A Few Choice Sentences Just Won’t Do… On the other hand, this collection of articles & posters, done over the last couple of months, with mounting fury, probably won’t get much of a reading. However, the effort and making a commentary to fit it all together has got it off my chest, as it were.
Critics of the NHS claim that we can’t afford to pay for it;
but the truth is that we can’t afford not to.
Jason Hickel (American anthropologist at the London School of Economics)
A double click will enlarge all posters
Professor Vernon Bogdanor: … [the Tory] approach to the NHS. Another ‘mess we inherited,’ they say, to justify changes for which nobody voted and for which they have no mandate. What they actually inherited was an NHS with the highest satisfaction ratings in its history, which are now sliding as waiting lists grow, health workers are deliberately demoralised, and Jeremy Hunt talks up failure wherever he can find it to open the doors to a new system geared to those who see healthcare purely as a source of profit. (Professor Vernon Bogdanor is Research Professor at the Institute for Contemporary British History at King’s College London and Professor of Politics at the New College of the Humanities, Emeritus Professor of Politics and Government at the University of Oxford and Emeritus Fellow of Brasenose College, Oxford)
Horror Stories as Mental Hooks
What sound like Tory-inspired BBC radio ‘news’ bulletins have bombarded us with horror stories and generalisations from specific reports of ‘failings’ in the NHS for many months, softening us up for the idea that unless it’s privatised and run by oh-so-efficient profit-making concerns run by Tory friends and donors it will collapse completely. The word ‘Hinchingbrooke’, referred to later, blows the lie out of the water. But the takeover continues willy-nilly.
Strange how the horror stories only began after the current government, without a clear mandate to do anything at all, took up its seat in parliament, at a time when public satisfaction with the NHS was high.
I had had a couple of major NHS surgical interventions (one distinctly life-theatening) in the ten years to 2011 and had nothing but praise for the institution that worked its socks off for me. In 2013 when I needed another intervention the brilliant NHS consultant of my so-called ‘choice’ was so overworked that, reluctantly, so I felt, he suggested I go to the ‘NHS wing’ of a private provider – so the NHS would have had to pay them for an operation that was not so successful and service that was appalling in various ways. Invited to fill in a feedback form, I wrote a damning assessment of the overall ‘private’ treatment I received (which started with private payers sitting on plush furniture in the waiting area while the plebs had hard plastic chairs) but there was no response – not even a ‘take it or leave it, you’re only a pleb…’
My personal support would always go to Aneurin Bevan’s NHS which cared unstintingly for my grossly disabled sister from 1948 till 2005 and which is now being systematically dismantled by the ideologues of the Right, the butchers of the Welfare State.
A Commons Early Day Motion dated 28th October 2014 was signed by 91 MP’s which noted
‘…that public services have been privatised and outsourced without giving a voice to the public service users affected by those decisions…’ and sought to recognise ‘…that the public needs real powers to object to sell-offs, access information and hold private providers to account for their performance… calling for the introduction of a Public Service Users Bill which would make the in-house option the default, require public consultation before privatisation or outsourcing and promote transparency, accountability and social value in public service contracts…’
With no hope or expectation of a positive reaction, I urged the person who is supposed to represent me in the House of Commons to vote for this Motion and I protested about the way the National Health Service is being privatised in a thoroughly underhand kind of way. In response, I was told in no uncertain terms that the NHS was not being privatised and was presented with a letter (dated 9th December 2014) from MP Letwin who describes himself as ‘Minister responsible for open public services’.
I think it’s worth noting the word ‘open’ which has entered discourse by means of a sleight of mouth: when you cut the crap, it presumably means that ‘public services’ are up for grabs, open for anybody to stake a claim on ownership, open to the highest bidder; I don’t recall any ‘open’ discussion about this redefinition of ‘public services’. It has been sneaked into the political narrative in a far less than transparent way.
Letwin (who was a one time non-executive director of NMRothschild Corporate Finance Ltd, which invests heavily in healthcare) suggests that ‘…The UK Government is implementing a demanding commercial reform agenda which is aimed at leveraging the Crown’s buying power, deriving better value for money and providing savings for the taxpayer to support deficit reduction and growth…’ That strikes me as privatisation in all but name.
This high-falutin nonsense (‘…leveraging the Crown’s buying power…’) is supposed to support the pretension that the programme is said to have delivered billions of £££ savings in the last three years. The question arises: savings for whom and at whose expense?
A Case Study
A single case study, recording a pattern that’s probably being repeated over and over again in a way that it’s impossible for ordinary people to keep up with, including myself if I had not chosen to keep tabs on things for a couple of months, makes a nonsense of these claims.
On 27th January 2015 we learned that… ‘an £80 million contract to run cancer scans for the NHS has been given to a private health firm with a Tory MP on their board, despite a rival NHS consortium allegedly offering to carry out the work for £7 million less…’ It seems that ‘…the NHS Trust that runs Royal Stoke University Hospital in Staffordshire put together a consortium with other NHS hospitals to enter what they called a ‘competitive bid’ for a 10-year contract to run scans across Cheshire, Staffordshire, Shropshire, Liverpool, and Lancashire. The scans, known as PET-CT, are mostly used for diagnosing and measuring cancers, and are a vital tool for fighting the disease…’ As it turned out, NHS England, the health service’s ‘head office’ set up by the coalition government to oversee and probably dismantle the health service by sleight of hand, ‘…rejected the bid from state-run providers and instead awarded the contract to Alliance Medical, a private health firm whose board members include leading Conservative MP Malcolm Rifkind…’ He ‘…gets around £60,000 a year to sit on Alliance Medical’s board, according to public records. He is a backbencher in a government whose health policy is now enriching his own company. Alliance Medical has a turnover of around £120 million a year, so this scanning contract, worth an estimated £8million a year, is a significant part of its work. Alliance Medical said Rifkind was not involved in the bid…’ So, who is getting the so-called savings and who suffers from the ‘expense’ of such savings?
What’s even more scandalous is that the scanner was originally purchased by public subscription. ‘…Most of the cash for the £3 million machine came from a bequest plus a £1 million Keele University research grant – and £250,000 was donated by the public. Ron Alcock, aged 75, from Cheadle gave £1,000 after the death of wife Jeannette of leukaemia in 2009. He said: “Because of Mr Cameron’s policies private firms are coming more into the NHS. “That scares people that it will be privatised and could deter them from raising money for things in future.” The Royal Stoke had pooled its expertise with Wirral-based Clatterbridge Cancer Centre and the Royal Liverpool to put in the NHS bid for PET-CT scanning across a region of around five million people…’ And presumably sufferers will have to pay handsomely to have a scan.
