What’s more concerning about last Wednesday’s approved Commons vote on the NHS reform is not so much its content, but with how much ease the bill sailed through parliament. It’s a down-the-line bill, plagued with clauses which will leave the public arm of the NHS in England in ruin, and there are several longsighted arguments that Cameron and Lansley will be able to make in the months (and years) to come.
Lansley is attempting to cover himself from all angles by introducing mixed markets into the NHS. If allowing private companies and charities to invest in healthcare (in what is supposed to be an attempt to save money from the public sector) doesn’t work, he can argue it’s because the NHS is leaking too badly. Therefore if it is fully operated privately, the cash flow problem can be solved. Whereas even if mixed markets do help stabilise the economy more-so in healthcare, he can still argue that this can be furthered if the NHS is geared more towards marketisation. Either way, years down the line he can swing the door to the public sector closed at any time and still justify it one way or the other.
So let’s firstly look at the contracts which private companies will provide for healthcare, treatment, equipment etc. For a start, employing companies to engage in contracts to cover the scale required to make up for lost cash will not be feasible. Private firms will not be able to live up to the agreements they make. Mixed with this is a loophole created for them in the Freedom of Information Act where they do not have to make public certain details of their business. After quoting a letter sent to Andrew Lansley about this matter, False Economy stated that ‘at the outset of the new arrangements no information about an independent provider’s record will be available – as they will not yet have treated NHS patients’. For instance, if there is a contamination scare, the “independent” company who provide the money for acquiring said contaminated products would not necessarily have to provide details of the processes with which the product was gained.
That’s the market/economic arm to the problem. There is of course the social problem of siphoning off jobs and investment in the public sector. The NHS’ own figures, data which was confirmed by Randeep Ramesh in his Q&A blog, stated that ‘between May 2010 and May 2011 there were 96,071 (8.3%) leavers from and 77,871 (6.8%) joiners to the NHS in England’. Already the difference in re-employment can be seen, whereas if private companies were to take over from public investment, there is a huge question mark as to how many more of the people leaving would be re-employed by private firms (especially considering the government will scrap PCTs). Contracts would be smaller (or would require more legal, financial employees), patient numbers less and therefore the requirement for as many doctors and healthcare workers unknown.
Of course, the whole thing just sounds dodgy doesn’t it? The DOH’s Myth Buster document is almost as transparent as a window after a good scrub. For a start, it doesn’t contain any evidence or justification, only their good word, yet even from looking at the facts above leaves a somewhat dubious overhang on the bill. In the document they state ‘competition will not be pursued as an end in itself. We have said that competition will be used to drive up quality, and not be based on price. Nor will we allow competition to be a barrier to collaboration and integration’. Yet what happens when you use private money to drive up quality to say 50% of services, notably for the people who will most likely end up paying for healthcare, and leave the other 50% to wither? And who knows what collaboration and integration mean in that context. Then there was the whole confrontation between Cameron and NHS staff after he claimed they were all behind the bill (they weren’t).
Maybe this bill will save the public taxpayer a slight amount in the short-term, but is that good enough of a sacrifice to see the door to public healthcare closed at any time? And who does Lansley blame in years to come when markets do rule the NHS, and the leveraged asset borrowing schemes which allow companies to invest cannot swell any more? What happens when he makes banks out of our NHS? Before we know it, the words healthcare and derivatives will be thrown around when they come to find private companies borrowing against assets they don’t have. Or maybe they’ll barter with patients’ lives, as Wal-mart did during the years leading up to the global financial crash. While it may not be ‘the end of the NHS as we know it‘ according to Colin Leys, it’s a step in that direction.