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At the heart of general practice since 1960

England has taken a 30-year road to the ruin of the NHS

The Government’s market-led NHS reforms are the culmination of a drift that began with Margaret Thatcher. Wales and Scotland have no intention of following, says Dr Julian Tudor Hart.

The Government's market-led NHS reforms are the culmination of a drift that began with Margaret Thatcher. Wales and Scotland have no intention of following, says Dr Julian Tudor Hart.

When Margaret Thatcher invited Sir Roy Griffiths to apply his knowledge of Sainsbury's supermarkets to the NHS in 1983, she started a process which has proved unstoppable. New Labour's contribution to this process was to open the NHS even faster and wider to anyone with enough money and experience to make its work profitable.

There's no democratic mandate for any of this. For Labour in opposition, that should be an open goal, but their manifesto in 1997 promised: ‘Our purpose is simple but hugely important: to restore the NHS as a public service working co-operatively for patients, not a commercial business driven by competition.' Why believe them now? Can they even believe themselves?

In Wales, we stand on firm ground, impoverished but able to plan services for national needs, rather than compete to attract consumer wants. Labour in Wales never embraced ‘New Labour'.

Neither Wales nor Scotland proved willing to return healthcare to its pre-NHS status as a traded commodity. Our Labour health secretary Edwina Hart, and the Scots Nationalists' Nicola Sturgeon, are good friends. Both nations have ended the purchaser-provider split, returning to an NHS that brings the people who plan work closer to those who do it, with enough continuity for people to see the consequences of their decisions.

They have both built trust between top administrators and professionals, and have begun to weaken the irrational barriers between medical and social care.

The NHS was conceived and born in Wales – not only from Bevan and Lloyd George, but more fundamentally from the solidarity of coal-mining communities. That's a powerful history. With our backs to the wall, to history we turn. This Government is pushing us back to the Britain of the 1920s and 1930s, and we know it. But all GPs have already lost gains made by Bevan's NHS and the post-war welfare consensus, which made effective primary care possible.

In 2004, sale of practice goodwill by GP principals was reintroduced, adding to the debts incurred by the inflated house prices following collapse of social housing since 1979, and by introduction of university tuition fees following Labour's election in 1997.

But in most cases partnership is no longer an option. Established partners earn more if they employ salaried assistants, so that's what most of them do. After all, they are running their own little business. But not for long. In England, primary care will be big business, because the populations required for efficient commissioning of specialist care are in the millions. Enter Kaiser Permanente, UnitedHealth and other transnational outlets for investors running out of profitable markets. They have no experience of UK general practice, but they know how to make money, and that will be the bottom line.

Yet I wonder how profitable the ruins of the NHS will actually be? So do the managers of Humana, one of the largest US companies invited to take over the NHS – and who decided to pull out. Health secretary Andrew Lansley may yet be left swinging in the breeze. Remember the poll tax? It got into law, but was defeated by mass demonstrations and made Thatcher unelectable. Who would then be invited to rebuild a people's NHS? Probably Wales, Scotland and Northern Ireland, where we are still allowed to learn how to do it.

Dr Julian Tudor Hart is a retired GP and research fellow at Swansea Medical School. He topped Pulse's 50th anniversary poll of the most influential GPs of all time last year.

Dr Julian Tudor Hart

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