Picture: Dr Kailash Chand
For thirty years a market ideology which puts competition and profit-making above providing healthcare has plagued the NHS. Now, under the Coalition government, this ideology is threatening to kill it. As the Conservatives’ “reform” of the health service becomes more and more unpopular and provokes widespread opposition, the Labour Party has the opportunity to be at the heart of a coalition fighting to return the NHS to its founding principles – quality healthcare for all on the basis of need – in a modern setting.
Will it take that opportunity? That is what
Labour Party activists committed to defending the NHS are demanding to know.
The model resolution on the NHS being promoted for this year’s Labour Party conference rejects the notion of healthcare being provided in the market, rather than as a public service. It argues for a healthcare system providing a universal service based on meeting people’s need, not providing profit-making opportunities for corporations.
That is a powerful idea, morally and politically. The right of human beings to life and health should come before profits, and health services should strive to provide that right equally - regardless of personal wealth or ability to pay.
What is also important to understand – and what is certainly clear to me as a doctor – is how fantastically inefficient and wasteful market reforms to the NHS have been. If Labour is really committed to sorting out the mess the Tories are deliberately making of the NHS, if it really wants “what works” to make the NHS work again, it should commit itself to comprehensively reversing this marketisation.
The “internal market” or “purchaser/provider split”, scrapped under Blair only to be reintroduced under another name, has seen NHS administrative costs rocket from 6 to 14 percent of spending. (Under the Coalition’s plans it will go up further)
Private Finance Initiative deals have meant paying for hospitals and other NHS facilities many times over – justly compared to the exorbitant repayment rates on “pay day loans”. Since the Major government, 717 PFI projects have had a value of £54 billion, but have cost the taxpayer £301 billion! In many NHS trusts, for instance in South London, this has resulted in huge, unpayable debts which “necessitate” dramatic cuts and closures – sometimes even of neighbouring, financially solvent hospital trusts, such as Lewisham.
And the outsourcing of more and more NHS
services is not just bad for the patients and health workers directly affected.
It also means private providers cherry picking easy profit-making services like
safe one-off procedures, while an increasing cash-strapped NHS is left with
expensive services like caring for the old, chronically ill or mentally ill
All this wasted money is a big part of why patient care is being rationed more and more. Patients are being denied prompt hip or cataract operations – and the list of hard-to-get services will grow and grow, reducing the NHS to a skeleton. Money that could be spent on patient care is being spent on unnecessary bureaucracy, debt interest and dividends.
In some cases, companies are making a killing both figuratively and literally. Take Clinicenta, which recently had a contract for a treatment centre in Stevenage cancelled after a litany of clinical failings and investigations into three patient deaths after routine procedures. The company was actually paid £53 million by the NHS to end the contract! Worse still, its parent company Carillion – famous for its union-busting activities in Swindon – looks set to be rewarded with a £425 million PFI deal at the Royal Liverpool.
Meanwhile, Jeremy Hunt blames individual cash-strapped Trusts for making “bad choices”. Since last year’s Health & Social Care Act scrapped the government’s duty to secure a comprehensive health service, Hunt is now legally - if not morally - able to wash his hands of the entire mess - a situation that must be reversed urgently, and democratic accountability restored.
For Labour to really tackle this crisis, it needs a serious drive to reverse marketisation in the NHS. It must admit it made mistakes after 1997, loosening some of the screws which the Tories and Lib Dems are enthusiastically pulling out. Even the most nervous New Labour politicians should not worry: every poll suggests that taking this sensible, principled position would be wildly popular. Fewer than one in five people, for instance, want any more markets in the NHS.
The Labour Party founded the NHS. If its leadership want to save their party's most glorious achievement, they should support the resolution activists are promoting, as a whole, and step up with a serious campaign to put it into practice. Labour should be shouting from the rooftops that the NHS is being privatised and that before long all that will be left is an NHS logo. The privateers pulling our health service apart must be convinced that a Labour government will not let them get away with it – or they will carry on with their sordid business.
Like this piece? Please donate to OurNHS here to help keep us producing the NHS stories that matter. Thank you.