The launch of a new political party will make the NHS an election issue and test Labour’s commitment to the service it founded
The launch of a new political party – National Health Action – on Thursday marks an interesting political moment. Some of the brightest and best of the NHS doctors who led the fight against the coalition’s health and social care bill have lost confidence that the Labour party, which founded the NHS, now has the will to save it. Whether or not they can field up to 50 candidates in 2015, as they intend, or win a single seat, at least the new party could help to make the NHS an election issue and pose a question for Ed Miliband. He has promised that Labour “will repeal the NHS bill“, but how serious is this commitment?
Labour’s problem is that up to now what the coalition has been doing is a continuation of Labour’s own past policies. As early as 2003, Labour started inviting private companies to provide some kind of NHS secondary care such as hip and knee replacements, cataract surgery and dialysis, and went on to do the same for primary care and a wide range of community health services. Andrew Lansley and Jeremy Hunt have simply accelerated this process, ordering primary care trusts (now clustered into large groups) to put whole tranches of NHS services out to competitive tender. None of this is a result of Lansley’s Health and Social Care Act. But much more is to come, with the new GP-led clinical commissioning groups due to go live in April.
Community health services (physiotherapy, speech therapy, health visitors, etc) have been the most visible targets for privatisation so far. But corporate takeovers of GP practices are likely to accelerate as private companies win contracts to provide specialist services that are currently provided by GPs such as addiction treatment and minor surgery, cutting GP practice income and threatening their financial viability. The same process is in store for hospitals.
The other major driver of change is the so-called Nicholson challenge, which requires the NHS to find efficiency savings of an additional £4bn every year, for a total saving of £20bn by 2014. The rationale for these savings has never been adequately explained and in practice few of the cuts made so far seem due to improved efficiency. The savings are supposed to be invested in cheaper alternatives to hospital care, but as yet there is no evidence of this happening.
What is clear is that NHS staff are being cut and services are being rationed. The range of NHS treatments offered to patients is falling and so is quality. When GP-led clinical commissioning groups take over from primary care trusts in April these trends are likely to intensify. Clinical commissioning groups will employ private companies to do their commissioning. They will implement the market’s view of healthcare as consisting of a range of separate specialised services and the health market regulator, Monitor, will ensure that the contracts for them go to the lowest bidders.
Health market analysts predict that £20bn of the NHS budget – 11% – will soon be going to private companies. Many NHS hospitals, already reeling from cuts, will be downsized or closed. And senior government figures are talking of another £50bn of savings, implying the contraction of the NHS to a “basic” or residual service.
All this I and my co-author, Stuart Player, predicted in The Plot Against the NHS, including the spectacular cases of greed and abuse that were bound to accompany marketisation. These are now surfacing week by week as seemingly unconnected news items: chilling cases of profiteering at the expense of patients, such as the private hospital, Winterbourne View, to GPs making millions from the breakup of the NHS, as in last week’s sale of the out-of-hours company Harmoni to a private healthcare company (not unlike the way Russia’s oligarchs made billions from the breakup of the USSR).
Other cases are still to come, such as the super profits to be made from cherry-picking the profitable parts of NHS hospital work, or the massive losses to be expected from corporate fraud.
These things were predictable because they are in the nature of markets, even when there is a strong will to regulate them, which is clearly lacking here – the health watchdog is understaffed, weakly led and lacks effective sanctions. New Labour imagined it would always be able to “manage” the market forces it was unleashing on the NHS. But, as we reported in our book, by 2010 the forces were too powerful. Private providers do put profits before patients, and competition will force NHS providers to do the same. That is the way markets work.
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