NHS England’s special department, the ‘Strategic Projects Team’, was in charge of the procurement for the scanning contract – the very same team founded in 2009 to handle the management of Hinchingbrooke hospital in Cambridgeshire leading to the first full privatisation of an NHS hospital. ‘Circle’, the private healthcare firm that ‘rescued’ the hospital, hoping to make a big profit, was trumpeted for stepping in to triumph where the NHS had ‘failed’. Circle abandoned the hospital after a damning report from quality inspectors and because they found they couldn’t make a profit out of the hospital. So the hospital will be graciously given back to the NHS to pick up the pieces – at what cost to the taxpayer? – a clear case of what it is thought might make a profit being hived off into private hands and government friends while non-profit-making services to the community continue to be starved of funds.
This is the pattern of all privatisation ‘initiatives’. Hinchingbrooke has just been disappeared from the BBC ‘news’ bulletins. The BBC is fearful that its licence will not be renewed in 2016 if it does its job as it should be done – open and transparent reporting of the way things really are.
Back to Letwin’s Letter
‘The driving principle behind all public procurement policy is to award contracts on the basis of value for money through open and fair competitive tender in accordance with public procurement legislation…’
This is clearly not happening in the case of the Royal Stoke bid to run PET-CT scanning across their region nor did it happen in the case of Hinchingbrooke. In fact, the suspicion arises in the first case that a prominent member of the Tory government will ultimately benefit from the acceptance of a more expensive bid and in the second that Tory donors were theoretically being rewarded.
When a government minister chooses to engage in wool-pulling they get their minions to concoct linguistic gobbleygook. So, in Letwinese:-
‘Public sector procurers are required to assess value for money from the perspective of the contracting authority, using criteria linked to the subject matter of the contract, including compliance with the published specification. Wider socio-economic criteria can be taken into account at tender evaluation stage if they relate directly to the subject matter of a contract from the point of view of the contracting authority. However, the Public Services (Social Value) Act already places a requirement on commissioners to consider the economic, environmental and social benefits of their approaches to procurement at the pre-procurement stage.’
The one and only intelligent question that might come out of this shambles of an explanation is: what ‘economic, environmental and social benefits’ derive from accepting a private company’s bid rather than the less expensive one from groups already engaged in pooling their expertise over the scanning project?
Letwin then has the effrontery to offer reassurance to ‘the constituent’ [viz, myself] that, ‘whilst this government is the most transparent ever…’
At a time when the biggest lie & lack of transparency is that of the need for ‘Austerity’, pardon me, while I fall about laughing with profound and disgusted incredulity…
‘…we recognise that there is more to do and we are continuing efforts to ensure that as much information as possible is disclosed about performance so that public confidence in outsourced public services improves…’
Lack of transparency is the keynote of the Coalition Government. It flourishes across the whole of their dictatorship. So in another contexts:-
Or, relation to fracking, which my MP supports, watch the following on Lord Brown and transparency…
This government is transparent? About as transparent as a ten inch block of concrete.
Anyway, back to health issues…
There sure is ‘more to do’, says Letwin. His Government of toffs has no intention of doing anything about transparency while opacity suits them very well… Ian Syme, coordinator of North Staffordshire Healthwatch said:
“There’s little or no openness or transparency in these tendering processes, no public debate, no meaningful public scrutiny. Ask for details and you get obstructed by the ‘commercial confidentiality’ excuse.” He added: “The evidence is stacking up that NHS England have a privatisation agenda and NHS England are at the moment privatising NHS by stealth.”
But Letwin persists:
‘…we have been working with the Confederation of British Industry to agree key principles for greater transparency, which will be published early in 2015. Moreover, the Government has taken steps to improve our management of supplier relationships and performance, and to ensure that past performance is taken into account when awarding future work…’
Working with the CBI to agree key principles of transparency? – they are a corporate think-tank in league with the government. The key principles of transparency are pretty straightforward and don’t take much stating or even thinking about:-
• tell the absolute truth;
• don’t operate with a hidden agenda;
• use prose that makes sense;
• don’t wrap lies up in abstractions and gobbledgook;
• be open and clear…
It’s as simple as that – but impossible for the ideologues of the Right who have an agenda that they must keep hidden for fear of a revolution.
Letwin: ‘Finally, increasing competition and consumer choice drives innovation and efficiency…’ What is the proof for this? It doesn’t work in the energy industry, why should it work in the much more subtle healthcare field? In any case, ‘Competition’, presupposing it ever drives anything worthwhile, is not relevant to healthcare; ‘choice’ is of no consequence if your health is threatened: if you’re unwell you just want sorting out, as I was in 2011. True innovation in healthcare is naturally dedicated to finding even better ways to improve people’s state of being which costs money: doctors and consultants are professionally dedicated to doing what’s best for patients; all they have to compete against is illness and various kinds of decrepitude.
More Letwin obfuscation follows:
‘…Consequently we are committed to opening up government procurement, to levelling the playing field for suppliers of all size and type, and to identifying opportunities for further private and voluntary sector involvement in service delivery where these can offer benefits to the tax payer and service users…’
‘…levelling the playing field…’ a nonsense expression which could mean anything you like.
Letwin concludes ‘…I hope that this information enables you to respond to your constituent and goes some way towards addressing their concerns…’ Laughable!
Of course, all this simply increases my concern especially when I set such tosh against the case studies of Stoke Hospital and Hinchingbrooke – and that just for starters.
At the same time I am assured that the NHS is definitely not being privatised. My parliamentary ‘representative’ seems not to know what his colleagues are planning… Francis Maude (Cabinet Office minister), for example.
In The Daily Telegraph, 14th December 2014, James Kirkup reported that hospitals and other acute services could leave the NHS, to save money and improve care… That’s a great soundbite but it’s a contradiction in terms: ‘Saving money’ and ‘improving care’ do not mesh together – in order to improve care money has to be spent unconditionally to the point where improvements may be made.
Maude, dropping the official lies for a moment, letting the cat out of the bag, told The Daily Torygraph that,
‘…in the continuing shrinking of the state and the cutting of costs, almost everything could be handed over to mutual companies owned by employers and other non-state bodies. He also warned that public sector jobs and wages would have to fall sharply to ensure the Government lives within its means…’
The government already has the means to care for public services: make sure the rich and the corporations pay what they owe to the system by taxing them properly. It’s been shown that the so-called ‘deficit’ could be eliminated overnight by collecting all the tax that’s owed by the rich who exploit all the loopholes they can find or engage in the immoral tactic of shifting their outfits to ‘tax havens’. What do they care for the country, the state, and its people? Nothing. Profit rules OK.
Incidentally, always beware the word ‘mutual’ which is craftily slipped into sentences that are really about slashing & burning. It signifies nothing – but in the mouths of government officials it can sound vaguely benevolent – done for the ‘mutual’ benefit of all.
