The National Health Service (NHS) celebrates its 65th birthday today. While coalition politicians cut ribbons, they are also busy cutting the lifelines that make the service viable. Ceaseless scare stories, never ending costly reorganisations, rampant commercialisation and privatisation, and deliberate loading of unsustainable debt onto hospital balance sheets. It is time for a reminder of what we stand to lose, if we do not defend our Spirit of ’45 inheritance.
Life before the NHS
The National Health Service was born on July 5th 1948 – within living memory. The only recognised health system in Britain prior to the NHS was the system of National Health Insurance, established by Lloyd George from 1911. This insurance was paid by working men and their employers at a flat rate rather than graduated to account for differing levels of wealth; the Lord and the Layman paid the same fee. It also failed to cover dependents, therefore wives and children were left unprotected. Instead, the masses were at the mercy of others. An uninsured person could only gain treatment at a public hospital if they had Tuberculosis.
There were a patchwork of Voluntary Hospitals where those who could not afford private medical care may receive treatment if they could gain sponsorship or philanthropy. If all else failed, some Workhouses had their own infirmaries.
Access to healthcare was based on ability to pay, and the public health impacts were very real:
Every year, thousands died from treatable diseases – pneumonia, diphtheria, polio, meningitis.
One in twenty children born in the UK died before their first birthday.
Those who could not afford to ‘call the doctor out’ instead endangered themselves with bogus home remedies ranging from the ineffective to the downright poisonous.
Throughout the first half of the century, the 19th century view that Philanthropy alone could deliver the public health needs of the nation came under sever challenge. Over twenty years, a series of actions paved the way for the NHS:
The 1920 Dawson Report put forward the case for a national service under a single authority.
In 1926, a Royal Commission on National Health Insurance pioneered the idea of a health service funded by the public.
During World War II, the UK government took ownership of the medical service for the first time with the Emergency Medical Service – this catalysed the momentum for a nationalised health service.
In 1941, a government commissioned Independent Inquiry established that there were vast inequalities in healthcare provision across the country and across class.
The NHS is Born
Finally, the Beveridge Report into social care the following year put forward the National Health Service as one of the three pillars of a workable social security system. Two White Papers and a substantial US loan later (paid off four years ago), and the NHS was born under a Labour government and Health Secretary Aneurin Bevan on July 5th 1948. For the first time anywhere in the world, healthcare was based on citizenship, not ability to pay. This meant any person born in the UK was eligible to entirely free healthcare including GP, hospital treatment, ambulance services, opticians, midwifery and prescribed medicines. There were queues down whole streets outside GPs, Hospitals, Opticians and other service providers the day the NHS was born and for a while after. It was a moment the tide turned in Britain – to a more equal, collaborative society, respectful of the contributions of everyone.
Since this point, we have achieved vaccinations for diseases like Polio and Tuberculosis which has virtually eradicated these formerly common killers, life span has extended by over 10 years on average in the UK. By just 1950-55 infant mortality in the UK had dropped from one in twenty, to three in every hundred…today it stands at 5 in every thousand. DNA was discovered in the 1950’s. There are a plethora of achievements in public health and scientific understanding as a result of the National Health Service.
Sitting on a Goldmine
Despite all this shared success, there is a huge amount of wealth which could be getting made on the back of the sick. To some, this is a missed opportunity. In the sixty five years since its inception, private enterprise has been seeking a way back in.
The NHS today employs 1.7m people – Only the Chinese People’s Liberation Army, the Wal-Mart supermarket chain and the Indian Railways directly employ more people. It treats over 3 million people, in England alone, each week. The NHS budget in its first year was £437m (£9bn in today’s money) for 2012/3 stood at just under £109bn.
In short, the nation’s sick are a potential gold mine to the private medical industry. For all our complaints of waiting lists, uncaring nurses, ambivalent doctors and horrible food – Britain loves it’s National Health Service. In the last 25 years, it has saved more lives per pound spent than any other health service in the world except Ireland.
Given its success, no government has ever been able to even whisper the idea of privatising health care. We sold the gas, the coal, the water, the phone service, the postal service, and the railways. But there has never been anywhere near substantial support for selling the NHS and moving to a system of privately run healthcare.
With a population stubbornly attached to their publicly funded institution, what were successive neo-liberal governments and private healthcare providers to do? Privatise by stealth.
