Privatization / HEALTHCARE
Since its birth in 1948 Britain's National Health Service (NHS) has been a model for the rest of the world. It's been a national system of publicly owned and accountable hospital and community
Privatization / HEALTHCARE
Since its birth in 1948 Britain's National Health Service (NHS) has been a model for the rest of the world. It's been a national system of publicly owned and accountable hospital and community services funded from central taxation - where hospital doctors and nurses are salaried, under national terms and conditions of service.
Universal healthcare, provided free and fairly, released the population from fear of the risks and costs of care. Before the NHS more than half the population - mainly women, children and the elderly - had no health coverage.
However, a relentless concern with cost-cutting and market-defined 'efficiencies' over the last two decades has drastically eroded the central premises of universal healthcare in Britain. The undermining of central taxation as the funding base has been accompanied by governments shifting the costs and risks to patients and their families. The internal market introduced by Margaret Thatcher in the 1980s was the most visible aspect of these changes, but Tony Blair's Labour Government has followed the same privatizing path. The 1948 contract with the people is slowly being shredded.
In 2000 the Government launched a 10-year'reform' programme called the NHS Plan which continued the market-oriented, pro-business policies begun under the Tories. The Blair administration maintains that it doesn't matter who provides care - so long as it is publicly funded. And the extra costs of private profits? They're to be offset by increased efficiency and access, a claim which has been neither tested nor subject to scrutiny. The reality is that under the new plan people will pay more tax for fewer services and be hit with extra patient charges, plus the cost of private insurance. The NHS will be funder and regulator - but business will run the show.
Choice and competition: that's the promise. With'money following the patient', competition between providers is intended to improve both efficiency and quality of care. Doctors, nurses, hospital and community services will be more responsive to patient needs.
The Government claims that the NHS is centralized, bureaucratic and inflexible - a claim which has little evidence other than popular myth to support it. The Health Secretary, Alan Milburn, talks about'redefining' the National Health Service: 'Changing it from a monolithic, centrally run, monopoly provider to a system where different healthcare providers - public, private, voluntary and not-for-profit - work to a common ethos, common standards and a common system of inspection. This is the modern definition of the NHS.'
In 1992 the Conservatives created the Private Finance Initiative (PFI) as a scheme for luring private capital into new hospitals, instead of using tax money. It seems simple. Bankers, builders and service operators (like cleaning, catering and laundry firms) produce the cash and in return they get to lease the building back to the Government or to sell their services to the hospital. The contract is ring-fenced and guaranteed, usually for 30 years. Predictably these public-private partnerships have turned out to be a boon for investors but not so good for the public. Shareholder returns in the range of 15-25 per cent and the need for profits increase the costs to local communities. And the private sector's view of 'efficiency' has meant reduced services and job redundancies. Because the cost of PFI is met from the annual operating budgets of the hospital, less is available for direct patient care. The high costs of the first wave of PFI hospital schemes resulted in a 30-per-cent reduction in beds and a 25-per-cent reduction in budgets for clinical staff. More than 12,000 NHS beds have closed since 1997.
Back in Britain in 2000 the Secretary of State signed a new 'concordat' with the private sector, describing it as 'a permanent feature of the new NHS landscape'. The agreement allows private clinics and hospitals to provide the public with up to 150,000 'procedures' a year - things like cataract surgery, hip replacements or hernia operations. It also allows business to run NHS hospitals, form joint ventures with NHS organizations and to recruit overseas clinical teams for existing hospitals.
Alan Milburn has allowed eight private corporations to bid for public hospitals which don't meet the Government's draconian performance targets. These are BUPA and BMI (which together control 70 per cent of the British private health-insurance market), the Swedish-owned Capio, Interhealth Canada, Hospitalia Active Health from Germany and the British-owned Serco, Secta Group and Quo Health. Some of these outfits have never run hospitals before. The others have never run hospitals like those of the NHS which are at least 10 times the size of a typical private hospital.
The most controversial element is the creation of independent public-interest corporations with 'Foundation status'. These organizations will have NHS assets transferred to their ownership and be granted a licence to operate by an independent regulator. The proposals were drawn up in consultation with the private operators, including the chief executive of Kaiser Permanente, the giant Californian healthcare company.
The Foundation Trusts will be freed from NHS controls - they'll no longer be accountable to the Health Secretary but to a locally elected board. They are prohibited from selling their core assets. But 