Private cash is bad for our health

John Gallacher

In his introduction to the 60th Anniversary edition of Bevan’s seminal work “In Place of Fear” (Bevan Society), Gordon Brown states the challenges facing the NHS can only be met by “remaining true to the original values of the service- free at the point of use, open to all, rooted in the British belief of fairness and compassion”. Is the Labour Party safeguarding or threatening Bevan’s legacy?

Many of the key elements of the NHS model in England would be an anathema to its founder, Aneurin Bevan: a ‘world class’ commis-sioning strategy to promote competition through the internal market; patient choice; independent treatment centres; top up fees; and private finance for capital investment. These concepts do not sit happily with the Gordon Brown quote above. It is not experts in public law who are needed to advise on this latter day constitution, but competition lawyers to prepare the bill of sale as NHS services are parcelled into lots for sale, not to the highest, but the lowest bidders.

Margaret Thatcher proposed a ‘commissioning’ local authority which would meet once a year to issue contracts, but provide no direct services. This is coming to pass in NHS Trusts in England which no longer aspire to be direct providers of services, but to be ‘world class’ commissioners. The Great Yarmouth and Waveney Primary Care Trust Operating Plan 2008/9, for example, outlines a strategy which: “transfers resources and services away from traditional modes of provision” within “a strong local health care market with a range of ..cost effective service providers”

Across England clinical services in acute and primary care settings are being privatised, encouraged by the UK Government’s internal market and choice agenda.

Any ‘willing provider’ can operate in the ‘contestable market’ for health services. Competition is seen to be so fierce that a special Commission
for Co-operation and Competition is to be set up. The panel will advise the Strategic Health Authorities and the Department of Health on resolving disputes relating to competition for NHS-funded services. It will have the specific responsibility for considering complaints about issues associated with the procurement of clinical services, advertising and promotion, and the merger or acquisition of healthcare providers where an NHS body is involved.

On the announcement at the 2008 CBI Conference of the appointment of Lord Carter of Coles as the first chair of this Panel, the private providers ‘Partners Network’ commented:
“We are pleased that the Department of Health has now appointed Lord Carter of Coles as Chair of the new Cooperation and Competition Panel and look forward to working closely with him.
“We particularly welcome the fact that he has substantial commercial experience in the sector. The Panel has a vital role in helping to shape the NHS provider market, ensuring that there is a fair and level playing field and that competition plays a full and constructive part in securing the highest quality NHS patient care.”
The private sector is laying out the welcome mat to this Labour grandee who made his money in private health care. He is one of their own.

Introducing private providers and the profit motive, without any ceiling or limitation, is the beginning of the end of universal, free and fair provision of NHS services. Bevan himself said of the NHS: “It is therefore an act of collective goodwill and public enterprise and not a commodity privately bought and sold.”

Universality of treatment is also under threat through the system of ‘top-ups’ enabling NHS patients who can afford it to purchase drug treatments not approved for use or funding within the NHS. Again this is a fundamental breach of Bevan’s founding philosophy and his belief that: “The essence of a satisfactory health service is that the rich and poor are treated alike, that poverty is not a disability, and wealth is not advantaged”

The 1997 UK Labour Party manifesto promised to abolish the Tory internal market in the NHS. This was not delivered in England, but the first post-devolution Labour-Liberal Government did take steps to end the expensive and distorting internal market and the current SNP Government continues to oppose the involvement of the private sector in both bidding for GP services and the cleaning of clinical areas.

Nye Bevan would approve more of his celtic cousins’ stewardship of the NHS North of the Border.

John Gallacher is Regional Organiser, UNISON and lead officer for NHS Scotland