In Part Two of ‘Privatisation by Stealth’, Will Stent assesses the Conservative’s secrecy and deliberate continuous suppression of information in their efforts to privatise the NHS.
The case detailed at the outset of Part One – Alliance Medical’s 10-year, 80 million contract – not only exemplifies the Conservative’s agenda of privatisation, but also the way in which this government implements this agenda. Despite the NHS being ranked number one in a survey of the world’s top healthcare systems – and despite the fact the NHS ranked second lowest in expenditure – the Conservatives have long trumpeted the current nature of the NHS as unsustainable. Though both academic and public opinion do not support the Conservatives’ view, the government has not been dissuaded from stripping down and selling-off the NHS, and doing so without proper public awareness.
In Part One we briefly touched on how opening up NHS services and contracts to a fully competitive market meant that public trusts were now being forced to compete for these very contracts. This constructed competitive market is arguably the single biggest force working to undermine the NHS, both financially and practically. This market is established and maintained by Conservative policy and represents the focal point of the Conservatives’ reforms. Finally, its establishment has been one that is deliberately shrouded as much as possible from full public scrutiny.
The government has not released a figure as to how much actually running and maintaining this marketplace is costing. This is either because they genuinely do not know, or because they are suppressing it. Current estimations vary; the National Health Action party put the cost at £10 billion; the Centre for Health and the Public Interest have put it conservatively at £4.5 billion. Under the current strains of cuts, the NHS must make the avoidance of waste and unnecessary expenditure an imperative; this ‘market’ is a major source of waste, especially when the ‘start-up’ costs attached to each phase of this competitive market have further spiralled without check into the billions.
Statements on this market have further come from inside Westminster. A Health Select Committee revealed that the costs of running the NHS as a competitive market equated to 14% of its total yearly budget, with specific dramatic increases in transaction management and administration costs. Four of the Department of Health’s most senior civil servants, interviewed in the Committee’s proceedings, could not give accurate figures for staffing levels and administration and commissioning costs regarding the internal market arrangement.
There are some fundamental factors that must be remembered in this. First, this emphasis on competition has not led to any actual or tangible improvements in the delivery of patient care. Second, the agenda of privatisation being pushed by the Conservatives has forced important resources and finances away from patient care and toward costly and ultimately unnecessary bidding processes. Third, none of these costs or arrangements have communicated appropriately to the public, nor have they been presented for necessary parliamentary scrutiny and analysis.
The construction and empowering of this internal competitive market is the clearest example of the Conservatives implementing a privatised structure across a public service, and doing it with stealth and without proper scrutiny. But it is certainly not the only example.
Prime Minister David Cameron has personally quietly promoted the idea of paying upfront for the NHS, as a means of addressing its apparent-but-unsubstantiated ‘unsustainable’ nature. This cost would be through additional charges and insurance, not through an increase in tax. An enquiry into bringing this about was launched, not through party leadership, but through the recently-appointed – and barely-visible – Under Secretary of State for NHS Productivity, Lord David Prior. These discussions were downplayed and given fractional coverage, considering the potential consequence of such a policy. Not only does such a policy contradict the fundamental founding principles on which the NHS was established, but the idea of a pay-for-use NHS has already been discussed and subsequently dismissed by a number of top think tanks. Nevertheless, the fact that those Tory Peers who did discuss this concept moved for an enquiry demonstrates the willingness to push forward with an unpopular and unsupported agenda purely out of an ideological commitment to competition and profit.
The three founding principles of the NHS, as laid out by its founder Aneurin Bevan on July 5th 1948, were broad yet simple: it would meet the needs of everyone; it would be free on the point of delivery; and it would be based on need, not ability to pay. Tied into this and repeated since its inception was a commitment that this health institution belonged to the public. It was a right.
In a short space of time government policy has moved the NHS to a place distant from these founding ideas. If the public decided such a move should happen, or at least gave the vaguest nod of approval at such decisions, the direction of current government policy could claim some justification. But it simply can’t. Opinion polls since 2000 have consistently shown the public’s overwhelming rejection of any privatising or corporatising of NHS services9. The subsequent secrecy and deliberate shrouding of decisions made by this government show that they are aware of this, but have chosen to ignore and disregard. It seems clear that the current Conservative government will continue such a policy of stealth until the NHS resembles the organism they want. It will be an entity the public neither wants nor deserves, and though the title of ‘NHS’ will still be used, it will not resemble or share anything of the NHS established and admired in 1948.
Denis Campbell & Nicholas Watt, ‘NHS comes top in healthcare survey’, the Guardian (17 June 2014).
‘Government is failing in its ethical duty to prevent NHS waste’, NHA (6 November 2014): http://nhap.org/if-you-push-too-hard-nhs-efficiencies-become-inefficiencies/
Calum Patton, ‘At what cost? Paying the price for the market in the English NHS’, Centre for Health and the Public Interest (February 2014): http://www.chpi.org.uk/wp-content/uploads/2014/02/At-what-cost-paying-the-price-for-the-market-in-the-English-NHS-by-Calum-Paton.pdf
Vincent Moss & Nicola Fifield, ‘Savage Tory cuts and privatization have left NHS in critical condition’, The Mirror (3 May 2015): http://www.mirror.co.uk/news/uk-news/savage-tory-cuts-privatisation-left-5626911
Richard Grimes, ‘Government proposes inquiry into moving to a ‘pay NHS”, openDemocracy (15 July 2015): https://www.opendemocracy.net/ournhs/richard-grimes/government-moves-to-consider-nhs-user-charges
Colin Leys & Stewart Player, ‘The Plot Against the NHS’, Renewal: http://www.renewal.org.uk/articles/the-plot-against-the-nhs/