The ill-educated Osborne has apparently set out plans to reduce public spending to its lowest level since the 1930’s. Maude,
‘…who is drawing up plans for £20 billion of Whitehall savings by 2020, said that with the exception of defence and policing, every function of the state could potentially be done outside the public sector. But instead of ‘red-blooded commercial for-profit outsourcing’ [sic] to big companies, services could be transferred to a range of ‘mutual, joint venture or hybrid’ companies run by their staff. He said it would ‘give flexibility to evolve services around the needs of the user, which makes for a better outcome and saves money’…
Sez who? And there’s that word ‘mutual’ again. And in any case, ‘staff’, in the shape of wage slaves, already run companies. The corporate moguls simply pocket the profits created by hard-working ‘staff’. Nothing ‘mutual’ about that.
One might easily be forgiven for thinking that Maude is advocating honest public involvement, ‘mutuality’, but there’s no doubt that corporate entities will move in to fill the vacuum whenever they can sniff a profit to be made. The fraudulent policy of ‘Localism’, advocated by the Coalition in 2010, turned out to have nothing whatsoever to do with individual involvement in political planning – it’s simply that local corporations take over at a local level. Beware the term ‘mutual’ – that doesn’t mean co-ownership or anything like it any more than Free Schools are ‘free’ of anything. The frequent use of the word is a Government linguistic ploy.
The Concept of ‘Mutuality’
Writing in The Guardian, Monday 19 January 2015, David Owen points out that ‘…those who advocate ‘the market as the organising principle of the NHS’, have abused the term ‘mutual’ as a less abrasive way of achieving their objectives…’
One of the principles of ‘transparency’ – say what you mean without euphemism or circumlocution.
David Owen continues
‘…Hinchingbrooke Hospital is now in ‘special measures’ with an uncertain future, and the real NHS will have to pick up the pieces [ie pay for the government cockup]… Circle’s spin was that it was a ‘mutual’, because it was supposedly half-owned by staff; and commentators glossed over the fact it was half-owned by hedge fund managers. We were told it would ‘liberate’ NHS staff from the tired, over-centralised state solution. The marketeers believed that only by leaving the NHS and being given shares in their own hospital could staff be motivated to work harder for patients…
‘…The notion that such “mutual” structures are more responsive to grassroots staff was demolished by the CQC. The management of Circle merely replicated old hierarchies, with nursing staff reporting that they felt unable to raise concerns, with managers brought in from industry totally out of their depth. Morale at Hinchingbrooke was at rock bottom, with the last staff survey placing it in the lowest 20% of hospital trusts on key indicators including job satisfaction, bullying, training and potentially harmful errors…’
‘…The mutual concept is enthusiastically promoted by ministers. Turning every aspect of our public services into ‘mutuals’ as they imagine them – or mutual ‘joint ventures’ with growing opportunities for private investors – seems more politically sellable than more blatant forms of privatisation.
‘Maude has written to every acute hospital in England, inviting them to explore leaving the NHS to become just such a ‘mutual’… Ali Parsa, Circle’s founder and ex-Goldman Sachs banker, told a receptive media that more ‘business culture’ could work miracles on our underfunded hospitals. But …the A&E waiting time management system based on Argos tills failed – patients in Hinchingbrooke’s understaffed A&E were twice as likely as the average NHS A&E patient to wait so long that they gave up and left without being seen.’
So Much for the Business Model
Considering that ‘Circle Partnership’ gave up running Hinchingbrooke hospital not a month after the The Daily Telegraph report of 14th December 2014 because they couldn’t make a profit out of it, the following statement in the report makes for rather hollow reading: ‘…the National Health Service is already experimenting with transferring some ‘acute’ services out of the public sector. Hinchingbrooke hospital in Cambridgeshire is run by a company jointly owned by its staff and private investors… Critics have claimed that this has led to lower standards, a claim ministers reject…’ Critics turned out to be quite right.
Click to enlarge!
What would the Prime Minister have to say now? Something no doubt to cover tracks in some smooth-talking way or, more likely, he’ll just pretend it never happened.
Now, it’s of no consequence to me that the privatisation process was set in motion by Iraq-Demolition-Blair’s government. The idea of making a profit out of health is criminal whoever started it. But, with a version of the habitual snide remark about ‘the previous government’ and its so-called failings, ‘Maude insisted that his reforms were inspired by Labour, the previous government, saying, “The Blair public sector reformers got rid of the shibboleth – public sector good, private sector bad,” he said. “It’s not binary.” He added that there would be more such changes to come in the health service, adding that he did not ‘see a line’ limiting the number of transfers out of the public sector…’ – a circumlocution for total privatisation.
The replacement mantra, ‘Private sector good, public sector bad’, simply means jobs being moved over to the corporations and organisations owned by the millionaire supporters of the Tory Party who offer zero hours contracts and nil support for the less well off.
‘…Independent forecasters have said Coalition spending plans will mean the loss of another million public sector jobs…’ In his mealy-mouthed fashion, ‘…Maude admitted: “We won’t make the savings that have been set out without further reductions in headcount and pay bill.” He said this would not necessarily spell blanket pay cuts, but suggested that it was a mistake to think the state should compete with private sector employers on pay…’
‘Reductions in headcount’ is a euphemism for creating unemployment, depriving people of real jobs. Essential to the successful instigation of ‘transparency’ is using the right words to describe what you’re really talking about. The use of circumlocutions and euphemisms like ‘headcount’ is a sure sign that something underhand is taking place.
It Goes On and On…
Charlie Cooper, Health Correspondent of The Independent, Wednesday 17th December 2014 reported that NHS Nottingham University Hospitals Trust, regarded as a national centre of excellence for dermatology, has been forced to scrap highly rated services, including emergency care for patients with severe skin conditions including skin cancer, after losing six of its eight consultants reluctant to work for private-sector subcontractor, Circle, which won a contract to provide most of the local dermatology services last year. ‘…The Trust lost out to Circle, despite warnings from senior doctors that they would leave rather than be transferred out of the NHS…’ They were afraid that ‘…a profit-driven provider would not offer opportunities for academic research or training…’
The British Association of Dermatologists (BAD) warned that the privatisation and ‘fragmentation’ of specialist services was ‘decimating’ some areas of the NHS. Dr David Eedy, president of BAD, said it was now offering reduced facilities and a ‘fractured’ service, increasingly dependent on more expensive locum doctors…’
‘… “Nobody has thought through the implications for teaching, training and research – the whole future of British dermatology,” Dr Eedy said. He said the ‘exodus of staff’ should have been predicted. “Nottingham is just one example of the many fires we are fighting across the UK to try to keep dermatology services open in the face of poorly thought-out commissioning decisions and the Government’s lack of understanding of the implications of pushing NHS services into unsustainable models provided by commercially driven private providers or enterprises,” he said…’
I suspect that the government is only too aware of the outcomes of their policies: starve of funds, privatise, profit… Never mind service to the public…
‘…Dr Clive Peedell, a consultant oncologist and co-leader of the National Health Action Party, said the rate of outsourcing in the NHS required an urgent review. “We now have a shocking situation where an entire region is at risk of losing acute adult dermatology services,” he said. “Cancer services could also be affected because dermatologists play a key role in the management of skin cancers like melanoma.”…’
‘…Labour’s shadow Health Secretary, Andy Burnham, said: “The true ideological intent of the Government’s NHS plans is becoming clearer by the day. They ploughed on with this privatisation even though doctors said they would leave. It shows competition lawyers, not consultants, calling the shots in the Coalition NHS. Labour will scrap the competition culture and put the right values at the heart of the NHS”…’
One can only hope that this is unequivocal policy. We shall see, maybe…
But it goes on and on… Some positively evil things are happening. Hugh Pym, BBC Health Editor reported an NHS England plan ‘…to pay a reduced fee to hospitals for each extra patient they take on…’
The Daily Telegraph:
‘Hospital specialists [including some of Britain’s most eminent neuroscientists, cancer experts and cardiologists – people who should know what they’re talking about…] have hit out at plans to reduce funding for specialised operations and treatments NHS trusts provide, including some cancer care. Some 345 specialists have written to NHS England saying the changes could mean longer waiting lists and avoidable deaths. Under the plans, centres treating more patients than expected would receive just half the extra treatment costs. NHS England says these services have already seen a big increase in funding and now have some of the highest profit margins in the NHS…’
Profit margins that the private providers would no doubt love to get their hands on. This is sleight of mouth underhandedness… The general aim is to curb a growth in spending on specialist services – entailing cutting research – for conditions such as uncommon cancers, burns and medical genetics. One can only assume that there is now a deliberate policy to cull the whole population.
