One of my fellow chicken-breeders travelled to London yesterday. Jack was determined to take part in the sit-down protest against the so-called NHS reforms bill and reports today that Westminster Bridge was closed for over an hour in both directions. Thousands took part and there was a heavy police presence. The protest drew support from right across the country.
Janet Bennet, a pensioner from Liverpool was there and said; “The NHS is important to poeple and we need to stand up and protect it from this creeping privatisation”. Susan Secher, a human resources manager from London said; “Our greatest fear is that the NHS will end up as an insurance-based, two or three-tier service”. Margaret Greenwood, a therapy radiographer from London, said; “In two or three year’s time we may not have a recognisable NHS. It represents wholesale privatisation”. Our very own Jack Pilling said; We have to stand up and be counted on this. Lansley will destroy the NHS”.
The protest organisation ’38 Degrees’ organised a simultaneous flood of emails to members of the House of Lords who receive the bill this week. Lansley is offering further amendments, in fact the bill now scarcely resembles the one that he originally launched. But its central theme remains – the introduction of the private sector.
Whilst no one is opposing the idea of GPs having a greater role in the task of commissioning, it is the place of competition in the bill that is causing the biggest furore to greet any proposal since the poll tax. Of course competition is a good thing in many fields. If we don’t like the Tesco offers we can go down the road to Asda, and so on. But when applied to essential services the concept fails utterly.
The proposed model is very similar to the one that sold off the utilities. Does anyone seriously believe that water services have been enhanced by being in the hands of private companies? Or electricity, gas etc? What competition does in social areas is to create mega, monopoly suppliers. Where it has so far been introduced in health and social care fields it has created faceless, unaccountable, remote companies such as Southern Cross. When its minions fail to deliver proper care who picks up the bill? In their case the revelations of mistreatment exposed by Panorama forced the government to take over.
Throughout this saga Lansley has regularly cited the American example. What he hasn’t mentioned is that whilst NHS management costs run at not much more than 3%, those in the USA account for nearly 20%. Private health and health insurance generate enormous transaction costs. It’s an expensive business processing billing for healthcare, challenging what you are getting for money, litigating for wound infections etc – and paying clever underwriters to squirm out of paying patients or hospitals.
The very nature of private healthcare systems generating choice requires surplus capacity – empty beds – so that patients can exercise that choice. It requires the seperation of elective treatment from emergency. It requires more investment up front to serve the fewer patients better. It requires a two-tier service with a lower-cost administration for the second, and larger, tier. It requires higher standards for tier one, and lower standards for the rest.
All that apart the introduction of competition entails a massively expensive tendering system. The scope for legal challenges will be enormous, and who provides the services not bid for such as accident and emergency which defies any cost analysis leading to ‘prices’? And then there is the vast cost of the proposed “market testing” of every tender. This will involve specifications, extra staff to set budgets and even more to measure quality. And how does the commitment to public consultation on every change, and reviews of service access materialise?
At the heart of all this is the mistaken belief that you can take away from hospitals work that is attractive to the private sector and its shareholders. Yes, it can be done but the result will be wholesale hospital closures and an ever growing tendency for those with deep pockets or expensive insurance to go to private hospitals for all elective treatment.
This is not an argument about ideology. It is about practicalities. Partial privatisation simply will not work alongside the commitment to provide healthcare of equal quality to all. But Lansley continues to argue that it will. Since his track record for judgement is broadly similar to that of Liam Fox we believe him at our peril!
Which reminds us of the appalling record of both this and Blair’s government in regard to probity. How long will it be before the press exposes links between ministers and selected private giants?
The new bill is a bridge too far. If it proceeds it will be the biggest step-backwards in our recent history!