Remember the General Election that never was? Just before Gordon Brown bottled it, he asked his mate Lord Ara Darzi to rush out an interim report on the future of the NHS.The report is entitled, ‘Our NHS, our future’. You might want to call it, ‘Their big business, our future’.
I read the report carefully last week, because I was attending Darzi’s ‘International Clinical Summit’ on behalf of Unite. This was quite an unreal event that I will report on properly in another posting. Darzi’s report, though, is a significant one, as it shows only too clearly the Government’s vision of the NHS.
Privatisation runs right through the proposals like the letters through a stick of rock. Darzi calls for a number of ‘immediate steps’. These will include making patient care ‘more personal’ by embedding choice ‘within the full spectrum of NHS funded care, going beyond elective surgery into new areas such as primary care and long term conditions’. I think this probably means that patients will be encouraged to get their leg ulcers dressed privately, or their diabetes or arthritis managed by the local big business provider. It’s hard to see how this will make health care more personal, but Darzi obviously knows something we don’t.
Darzi praises payment by results on the grounds that it’s ‘making it easier for money to follow the patient’. This, of course, has nothing to do with health care, but allows private sector providers to make money. Payment by results also creates a massive and unnecessary bureaucracy within the NHS, as hospitals now charge PCTs for every single procedure they carry out (and sometimes indulge in overcharging manoeuvres known as ‘gaming’). This is what happens when you turn the NHS into businesses that are forced to compete with one another in order to survive.
Darzi believes that ‘independent sector providers have also helped extend choice, add capacity and spur innovation’. The reality is that Independent Sector Treatment Centres have been feather-bedded by the Government, with guaranteed income whether they do the work or not; they have done little to expand capacity but have destabilised hospitals by stripping away routine work; there is evidence of worse patient outcomes; and ISTCs have cost up to six times as much as an NHS provider! This could perhaps be called innovative – but it certainly isn’t desirable.
There is also enthusiastic support here for the privatisation of commissioning. This is very, very sinister indeed. This is about removing accountability from the NHS to a shocking degree. Big business will plan health care, big business will purchase health care (with public money), and big business will sign the contracts either with their subsidiary companies or with companies with whom they’ve done partnership deals. This is all about handing over our NHS to private sector sharks. It has nothing to do with high quality patient care.
GPs are also under attack – a major theme of Darzi’s report, and of real significance. The Government has wanted for a long time to break the power of the family doctor service. Getting a doctor to do it for them is quite a clever plan.
Lord Darzi is very skilled at dressing up privatisation in progressive language. There’s stuff here that most health workers would agree with wholeheartedly – about integrated care, the safest possible health care, fair health care meeting the needs of a diverse population and so on. There is an obvious challenge, though. Ripping the NHS into tiny pieces, and handing out the profitable bits to the private sector, cannot conceivably be of benefit to patients.