Moving Deckchairs on the Titanic…
‘…Just what should NHS priorities be at a time of rising demand for care and more sophisticated medical technology and treatment becoming available? ‘…NHS England have taken a decision to shift some resources from specialised provision, including some complex cancer surgery, to areas which they feel are in need of more funding, such as mental health. In effect it has a cake, agreed with the Department of Health, and it has decided to slice it differently from next year. There is no plan to cut specialised services, rather to pay hospitals less for each new patient they take on. Hospitals and their consultants are understandably upset that their income for new work will be lower than they expected. They warn that patients will suffer as waiting lists for treatment will get longer. Why, they argue, should people needing cancer treatment lose out at all?’
Quite right. I speak as a more than grateful recipient of such treatment.
Though it sounds good – ‘…no plan to cut specialised services…’ – paying hospitals ‘less for each new patient they take on’ is an underhand, far less than transparent way of making cuts. One can imagine Tory apologists sitting around a table brain-storming ways of cutting & slashing whilst giving the impression that they are being so benevolent & caring.
However, the letter [from the specialists concerned] quoted by the Daily Telegraph says
‘…the proposals will leave hospitals with a choice of treating patients and incurring a financial loss, or not treating them at all. The clinical consequences of these longer waiting times and a lower quality service to patients with conditions such as heart disease, liver disease, leukaemia, complex cancers etc will be severe… Each patient should get the treatment they need where and when they need it, instead of essentially robbing one part of the system to pay for another…’
In a separate letter to the Daily Torygraph, a leading cancer expert said the changes would devastate services for the most sick. Simon Oberst, director of clinical development at Cambridge Cancer Centre, based at Addenbrooke’s Hospital, said the plans flew in the face of promises by the health secretary to improve Britain’s poor rates of cancer survival. ‘Hunt’s fine words are belied by his specialist commissioners at NHS England,’ he writes. The senior manager of cancer services said ‘…the proposals were perverse, given recent statements from the health secretary acknowledging that hospitals currently see 51 per cent more patients with suspected cancer than in 2010…’ It seems that there will also be an average 6 per cent cut in provision for chemotherapy.
And it all started when the so-called ‘Coalition’ came to rule us.
The NHS is not Being Privatised?
On Sunday 9th September 2012, Daniel Boffey, policy editor of The Observer, reported that Hunt, the new health secretary, personally intervened to speed up the takeover of NHS hospitals in his constituency by a private company, Virgin Care. He wanted the £650m deal to be swiftly signed to end the delay caused by concern for outcomes. Virgin Care, part-owned by Sir Richard Branson’s Virgin Group, subsequently agreed on a five-year contract in March to run seven hospitals along with dentistry services, sexual health clinics, breast cancer screening and other community services. The takeover took place, concerns not addressed.
The shadow health secretary, Andy Burnham, said that
‘…never before has a health secretary handed over his local NHS lock, stock and barrel to the private sector. If what has happened in his own patch is his blueprint, then now’s the time for him to be honest with patients and staff. It is time the health secretary broke his silence on his plans and told the public how far he wants to privatise the rest of the NHS in England…’
Suspicions about Hunt’s motives are confirmed when we learn that
‘…he co-authored a book that supported transforming the NHS into a system of universal insurance where patients buy health care from the provider of their choice. The book, Direct Democracy: An Agenda for a New Model Party, sets out an alternative vision for a dismantled NHS. It says: ‘The NHS was designed over half a century ago, at a time of rationing and deep poverty. It was, and remains, a child of its time, conceived on the principle that the beneficent state should be a monopoly provider. But we know today that monopolies rarely act in the best interests of consumers. Because government both funds and provides health care, medical professionals are beset with political targets and central direction, distorting clinical priorities and preventing innovation.’
This is Orwellian double-think. There do not have to be political targets in a properly funded NHS and it all depends on who is running a monopoly – profiteers or real professionals…
The book Hunt is involved in adds: ‘We should fund patients, either through the tax system or by way of universal insurance, to purchase health care from the provider of their choice. The poor and unemployed would have their contributions supplemented or paid for by the state.’ Given a policy of 100 years of cutting & slashing, of so-called Austerity and a consistent attack on the poor and unemployed, it’s highly unlikely that the latter would happen at all and a private insurance system is simply a way of helping insurance companies to make even more profit.
A source close to Hunt denied that the minister wrote the section in the book about the NHS and said that ‘it does not reflect his views’ – so exactly what are his views and why did he allow his name to be associated with the book? It is claimed that he attemped to remove a tribute to the NHS from the Olympics opening ceremony. Now why would he do that?
Hinchingbrooke Should be Made to Haunt the Coalition
On the 9th January, 2015, Benedict Cooper, freelance journalist on medical matters, pointed out that Circle’s dumping of Hinchingbrooke Hospital was no surprise especially to National Health Action Party founding member and Save Lewisham Hospital veteran Dr Louise Irvine who said: “This is exactly what we warned and predicted would happen and illustrates the folly of private sector involvement in our NHS. When the going gets tough, the private sector gets going – and dumps NHS patients. The privatisation experiment has lamentably failed”.
In the autumn of 2014 there was a damning report by the Care Quality Commission (CQC). Shocking failings were revealed: ‘…little internal or clear external oversight of how the trust managed risks to the quality of care… lack of clarity or coherence over who was responsible for the oversight and scrutiny of the trust’s quality agenda; poor hygiene standards; and a ‘blame approach, rather than that of a supportive and patient focused approach…’ And this after Circle had been held up as a shining example of a private company stepping in to triumph where the NHS had failed. Benedict Cooper points out that ‘…when private companies bin their contracts with the NHS in such a self-serving fashion, it is the trusts’ time and precious taxpayer funds that end up being wasted on picking up the pieces… What cost will Circle’s walking away be to Cambridgeshire and Peterborough…?’
