NHS - becoming a logo for private providers? Image: Graham Smith
The Health and Social Care was passed 27 March 2012. Crucially and most seriously, it removes the UK government’s obligation to provide universal healthcare in England, something so fundamental it amounts to the abolition of the NHS. As Dr Jacky Davis, co-chair of the NHS Consultants Association says: "After the passage of the unwanted, unneeded and deeply undemocratic NHS bill, we no longer have a national health service."
There was overwhelming opposition from the medical profession – for instance, from the British Medical Association and all but one of the 26 royal medical colleges. This was not communicated by the mainstream media, particularly the BBC. Although the NHS affects every man, woman and child in England, most remain in the dark about what has happened.
The government has played a big role by repeatedly concealed the purpose of the bill - to make possible the gradual dismantling of the NHS and its replacement in a few years by a market system, based on ability to pay rather than need. According to Michael Portillo: the Tories did not believe they could win an election if they told you what they were going to do [to the NHS]".
The government also used mis-information to justify its reforms. According to Portillo, the Tories had to do something about the "incredible inefficiency" of the NHS. The truth is the NHS is one of the fairest, most efficient and cost-effective healthcare systems in the world. It has half the per capita costs of the US health system - which is not universal - and has a higher life expectancy and lower infant mortality (OECD figures).
The government even defied a Freedom of Information act ruling to make public the risk assessment of the bill, despite the commissioner's verdict of "exceptional public interest". And there was a massive conflict of interest, with 1/4 of the MPs and Lords who voted for the Bill having financial stakes in private health companies that stood to benefit by from the bill's passage. “Care UK”, a private health company donated significant money to the office of health secretary Andrew Lansley.
In addition to removing the universal right to healthcare, which has existed since 1948, the HSC Act also opens the door for charges without limit for NHS services. It permits private providers to take over any NHS services. And it allows up to 49% of the business of NHS hospitals to be private. Quite apart from the fact that the intention is almost certainly to eventually increase this percentage to 100% - ie: create a US-style insurance-based system - this will create a health system with two queues: one for the poor and one for the rich. In a cash-strapped system, a rich person with a minor ailment will be treated over a poor person with a more serious ailment. "Care will never again be according to need but ability to pay," says Dr Clare Gerada, Chair of the Royal College of GPs.
The Faculty of Public Health's risk assessment warns of 1) Loss of a comprehensive Health service, 2) Increased costs, 3) Reduced quality of care, 4) Widening health inequalities. In a nutshell: the NHS is integrated, comprehensive, cost-effective, accountable. A mix of providers is fragmented, unaccountable, expensive, only profitable services." ‘Integrated’ means that data is shared – something which was not the case with the private companies involved with the recent breast implant scare – and that patients receive care from a multi-disciplinary team of doctors, nurses, physios, district nurses, and so on. ‘Comprehensive’ means that all people and all ailments are treated. ‘Accountable’ means that problems are made public and not concealed by commercial contracts.
But the risks highlighted by the Faculty of Public Health are all short term. The NHS is being removed gradually - no government would dare remove it in one go since, at the last election, it had the highest-ever public approval rating. However, the end-game is an insurance-based system like the US where, without health insurance, you will not be able to get treatment for you and your family. The term NHS will be meaningless. "The NHS will be reduced to a logo, a budget and a few qangos," says public health physician, Dr Alex Scott-Samuel.
Most people remain in the dark about what the HSC Act does because of failure of the mainstream media. As has often been said on Twitter, if the BBC covered economics like it has health, nobody would know there had been a global financial crisis. On the day the Act was passed the strap-line across the bottom of BBC News broadcasts said "Bill which gives power to GPs is passed". It would be difficult to find a GP who agreed with that.
At a time of severe financial pressure, huge sums of money – estimated at more than £3 billion - are being diverted from patient care to fund the reorganisation necessary to implement the HSC Act.
The implementation of the HSC Act is creating huge amounts of duplicated bureaucracy – the principle cause of the high cost of the US healthcare system.
Gradually, the government is starving the NHS of money. This is deliberate. As hospitals run out of money - and the exorbitant repayments on PFI deals are a major factor here - they become prey to takeovers by private companies. This has already happened, with Serco taking over Newmarket Hospital.
Not only does a private company cherry-pick profitable services but it gains infrastructure paid for by the taxpayer. It can also give preferential access to equipment such as kidney machines, blood and organs that were specifically donated by the public to the NHS for use by everyone.
NHS services must be put out to tender. The core business of the transnational corporations that are bidding is winning government contracts, as they have the experience, deep pockets and legal expertise to do so. Small enterprises and local GPs cannot compete with them in tendering for services as has already been seen in the Virgin takeover of community services in Surrey and children’s' services in Devon. When private companies fail, such as the company with the contract for GP services in Camden, London, patients are high and dry.
The starving of the NHS of money to force the pace of its sell off to private companies is forcing the imminent closure of 4 out of 9 A&E departments serving NW London. It is forcing the closure of Lewisham Hospital A&E and maternity unit, despite the fact that they are highly rated as centres of excellence.
Trusts are getting together in cartels to force down nurses' pay, though nurses have experienced a pay freeze (ie: pay decrease, taking into account inflation) for several years now. Dr Peter Carter, Chair of the Royal College of Nurses is predicting the loss of 56,058 nursing jobs.
Lastly, the fragmentation of the NHS is reducing data sharing. This means it is even becoming more difficult to assess just how healthcare is worsening.
Cameron's destruction of the NHS is arguably the worst crime committed by a UK government against its people in generations. He is dismantling a much-loved and precious institution while lying that he is not. And he is doing at a time when Barrack Obama in the US is moving his country from a disastrous market-based health system to a universal system of healthcare similar to the NHS. Cameron is doing it with no mandate and he is doing having concealed his health policy prior to the 2010 election. The NHS represent everything the British people hold dear. It is integral our culture and, as Danny Boyle demonstrated at the 2012 Olympics, defines Britain, symbolising fairness and working together for a common good.