The Hollowing of the NHS

The British are usually quite humble nowadays. That or pessimistic. Even though Andy Murray won a Wimbledon title this year, I can still remember my father commenting on how he lacked stamina compared to his opponent, or how his foreign opponent wouldn’t make Murray’s mistakes. I use him as an example, but I think it’s fair to say that the British have a reputation for lacking pride in certain circumstances. However, there are still the odd few British establishments which are exhibited with pride – the National Health Service (NHS) being one.

The NHS is in trouble. When it was first formed, by a Labour government in 1948, it was thought to be cost effective due to the belief that if free health care was available to everybody, the overall health of the country would improve and this would cause the running costs of the NHS to fall as fewer people fell ill. Unfortunately this rather novel idea never materialised and costs have spiralled, leaving politicians to bicker over how to solve the problem ever since.

Photo: comedy_nose @ Flickr
Photo: comedy_nose @ Flickr

The original structure was that public funding was pumped into a state organisation that provided the care directly, with no avenue for profits (in terms of the provision of care). The system would care more about the person rather than how much money could be made out of them – an issue which appears to be prolifically publicised in American hospital shows. Now, people have been shown that free healthcare is possible in the United Kingdom. The Conservative party know the unpopularity they may attract if they state an intention to privatise the NHS. In fact, none of the three major parties have mentioned an intention to do this. So, if you wanted to open up the NHS to privatisation, how would you do it with no-one noticing?

The government has appeared to have found the answer – contracts. And the Health and Social Care Act 2012. With the government manifesto pledging no more ‘top down re-organisations’, a UK court ruled on the bill’s lack of a ‘democratic mandate’. The judgement commented that ‘There was no indication prior to the White Paper that such wide-ranging reforms were being considered. [It] was published without prior consultation’. Add that to the fact that the paper was published very shortly after the coalition government was formed, and something begins to smell a little fishy. Or, as the judgment comments stated, ‘…the NHS reforms were introduced in an exceptional way’. So how has this bill changed our NHS? Well, it is effectively turning the NHS from a service provider to a health insurance fund for private health companies. Let me use ‘NHS Direct’ as an example.

NHS Direct used to be a branch of the NHS which provided non-urgent care over the phone. You picked up the phone and you dialled the number to get advice from a nurse. Paid by the NHS to an NHS provider, theoretically with no private company involved take some of the money as profit. However, NHS Direct is being replaced by ‘NHS 111’ which is supposed to be the same service just with a different number. Yet ‘NHS 111’ is a different service entirely. It could be provided by NHS Direct, or be provided by a private company who has won the contract to provide ‘NHS 111’ and is being paid to provide the service whilst taking a profit – exactly who gets what is determined by your location. To try and put it simply, NHS 111 is a new middle man. Whereas you used to work directly with the supplier, now there is the shop keeping middle man who can opt for a different supplier offering a supposedly better deal. Head hurting yet?

This is happening throughout the whole institution. Non-profit NHS Primary Care Trusts which used to be given the public money to pay for the services provided (most often through providers they owned) have now been disbanded. Instead a board of GPs has been given that money and can either choose to spend it through NHS providers or with private healthcare operators. It is supposed to give patients ‘choice’ due to the NHS failing, but if the NHS can’t provide services at £105.9 billion (2011-12) without making a profit, how can the private sector provide those services for the same money AND make profit on top. So, maybe the money isn’t being spent to benefit patients.

Perhaps (and I know that this never ever happens – sarcasm alert) the GP board will pay the money into a company in which they have a financial interest. Just a hunch.

So the question as to why this type of practice is being executed is still left unanswered. The more pessimistic, Andy Murray-bashing type of Brit may say that it’s corruption. Private health companies influencing government policies in order to line their own pockets, whilst calling this better for the taxpayer. I think it’s time we all found out about these quiet deals happening behind the NHS logo and the reasons as to why these deals are happening so silently, before there’s nothing left to save.

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