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Healthcare and markets will make you sick

Even the right-wing Coalition government is well aware that the National Health Service is embedded in the social being of Britain. So while savaging the rest of the public sector, they have committed to real terms increases in health spending. There’s a big sting in the tail, however.

The government’s White Paper on the NHS proposes major changes. At the heart of them is the plan to involve private sector corporations and impose competition and market forces in the running of the NHS. This dramatic change is part of the attempt to restore the bankrupt for-profit capitalist system to health. It cannot be allowed to succeed.

Many of the changes in the White Paper look good on paper. The intention to move from quantitative output targets that distort clinical decision-making to qualitative health outcomes has seemed like an unattainable dream for decades. “The government’s objectives are to reduce mortality and morbidity, increase safety, and improve patient experience and outcomes for all.” Who would argue with that?

There’s a whole new public health initiative, handing responsibility to local authorities. There’s even talk of "health and wellbeing boards" and employee-led organisations. Good stuff all round.

We’ll get more choice over where we go and who we get to treat us. We as patients will share the decisions on the care we get with clinicians. We’ll be able to share our records with who we like. Fantastic. And good riddance to the suffocating layers of target-driven management built up during 11 years of New Labour and the overpaid hordes of management consultants.

So where is the downside? The market is back with a wholehearted bang. Whilst the majority of NHS funds will be in the hands of consortia of GPs, they will be buying services from Foundation Trusts and any other “willing providers” including those in the private and voluntary sectors.

Companies like Assura Medical, Tribal, Bupa and even the commercial wing of Imperial College can already be heard rubbing their hands together in anticipation of the spoils. Foundation trusts have had their private income capped to date, but this is to be lifted. They have already said they will compete with private firms for patients and launch joint ventures with companies. University College Hospital in London has already gone down this route with a private US health firm which has located a private unit on its site for cancer treatment.

Monitor, the regulator for NHS Foundation Trusts will promote and enforce competition in the market. Its powers, so far only outlined, are nevertheless awesome. The White Paper says that Monitor will have powers to “help open the NHS social market up to competition”.

Competition, then, is the termite infestation that will eat away at the heart of the NHS. Experiments with introducing private provision of services into the NHS have been underway for many years, so far with little success.

The National Health Service is the strongest possible concrete evidence of the altruistic, collective, needs-satisfying potential of the human race once freed from the absurdities of social relationships based around property ownership, and activities motivated by profit.

It has established, in practice, the universal right of access to healthcare free at the point of delivery based on clinical need, not the ability to pay. It is provided by a network of public sector organisations employing close to 1.5 million people.

Aside from the need to earn a living, the majority of the nurses, doctors, paramedics, scientists and technicians, estate maintenance and administrative staff, cooks and cleaners, and, yes, even managers are motivated by the health needs of people they care for, twenty four hours a day, seven days a week.

By any measure it is a stunning achievement. Despite its many faults it has become a model for the rest of the world. That it exists is a source of astonishment and envy. The response to the White Paper surely has to be to fight for the extension of the principles and practises of socialised, not-for-profit health care to the rest of the economy.

Gerry Gold
Economics editor
14 July 2010

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