On 5th July 1948, the day the NHS was launched, Nye Bevan made a speech in Preston. The Socialist Health Association has a fascinating collection of Bevan’s speeches. Reading them is a valuable reminder of the savagery of current attacks on the NHS.
Bevan, at the birth of the NHS, mentioned drug treatments in passing. He was fiercely critical of the notion that patients should have to pay for drugs or any other part of their care. The press report at the time said, ‘Mr. Bevan had a sharp reproof for general practitioners, who told applicants they were prepared to keep them as paying but not public patients. This was a “wicked thing”. There was no limit to the cost or quality of drugs which might be prescribed‘ (my emphasis).
What a contrast to 2008, where we now see the introduction of top up fees in the NHS. The review on ‘top-up fees’ has ruled in favour of patients paying privately for drugs that are unavailable on the NHS – no great surprises there, but the consequences will be vile.
The option selected by Professor Mike Richards, the author of the report, is ‘separate care’. Patients will be entitled to receive NHS treatment and to pay for private care in another setting – a private hospital, or a private facility within an NHS hospital.
This is fantastically dangerous. In 1948, a fundamental principle behind the NHS was that the NHS would pay for all the care that patients need. That principle has been central to the NHS for most of the last 60 years. Quite rightly, there has been outrage when we hear of patients denied the treatment they need.
Suddenly, the argument has shifted. Suddenly, it’s common sense that the NHS can’t afford to meet everybody’s needs. Suddenly, the priority is that we defend the right of patients to go private – as an alternative to defending their right to publicly funded healthcare.
Richards acknowledges the arguments ‘for’ and ‘against’ his preferred option.
In favour, we have ‘Patients will have the choice to buy additional private drugs from the private sector’.
Against, there is the rather important point, ‘Many patients will be unable to afford additional private treatment’.
So what are we left with? The intention is to establish a new norm where the NHS provides whatever level of care is deemed ‘cost effective’ – subject to Richard’s comments that ‘there is a general recognition that there is a limit to the level of services that the NHS can deliver and that this will inevitably lead to difficult decisions having to be made about the availability of treatments’.
Clinical care is therefore determined immediately and directly by ability to pay. There is nothing positive or progressive about this at all.
The last time I wrote on this, I quoted from Bevan’s ‘In Place of Fear’. The quote bears repetition: ‘The collective principle asserts that… no society can legitimately call itself civilized if a sick person is denied medical aid because of lack of means’.
What a tragedy that New Labour has forgotten this. One of our priorities going forward must be not just to fight the overt privatisation of the NHS – but also to fight hard for a genuinely comprehensive NHS, where care is not based on ability to pay.