Government Policy and the NHS: Remarks on Possible Privatisation

Okay, it’s been a long time since I wrote anything on this blog. Some of that is because I had other things that required my attention, and some of it was because I got sick and tired of arguing with some of the commenters. Now that I’ve sorted some of the other stuff out, hopefully I can get back to blogging.

This is going to be a purely secular post. In th epast I’ve avoided puttin gpolitics into the blog because I saw its purpose purely as defending Christianity. Jesus states in John’s Gospel that ‘My kingdom is not of this world’, and the question of salvation and belief in the Risen Christ should unite Christians of all political beliefs and none, as well as the Lord’s call to care for the poor. Those on the Left have traditionally believed that this is best done through collective action by institutions such as the state. Those on the political Right, by contrast, believe that this is best achieved through private charity and individual self-reliance. A survey made a few years ago noted that politically Conservative American Christians gave more to charity than secular Liberals. Of course, there are many people, including Christians, who support both approaches and are personally generous as well as supporting various state institutions that are intended to combat poverty, such as the British welfare state.

Most people in Britain support the NHS. It’s done a magnificent job of combating disease and preserving the nation’s health in Britain since its foundation in 1948. The Government reforms introduced today, including provision to open it up to greater private competition may threaten its continued existence and efficiency. Many see it as privatisation by the back door. I thought I’d therefore try and remind poeple what Britain was like before the NHS was set up. Some descriptions of the quality of medical care for the working class and a discussion of the issues involved in private health care is contained in the social work text book, Mastering Social Welfare, by Pat Young (Basingstoke: MacMillan 1989). Young nottes that prior to the NHS, there was some state provision of medical care. Services for pregnant woemn and children had been set up at the beginning of the 20th century. The Liberal goverment in 1911 introduced employment linked insurance to pay for the medical care of those in work. Under the Poor Law, local authorites also provided some infirmaries, hospitals and mental hospitals. Despite this, there was great variation in the quality of the care provided, and consirable social stigma attached to such state care. She illustrates this with the following quotations, taken from people in Sheffield:

‘(In) Attercliffe in Sheffield’s East End which housed the heavy industry of the Don Valley and the workforce which operated it – bronchitis was a way of life. People expected to live with it, suffer from it and eventually die from it, with only their weekly bottle of medicine for relief’. (p. 257).

Young also includes the memories of two women, who recalled struggling to pay the bills:

‘Bills from general practitioners were always hard to meet … Kay remembered especially a doctor in the Crookesmore district of Sheffield who employed a debt collector … the effects were particularly severe for working class women, who due to a policy of not employing married women in Sheffield always tended to fall outside the insurance scheme. ‘Mother never had the doctor’. ‘You just didn’t go to the doctor until you were on your last legs’. Kay recallede how her own mother hadn’t gone to the doctor even though she was in bed with asthma. And Jessie likewise how her mother continued to suffer with high blood pressure, even though she knew that tablets were available which could have helped to lessen her condition’ (p. 257).

Young also includes the memories of a GP, Dr. Arnold Elliot, who practised before the NHS was set up.

‘I ran my practice from a small house in Ilford, but most surgeries were lock-up shops in industrial areas. On the whole, most of them were awful, with no running water, heat, lighting or toilets, some with no couches.

I knew one East End doctor who had a cigarette machine in his waiting room. Many doctors had two doors, one for ‘panel’ patients (the insured workers) and one for private patients, who weren’t kept waiting.

Doctors didn’t speak to each other, because they were deadly enemies. They went in for headhunting the bread-winning panel patient, who would often bring in the rest of his family.

Various private arrangements were set up for his dependants so-called ‘clubs’ – where they paid a small amount a week for a doctor and medicine. For the destitute, there were dispensaries, which engaged the service of a doctor for a small annual payment … Doctors used to dispense their own medicines too. The pharmaceutical firms came round and filled up the big ‘Winchester’ bottles every week. Many of the medicines were placebos; aspirin, for instance, which was available in a red or yellow mixture. You had to give the same colour to a patient every week, and sometimes there’d be trouble when you had a locum in and he gave out the wrong one. It sounds immoral, but that was trade.’ (p. 257-8).

YOung also includes the recollection of the qulaity of care by Sir George Godber, one of the founders of the NHS. He conducted a survey of the type of care available in 1942, and found it to be appallingly inadequate:

‘You must remember hospitals in those days were very different from today. An isolation hospital might only have five beds. Tehre was a hospital for scarlet fever in the Prime Minister’s (Margaret Thatcher) home town of Grantham that was housed in a wooden hut on the top of a hill without sewers or water – the water was delivered by cart once a week. The system in 1942 was incapable of delivering modern medicine. There were dilapidated buildings, insanitary conditions on the wards, inadequate space for radiology and laboratory services.

