29 October 2013 — Red Pepper
By repackaging privatisation as ‘reform’, the government has tried to sell voters the idea of dismantling the health service. Jacky Davis exposes the main marketing myths behind the NHS giveaway
Myth: We can’t afford the NHS
International studies have consistently shown the NHS to be one of the most cost-effective health services in the world. A recent Commonwealth Fund study showed that the UK saves more lives for each pound spent, as a proportion of national wealth, than any other country looked at apart from Ireland. Among the 17 countries considered, the US healthcare system was among the least efficient and effective.
If we are agreed – and most people are – that the state has a role in providing health care, then the NHS is doing a good job with our money.
Myth: ‘Health tourism’ is bankrupting the system
The most reliable figures suggest that unrecovered costs from treating foreign nationals account for less than 0.2 per cent of the NHS budget. The government has encouraged scaremongering as a useful distraction from the real problem of £20 billion in cuts to the service.
Myth: The government has no intention of privatising the NHS
Politicians assure us that the NHS will remain ‘free at the point of delivery’, but one tenth of surgeries are now privately owned, and contracts worth millions of pounds have been given to the likes of Virgin and Serco. Because contractors may go on using the trusted and familiar NHS logo, patients may not even know they’re receiving treatment from a private company.
These claims also assume that how we pay for our health care is the only thing that matters. The population values the public service ethos that has traditionally underpinned the NHS. Polls show that the majority of people want local and national government to run public services, and only consider contracting out if this fails. People also want accountable health care, while private contracts hide behind ‘commercial confidentiality’. The chair of the House of Commons public accounts committee, Margaret Hodge, says that even she can’t break through their wall of secrecy.
Myth: Private companies will deliver a cheaper and more efficient NHS
There is not a scrap of evidence that the price goes down and efficiency increases when private companies deliver NHS care. In fact, the evidence points the other way. Costs increase and services may well get worse. The fiasco of hospital cleaning has shown the reality of privatisation: apparent short-term savings, but at the expense of lower hygiene standards, higher rates of hospital-acquired infection, the break-up of established ward teams and casualisation of the workforce.
Already we have seen major companies such as Serco criticised for failing to report accurately on their performance. Recently an NHS contract for elective services with the private company Clinicenta was terminated due to poor quality care. It has been bought out at great expense to the taxpayer and taken back in?house by the NHS.
Myth: The government’s reforms are aimed at cutting bureaucracy
The Health and Social Care Act was never about cutting bureaucracy, though that argument helped to get Lib Dems on board and push the massive bill through parliament. Today we have a bigger bureaucracy that consumes more time and resources. The 150 primary care trusts have morphed into 211 ‘clinical commissioning groups’ (CCGs). Most of the CCGs’ work is outsourced to ‘commissioning support services’ (CCSs), to be performed by people the NHS does not call employees, and who are not subject to the Freedom of Information Act. By 2016 these services will have been put out to competitive tender.
CCGs and CSSs are monitored by a new national bureaucracy, NHS England, which has 27 local area teams that don’t meet publicly or publish papers. Among the other tiers of bureaucracy are the health and wellbeing boards, Healthwatch England, toothless local Healthwatch patient groups (which are forbidden to conduct any ‘political’ campaigning), citizens’ panels, clinical senates and dozens more. The difference is that the new bureaucracy is less accountable.
Myth: The reforms will save money
The NHS is now less cost effective. Money is being wasted on turning hospitals into a market, in which they have to compete rather than cooperate and GPs are legally required to spend money on expensive and lengthy tendering processes. The proportion of the NHS’s budget spent on administration has increased dramatically, rising from around 6 per cent to around 15 per cent (the government won’t tell us exactly how much). An increase of this size represents about £10 billion. Another £54 billion has been spent on PFI projects that will eventually cost taxpayers an estimated £300 billion. Meanwhile, the NHS has suffered rationing, bed closures and staff cuts over the past two years. If we abandoned costly and unnecessary privatisation schemes, we would save billions for frontline care.
Myth: The reforms will give patients more choice
Patients have less choice now than they did 20 years ago, when a GP could send a patient to see any provider. Many GPs are now given targets to lower their referrals to hospital. Referrals may pass through a management centre where they are checked and may be redirected by people with little or no clinical training and no knowledge of the patient. One in eight referrals is rejected altogether. Operations once available from the NHS, such as joint replacements and hernia repairs, are increasingly being rationed or withdrawn.
Market ‘competition’ is unlikely to result in diversity. Large companies have the resources to enter expensive tendering processes for NHS contracts, crowding out NHS workers and small social enterprises. Between April and August 2013, 16 major NHS contracts went to the private sector and two to NHS providers. If this continues we face the possibility of quasi-monopoly private providers, which may have more talent for winning contracts than for running clinical services. The private sector also has no obligation to provide a full range of services, so it tends to pick the ones it sees as profitable. Any replacement of local NHS providers by private companies can result in reduced services and gaps in care for vulnerable patients.
Myth: The reforms put GPs in charge
Polls show 73 per cent of GPs now believe they have been set up to take the blame for rationing health care. Far from being in charge, GPs will effectively be rubber stamping decisions imposed by NHS England and commissioning support services. Only a third of GPs are actively involved with the work of CCGs, and of those who are involved, more than a third have links with or shares in private medical companies and insurers.
Myth: The reforms give power to local people
Local consultations have been consultations in name only. Petitions with thousands of signatures have been ignored. After Lewisham’s local hospital was sacrificed – to bail out a nearby trust crippled by a massive PFI debt – community members had to take Jeremy Hunt to court to overturn the decision. Ministers have said they’ll appeal, or change the law if necessary to give themselves new powers, making their willingness to go against local people entirely transparent.
The English NHS is under attack as never before, with the government briefing against it at every opportunity and aggressively pushing a privatisation agenda. But the NHS wasn’t broken and didn’t need fixing. When the Labour government left office, the NHS had its highest ever popularity ratings. After investment in the service, waiting lists had come down and outcomes were improving rapidly. There was every reason to believe that a public, accountable NHS could continue to evolve, improve and meet the challenges of the future, including care for an ageing population.
Jacky Davis is a consultant radiologist, co-founder of Keep our NHS Public and co-chair of the NHS Consultants Association. She is also co-editor of NHS SOS: how the NHS was betrayed – and how we can save it (Oneworld Publications, July 2013)