No one has noticed that the health and social care bill is dismantling the NHS
Allyson Pollock and
Thursday April 26, 2001
The government is preaching "modernisation" of the health service. But New Labour's first term looks set to end with a law which could dismantle the NHS and take the UK down the US route of healthcare.
The health and social care bill, on its final stages in the Lords, will transfer to the private sector the ownership and entitlements in our NHS enjoyed by citizens for 50 years. In the new NHS, large corporations - at the expense of the taxpayer and of patients - will provide healthcare for profit in a commercial marketplace.
This appears to have gone unnoticed. There has been huge controversy over the proposed abolition of community health councils. There has also been fierce debate about a clause relating to the publication and use of patient information. But there has been almost no discussion of the ironically numbered clause 4. This clause will allow commercial companies, supported and underwritten by the government, to provide healthcare to the NHS for profit.
Ministers emphasise that their immediate purpose is to set up companies that will secure private sector investment in GPs' surgeries in run down inner-city areas. What, other than large financial incentives from the government, would induce commercial organisations to invest in such unlikely sources of profit?
Ministers refused to accept amendments that would ensure clinical services continued to be provided by the NHS. So these private companies will also be able to employ doctors and nurses to provide healthcare that the NHS once provided. And given the shortage of staff, any company able to supply doctors and nurses will be able to dictate terms.
Ministers would almost certainly describe a vision of the NHS held to ransom by a huge private healthcare market as scaremongering. But we only have to look to the US to see such a market. In fact, many of the companies entering into the public-private partnerships envisaged by the bill are likely to be subsidiaries of US multinationals.
The trillion dollar US healthcare industry is in financial meltdown and many providers are in voluntary liquidation. To survive, the industry must find new sources of profit. Buying up GPs' surgeries in the UK and leasing them back to the NHS would be one source of income. So would employing doctors and nurses and selling their services to the NHS.
But US finance and healthcare companies are used to a market in which they can also make profits through charging users. The NHS principle of healthcare free at the point of delivery has been a stumbling block: but the government has now found a way of breaking this 50-year compact with the people.
In addition, the bill allows the creation of care trusts which will hold budgets for both health and personal or social care. This measure has been widely hailed by politicians of all parties as a means of integrating health and social care. But healthcare is now provided free at the point of delivery, while personal care, currently provided by local authorities' social services departments, is means-tested and charged for. So the implication of bringing personal care under the new care trusts is that, for the first time in its history, an NHS body will be able to charge for care.
The government has made charging easier by guidance limiting NHS care to six weeks after a hospital stay or acute illness. People with illnesses such as stroke, Alzheimer's disease or multiple sclerosis could find they are paying for things, newly classified as "personal care". People will have to get used to it. And the idea that the NHS is free will begin to be eroded.
The bill will remove both practical and psychological barriers to our seeing NHS bodies as providers of private healthcare. The government's export advice agency, Trade Partners UK, describes the NHS as "one of the world's best healthcare brands". There will be nothing to stop the new NHS trusts, resentful of their limited cash allocations, from capitalising (literally) on the NHS "brand" with joint ventures to sell long-term care and private healthcare insurance to their patients.
In the new NHS more care will be provided for profit. The government says it does not matter who provides care, so long as it is paid for by the public purse. But ownership matters. We object to care trusts partly because they will take control of social services from elected local authorities and put them in the hands of unaccountable quangos. The bill gives those quangos the power to hand over public resources to companies that profit from ill-health.
Before 1948, 50% of the UK population had almost no access to care. And today we need only look at the US to see the effects of care based on ability to pay. There, the profit motive denies 50m citizens, including 10m children, access to healthcare and 40% of personal bankruptcies are due to healthcare bills. This bill is destroying the legacy of Beveridge and Bevan as all parties sit by and watch.
Allyson Pollock is professor of health policy at University College, London. Fiona Campbell is coordinator of the Democratic Health Network