There were casual wards where tramps stayed overnight and even more depressing house wards where elderly residential patients waited to die in the most uncivilised conditions – the nights spent in narrow and dark dormitories of 20 to 30 beds and the daytime sitting on hard benches in a different room looking at their feet’. (p. 258). Some indication of the massive lack of hospital provision is given by the fact that the Hospital Building Plan of 1962 recommended that for every 100,000 to 200,000 people there should be a general hospital with 600 to 800 beds. A massive campaign of hospital construction shortly followed.

Although an initiative of the Labour party following the report of the Liberal Peer, Lord Beveridge, many Conservatives under Rab Butler also supported the creation the NHS. One of my mother’s friends was a staunch Conservative. Her ownly family was solidly Conservative and her husband was a Conservative local councillor. She recalled how her father had broken with family tradition to support the NHS’ foundation. He had been a pharmacist, and at a family meeting told them that very many of his customers were receiving their medicine on credit, because they simply could not afford to pay for it. He therefore stated that he was going to vote Labour on this occasion because the country needed the NHS.

Problems of Private Medical Care

Since Margaret Thatcher, the government has promoted increased private provision of medical care and the adoption of private medical insurance. There are severe problems with this policy, however. Firstly, as they are commercial organisations run for profit, they concentrate on low-risk subscribers to the exclusion of those who are high risk. They also tend not to provide a comprehensive service, but specialise on those illnesses, which only require a short stay in hospital and routine surgery. Pregnancy and childbirth are not covered, and cover is only limited to a sertain number of days in the year.

Another criticism is that under private health care, insurance companies shift the emphasis from the need for treatment to the ability to pay. By providing treatment to those who can pay, private insurance has reduced pressure on the government to solve the problem of waiting lists. One criticism of the existence of pay-beds in the NHS is that it encourages queue-jumping and again leads to concentration on those who can pay, rather than those who need it.

Private health care has also been subsidised by the state in a number of different ways. Private patients in NHS hospitals do not pay the full cost of the hospital’s maintenance, construction and staffing. Private medical staff have also been trained at the expense of the state. (This was in 1989, long before the introduction of tuition fees under New Labour and their increase under the present Conservative-Liberal coalition). The private sector also does not provide post-op0erative health, social services or home care. Private hospitals also generally do not have expensive equipment and use NHS facilities. Private medical insurance has also been subsidised by the state through the tax relief given to employers providing insurance for their staff.

It would also be impossible for all health care to be funded privately, with or without private insurance. America, for example, has a large publicly funded system – medicare and mecicaid – to treat the less prosperous and elderly. Furthermore, private health care also creates a two-tier system in which the better-off get better care. The greater provision of private medical services in Britain could produce a similar system over here.

There is also no evidence supporting the claim that hospitals are cheaper and more efficiently run privately. The lack of central control over hospitals in the US and the close relationship between the insurance companies and the medical profession has led to high charges and large profits for both of them. Private medical treatment in America involves long and costly administrative procedures. Young’s assessment of private medical care in America inicludes the quotation that in America ‘admittance to hospital for aminor disorder involves an orgy of form-filling and medical insurance checking which makes filling in a car accident claim look simple.’ (p. 268).

Young notes that the benefits from private insurance are argued to be a reduction in NHS expenditure and the taxation that supports it. Those who can pay have freedom of choice and the option of paying for extra services. She therefore concludes that ‘it would seem that there are advantages to some individuals in allowing a private sector to coexist iwth the NHS. However, the existence of such provision constitutes a serious threat to the future of the service set up to guarantee access to high-quality medical care regardless of ability to pay’. (p. 268).

Young wrote this in 1989, and since then much has changed. I do know a number of people who have benefited from private treatment. Much of her criticism appears still valid, and and in certain respects the situation has become worse. Twenty years ago when Bill Clinto was in power, one of the British broadsheets estimated that a tenth of American citizens could not afford medical insurance. A BBC report in February 2013 on BBC 1 noted that the figure was now 1 in 8. One of the major issues in American politics under George ‘Dubya’ Buch’s administration was the increasingly high cost of medical insurance.

A friend of mine also studied medicine at university. According to him, many American hospitals are already secretly kept afloat through state support. Under American law, hospitals have to provide emergency room services regardless of the patient’s ability to pay. As a result, some hospitals find it difficult to remain solvent and require payment from the local authorities to remain in business.

It’s because of these considerations that I consider the government’s proposed reforms to the NHS to be wrong and damaging, both to the institution they claim to wish to reform and the country as a whole, and I strongly believe that they should be opposed.

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