Inefficiency and waste and profits for the boys when the Government’s plan was supposed to be to save money and cut the so-called deficit…
Click to enlarge!
Three years after the Coalition began its nasty reign it was already clear that private firms were already running frontline NHS services without publicising the fact – that is, with lack of transparency.
On May 29th 2013, RosWynne Jones, journalist, who stands up for ordinary people, reported that Branson’s Virgin empire (‘planes, trains and telly’) was already running more than 100 services across the NHS. Visiting the Urgent Care Centre at Croydon University Hospital in South London, she told Sharon Byfield, 51, who was taking a break from her mother’s bedside. “I can’t believe what you are telling me,” she says. Her mum had been in intensive care for three weeks following a massive heart attack, now being treated by the NHS, but had come in through the UCC, run by Virgin Care. RosWynne Jones asked Sharon and her husband Neil, 44, whether it mattered to them who was running the place. “Of course,” Sharon says. “It’s about being straight with people. You should know who you’re being treated by.” “They say they’re not privatising the NHS,” Neil says. “But then they clearly are. If Virgin’s running this place, it’s privatised, isn’t it?”
But RosWynne Jones found it impossible to tell other people. It’s all kept secret with a studied lack of transparency. Usually, she says, when Branson launches a new line of business there are PR stunts but inside Croydon UCC there is not a single trace of Virgin branding… The clinic says NHS clearly outside.
But the truth that is not publicised is that ‘…the Government’s health reforms have already handed £7billion in contracts to private firms such as Virgin, private equity-owned Care UK, Serco and Circle. In late 2012, a further £20billion ‘bonanza’ for private firms was predicted by corporate finance adviser Catalyst.
Virgin Care’s interests inside the NHS are astonishingly diverse – sexual health services, children’s services, radiology departments, diagnostic and urgent care centres and even entire GP practices. In 2012, it won a £100million-a-year deal to run a whole host of services in Surrey, including community hospitals. In April 2013 it began a £132million deal to run children’s services for Devon County Council – including mental health, school nursing, health visits and care for the disabled. In May 2013 it announced a contract worth £6.6million to run healthcare inside HMP Bullingdon in Oxfordshire.
How come we don’t know about this? It seems that ‘… NHS brand guidelines require Virgin to ensure that the NHS is the primary logo…’ RosWynne Jones goes on to say that
‘…Section 75 of the Health and Social Care Act, passed in April 2013, has now opened up the NHS like a car boot sale. Campaigners say newly privatised services are being run at a loss while corporates hoover up the rest of the contracts. In two years’ time, the odds are they will be making a profit. Do we really expect these companies to run the NHS for the good of their health? Section 75 now makes it compulsory for services to be put out to tender.’
Now Here’s a Real Man
My rage at what’s going on is monumental. The sense of alienation I feel is inexpressible so here’s a quotation from Harry’s Last Stand by Harry Leslie Smith (born 1923). I let it speak for me. Says Harry:-
To me, the introduction of free health care was the first brick laid on the road to the social welfare state. So it has always been difficult for me to listen to politicians, proud possessors of health insurance and shares in private health care companies, when they talk about how the health service that we fought so hard to build must change. The coalition government’s Health and Social Care Act will create a two-tier health care system. This act will see the NHS stripped down like a derelict house is by criminals for copper wiring.
UKIP has even proposed that A&E patients should have the right to buy their way to the front of the queue, while in Merseyside a private for-profit cancer clinic has set up shop under the NHS umbrella. Where will all of this end? What will be given the greatest priority in a new health care system that sends every service, from blood work to chemotherapy, out to the lowest bid tender?
It ends where I began my life – in a Britain that believed health care depended on your social status. So if you were rich and insured you received timely medical treatment, while the rest of the country got the drippings. One-fifth of the lords who voted in the controversial act – which provides a gateway to privatise our health care system – were found to have connections to private health care companies. If that doesn’t make you angry, nothing will.
Sometimes I try to think how I might explain how we built these beautiful structures in our society – which protected the poor, which kept them safe at work, healthy in their lives, supported them when they were down on their luck – only to watch them be destroyed within a few short generations. But I cannot find the words.
Other than expletives, I really cannot find the words to describe my rage at what’s being perpetrated and so I resort to quotations and posters collected from the Internet.
Click to enlarge!
Back to Hinchingbrooke
The Hinchingbrooke Hospital farce has completely disappeared from the airwaves of the BBC, an arm of the Tory Party. Their ‘News’ bulletins never ask the question – why did England’s privatised hospital deal REALLY collapse? Never mind asking why Circle Health was given the contract in the first place. Of course it wasn’t because Ruddock, Arbib, Odey & Platt with stakes in Circle Health had donated £million and a half to the Tory Party. This is corruption on a grand scale and the majority of the electorate either don’t care or are too busy getting on with their own lives to bother or to make the time to find out. And the Power Possessors know this – they know just what they can get away with.
On 14th January 2015, Caroline Molloy, freelance writer and Green Party Activist, said that
‘…shocking examples of poor care were part of the reason Circle withdrew from running Hinchingbrooke Hospital. When Circle announced it was pulling out of its contract to run the Hinchingbrooke Hospital it blamed a £5million loss and an NHS crisis including ‘unprecedented increases in accident and emergency attendances, insufficient care plans for patients awaiting discharge, and funding levels that have not kept pace with demand…’
Because ‘…the real reason was a damning report by the Care Quality Commission (CQC) which awarded its worst ever rating for ‘caring’. Both safety and leadership were also bottom of the heap. Circle’s cleverly branded ‘mutual’ model, far from ‘liberating’ NHS professionals to make grassroots-led improvements, had in fact replicated some of the worst hierarchical, bullying practices to be found in the NHS. And it had lost the caring and expertise that are the NHS’s strengths, principally as a result of poor leadership and financially-driven staff cuts to satisfy investors. [To increase the profit…]
Circle’s medical services were found to be delivering ‘poor emotional and physical care which was not safe or caring…people were not treated with dignity and respect… some patients were afraid of certain nursing staff…’ During their two-day inspection the CQC witnessed patients being left dirty and distressed, and treated rudely or roughly: ‘…we heard a staff member say to the patient, “Don’t misbehave, you know what happens when you misbehave”. We later asked the patient what they thought the staff member meant by this; the patient became withdrawn and was unable to provide us with an answer…’
‘…A patient on Apple Tree Ward, who required support during the night to go to the toilet told us that staff were ‘often too busy’. “…They tell me to go in my bed and they will change me when they have time…”’.
When ‘failings’ in the NHS are revealed the BBC goes overboard to highlight them – these private defects went without notice.
Inspectors found a patient with ‘challenging’ behaviour had been sedated without any record of a proper assessment of their mental state or best interest.
