Harry Wells writes for us today on why the Left should oppose the NHS reforms.
Now seems like a good time to point and laugh at Andrew Lansley’s ‘reforms’ for the NHS; they’ve essentially come to a standstill in the face of public backlash and concern from the medical profession. It would be unfortunate, however, if the left were not to take what is essentially yet another Thatcherite privatisation, albeit in its early stages, totally seriously, only to have to swallow their laughter should the bill make it through both Houses.
If you look at what Lansley proposes to do completely at face value, it doesn’t seem to be particularly pro-market, just anti-bureacracy. He wants to scrap the UK’s 151 primary care trusts, which at the moment deal with a specific area of the NHS each; so, for example, each major city has a PCT, and also several ‘regions’ subdivided according to geographic suitability and location, such as North East Essex. He then wants to devolve the budget managed by these PCTs (that’s 80% of the NHS budget), and give £80bn of that to groups of GPs, called General Practice Commissioning Consortiums (GPCCs). These GPCCs will then operate a regional area similar to that covered by the PCT, although likely much smaller, deciding on which services and medical products to purchase, and, if there is a hospital nearby, agreeing on contracts with the hopsital for anything from supplying to cleaning.
However, scratch the surface and you see nothing but Thatcher’s grin. Lansley wants these supplies and contracts to be fulfilled by ‘any willing provider’, essentially opening the door to the free market. Moving further into the idea of ‘any willing provider’, it soon becomes obvious to anyone with a realistic view of the free market that if budgets come under strain, corners are going to be cut. The GPCCs will be browsing a medical eBay, and unfortunately, the best deal for them is not always going to be the best deal for their patients.
As well as opening up the supply of services and goods to the NHS to the free market, Lansley wants to encourage more hospitals to become Foundation Trusts; these were established by Blair in 2005, and are, at a crude comparison, the Academy Status of hospitals. These hospitals are, and the new ones will become, far more independent from the state; in the Prime Minister’s words, they will ‘rely less on external oversight’, manage their own budgets, and also have the cap on the revenue they can receive from private patients removed. Once again, the market comes into play; if there is no cap on what hospitals can charge (I’m getting a slightly bittersweet taste of deja vu here; universities, anyone?) private patients, they will want to take in more private patients. If a budget is under strain, there’s every chance that this extra source of income is going to come at the cost of patients relying on the state. Which, unfortunately for the Conservatives, is still the majority of the population.
That’s essentially some of the most important reasons that the left should oppose the reforms; they’re the first step towards a private healthcare sector, the beginning of inequality in an area of people’s lives too precious to risk. I’m aware that this post is getting slightly long-winded now, so I’ll follow it up in the near future, should the bill get up with both legs intact.