The detriment of the NHS Bill
Fear-mongering about the NHS is commonplace now, although it is largely lacking in content.
“Don’t Let the Tories Privatise the NHS”
screamed the headlines. The message that the proposed reforms that has all but eclipsing very valid argument towards reform.
There is a principle that the NHS is steeped in bureaucracy. Very few people will disagree. Many of us have sat in a GP surgeries watching them fill out another form or take another box of a computer system in order to meet their requirements. This bureaucracy was created by the Labour Administration in order to justify the vast expense of the NHS and to ensure that they were meeting targets. And yes, while waiting times reduced, and more people are able to access dentists, as a result paperwork quadrupled.
Then there is the assumption that there are too many managers. There are. Whether they are front-line staff (matrons are now entitled “ward managers”-which most tabloid newspapers seems to interpret as not having nursing training at all) or administration based box-tickers, there is a top-heavy management structure within the NHS that is not justifiable.
Yet despite the many things are crying out for reform, there are serious and valid arguments presented against the NHS bill. However such arguments are seemingly too complex for our soundbite nation to process.
Privatisation
Firstly, the “privatisation” argument. Private hospitals already deliver NHS care due to Labour administration expanding services in order to meet waiting time delays. However, the reality is far more daunting under Lansley’s proposals. The existing proposals would actively promote competition between the NHS and private care. This is one of the key issues the Liberal Democrats have objected to. There is nothing wrong with private hospitals providing alternative care where it’s more easily accessible (for examples plans, assessments and even surgery). However, to compete will quite simply cripple the NHS. Private health care have additional incomes to allow them to beat NHS hospitals hands-down. All they are lacking in is locations. The moment competition is created, the state provisions will automatically become a second-caste system. This is not “privatisation” directly, but the creation of a system like we see in America, where only the destitute attend public health centres.
Another argument can be made under this heading is that of transparency. During 13 years of Labour administration, a number of public services began to be commissioned, therefore contract and tendering became a normal part of councils, education and the NHS. However, having private companies that run public services are protected by “commercial sensitivity”.
While a lot of people may be anti-Freedom of Information requests, such requests allow us to hold our public services, and the politicians that decide them, to account. The moment a private hospital starts to deliver public services, they are excluded from this transparency. This is a curse of privatisation across the public sector.
Take the example of ATOS health care, currently contacted to deliver investigations into people’s disability conditions, of which 7/10 rejections are found to be valid applications on appeal. It’s taken solid months of campaigning to bring this organisation to account, as they are not liable to normal freedom of information requests. This is bad enough in the welfare state, but imagine how bad it can get under the hospital state. We could end up with people not being treated for hours, no beds available, waiting lists expanding far beyond the current timelines, and all of its protected under a veil of private organisation.
Choice
If choice is so good for markets, why are energy prices so high?
Then there’s all this “choice” malarkey. I don’t look for choice in my NHS care, I look for universal accessibility. As many people are aware I have a disability that requires a great deal of medical time. I often have the opportunity to travel 45 miles in order to be seen quicker. However, this is a balancing act between needing to be seen quickly and needing to take significant amount of time off work in order to be seen so quickly. Ultimately, we want quick and close to be relational.
Mark Steel provides a stunning riposte to a senior member of the NHS commenting that having the most hospitals per head in the region was inefficient. And yes, often, outpatient units can be outsourced to more modern buildings, where experts in specific areas can congregate and see more people at once. However, if you’re having a baby, or a heart attack, or indeed anything that requires swift medical attention, you want as close as possible.
So so-called efficiency, while it may make business sense, does not make medical sense. Certainly not to the patient.