Circle’s junior doctors were often labelling patients ‘do not resuscitate’ without discussing the decision with patients or relatives, and without any apparent oversight from senior doctors. Sometimes the failure to discuss was because the patient lacked mental capacity, notes often suggested – but the CQC ‘saw no evidence that a mental capacity assessment had been undertaken in any of the patient records we looked at’. The CQC notes ‘We found many instances of staff wishing to care for patients in the best way, but unable to … prevent service demands from severely impinging on the quality and kindness of care for patients’.
Circle had won the contract by promising what the Public Accounts Committee called an ‘unrealistic’ and ‘unprecedented’ level of savings – urged on by government officials. Circle’s Full Business Case said it would achieve this by altering ‘nurse-patient ratios’ but exactly how was blacked out of the plan when it was eventually published. Leaks suggested plans to cut 320 posts in total. Within 6 months of taking over, Circle had already scrapped 46 full time nursing posts, then Chief Executive Ali Parsa (an ex-Goldman Sachs banker) admitted.
Circle loudly proclaimed its rapid improvement in the key ‘4 hour A&E waiting time’ target as evidence that ‘privatisation had quickly turned Hinchingbrooke around’. But the CQC discovered the hospital kept patients waiting too long in ambulances before they were allowed into A&E. And after they were seen in A&E, they then waited far too long – up to 12 hours – to be admitted to hospital. On this measure (so-called ‘trolley waits’) Hinchingbrooke had one in 5 patients waiting between 4 and 12 hours, compared to a national average of only one in 20 patients.
So Much for Key Targets
And whilst waiting in A&E, an unusually high number of patients (double the national average) left before being seen, fed up of waiting – and presumably unimpressed by the waiting-management computer system Circle had boasted was modelled on the Argos tills. (Circle’s senior management team had been hired from Argos, Avon, Faberge, Tesco and fashion-website Asos, bragged Ali Parsa in an article entitled “Government should not be running hospitals”).
‘…the chaplain singled out for special praise…’
Otherwise, the inspectors found ‘…incomplete patient notes, missing care plans, infected catheters, unwashed hands, broken clinical guidelines, fluids were repeatedly out of reach of patients, call bells were placed out of reach, diabetic patients were left without food…’ on and on. ‘…Many patients were being moved between wards in the middle of the night. One patient on the acute surgical and trauma ward said that they had been on seven wards in the first three days of admission, and had been moved at 12.45am, 3am and 5am on different days…’
Staff morale was amongst the lowest in the country. ‘…Staff told the CQC that shortages also meant little time for training. For example, staff at ward level were not competent in caring for people at the end of their life, because they had not received the training required to enable them to undertake this role…’
Caroline Molloy concludes that
‘…just as opponents to the Health & Social Care Act pointed out, what the private sector really want to do is cherry pick, taking the government money to run all the predictable and easy stuff – starving the rest of the NHS of funds as a result…’
‘…In nearby Bedfordshire, Circle recently won a huge ‘integrated’ ‘prime contractor’ contract for all musculo-skeletal services in the area – and promptly tried to sub-contract the undesirable bits back to the NHS on Circle’s own terms. As the local NHS hospital told the BBC, “Our concern is that if we don’t have the planned work coming through, then with the way the NHS is financed, we don’t know whether we will have sufficient money to provide the emergency service.” Recent reports suggest Bedford Hospital is now in severe financial difficulties…
It Goes On and On…
On 17th January 2015, Dan Bloom posted an article in MailOnline indicating that NHS was more than doubling spending on private beds for mental health patients after slashing hundreds of its own beds in order to save money.
‘…Cash-strapped hospital chiefs are spending vast amounts on sending mental health patients into private care after they axed more than 1,000 NHS beds – in order to comply with the Government’s demand to ‘make saving’. Damning figures compiled by MailOnline show the soaring amount paid to private firms to provide ‘out-of-area’ beds (maybe hundreds of miles from patients’ homes & costing the taxpayer thousands of pounds) which are used as NHS mental health wards are cut back. Figures provided by 22 mental health trusts show they spent £38.2million on private sector out-of-area beds in 2013/14 – two and a half times the £14.7million they spent in 2011/12.
Mark Winstanley, chief executive of Rethink Mental Illness, said: ‘Sending people away from home for treatment, while cutting beds in local mental health wards, makes no sense financially and causes human misery. Not only is this a bad use of vital NHS resources, it is also very distressing for people because it delays them from getting treatment and cuts them off from their family and friends. Everyone who needs a hospital bed should be able to get one close to home, no matter where they live or what their circumstances are.’
The Royal College of Nursing warned care was at crisis point, with 1,500 mental health beds closed down since 2010.
General secretary Dr Peter Carter told MailOnline demand has risen by almost a third since 2010. ‘It’s a false economy to make these sorts of cuts,’ he said. ‘This increased NHS spending on private sector beds is a sign that the health service lacks capacity and urgently needs to increase its own provision. This short-sighted approach also undermines the quality of patient care. Inadequate provision means there’s a severe lack of mental health beds in many communities and too many patients have to go hundreds of miles away from home to access a service… Some patients with serious mental illnesses are having to wait until their health deteriorates to such an extent that they have to be detained before they start getting specialist care. Children with mental health problems have been placed in police cells because there aren’t beds available. One of the worst offenders was the South London and Maudsley NHS trust, which leaped from spending £1.8million in 2011/12 to £5.5million last year.
A spokesman in a mealy-mouthed coverup, said that the government has invested £450m since 2010 to improve access to talking therapies, helping almost a million people. The Government has made it clear that beds must always be available for those who need them,’ the spokesman added. ‘We are going further than ever before to put mental health on a par with physical health and we expect NHS Trusts, who have committed to making this a reality, to ensure mental health doesn’t lose out in local spending…’
On February 21, 2015, the day I posted this Glob, we learn that, as an election ploy, the Coalition is going to devote £300m to mental health… For god’s sake let’s not be constantly fooled by these criminals of the Right.
A Locum A&E Doctor Speaks Out About
the Silent Privatisation of the NHS Workforce
On 3rd February 2015, Paul Teed, a junior A&E doctor wondered why the government is privatising its own in-house locum agency when MP’s are highlighting soaring NHS spending on agency and locum staff. He said,
‘Last year, I worked as a locum A&E junior doctor. I saw the fragmentation caused by the internal market and Health & Social Care Act first hand and soon realised who benefits from the coalition’s privatised healthcare designs – the privileged, not patients.
The overall spend on locum doctors is at an all-time high. It is particularly high in A&E departments and worsening. Spend on agency staff to fill medical rotas across hospitals has risen ‘exponentially’, Department of Health officials have told MPs on the influential Public Accounts Committee (PAC). The PAC’s new report released today reveals last year alone, agency spend jumped from £2.1billion to £2.6 billion. It costs the public purse an average of £400,000 to train an emergency consultant, according to Margaret Hodge, Chair of the PAC. Yet every year a hundred A&E consultants are now leaving the NHS to work abroad. Those that remain increasingly work for locum agencies – which profit by charging the NHS an extra 30% for the work.
