BOOK REVIEW

Pauline Bryan

NHS plc: The Privatisation of Our Health Care
Allyson M Pollock Verso £15.99

In the preface to 'NHS pIc' it states that the book "aims to record what is happening in an accurate and accessible way. The public have a right to know, even if the process has already gone too far to be easily or quickly reversed."

Unfortunately at £15.99 in hard back it isnt that accessible. It is however written in a style that combines academic rigour with a strong sense of anger about the destruction of the National Health Service. Allyson Pollock's pessimistic assessment, that the process cannot easily or quickly be reversed is hard to question once you have read the detail of how the service has been deliberately and systematically dismantled for the benefit of international capitalism.

The book gives an outline of the origins and development of the NHS, giving a flavour of each era of the past 60 years. It takes it from the early compromises and the struggle to operate within Victorian buildings and Victorian attitudes, through Enoch PoweJrs attempts to introduce central planning for hospitals which he described as "planning on a scale not possible anywhere else, certainly this side of the iron curtain". It describes the Thatcher years when she and Roy Griffiths of Sainsbury's supermarkets introduced the early forms of commercialisation with outsourcing and internal markets.

The meat of the book is a detailed study of how the Labour Government, coming from a Party that would have been expected to defend the NHS, has gone so much further in privatising the service than Thatcher would have dared even in her wildest neo-liberal dreams. Why has this happened? The answer doesnt lie particularly in health care or in the UK. It is a global phenomenon affecting all types of public service and is a response to the demands of powerful capitalist interests. The answer to why a Labour government is leading this onslaught and promoting their ideas to other countries in Europe and elsewhere asks a question of Labour Party members and what they should do to stop it.

For Party members who still believe that the Labour government has been forced down a path that it would not have chosen, they should be aware that from the earliest days in power new Labour brought in people whose specific interest and remit was to smooth the path of privatisation. They seconded people from construction companies and consultancies who then returned to use the structures they had helped create to bring private sector interests into the health service.

Capitalism does not care if it makes money out of arms trading, supermarkets, oil, prisons or health care. It is all the same to a multinational growing in size, wealth and power. What makes health care so attractive is that people will always get ill.

The multinational pharma industry has long leached of public health care. Builders have made their money in construction. More recently cleaning companies and caterers etc have got their fingers in the health care pie. But the real money is in cherry picking the most profitable parts of delivering care and gaining control of hospital resources. US companies had little scope left for internal growth and its near neighbour, Canada, is protecting its public health care service from commercial incursions. Europe and particularly the UK were identified as an important potential market. GATS treaties were used as a lever to open up public services to competitive tendering and Pollock claims "The [New Labour] government's idea was evidently that this would eventually apply to health services too. While it claimed that health services were excluded from GATS agenda, its privatising reforms were increasingly bringing them within the ambit of international trade law."

The impact on the NHS of privatisation has been fundamental, but largely hidden beneath a multitude of small changes such as the resources put in to private beds in PFI hospitals, charges for non-medical services such as TVs, the use of private diagnostic and treatment centres. These and many more incremental changes are impacting on the ethos and delivery of the service, for the individual user, for medical staff and clinical autonomy and importantly for those who try to plan and deliver a comprehensive national service. Pollock describes the impact on the NHS, "very soon every part of it will have been 'unbundled' and commodified. "

The media has been drip-fed and ended up colluding with the notion that the health service as we know it is 'unaffordable' and 'unsustainable'. A similar process is also going on around pensions. Pollock points out that hard evidence to support this is hardly ever presented. She gives examples of how information is put in the will be the central to discussions in Scotland as efforts are made to change the policy here. The book exposes the distortion of language used in describing foundation, hospitals as part of local democracy. The 'members' that make up the democratic element can in no way be described as representative. There has been a long argument in social democracy that bemoaned that the better off always got the better services under universal provision. They could manipulate the service to their own advantage while poorer people were less adept and using the system. This is probably the case, but the foundation hospital approach would simply enshrine this bias. If a 'goo~ three star hospital, which is probably located in a better off area, is able to take over failing hospitals, probably in a poorer area, it gets access to the resources of the poorer hospital. Staff and services can be relocated to the convenience of the better off residents. After all, they are more likely to take advantage of the private beds that will be available and make the 'co-payments' for special services while the ground work for the adoption of foundation hospitals and other solutions that would bring it totally in line with the prevailing ideological framework. The current round of Scottish Policy Forum debates on health must be used to give a resounding 'no' to the introduction of foundation hospitals and a resounding 'yes' to democratically controlled national planning.

There will probably be a lot of double talk about respecting devolution, but be warned by the recent coverage of John Reid speaking in Paisley at the end of January. As reported in the 'Heral~ by Catherine MacLeod, one of the more Blair-friendly journalists, John Reid was going to "throw down the gauntlet to the government's critics (meaning members of trade unions and the Labour Party) with an unremitting defence of choice and reform in public services... ...Mr Reid does not differentiate between public service provision north and south of the border It is inconceivable to believe that he is not piling on the pressure to accelerate the pace of reform in Scotland And while he does not say so explicitly (though he probably has to MacLeod), he hints that the necessary improvements will not take place without a radical reforming agenda of reform (sic)."