Last week saw the publication of the Government’s latest plans for the NHS. There is an enormous pile of documentation for campaigners to get our heads round. Darzi – or whoever writes this nonsense for him – is a past master at generating fine sounding rhetoric designed to conceal privatisation and worse patient care.
A good starting point in understanding the latest attacks is the following introduction from Allyson Pollock (from the Guardian, on 1st July). Pollock is the UK’s leading researcher into NHS policy, and an acknowledged expert in this field.
Lord Darzi, the unelected health minister, has signalled that Labour will continue to dismantle and privatise the NHS delivery system, its staff and services – handing taxpayers’ funds to multinational companies, and remodelling the service along the lines of US healthcare.
It is all a far cry from their 1997 manifesto pledge: “Our fundamental purpose is simple but hugely important: to restore the NHS as a public service working cooperatively for patients not a commercial business driven by competition.”
Markets introduce new costs that do not occur in integrated public
services: billing, invoicing, marketing and profits. All these divert resources and funds away from the service, creating enormous inefficiency.
So what is the government up to?
Darzi provides the clearest sign yet that Labour is planning to introduce charges for healthcare, crossing the final rubicon of NHS privatisation – its funding base.
The commercial sector, unlike NHS public services, has market freedoms that the public sector does not – the freedom to levy charges and restrict care, and to downgrade or deregulate staff terms and conditions. The commercial sector’s first duty is to shareholders and risks must be managed either by reducing staff wages and terms, cherrypicking profitable patients and treatments, or by ensuring that it is not faced with the enormous costs of unpredictable care.
Co-payments and top-up insurance were alien terms a decade ago: they are direct imports from the US healthcare industry. Today they trip off ministers’ tongues. Contrast this with the NHS Plan 2000, which stated that “user charges are unfair and inequitable in they increase the proportion of funding from the unhealthy, old and poor compared with the healthy, young and wealthy.”
In theory, government cannot prevent the private sector from selling health insurance and top up services. In practice, the new providers of healthcare have seen the political unacceptability of introducing charges too early, although the boundaries between what is public and what is private are blurred.
So the Darzi report, instead of renouncing charges, paves the way for them. First, it trails the idea of a NHS constitution which will set out rights for care. In doing so it introduces the notion that there will no longer be NHS open-ended care according to need, following in the footsteps of NHS dentistry and long term care. The constitution reflects the current attempt to redefine NHS care into a basic minimum package. For example, in the newly privatised general practice agreements, the government has fragmented previously integrated services into core, additional and enhanced services. It has ended the open ended duty of care, and introduced the notion of time limits and defined entitlement.
How long before the government allows the commercial sector to define a basic package of NHS care, beyond which everything else is paid for and charged for through top ups and co-payments? That, after all, is the American way.
The report also proposes introducing personal budgets. There is no logic to these because individual budgets pass risk down to the patient. But the idea, of a sort of portable voucher system, is a Republican one: patients can get so much care and top up and carry the risks.
Darzi does not renounce charges: “We will ensure that the programme fully supports the principles of the NHS as a comprehensive service, free at the point of use,” he says. But this contrasts with the 1977 NHS Act, which says “services so provided shall be free of charge except in so far as the making and recovery of charges is expressly provided for by or under any enactment, whenever passed.”
Labour has crossed its final Rubicon. The NHS Plan 2000 allowed the break-up and commercialisation of NHS services because the government claimed it didn’t matter how services were delivered so long as they were publicly funded. Now tax-based funding is to be undermined, and that means an end to universal coverage.
Universal coverage is not discussed by Darzi, and nor is equitable redistribution on the basis of need. Instead most of his report is dedicated to quality. This is the American way. The US jusitifies the denial of care to 50 million of its people by focusing attention on quality of providers, not access or response to need.
The problem for the government is that no country has a for-profit sector delivering universal healthcare, and it has no evidence to support the policy of a market in healthcare. The Darzi report is simply a glib advertising campaign on behalf of the healthcare industry and a new generation of greedy healthcare entrepreneurs. What of the losers? The hidden hand of the market renders invisible the old, the poor, the chronically sick and the long-term disabled. But as the winners see their FTSE100 stocks rise, the English will know what it is not to have freedom from fear.