policy has been to divert billions of pounds of NHS spending to for-profit corporations, including the multi billion pound PFI debt programme. Inflation-proofed PFI payments absorb around 15 per cent of hospitals’ budgets and the figure is rising. No wonder facilities must close, staff are being sacked and patients turned away. 

These sources of profit have not always existed. Viewing the English NHS and other European health systems as unopened oysters of profitable opportunity, corporations in the USA and Europe have worked long and lobbied hard to open public health care systems to the market.

Ten years ago, the United States trade delegation put it like this: “the US is of the view that commercial opportunities exist along the entire spectrum of health and social care facilities, including hospitals, outpatients, clinics, nursing homes, assisted living arrangements, and services provided in the home.”

Today market predators want more than NHS funds. Claiming, as they have always done, that buying from them will save public money, corporations now want the concession to charge and sell private health care to NHS patients and introduce charges for health care and private health insurance. 

Politicians have offered no answer to the patient protests and ‘save our hospital’ campaigns that commercialization has generated so far. Protest will escalate as the new policy hits home. So, just as Europe’s bankers have got a technocrat to destroy Greece’s public sector, including its national health service, English politicians are distancing themselves from the fall-out from NHS privatizations by vesting responsibility in a hands-off board. 

Commercial interests and right wing ideology lie behind the Health and Social Care Bill (the “secretary of state Abdication Bill” as David Owen, a former health minister, calls it). The Bill abolishes the Secretary of State’s duty to provide comprehensive health care and dismantles the bodies created to deliver it.  In their place it introduces the structures and systems of patient and service selection and patient charges. Not patient choice but choice of patient will be the order of the day.

All of this is unpacked in a series of briefings for the Lords by health professionals.

In a two-pronged approach, public health services are transferred from the NHS to local authorities with the functions of both so poorly defined as to bring utter confusion to patients’ and citizens’ rights. The scene is set for a re-run of the transfer in the 1990s of long-term care responsibilities to councils when funding was privatized through means testing and charges. Worse: it’s returning to pre-1948.

Not everyone will be covered for all services in the new “NHS”. The government has gone to great lengths to ensure that the newly created commissioners of NHS services (the so-called clinical commissioning groups, CCGs) do not have responsibility for comprehensive care for all residents in one geographical area.

Instead the commissioning groups will able to recruit patients from GP lists across the country. This is not patient choice. It is commissioning groups choosing patients and purchasing what the commissioning groups deem to be the appropriate NHS cover. Selection will be the name of the game.

David Nicholson, chief executive of the NHS Commissioning Board, made this absolutely clear when he advised patients to shop around across the country for their GPs based on the range of services offered. (See briefing number 4: clauses 3, 4, 6 & 7).

Clever informed middle class patients may be able to shop around for the best choice of health plans and services, just as some now do for utilities. But there is no guarantee of success, as anyone who tries to navigate electricity, gas, telecom and rail providers know.  And try making a complaint! The information is too dense and complex, and the costs too high for the average person to understand what is on offer from complex health care packages.

Patient choice is the great con. Patients won’t choose. They will be chosen on the basis of their risk profile. Many of the health care companies now active in the UK manage financial risk by placing time limits on care, introducing cost deductibles, copayments and restrictions on the number of GP visits, hospitals visits, operations. All are commonplace in private health insurance. They are the spectre of what is to come if the Health and Social Care Bill is passed.

The only hope is the House of Lords.  So far peers have signalled general dissatisfaction with ill-specified transfers of fundamental ministerial powers.  Lords Owen and Hennessy tabled an amendment that made precisely this point and although it was defeated it helped put other peers on notice that forensic examination of the Bill was needed on constitutional grounds. 

With all party agreement on 3rd November the House of Lords agreed that Clause 1, which sets out the duties of the Secretary of State, would be paused and taken off the floor of the house for further deliberation until the Bill returns to the House at the Report stage. It is Clause 1 that severs the duties of the secretary of state to his people to provide and secure comprehensive care. (See our briefing here).

Clauses 4, 6, 7, and 10 give extraordinary discretion to the new corporations with powers to select patients and services.

The next few weeks are critical for the Lords.  It is up to health professionals and the medical colleges to help them unpack the Bill and follow the amendments as the Lord scrutinize and debate the Bill clause-by-clause through the committee stage. Peers are taking this Bill seriously and giving it the scrutiny that the coalition’s majority prevented in the Commons.  

The NHS will be abolished if the Bill is passed in the Spring. Were that to happen our immediate task would be to draft a short bill to restore it.

The briefings show that the structures and functions crucial to protecting our comprehensive health care system are being systematically dismantled. The analysis goes to the heart of what is needed to restore the NHS and it goes to the heart of the government’s lack of candour about the true purpose of its reforms. 



About the authors

David Price is a senior research fellow at Queen Mary, University of London.

Allyson Pollock is professor of public health policy and research at Queen Mary, University of London and was previously Director of the Centre for International Public Health Policy at the University of Edinburgh. She is a leading authority on public health and the implications of privatisation for public services, and the author of NHS plc, on the privatisation of our health care under New Labour.