This week, I actually had to look up the term ‘Liberal’ and ‘Democrat’ again in the dictionary. The Party may be advocating free trade, but they certainly are going against individual liberties and social political reforms with the introduction of the NHS reform bill. The Health and Social Care Bill is making its way through parliamentary legislation, as Labour failed this week in derailing the coalition’s final plans to privatise Britain’s healthcare system.
It’s important to understand the journey that the National Health Service has taken since its inception on July 5th 1948, in order to truly grapple with post-war British mentality. The ethos and the pattern of the NHS had much in common with the newly-nationalised state industries, railways, steel and the utilities after the Second World War.
Former Labour politician, Aneurin Bevan had created a command structure for the NHS, a ‘welfare state’ ideology and the idea that the system would be heavily dominated by those providing the services. Mr Bevan written in “In Place of Fear” (1952): “The collective principle asserts that [...] no society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means.”
According to Medicine and the Community published in the British Medical Journal, author Sir George Godber said that what the NHS had done for society was change the way in which people could obtain and pay for care. They ceased to pay for medical attention when they needed it, and paid instead, as taxpayers, collectively. The NHS improved accessibility and distributed what there was more fairly. It made rational development possible, for the hierarchical system of command and control enabled the examination of issues such as equity.
The Times pointed out that the ‘masses had joined the middle classes.’ Doctors had become social servants in a much fuller sense. It was now difficult for them to stand aside from their patients’ social difficulties or to work in isolation from the social services. The Ministry of Health, having worked for the establishment of the NHS, now became passive.
The original structure of the NHS in England and Wales had three aspects, known as the tripartite system consisted of hospital services, primary care including general practitioners and community services run by local authorities. The service was an extension of the centralised state-run ‘Emergency Medical Service’ (EMS).
The government had grasped the reality of the situation: thousands of people ailing from conflict meant that half of Britain’s workforce was out of commission, and in turn the economy had no labour force to continue growth in the country. Before the nationalised health system, patients were generally required to pay for their health care.
So what does the Health and Social Care Bill 2010 – 2012 entail for UK citizens now? Well, for a start, groups of local GPs and other clinicians will plan and buy most of the health care for the people in their area, known as ‘commissioning.’ It will be Clinical commissioning groups (CCGs) that will be in charge of budgets for their area.
The new arrangements will be very different and mean that GP groups are in charge. And strategic health authorities will be abolished by April 2013 and primary care trusts (PCTs) will formally hand over their commissioning responsibilities to GPs by April 2013. All NHS hospital trusts will become foundation trusts, in which NHS hospitals that are run as independent, public benefit corporations, and controlled locally.
Essentially, the government’s move will lead to the abolition of all 10 strategic health authorities and the 152 management bodies/ primary care trusts. The new structure will be held accountable by an independent NHS board which would be free from political interference, the government said. Meanwhile, responsibility for public health will be passed to local authorities. Hospitals are to be moved out of the NHS to create a “vibrant” industry of social enterprises under the proposals.
And that’s the key issue. The repercussions of changing healthcare into another ‘industry,’ is that the NHS will no longer be a national service, but a local business, with the quality of care being at jeopardy as it runs as another entrepreneurial venture. The ‘welfare state’ ideology has been demolished into a capitalist dream and the only welfare considered will be private patients with insurance companies lining their pockets.
It reminded me of a moment in Michael Moore’s acclaimed 2007 documentary ‘SiCKO,’ based on the American healthcare system. The film compares the for-profit, non-universal US system with the non-profit universal health care systems of Canada, the United Kingdom, France and Cuba. Mr Moore entered a UK hospital and was astonished to find that patients had no-out-of-pocket expenses. While according to the film, fifty million Americans are uninsured and the remainder, who are covered, are often victims of insurance company fraud. And it seems like the UK are heading in the same direction.
Yesterday, an emergency debate was held at the House of Lords which showed the Liberal Democrats ousting individual freedom for free market economics. Shadow Health Secretary Andrew Burnham said that one of the “best health services in the world” and the “Labour party’s finest achievement” was being dismantled. He opened a debate over whether the Government should publish the Risk Register, an internal document on the risks associated with the health reforms.
Mr Burnham argued for transparency in the system, a key factor to a nationalised public service. However, political stealth officially made its way into parliament, as the Commons voted 328 to 246, majority 82, against Labour’s attempt to derail the Health and Social Care Bill. But then it won’t really be a state-run ‘public’ service anymore, (which the Liberal Democrats fail to admit) and so no one will be held accountable for the imminent crash.
Colin Leys, an honorary professor at Goldsmiths University of London and author of ‘The Plot Against the NHS’ wrote an article last September, highlighting ‘the end of the NHS as we know it.’ Mr Leys reiterated that the cost of market-based healthcare was more expensive to implement, than the current system. He said:
“From making and monitoring multiple and complex contracts, to advertising, billing, auditing, legal disputes, multimillion pound executive salaries, dividends and fraud – [it] will soon consume 20% or more of the health budget, as they do in the US.”
And now the only difference between the US system and the coalition government’s reforms is that they continue to work under the guise of a social democracy. But the government are heading towards an epic collapse, verging on Tony Blair’s ‘Iraq,’ and it’s unlikely they will ever recover.