If you’re not convinced, quite a good story is a friend of mine who sat in the deckchair that promptly collapsed. Her finger got caught within the deckchair and the pressure chopped off the top of her index finger, just above the bone. The obvious thing to do was to wrap it in ice and get to the nearest hospital. However, due to closures at nearby hospitals, she was forced to travel 45 minutes in the ambulance. As a result, while they sewed the top of the finger back on, it was already dead and later dropped off of its own accord. The consequence of this is my friend doesn’t have the top of her finger. This is a significant impact in her life issues as she is a vet. Conducting examinations, even typing, this failure to provide swift service has a significant impact on her life.
GP Consortia
David Cameron makes the argument that a GP knows patient care best. This is an interesting, but unsurprisingly, paternalistic persuader from our current prime minister. GPs represent a paternalistic figure in society whom we look to for advice and guidance, therefore in whom we normally trust. However, what David Cameron doesn’t say is that the “GP consortia” is not a consortium of all of the GPs in the applicable area. Rather, it is a collective of GPs who have effectively tendered for the project and will pull all other GPs into line with their management system. Rather than it being my kind doctor knowing what’s best for me personally, as indeed Cameron’s smooth lines imply, it’s a collective of faceless GPs who have employed a management company or other limited company organisation to manage the administration and have reasonably little interest in the benefits for their patients other than to save as much money as possible.
And of course, when one talks about a GP knowing best, one must first believe in that statement. If you never had any idiopathic condition, you will know that GPs are generally reluctant to make referrals, know very little about condition in depth and will always refer you to a consultant. Yes people with long-term conditions are only around 18% of the population, but they still account for a significant amount of service use from the NHS. I’d much rather a consultant looked at what care was necessary for me then a General Practitioner. Of course, I don’t do GPs down as much as Prof Illich does, but I don’t necessarily hold them in such reverence.
Funding
Another significant argument against the NHS proposals is that the funding of the so-called GP consortia. under the proposals, and largely in the reorganisation in the run up to 2014, NHS trusts have to reduce all debts to zero. they cannot have a financial deficit when they hand over to GP Consortia. In the event the GP consortia go into financial deficit, then the consortia will be closed down.
Let’s put it in another way. We’ve all seen the article about NHS cutting so-called ‘cosmetic’ surgery due to costs, this includes IVF, gastric bands and breast implants. However, in a lot of cases, as with this particular south London site, such cost-cutting may not save the trust. therefore, there will be no trust for the GP consortia to takeover, and so there will be no obligation for the GP consortia to deliver NHS healthcare.
When the GP consortia does take over a Healthcare trust, in the event that they experienced some form of miasma, whether an outbreak of cholera or a particularly violent car accident, the trust may well expend all of its budget in a very brief period of time. What are the options then? Well, they could charge?
This is another very strong indication of an indirect route to privatisation.
One term that I have loathed for the duration of the coalition has been the “free at the point of entry”. This has been used about so many things now that it’s become trite. University it is “free at the point of entry”. The NHS could well be “free at the point of entry”, but that does not prevent retrospective payment through insurances or invoicing.
Right to Healthcare
The key issue that barely gets a mention, let alone a headline in the arguments against reform is that the proposal removes the duty upon the Secretary of State to provide health care. This is the fundamental founding principle of the NHS. There is a right to healthcare in the UK.
It’s not rocket science. To remove such a duty on the Secretary of State would remove that entitlement to the National Health Service. And this is completely unacceptable.
Ad Infinitum
The arguments extend. Rather like a strategic chess game, we must accept the proposals under Lansley’s bill are influential positioning of key pieces to direct significant change to a health system. Not only will the bill present many opportunities for indirect privatisation, but it continues to undermine what the healthcare services. For most British people, the National Health Service is universal, openly accessible health provision. All of these elements will be removed by the NHS bill.
Those who are pro the health Bill have sought to undermine campaigners against proposals as being emotional and hysterical, and therefore to be ignored. However, there is logic in the outbursts just as there is logic in the headlines. Instead of the emotive and therefore dismissible as nonsensical campaigners outside Downing Street who launched a bitter role at Lansley, we should be presenting coherent arguments in reshaping the legislation.
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