Dr Paul Hobday, a GP in Maidstone, lays out his fears over the NHS reforms for both patients and the profession
This is about the thirteenth reorganisation I've seen in my three decades as a GP.
Up until now I've put it all down to the fact that politicians can't resist ‘fiddling', and if we called all managers administrators instead, they'd administer rather than think they too have to introduce change for change's sake, or to prop up their egos. This ‘reorganisation' is far more sinister however, as the label ‘NHS' will not be in any way applicable afterwards.
This white paper represents the coalition Government's proposals for legislation to privatise the NHS. It is the next logical step in the seamless acceleration of the policies of the last Government. Tony Blair was elected in 1997 on a platform of abolishing the NHS market, but a few years later reversed this without a mandate from the electorate.
The present Secretary of State gave a pre-election pledge that there would be no more major reorganisations in the NHS. And why wasn't the NHS a ‘hot topic' in the election campaign? Because all three main parties are in agreement that commercialisation is the way forward. Those believing in the founding principles of the 1948 NHS were disenfranchised. Now the main aim of the white paper Mr Lansley has introduced is to hand over the provision of NHS care to private companies. This policy is called ‘patient choice'. To enforce this change, commissioning in England is to be privatised.
GPs have no choice but to amalgamate into commissioning consortia (GPCC) which have the task of commissioning the bulk of the NHS care under the control of a National Commissioning Board (NCB).
The GPCCs and the NCB are open to be largely run by private interests. The appointed NCB could contain figures from large health corporations. GPCCs in some areas are at risk of being dominated by a clique which would turn to the private sector to do the commissioning for them. There is a real danger of damaging conflicts of interests when ‘GPs' are both service providers and service purchasers.
The present commissioners, the primary care trusts and strategic health authorities, are a publicly-run bureaucracy and would get in the way, so are to be abolished by 2013.
This plan to privatise commissioning is skilfully hidden by saying that GPs will be in control of 80% of the NHS commissioning budget, through GPCCs. But these GPCCs would take over the debts of the PCTs and then have to ration care on a massive scale as they would be held responsible for cutting the NHS budget by £20bn.
The nominally responsible GPs would then be blamed for the withdrawal of care and treatments and for closing hospitals.
The publicly owned infrastructure of the NHS is continuing to be closed down, sold off and privatised as the cuts proceed and the private companies move in (e.g. PFI and LIFT buildings, privatisation of NHS procurement, IT contracts, privatisation of ambulance and pathology services, ISTCs etc.). The new commissioners are instructed to carry out ‘patient choice', by ending the present position of ‘NHS as preferred provider' and changing to an ‘any willing provider' policy.
The new ‘market' of competing providers would be regulated by Monitor, which would also introduce price competition by abolishing national tariffs, and deciding ‘best practice' tariffs. The new commissioners are instructed to continue the ‘reconfiguration' of NHS care by driving down GP referrals of patients to hospital, and removing hospital care.
The aim is to ‘liberate' the NHS from the structures founded in 1948:
- Publicly owned hospitals and infrastructure
- Publicly provided service by staff on national terms and conditions and pensions
- National system of education and training
The three parts of the NHS are all to be privatised:
- Community care is to be outsourced by April 2011
- Primary care is increasingly owned and run by private health companies employing APMS general practitioners
- The hospitals are to be denationalised. They must all become Foundation Trust businesses and then convert to ‘social enterprises'. The latter are the transition stage to fully-fledged private hospitals. Hospitals must make money or go bankrupt and fail and must not be ‘bailed out.'
The consequences for NHS staff are the loss of thousands of posts through cuts, and the forcible transfer of employment to private companies with removal of national terms and conditions and NHS pensions.
The consequence for patients is the rapid and drastic removal of care provided: fewer hospitals miles from home, and the withdrawal of all types of treatments and care.
The white paper demands increased individual patient budgets, which together with provision by private companies, pave the way for charges and private insurance.
The vision of the future is one in which corporate interests will be given incentives to select patients, time-limit care, sell top-up insurance and introduce charges for some elements of care no longer provided by the NHS. The Government will then want to see the development of practices competing against one another for members (patients), just like US health insurers. That's a chilling prospect for the elderly, those with chronic illness and people with mental illness and long-term needs, who are often of no commercial interest to the corporate because of their high healthcare costs.
The white paper proposals will inevitably lead to the end of the NHS as a publicly owned and provided system of healthcare funded by taxation, with the right of every citizen to have access to comprehensive, high quality healthcare, free at the point of need. ‘NHS' will be nothing more than a title. Just as the USA is waking up to the inefficient, unfair, corrupt and discriminatory healthcare system they have, we are being driven in that direction - for ideological reasons.
The danger is that without careful and informed debate one of the best-loved and most successful public institutions of the last 60 years will go down undefended.
Dr Paul Hobday is a GP in Maidstone in Kent
The end of the NHS