Basu and Stuckler on the Privatisation of the NHS

Body Economic Pic

Earlier this week I put up a piece about The Body Economic: Why Austerity Kills, by the medical researchers David Stuckler and Sanjay Basu (New York: Basic Books 2013). The book shows, using examples of recessions from the Great Depression of the 20s and 30s, to contemporary Britain and Greece, and the massive privatisation of the Russian economy after the Fall of Communism, how recessions and the austerity programmes that Conservatives use to try and correct them, also cause health crises. Conversely, welfare states that support people, not only give their peoples good health, but also create prosperity.

The two authors are also very much aware that the British National Health Service is being privatised, and are very critical of this. They write

Today the NHS’s founding principles are being forgotten, as the conservative Tory government seeks to make the NHS more like the American profit-driven, market-based system. When the Tory government came to power, they revisited a pamphlet developed under the previous Tory government of John Major that called the NHS a “bureaucratic monster that cannot be tamed” and in need of “radical reform”. In 2004, Oliver Letwin, the pamphlet’s lead author, said the “NHS will not exist” within five years of a Tory election victory. Indeed, after the Tories came to power they proposed the Health and Social Care Act, which embodied the free-market principles of the radical pamphlet.

It was difficult for us to understand this decision. Overall in 2010, before the Tory government began dismantling the NHS, the UK spent less of its GDP on health (8 percent) than Germany (10.5 percent), France (11.2 percent) or the United States (19 percent). Ultimately, the Tories’ position was not based on evidence but ideology-the idea that markets, competition, and profits would always be better than government intervention.

A highly divisive public debate over the Health and Social Care Act ensued. Over staunch opposition from the Royal College of Nursing and almost all of the medical Royal Colleges (the UK equivalents of the American Medical Association), Parliament approved the Act in 2012. Thus began what many regard as a major move towards privatization of the NHS. Repeatedly, David Cameron promised the British public that the Act was not “privatising the NHS” and that he would “cut the deficit not the NHS.” The Liberal-Democratic leader Nick Clegg said, “There will be no privatisation.”

The Department of Health website even stated that “Health Ministers have said they will never privatise the NHS.” But the data tell a different story: increasingly, the government is transferring large swaths of healthcare provision to private contractors.

Private profiteers are replacing dedicated doctors. In October 2012, the government awarded 400 lucrative contracts for NHS services, worth a quarter billion pounds, in what was called “the biggest act of privatisation ever in the NHS.” Virgin, for example, won lucrative contracts to deliver reproductive care (no pun intended). But the result was not the efficiency of private enterprise, but what had already been seen in the US market model-profits at the expense of patients. One journalist found this to be the case at health clinics in Teesside, northeast England. After Virgin won contracts to take over the services, the clinic repeatedly missed targets for screening people for chlamydia. It was a simple task that the NHS fulfilled easily. The journalist found a memo that revealed “staff were asked to take home testing kits to use on friends and family to help make the numbers up.” In Oxford, patients complained about increasing wait times to see their doctors after Virgin took over a local practice. Virgin responded that the practice had been underperforming when it was taken over, and that “there are still improvements to be made but we’re pleased that progress so far was recognised and applauded by councillors.” And so began what continues to be a highly sophisticate public relations campaign.

The UK’s next step toward US-style market-based medicine is moving forward at the time of this writing. It encourages patients to spend out of their pockets for healthcare rather than use the government-funded NHS. The Tory government is extending pilot projects to offer those with chronic illnesses “personal budgets” so that they themselves can make choices about how to manage their care, with few safeguards against profit-seeking swindlers or predatory insurance companies despite a government evaluation that highlighted many problems with this approach.

Early evidence suggests the Health and Social Care Act may in fact be hazardous to the health of the citizens and residents of the United Kingdom. Just before the Coalition government came into power, the NHS had the highest patient approval ratings in its history, over 70 percent. Within two years, approval fell to 58 percent, the largest decline in three decades. There are already warning signs that the healthcare situation in Britain may come to resemble that in the US before Obama. Patients are being turned away from privately managed clinics, some of which simply close their doors after meeting a daily quota to fulfill their contractual obligations. And in the first year of reform, emergency room visits jumped to the highest in the decade- perhaps because more people are neglecting preventive care, like Diane. As the editor of the Lancet warned, “people will die.”

Whether the British people will fully accept this radical privatisation of their healthcare system remains unclear. But once market incentives take hold of a public system, it becomes difficult, if not impossible, to reverse course. In the UK, the recession-fueled combination of austerity-and-privatisation seems to be creeping into every dimension of the social protection system. But evidence of its harms should give us all pause. (pp. 105-7).

Part of the way the government is selling its privatisation of the NHS to the public is through artificial funding crises, in which hospitals develop massive budget deficits. They are then amalgamated with another hospital under a PFI scheme, or given over to a private healthcare company to manage. Points West, the local BBC news programme for the Bristol region, last night revealed that Southmead hospital was also in the red to the tune of £48 million. And I suspect a similar fate is being lined up for it here.

This privatisation must be stopped, and those who support it – the Conservatives, and the Blairites in New Labour, must be thrown out of office immediately. Only Jeremy Corbyn has said that he will reverse the NHS privatisation. It is up to us to support him, regardless of the smears from the media and the Right.

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2 Responses to “Basu and Stuckler on the Privatisation of the NHS”

  1. Jayne Gribbin Says:

    My partner was diagnosed with cancer over 2 years ago, but it took nearly 18 months before they found out what was wrong with him, he was going to his local doctors nearly weekly, but they wouldn’t send him to hospital for a scan, the doctors told him they didn’t have the authority (in other words they didn’t want to pay for one) he finally got that bad he went to A&E on a Friday night and by Sunday morning he was transferred to the specialist cancer treatment hospital, the doctors at that hospital told him that if he had left it another week, he would have been paralyzed from the waist down, as the cancer was round the base of his spine and in his kidney’s, he is now well on the way to a full recovery. This government makes me sick, they just don’t care about anything except lining the pockets of their Eaton buddies and of course there own as well.

    • beastrabban Says:

      I’m so sorry that your partner had to go through that, Jayne, but I’m glad they found the cancer just in time, and I’m very glad he’s on the road to recovery. Cases like that, where people’s lives are being endangered because of the government’s doctrinaire hatred of state healthcare, make me heartily sick as well. And I absolutely agree with you, that they don’t care about anything except making more money for themselves and their equally wealthy and well-connected friends.

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