New Labour, Tories, Lib Dems: All Outsourcing It Together
The Health System is being gutted by endless and costly reorganisations, rampant commercialisation and outsourcing, and unaffordable PFI contracts.
The latest major reorganisation of the NHS, under the Health and Social Care Act, will suck another £4bn out of the health service. This comes on the back of £780m blown by New Labour on 70 reorganisations in just four years between 2005 and 2009. Anyone experienced in change management can tell you that this level of change, which does not allow for new systems and processes to bed in or for their benefits to be measured, is simply madness.
Each of these reorganisations has been centred not on the patient, but on vague concepts of ‘choice’ and ‘competition’. These are bywords for privatisation – the attempt to force open a closed market to the rabid private sector we already shunned in favour of our public service.
There is a growing trend across the country for NHS Trusts to become mere managers overseeing almost entirely privatised healthcare. To give just two examples:
Southampton Primary Care Trust has outsourced a third of its elective procedures to private providers.
Serco was recently awarded a £140m contract to deliver all of Suffolk’s community health services. Both areas have seen serious performance issues and large reductions of staff.
A report by corporate finance consultancy Catalyst, published in September, estimated that newly privatised healthcare services will be worth up to £20 billion over the next few years. Private companies Circle, Virgin Care and Serco have won contracts worth £700m to provide NHS services just this year. NHS outsourcing to private providers rose by 10% in a single year last year, and is set to increase to 40% of all services by 2020.
The S75 Regulations of the governments Health and Social Care Act will deliver the NHS into the hands of these private companies. The new ‘Competition Regulations’ force the NHS to put all but a tiny minority of services out for competitive tender. The majority of services currently run by the NHS will shortly and swiftly be turned over to profit making private healthcare providers. This is privatisation by the back door.
At the same time, 22 of the 103 NHS trusts to enter PFI are facing financial difficulty due to the exorbitant PFI repayments. Some hospitals are having to handover a fifth of their annual budget on paying for the PFI deal.
Big Banks are now setting up shell companies in offshore tax havens, which they use to buy up these struggling hospitals for a pittance. HSBC, recently found guilty of building an entire subsidiary bank to launder money for Mexican drug cartels, now owns three NHS hospitals outright in Barnet, West Middlesex and Middlesex. The shell company set up to buy the banks is registered in Guernsey, so no tax will ever reach the UK treasury.
New Labour laid the groundwork and the Coalition have expedited the break up, sell off and end of our National Health Service. We are left with just the brand and the funding mechanism. Given the clearly doomed fate of these services to prove financially viable, it will not be long before the case is made that we can no longer afford a public health service, and we will lose the last surviving principle of the NHS – free at the point of use.
Self Interest over Public Interest
The reality is that wherever we look, our regulatory bodies, our parliamentary bodies, all the institutions meant to protect and serve the long term public interest – these institutions are stuffed with individuals who have abandoned this role in favour of their own short term self-interest. The NHS story is sadly, no different.
The MPs and Lords drafting and voting this privatisation legislation through, have a personal financial interest in the outcome. Social Investigations produced an excellent piece of investigative journalism revealing:
- 206 parliamentarians have recent or present financial private healthcare connections
- 142 Lords have recent or present financial connections to companies involved in healthcare
- 124 Peers benefit from the financial services sector
- 1 in 4 Conservative Peers have recent or present financial connections to companies involved in healthcare
- 1 in 6 Labour Peers have recent or present financial connections to companies involved in healthcare
- 1 in 6 Crossbench Peers have recent or present financial connections to companies involved in healthcare
- 1 in 10 Liberal Democrat Peers have recent or present financial connections to companies involved in healthcare
- 64 MPs have recent or present financial links to companies involved in private healthcare
- 79% of these are Conservative
In ordinary circumstances we might well express our dissent to our parliamentary representative – but these are not ordinary circumstances. This government has laid an all-out assault on the NHS and there will be little left of it by 2015 – and the Blue Labour party we have today have been entirely complicit in bringing us to this point. If we want to save the NHS, we must recapture the spirit of ’45 and make a stand for it together – refusing to be ignored and have our collective interests subjugated in favour of an elite minority. In the words of Aneurin Bevan, the founder of the NHS, the service “will last as long as there are folk left with the faith to fight for it.”
For all of our sakes, fight dammit!
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