Tuesday, 13 July 2010

Dismembering the NHS

On the surface, the government’s planned NHS reforms sound like a positive step forward. Greater freedom for staff on the front line to be involved in decision-making – good idea. A patient-orientated NHS – great. Getting rid of unnecessary bureaucracy – excellent. All of these things would, on paper, make for a streamlined, well-targeted NHS. However, in practice what this will actually mean is our old friend privatisation creeping in through the back door. It’s important to note that Labour opened the door and invited privatisation into the NHS to start with through PFI, but it is the Tories who will set the table, make its bed and give it the key to the safe.

The best way to understand the true nature of these measures is through the eyes of a party which has pledged to ‘ring-fence’ the NHS but is ideologically driven to privatise as many public services as possible. It would be indefensible for any government, ring-fence pledge or not, to come to power and simply say “We’ve had quite enough of this free healthcare malarkey so we’re selling it off to the private sector. Anyone who has a problem with that can go fuck themselves.” Unable to do this (and I think we can be certain that many Tories would very much like to) the only option is that of privatisation through covert means. Using the “cloak of GP commissioning,” as Jeremy Corbyn puts it, the Tories plan to put 80% of the NHS budget under the control of multiple ‘consortia’ of GPs. This move, the government would have us believe, will give local practitioners more say over what treatments and equipment are required in their areas by giving them control of service commissioning and remove the restrictive grip of centralised government. What they actually want is well demonstrated by an extract from a summary of the key changes on the BBC News website: “Hospitals - Encouraged to move outside the NHS to become "vibrant" industry of social enterprises.” Combined with ministers stating that it shouldn’t matter which sector service providers come from – public, private or voluntary – and the emphasis on ‘choice’, the message here is clear: the government want more competition in the NHS.

As stated above, Labour brought elements of this privatisation in with their own policies which arguably led to the squandering of much of their record investment in healthcare on private companies’ middleman and consultancy services when pumping the money directly into actual, state-run services would have been far more effective. This has led to a narrowing of the debate on the desired direction of the NHS. Now the choice seems to be “Do you want a little bit of private involvement or a lot?” No major party seems to be suggesting that an entirely state-run NHS with public health at its heart would be the way forward – all debates seem to revolve around ‘patient choice’ and who is in charge of commissioning.

The danger here, and arguably the Con-Dem intention, is that these local GP consortia will preside over the coming ‘austerity’ measures and be forced to make the ‘tough decisions’ the government loves reminding us are necessary, meaning that the blame if anything goes wrong will be laid squarely at the door of local mismanagement rather than flawed centralised policy. Another effect of these measures will be to force these groups of GPs to commission the cheapest possible service providers who will ostensibly come from the private sector and be of a far lower quality (see the multiple problems hospitals have had with cleaning companies over the years) and the privatisation of one of our most important public services will seem to have been a logical, decentralised decision. But what are we worried about, anyway? This approach worked really well with the railways, didn’t it?

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