When I work for a publicly funded agency the fee goes ultimately to the private equity firm, the Blackstone Group, whose chairman is so concerned with our nation’s health that he’s also on the board of British American Tobacco. The scale of the profit is highlighted in the offer of a referral bonus of 50p per hour of every hour another doctor works if I get them to work through them. Thus the NHS subsidises an ever increasing amount of stakeholders who profit from privatisation.
We’re told that NHS human resources administration is being outsourced to these agencies for the sake of efficiency, but in truth the same tasks are repeated, sometimes in triplicate, merely adding another layer of corporate bureaucracy for all involved.
We Should be Speaking Out With More Determination
In The Guardian of 6th Feb 2015, Owen Jones sums it all up:-
… the NHS is our cherished national institution: research by British Future two years ago revealed it made us most proud to be British, coming ahead of both army and monarchy. We are quite literally born into it; it is our confidante for some of our most personal worries; it tends to us whether we have broken bones or are consumed with anxiety; and it is there, unconditionally, until we die. How could we have been so passive when it came under attack?
The King’s Fund has today given the definitive verdict on policies the electorate neither asked for nor were consulted about. The so-called reforms have proved ‘disastrous’, it says. Its chief executive speaks of three wasted years when the NHS desperately needed to focus on ‘growing financial and services pressures’ but is now left with a structure that is ‘complex, confusing and bureaucratic’ and ‘not fit for purpose’. For any organisation this would be a damning verdict. But this is our NHS which has been assaulted and traumatised.
Complexity Deliberately Designed to Fool Us
How have they got away with it? In part, the government’s policies were shrouded in so much complexity it often seemed hard to understand what was going on. Ex-health secretary Andrew Lansley’s Health and Social Care Act 2012 was notoriously much longer than the original legislation that introduced the NHS in the first place. Then there is the lack of media scrutiny. The public’s affection for the NHS is not shared by many of those who run the British press, many of whom shun public healthcare and go private. For the left, a battery of government assaults – from social security to education – meant overstretched resources. Bread and butter issues, like disabled people forced to pay the bedroom tax, often feel like more of a priority than a complex problem with longer term implications.
Government apologists will seize on the report’s finding that although damaging marketisation has taken place, the feared mass privatisation has not materialised. Opponents of the government’s policies always pointed out that the legislation laid the foundations for long-term rather than immediate privatisation. The ‘National’ was stripped from an increasingly fragmented National Health Service.
As Open Democracy points out, for example, the Tories have been promoting the sell-off of NHS property. And critics of the King’s Fund, such as National Health Action Party co-lead Clive Peedell, suggest it is undermined by previous support for pro-market NHS policies. Another pro-government defence is that Labour in power promoted privatisation, which is of course absolutely the case – and yet another reason why the leadership needs to draw a clear line with its past.
The NHS has been fragmented by this government’s policies: it is being squeezed of cash and resources; cuts to local authorities have heaped pressure on it; and it is being ever more stretched by an ageing population. This winter’s A&E crisis was a cry of pain from the NHS, and there will undoubtedly be many more to come. Labour has to be held to its pledge to promote integration rather than fragmentation. We need an NHS that focuses on prevention rather than managing disease.
But here’s the problem. There have been dedicated, dogged campaigners – but too few of them. We didn’t like what the government has done, we didn’t ask for it – but much of it has gone over our heads. We love the NHS – but we have been all too quiet as it has been fragmented and undermined. We have proved that it is even possible to attack our most treasured institution without causing too much fuss. It is a lesson that this and future governments will remember. Perhaps, then, it is time to speak out.
‘Liberating the NHS’ into the Hands of the Profiteers
In the Independent 7th February 2015, commenting on a highly critical report by the King’s Fund think-tank, Charlie Cooper wrote that Lansley’s ‘damaging reforms were at root of the current NHS crisis’ – they had probably contributed to the current crises in the NHS. Changes set out in the Health and Social Care Act 2012 amounted to the ‘biggest and most far-reaching legislation in the history of the NHS’. The Coalition’s health reforms were ‘damaging and distracting’ for the NHS, and government policy for the past two years has been ‘devoted to limiting the damage’.
Drawn up during Mr Lansley’s time in opposition from 2005 to 2010, they were outlined in a now-notorious White Paper in 2010, subheaded ‘Liberating the NHS’. They led to the complete overhaul of the management and bureaucratic structure of the NHS, while also placing a stronger emphasis on competition and markets in the provision of care. But they coincided with a time of rising pressure on hospitals and GPs from an ageing and growing population, as well as a dramatic slowdown in government funding.
Meanwhile, an Hunt apologist said the King’s Fund report highlighted ‘why both the public and the health sector should be wary of Labour’s plans for upheaval and reorganisation.’ What planet are they on? Labour’s plans for upheaval? One of my own principles is always to listen to what you say about other people because what you hear will tell you more about yourself than it will about them.
Click to enlarge!
Take It from an American – Britain’s NHS is As Good As It Gets
‘…It’s no wonder that 30% of healthcare spending in the US is absorbed by bureaucracy – nearly twice the proportion that other industrialized countries spend. This is rather strange, given that the chief justification for private healthcare is that it suffers less bureaucracy. It turns out that exactly the opposite is true…’
Let Jason Hickel (anthropologist at the London School of Economics) conclude this horrific recital of mine. On 16th February 2015, he wrote this brilliant article in unmitigated high regard for Aneurin Bevan’s Health Service:-
As an American, I have followed the debate about the future of the National Health Service with curious fascination. I must say I don’t entirely understand why this has even become a question – why anyone seriously thinks that privatizing the NHS would be a good idea, or why we have to resort to citizen campaigns simply in order to keep it around. As far as I can tell, the NHS is one of the best things Britain has going for it, and it would be a monumental step backward to let it go.
I haven’t always held these views. Being on the left, I have long been committed to the principle of socialized healthcare, but, like most of my countrymen, I secretly suspected that such a system could never really work in practice. Before I moved to London in 2011, I had visions of the NHS as a quagmire of forms, queues, and long waiting times. These assumptions affect US progressives as much as they do devotees of Fox News: they’re in the water, part of the commonsense furniture of everyday life. Somehow we all end up believing that America’s private, for-profit healthcare system is our only hope, and without it we’re likely to end up dying while waiting in line for basic treatment. For most Americans, the specter of socialized healthcare – and of the NHS in particular – looms like the heavy shadow of Russian bureaucracy in a Gogol novel.
I was forced to confront these assumptions when I made my first visit to the doctor, which I put off for a long time out of sheer fear. I expected to have to take a train to some government complex where I would submit myself before a nameless bureaucrat behind a glass barrier in a brutalist concrete building. I literally thought this. So I was pleasantly surprised when it turned out that all I had to do was walk five minutes down the road to the nearest GP.
