Nick Clegg recently accused Shadow Health Secretary Andy Burnham of being responsible for the first UK hospital privatisation during the last government, in a reference to Hinchingbrooke Hospital. Burnham quickly retaliated by declaring Clegg to be distorting the truth, with a comment that would have clearly hurt the Labour message. The NHS is to Labour what the economy is to the Tories, or what immigration is to UKIP – or so they claim. Labour is unashamedly running their General Election Campaign on the premise that it is only in their hands that the NHS is safe. But is it?
The truth is, the NHS fell into the dangers of privatisation a long time ago, and nearly everyone, bar the Greens, seem content on leaving it there. In fact, both Labour and the Tories have seemingly given their own privatising kick to the NHS whenever the opportunity presented itself.
Today health has become one of the most significant fields of political economy. In a capitalist economy this means commercial forces seeking to make it into a field of profit, and replacing the philosophy of public service, with a structure serving the market economy. But how does the UK’s most important public service, the NHS, deteriorate into a private market?
As with any establishment, the easiest way to weaken it is from within. With the NHS this was first achieved with the introduction of an internal market within the service. This consisted of breaking it up into separate little parts that have to act like individual companies. Rather than cooperating to meet patient needs, UK health services now need to buy and sell services from one another using a complex system consisting of internal contracts and fees. With this move the public service ethos of the NHS starts to be replaced with a market model where ‘competition’ is key.
In the early 1980s successive governments began to reintroduce most of the features of industrial commodity production and competitive distribution. The internal market was first openly called for by Margaret Thatcher in 1988, and was firmly put into place by the NHS and Community Care Act of 1990. In 1997 Labour pledged to scrap the internal market altogether, but managed to extend it even further than the previous conservative administrations. This left an NHS fragmented into little bits, with all of those bits following a private model whilst being publically funded and publically run.
After this considerable weakening of the health service, it is a lot easier to ease private companies into the system, and roll out an outsourcing scheme throughout the service. This was achieved in the UK by replacing some of these publically funded publically run bits, with publically funded bits that are privately run. This exact type of outsourcing was introduced by the Tories in the 1990s, only to be extended by New Labour in 2006. So when Labour speak of the Tories’ ‘privatisation through the back door’, it’s simply not the case, it’s right through the front door for which Labour laid the welcome mat down.
The New Labour legacy was a roll-out of a policy called Any Qualified Provider, which was eventually made into law by the current Con-Lib government in the Health and Social Care Act 2012 – you’d think they were all in it together? The government came up with an ingenious plan never to explain this step, by accrediting it all to Andrew Lansley, with numerous government ministers appearing to claim that no one else in government understands the ‘Lansley Reforms’ as they are far too complicated. However, what is clear from this act, is that now almost all services have to be put out to tender, and can be bought by private firms. So look out for a McDonald’s health care hospital with an NHS label stuck on it, coming to a town near you. (Lansley famously included representation from companies like McDonald’s, Mars and KFC for consideration for public health-related bills during his time as Secretary of State for Health.)
At this point the private sector has been allowed to comfortably establish itself within the very structure of the NHS. But these companies want profit. So, to allow the public to get used to the transition, they initially start charging for some of the services that are deemed to be ‘non-essential’. At present the UK health service charges those in work for prescriptions, opticians and dentists. Direct patient charges, or ‘co-payments’, were introduced for the first time in 1952, just four years after the service began, starting small but ending very big indeed for some services, most notably for dentistry. As the privatisation of the NHS deepens, we can expect more of these charges to creep in, maybe for things like x-rays and ambulances, as is the case in other countries. This further decays the public service ethos of the NHS, ensuring that less and less is available for free. After a while only very basic care will be available for free, resulting in a two-tier system; where people who can afford to pay get treated promptly in the private sector, while those who can’t or have complicated needs have to join a long waiting list to use the few remaining public health services.
Once the NHS has reached this rather desperate state, the next step is to try to deny and withdraw free services entirely, starting with groups that are perhaps deemed politically unpopular. There has been a recent push in the UK to start charging foreign nationals for NHS care, this could extend to immigrants as a whole – immigrants often being the easiest people to pick on, despite the fact that the NHS would cease to exist without them.
Withdrawing free care from one section of society paves the way for going further. For example the next step could be to follow in Canada’s footsteps and make it difficult for unemployed people to get free health care, on the basis that they’re not paying for it through tax. Such a move would greater reinforce the idea that health care is no longer a public good, or a fundamental right that we provide collectively for our whole society. Health care would have become an economic commodity; something you buy for yourself paying tax and national security, and if anybody is unable to pay their way then they are undeserving.
The final piece of the puzzle is to scrap free health care altogether. After consecutive funding cuts to the heath budget, there would be so little heath service left, that removing the service would be deemed the most rational and economical option. The very last free health services would now be forced to sell off and surrender to private domination. This would mark the end of the NHS, the UK’s most treasured establishment, thus returning the country to the pre-war system of the 1940s, a time when those that couldn’t afford access to health care were denied it.
Currently all political parties think the answer to ‘fixing’ the NHS is to throw money at it and hope for the best. And although it is certainly true that the NHS is short of resources, the solution is not simply money alone. Regaining the founding principles of equality of service should be the priority if we truly support a view of a world in which universal access to healthcare is a fundamental right. For this to be realized the NHS must be renationalized, and put back into the hands of those it was created to serve.
Oh, and as for the Clegg vs Burnham debate, on this occasion I guess I have to say, I agree with Nick.
Panitch, Leo, and Leys, Collin, Morbid Symptoms: Health Under Capitalism, (London: The Merlin Press, 2009) http://books.google.ca/books/about/Morbid_Symptoms.html?id=wCOWPgAACAAJ
Player, Steward, and Leys, Colin, The Plot Against the NHS, (London: The Merlin Press, 2011), http://www.amazon.co.uk/The-Plot-Against-Stewart-Player/dp/0850366798
T. Hart , Julian, The Political Economy of Health Care: Where the NHS Came from and Where it Could lead, (Bristol: The Policy Press, 2010), https://books.google.ca/books?id=h5_6-NeAqcsC&pg=PA196&dq=morbid+symptoms:+health+under+capitalism&hl=en&sa=X&ei=lm6MVO_wJYS17gbfv4CoDA&ved=0CCAQ6AEwAQ#v=onepage&q=morbid%20symptoms%3A%20health%20under%20capitalism&f=false