Girlfriend in a Coma
The NHS (National Health Service) is a publicly funded health care system that functions in Scotland, Wales and Northern Ireland.
As the election looms on, nine out of ten people fear the NHS being cut. Yet, there are plans that five years from 2011, the NHS will suffer a shortfall of £15Bn. This will no doubt affect services, and be detrimental to the service that the NHS provides.
However, historically there have always been cuts made to the NHS, which had its spending slashed within the first three years of its establishment: £8.5bn (in today’s prices) was spent on the NHS, in 1951-2, it fell to £8.4bn, and in 1952-3, to £8.3bn. Notably it was a Tory government in place, fronted by Winston Churchill whom performed the cuts due to ‘promising to slash taxes’. However, overall spending has increased in the past 60 years.
I shall now look at the forces behind establishing the NHS as we now know it today.
It was the Cabinet Memorandum. Social Insurance and Allied Services. Summary of Report by Sir William Beveridge. 25 November 1942, that looked at social security and how it was distributed in England, in the report Beveridge made a LIST OF PRINCIPAL CHANGES RECOMMENDED, a pivotal change he requested was
“…the Separation of medical treatment from the administration of cash benefits and the setting up of a comprehensive service for every citizen, covering all treatment and every form of disability under the supervision of the Health Department.”
Prior to this report, Individual families had to receive care from a variety of different organisations, each trying to fill the gap between the individual services, much like America’s free market health system today. The irony being it was the so-called ‘threat’ of socialism, that pushed a conservative government to establish the universal healthcare system, using ‘kindness’ as means to attain ‘power’.
In 1919 the Ministry of Health Act created the Ministry of Health, consolidating under a single authority the medical and public health functions of central government, and the co-ordination and supervision of local health services in England and Wales. The newly formed Ministry took over aspects of child and maternal welfare and medical inspection, as well as the treatment of children.
By April 1924 a conference was held under the auspices of the Labour Party, attended by a wide variety of organisations including the British Medical Association, the voluntary hospitals and members of professional staff associations. The conference was called to discuss the desirability of further state aid to extend and maintain the hospitals.
“The only way out of the impasse was for the state to accept the responsibility of providing hospital treatment for all who needed it, transferring the poor law infirmaries to the local authorities, and giving the voluntary hospitals the choice of remaining as they were, or of coming to an arrangement with the local health authority.”
The NHS was established in 5 July 1948 under the intention that the healthcare is a right, not a privilege.
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It was financed from central taxation. The rich paid more than the poor for comparable benefits and Bevan regarded this as a crucial part of the scheme
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Everyone was eligible for care, even people temporarily resident or visiting the country, though now if you’re without the adequate insurance you’ll have to pay. People could be referred to any hospital, local or more distant.
- Care was entirely free at the point of use, although prescription changes and dental charges were subsequently introduced
As the recession hits, all of the three main political parties are calling for cuts to public services, this will include the NHS.
Jacky Davis the Co-chair, NHS Consultants Association, as well as Dr Hamish Meldrum Chairman, British Medical Association, have both attacked the Governement’s use of the private sector, with the idea that ‘private is cheaper’.
“We must dispel this myth that the private sector can always do better. While there will always be opportunities to improve efficiency, the NHS consistently provides high-quality care at exceptionally good value for money. ” - Dr Hamish Meldrum
“I recently met Paul Corrigan, one of the chief architects of the NHS “reforms”, at a debate about the role of the commercial sector in delivering NHS care. I asked him to produce the evidence that the private sector delivered cheaper, better-quality care with more innovation. He said it was “too early to tell”. There is no evidence. Those who say otherwise should be challenged to produce the proof. ” - Jacky Davis
Lilian Macer, chair of UNISON’s Health Service Group Executive, said “the reality is that the NHS continues to provide excellent care regardless of income or employment, and at a fraction of the cost of the American system”.
Britain’s largest trade union has opposed the privatisation of the NHS, as well as the BMA, and the NHS consultant associations.
The ‘backdoor privatisation of the NHS’
The following is from a report conducted by Alex Nunns
Payment By Results
Under payment for results, hospitals are paid for procedures undertaken, rather than being allocated a budget with which to meet identified need. This puts hospitals in competition with each other for patients, as well as with private sector providers. More patients equals more funding, creating inflationary pressure. Prices are set according to a tariff, which has produced perverse incentives and encouraged gaming
Choose and Book
The facility for patients to choose the site of their secondary care from a limited “menu” of providers, including at least one non-NHS facility, acts as a golden stairway for the private sector to raise its business within the NHS. Tony Blair has said that by 2008, 40% of the work carried out by private hospitals will be paid for by the NHS.