Upon arriving, I went straight up to the counter – no queuing required – and asked to register. Instead of the multiple page forms that I expected to fill out, which I had grown accustomed to completing every time I visited a doctor in the United States, I was presented with a single quarter sheet with the obvious fields: name, date of birth, and address. Nobody asked me for a health insurance card. Nobody asked if I would be able to pay. Nobody asked me for a British passport to prove that I was worthy of care. The edifices of my worldview began to crumble around me.
Fine, I thought: registration may be simple, but surely I’ll have to wait weeks for my appointment? Or even months? I was wrong again. I was given a slot that very afternoon.
I did have to sit in the waiting room, I’ll admit: for a sum total of 15 minutes. During that time, I marveled at the attractive display of public health information lining the walls – something I had never encountered in the US. It struck me, for the first time, that a publically funded healthcare system actually has an incentive to maintain good public health through mass education and preventative care. What a refreshing change from the perverse incentives built into the American model, which not only lacks this motive but operates according to the opposite logic: the more bad health there is in the population, the more money there is to be made from it.
My doctor was warm and professional, set up the referral and ordered my tests, and sent me on my way. As I passed by the receptionist at the front desk I felt almost guilty, and actually stopped to ask her if I needed to pay anything before leaving: surely there must be at least a small fee? She laughed at me. To this day, three years later, I still can’t get used to it, to the idea of health as a public good – it seems too humane to be true.
Some might rush to conclude that this surprisingly positive experience is probably due to the fact that I live in a posh white part of London. But I don’t. I live in Kilburn, and the clinic in question is adjacent to a number of council estates. The vast majority of the clinic’s patients are working class, and only about half of them are white. The first-rate care I receive is the care that every resident receives, regardless of their race or class – as a basic human right, as part of the social contract, as a feature of the collective solidarity that Clement Atlee’s Labour government forged in the 1940’s from the ashes of World War II.
And it’s not just that this clinic happens to be a good apple in a barrel of bad. I’ve been referred to specialists in other units – including large hospitals – on a number of occasions, and each time I’ve found myself amazed at the efficiency of the service. At one point I was referred for a possible case of melanoma. I was seen by a dermatologist at the first break in my schedule. So much for languishing in line for treatment. Why so efficient? Because there’s a powerful incentive at work: the NHS saves money by catching cancer early.
And it’s not just life-threatening illnesses that call forth the best of the NHS. The mundane phlebotomy lab I had to visit recently at the Royal Free Hospital was run like a well-oiled machine, caring for fifty patients an hour at peak time without a glitch. The system just works. We needn’t rely on anecdotes to prove this. The Commonwealth Fund recently released a report comparing the health systems of 11 highly industrialized countries. In the category of efficiency, the UK ranked number 1. The US, by contrast, ranked last. So much for the theory that profit stimulates efficiency. The UK also ranks well above the US in terms of timeliness of care, contrary to Fox News propaganda.
I suppose I shouldn’t be surprised; while living in the US I spent an astonishing amount of time waiting for appointments and sitting in receptions, even as a paying customer. I sometimes caught myself wondering if things might be different if I were able to pay more.
And it’s not just in the areas of efficiency and timeliness that the UK performs so well. It comes first in almost every other category – equity, access, quality, etc. – making it the best overall healthcare system in the world. As for the overall ranking of the US: dead last, again. The Commonwealth study didn’t measure bureaucracy, but I suspect that here too the UK would win handily. While living in the States I was regularly frustrated by the amount of time I had to spend not just filling out forms, but reviewing costs, interpreting bills, paying fees, comparing coverage plans, and badgering my insurance company over the phone to shell out for their fair share (an obligation they routinely shirked).
It’s no wonder that 30% of healthcare spending in the US is absorbed by bureaucracy – nearly twice the proportion that other industrialized countries spend. This is rather strange, given that the chief justification for private healthcare is that it suffers less bureaucracy. It turns out that exactly the opposite is true.
As for how likely a patient is to die for want of life-saving services: I wouldn’t choose to take my chances in the US, given that I’m not a millionaire. A close friend of mine recently discovered she had a fast-growing mass on her ovary that would lead to swift death if it wasn’t removed within the month. It sounds like a no-brainer, but before she scheduled the surgery she had to count the costs: her insurance company agreed to cover 80% (after much pressure from her doctors to get the company to cover it at all), but she would be responsible for the remainder – a sobering $40,000. She’s alive today, but she’ll spend many years working extra hours to pay off the loan she took out just to stay alive.
She is not alone. Millions of Americans are in debt due to healthcare costs, which is the number one cause of personal bankruptcy in the United States. In the UK we don’t have to face this terrible anxiety; it would be difficult for me to overstate how liberating this feels.
These are stories and statistics that I regularly wheel out during conversations with my American friends and family. And while they usually accept the evidence that I offer up (albeit somewhat grudgingly), they always insist that, sure, it sounds like a great service, but there’s no way it can be financially viable, right? But here again the evidence defies assumptions. The Commonwealth study confirms that the cost the UK pays for delivering the best healthcare in the world is less than any other industrialized nation: only $3,405 per capita. The most expensive healthcare system, by contrast, is the US, at $8,508 per capita – more than double the UK, while delivering much worse results.
Critics of the NHS claim that we can’t afford to pay for it; but the truth is that we can’t afford not to.
These data tell a clear story. But ultimately it’s not the extrinsic values of efficiency, timeliness, and low cost that make the NHS great. The NHS is great because it’s built on the principles of solidarity, universality, and equality – and because it is staffed by people who believe deeply in its basic moral mission. It is for these reasons that, when the NHS was founded in 1948, the Minister for Health Aneurin Bevan famously proclaimed that it was ‘the most civilized step that any country has ever taken…’
Yet, tragically, the present government is doing its best to dismantle the NHS, with the ultimate goal, it would seem, of replacing it with the US model. The Health and Social Care Act of 2012 put an end to the mandate for the state to provide comprehensive healthcare to every resident of England free at the point of use, and has allowed for-profit companies to buy up huge chunks of the NHS (£10 billion worth of contracts have already been handed out since the Act was passed). The Tories know the US system performs worse on every conceivable count, but they are willing to go there anyhow: the healthcare market-in-waiting is just too juicy to leave untapped.
Bevan knew that the NHS would face opposition from powerful private interests, but he was hopeful that it would prevail: “The NHS will stand,” he said, “as long as there are those who will fight for it.” Many Britons are doing just that. But, thanks to skillful government subterfuge, the vast majority do not even know that their cherished healthcare system is under threat, and many others don’t understand what it’s like to live with the dysfunctions of a private alternative. It’s sometimes hard to realize how good something is until it’s taken away from you. To England, I say, take it from an American: what you have is as good as it gets, and it’s worth defending. Your civilization depends on it.
Thanks to all the people I’ve quoted. I hope they won’t mind what I’ve done…