The new Tory-Lib Dem coalition in the UK is planning to privatise the national health service in defiance of the evidence. But Labour is hamstrung by its record, observes Seumas Milne of the Guardian.
When it comes to spin and honeyed words, the Cameron-Clegg show is already putting Tony Blair and Peter Mandelson in the shade. However extreme or cockeyed the policy, from savage benefit cuts for the poorest to the chaotic scrapping of school building projects, a gentle gloss or a winning apology from a coalition frontman and critics go weak at the knees. But this time they have outdone themselves.
Under the banner of Liberating the NHS, the health secretary Andrew Lansley this week unveiled a programme of dramatic change, promising to free the English health service from bureaucracy, put family doctors in the driving seat and hand power to patients. What could be more appealing to a workforce and users fed up with bureaucratic directives and corporate managerialism?
In reality, Lansley’s health white paper opens the door to the comprehensive privatisation of healthcare and the end of the NHS as a national service. If the plans are taken to their logical conclusion, by 2015 the NHS will be little more than a brand. From a major public service with a million employees, it will have become a central fund with a minimal workforce, commissioning services from a string of private companies in a fully-fledged healthcare market.
“The bottom line of this is the abolition of the NHS,” Dr David Price of Edinburgh University argues. “It will remove the government’s duty to provide a universal healthcare service.” His colleague, Professor Allyson Pollock, believes it will lead to “full privatisation”. Andy Burnham, who did Lansley’s job until May, calls it the “dismantling of all public accountability and national standards in the NHS”.
The scale of what is being proposed has yet to sink in. By handing control of the bulk of NHS funds to England’s 35,000 GPs to buy healthcare, the government hopes to divide the medical profession – who have mostly opposed privatisation – and appeal to patients, who feel more at home with local doctors than health trust bureaucracies.
But self-employed GPs will be forced to form consortiums, which are then expected to be run by the private firms that chafed at the last government’s slowness in opening up the “commissioning market” to unconstrained profit-making. No wonder Kingsley Manning of the health firm Tribal is looking forward to the “denationalisation of healthcare services in England”.
Meanwhile, all hospital trusts are to be turned into freestanding businesses outside the NHS. They will be allowed to go bust or taken over, encouraged to form “partnerships” with profit-making private companies and obliged to remove all limits on private provison. These new, independent trusts are supposed to be not-for-profit “social enterprises”, but health policy experts scoff at the distinction when profits can be distributed as “surpluses” or extravagant salaries to directors.
Why should anyone worry who provides healthcare? Because the weight of evidence is that private markets in health bring exorbitant administrative costs, lead to cherrypicking of more profitable patients, increase inequity and the postcode lottery gap, generate conflicts of interest, are unaccountable, and increase pressure for top-up payments and “care package” limits.
The scandalous costs of creeping privatisation are already clear enough, from PFI projects to independent treatment centres. This year the Commons health select committee found administration costs had risen from 6% to 14% by 2005 as a result. They’re certainly higher now – and are double that in the US, by some estimates. But now the coalition wants to put the NHS in the hands of the very health corporations that fought Barack Obama to a standstill over his attempt to bring universal health coverage to the US.
No wonder the government is already ditching patient rights over GP and hospital appointments, and David Cameron was dithering yesterday about whether to maintain the right for cancer patients to see a specialist within a fortnight. The prime minister also struggled to explain why this upheaval in the NHS would avoid the increased costs that has attended every other reform.
No doubt he hopes to slash pay for NHS staff who end up being employed by the new foundation trusts or private companies. But the whole plan reeks of a triumph of ideology over common sense and public opinion. Only two months ago, the coalition parties solemnly pledged no more “top-down reorganisations of the NHS”, and elections to primary care trusts. Both promises have been scrapped (the trusts will be abolished), while the Lib Dems have been given the sop of local government control of public health, about to be engulfed in spending cuts.
But of course this isn’t just about the Conservatives and the Lib Dems. New Labour laid the ground for everything the coalition is planning to do to the NHS – as with privately controlled academy schools and its abortive attempt to privatise Royal Mail. The market structures, foundation trusts, even the insertion of US corporations into commissioning and GP consortiums were all products of the Blairite version of “public service reform”.
In fact, Lansley’s scheme to dismantle the health service is what Tony Blair himself yearned to do, if only he hadn’t faced the “block on reform” next door. As Mandelson spells out in his memoirs, it was Gordon Brown’s foot-dragging on foundation hospitals and tuition fees that gave Blair the excuse to renege on his promise to resign before the 2005 election. But privatisation continued under Brown’s premiership, if at a slower pace.
The result is that Labour opposition to the assault on the NHS is hamstrung by its own record. With the exception of Diane Abbott, none of the candidates in the leadership election has yet come out for an alternative to privatisation – even though both Wales and Scotland have successfully turned their backs on it. David Miliband lauds Blair’s reforms, while in the battle for Labour’s London mayoral nomination, Oona King has as good as defended postal privatisation.
That will have to change if the dismemberment of Britain’s most important social institution, backed by a corporate lobby that has its claws in public life, is to be prevented. It will need many others, of course, including Lib Dems, doctors and other health professionals, trade unionists and patients groups – even Tories. But it’s a fight we all depend on.