Independent Sector Treatment Centres
ISTCs are stand-alone private sector clinics specialising in a limited range of simple treatments, such as cataract operations or hip replacements. The NHS contracts ISTCs to carry out procedures at a fixed global price, which is paid whether or not the operations are actually performed. They also have a negative impact on clinical training. Neither do ISTCs provide value for money: the Department of Health admits that on average these centres have been paid 11% more than the NHS for each procedure, despite only taking on simple and cheap cases and not having to train junior staff. With these factors added in, ISTCs are being paid around 30% more.
Outsourcing the commissioning function of Primary Care Trusts (PCTs)
The tendering process is currently being handled by the Department of Health, which is drawing up a framework agreement and a list of approved companies that PCTs can contract to take on commissioning. Private companies would thereby gain control over which treatments patients receive and who provides them.
Privatising GP services
The Alternative Provider of Medical Services contract is the vehicle being used to bring the private sector in to run GP services. This is a new form of contract, which according to the government is intended to be “light touch and low bureaucracy”. It requires a dramatic shift towards a commercial business model, as contracts must be tendered in a competitive process. The Department of Health has taken control of the procurement of GP services in 30 areas. The deals will be worth £150-200 million.
Practice-based commissioning
Practice-based commissioning allows the commissioning power for purchasing treatments - including hospital operations - to be transferred from PCTs to groups or consortia of GPs. It is part of a move away from the needs-based planning of health services towards a fragmented market with entry opportunities for the private sector.
Outsourcing PCT provision
Commissioning a patient-led NHS, published in summer 2005, set out plainly the Government’s vision: PCTs were to stop providing services, which would be delivered by a patchwork of the private sector and social enterprises.
Unbundling of primary care services
Primary care services are being broken up into saleable commodities in a process known as unbundling. The services required of all GPs have been whittled down to a core, which can then be topped up with locally negotiated additional elements provided by traditional GPs or, increasingly, by companies and corporations. These new entry points and market opportunities for commercial providers are already being exploited for out-of-hours services and immunisation, and mean that in many situations patients have no choice but to use the private sector.
Integrated Clinical Assessment and Treatment Service
ICATS sit between primary and secondary care, carrying out diagnostic tests and performing some procedures, but also have the power to refer patients on to hospitals and ISTCs. There has also been
“concern regarding the inadequate engagement of professionals and partner agencies in the development of the proposals” regarding the use of ICATS within Royal Bolton’s Hospital.”
Private Finance Initiative
Under the private finance initiative an NHS trusts signs a contract with a consortium of companies, which builds and maintains a hospital. The NHS trust then rents the hospital from the consortium, typically over a 30-year period. The purported purpose of PFI is to transfer risk to the private sector. But once the hospital is built that risk is so small that astronomical profits can be made from refinancing deals - as in the case of the Norfolk and Norwich Hospital, where the Octagon consortium made gains of £95m, and tripled its original expected internal rate of return from 19% to 60%, but left the hospital with extra potential liabilities of up to £257m should it need to terminate the contract early.
Local Improvement Finance Trust
LIFT is often referred to as the primary care version of PFI, but there are differences. The rates of profit flowing out of the NHS to private shareholders is just as high, despite the much lower risk of building a GP surgery compared to building a hospital. LIFT projects are costing up to eight times more than traditional ways of building. In Newham in east London, two LIFT premises that cater to just 9% of the local population are taking up 28% of the PCT’s expenditure on accommodation.
Subsidising private sector infrastructure
Recent Department of Health guidance on commissioning seeks to “reduce the risk for providers and consequently make the provision of new services more attractive to… new entrants”. It advises that this be done by paying a “supplement… to cover the set-up or development costs faced by a new provider”; by guaranteeing the “minimum income to be provided”; and by “lowering the barriers for new providers” through “reducing the capital investment required from the provider” - i. e., supplying the buildings.
Privatisation of NHS Logistics
The government decided to outsource it and a large part of the NHS Purchasing and Supply Agency to the German delivery firm, DHL, and its sub-contractor, Novation, in the biggest single privatisation in the NHS yet. Novation will carry out the crucial role of procurement with control over £4 billion of NHS money. There are serious outstanding allegations against Novation in the US. The Department of Justice is currently investigating the company over bribery and defrauding American public health schemes. There is also a wealth of evidence to suggest that Novation’s activities inflate the price of medical supplies in the US.
Privatisation of oxygen supplies
The service supplying oxygen to patients with breathing difficulties was privatised in February 2006. Previously it had been run by local pharmacies working with GPs, and oxygen was delivered within a strict target time of hours. But after the service was handed over to four multinational companies - Air Products, Allied Oxycare/Medigas, Linde and BOC - there was chaos, with patients arriving at pharmacies blue in the face after being unable to obtain oxygen for three days.
Privatisation of pathology services
In August, the Government announced an expansion of private sector involvement in pathology and diagnostic tests. Five independent providers were chosen as preferred bidders to supply more than 1. 5 million diagnostic procedures, including X-rays, ultrasound scans, and blood and other tissue tests, under contracts worth £1bn over five years. This came after a review by Lord Carter warned of the dangers of fragmenting pathology through the privatisation of the sector - a position reinforced by the Royal College of Pathologists.
Private ambulance services
Where the contracts are won by the private sector, there have been problems. For example, the South East Coast Ambulance Service NHS Trust is having to transport patients who private company GSL have been paid and contracted to carry.
Off-shoring medical secretaries
An increasing number of NHS trusts are cutting trained medical secretaries in favour of cheaper services abroad - typically in India or South Africa. This has raised fears for safety, with examples such as hypertension being mistaken for hypotension, with potentially fatal consequences.
Connecting for Health
The NHS’ ill-fated IT programme has given corporations a huge slice of public money and unprecedented involvement in shaping the way the NHS will deliver care in future. Latest estimates suggest the cost to the taxpayer could reach £20bn, compared to an original figure of £6.2bn.
A Vision for the future
Just across the pond, we can view a system of what the NHS could eventually be.
The question however, is this - how did the US get there?
Between the 1800s - 1912, took no measures to make sick insurance compulsory for every citizen, what then occurred was that the states were left to rely on private and voluntary programs for healthcare. Though there were some voluntary funds available, there was no laws in place during the 19th century, or in fact the early 20th.
In 1906, the American Association of Labor Legislation (AALL) established a campaign for healthcare. They sought not to remove capitalism, but to reform it (where have we heard that before?) unlike the fragment parties of the left, they were able to draft a model bill for healthcare in 1915, after having established the first national conference in 1913.
Essentially the bill covered the working class, covering the services of physicians, nurses, and hospitals, Sick pay, maternity benefits, and a death benefit of $50 were also included.
The costs were distributed between the state, the citizens, and the employers.
Progressive Era
Notably during the progressive era of Theodore Roosevelt (1901 -1909), he supported health insurance as he believed that no country could be strong whose people were sick and poor. (Essentially he really means that America could not be prosperous if its workers weren’t healthy).
Most of the reform took place outside of Government, and notably, unlike Europe there was not a strong working class labour or socialist movement that was pushing for reform.
It was in 1917 that the US entered WWI, and with that propaganda emerged, condemning the ‘German socialist health insurance’ , and at this time what with the ‘red scare’ of (1917-1920) which began after the Bolshevik russian revolution of the same year, health care reform proposals were put back until the 1930s.
So why had health care reform failed up to now? This in part due to: Opposition from doctors, labor, insurance companies, and business all of which stood to lose with state funded healthcare, pharmaceuticals in particular.
The Great Depression
The great depression had swept America, and subsequently the social security act was passed: whilst allowing for unemployment benefit (which at the time was in desperate need) and benefits for the elderly, yet healthcare was omitted once again.
The healthcare company Blue Cross begins to offer private healthcare coverage to US citizens, against the counsel of health professionals. As of 2008 Blue Cross profits were $320m.
By the 1960s they were over 700 insurance companies selling health insurance. In the 1970s healthcare costs escalated rapidly, partly due to inflation, the economy, and high medicare expenditure. As the 80s arrive, so too do the corporations, in US hospitals that is. President Reagan initiates the ‘payment by diagnoses plan’ (what this means is you pay the cost of what you have, rather than the cost of treatment).
As the 1990s settled in, healthcare costs had once again doubled against the rate of inflation, and another healthcare reform is failed to pass through U.S. congress.
America, one of the wealthiest countries in the world, and yet:
One in every six Americans under the age of 65 did not have health insurance (18%) in 2006
Almost 47 million Americans lack health insurance coverage, which represents more people than the entire population of Canada.
9 million children are uninsured in the U.S., while another 23.7 million –nearly 30 percent of the nation’s children- lack regular access to health care.
Thirty-eight million people from working families were uninsured in 2006 because not all businesses offer health benefits,not all workers qualify for coverage, and many employees cannot afford their share of the health premium.
Something borrowed, something new
With the Bolkstein Directive being pushed through the EU, Healthcare in England will radically change as it has two aims: to erase any national laws and standards that make it difficult for European companies to enter the markets.
The Second: to allow any business to operate anywhere in the EU according to the rules of its “country of origin.”
Which means that healthcare is likely to be seen as a lucrative (The UK’s healthcare market represents around £75 billion.) this “economic activity”, is a commodity to be traded across the EU much like any other, argued David Rowland.
The official stance of the directive is that the UK government has promised to exclude publicly funded healthcare from the directive, however like tuition and top-up fees, as for long this will last, remains to be seen.
If the backdoor privatisation of the NHS continues, it could see taxpayers contributing up to £24 for every £1 earmarked for lucrative private-sector contracts to run services for British hospitals.
The future of the NHS, is likely to be a hybridity, mixing public and private services, and notably profit will dominate over need, subsequently the original intentions of the NHS will be long forgotten in the ever quenching thirst for profit.
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