You may have seen footage from the recent RCN Congress of the icy and sometimes hostile reception Health Secretary Andrew Lansley received from nurses. If you’re one of the very few people in this country who isn’t either working in the NHS or has a relative who is, then you might not quite have understood what all the fuss was about.
I’m married to a nurse, and I see her come home from every shift physically and emotionally shattered. The work is hard, she cares about her patients, and the ward is chronically short-staffed, in spite of constant pleas that the situation is sometimes so bad that patient safety is at risk. Management attention seems to be on cost-savings, and how to adapt to the upheaval and risk caused by Lansley’s forced-through ‘reform’ of the NHS, which is going to force health trusts to allow in a far greater level of participation by private companies, resulting in a fragmented system, deterioration in pay, hours and conditions for staff and will inevitably impact negatively on patient care.
This ‘reform’ is universally unpopular with health workers. Doctors, nurses and other professionals say the changes are unnecessary and harmful. So why is Andrew Lansley – fully backed by David Cameron – so determined to do it?
In March 2012, Lansley wrote an article for the British Journal of Nursing, in which he said:
“Some people say we should not have embarked on this programme of NHS reform. To those people who doubt what we are doing I would say, because of the pressures we are facing, we cannot afford not to reform the NHS. To take the approach advocated by Labour of simply sitting on our hands would be storing up a crisis for the future”
He goes on to say that costs are rising at an unaffordable rate and that this means “we need to rethink how the system works”.
There’s a lot of peripheral spin by the Conservatives about how the new system will improve patient choice etc, all the usual Tory dogma that makes the ill into consumers rather than patients, as if this is somehow guaranteed to mean better care. But – from the Health Secretary’s own pen – the key driver of his determination to make the changes is cost. ‘We can’t afford not to’…
If you’re a casual consumer of news, the soundbites the government repeats endlessly might have you thinking, ‘Well, he’s got a point. We’re massively in debt, they’re trying to clean up Labour’s mess (which is a lie anyway – see my post http://skwawkbox.org/2012/05/23/the-myth-of-the-inherited-mess-52/). We have to cut costs everywhere, and the NHS is no exception.’
However, if you look at the situation a little more closely, you’ll find that Lansley’s claims don’t stand up. (If you’ve read my other posts and you think you’re seeing a trend, you’re absolutely right – this government absolutely has a very different, and very dark, hidden agenda that it tries to disguise with its public pronouncements).
Lansley’s reforms, in allowing private companies to bid to provide NHS services and even to run whole hospitals, aim to emulate the situation in the USA, where most hospitals are essentially private companies and are run for a profit. The wellbeing of patients is secondary to the profit motive – treating people is just how they make their money. You might think this is a price worth paying if it’s going to save the great British tax-payer money, but will it?
No. The government blocked the Freedom of Information Act request for the release of the Health Dept risk assessment of the (at that time proposed and now being implemented) changes, vetoing the release in defiance of a several court judgments that it should make the assessment public. However, under public pressure they did release an edited version. The 3 images below are of items in the edited report (and if these are in the edited version, God knows how much worse the parts they’re hiding must be!). 2 items are red-flagged (typically, the one about impact on staff only gets an amber flag):
Note the wording: ‘This leads to…increased cost and poor performance’. Not might lead, may lead. The report recognises – and without any proposed remedy – that Lansley’s ‘reform’ will lead to increased cost, as well as poor performance.
The report recognises that under the new, fragmented system, financial control will be lost.
The report recognises that, in the new system, there will be adverse financial implications for staff. Private providers, seeking to maximise profits, will push down wages as far as they can. It’s absolutely clear that private healthcare providers, because they have to make a profit, can only compete with the not-for-profit NHS on costs by reducing staff costs – which means fewer staff, and poorer pay for those that they do employ (and of course almost certainly economies on things like quality of materials, bandages and so on used on patients).
This stands to reason. Although the logic that adding a profit-layer must add cost seems to evade the Health Secretary and his boss, it’s absolutely inescapable. Virgin’s healthcare subsidiary recently lodged a complaint against Yorkshire NHS regarding a bid that was awarded to the NHS provider:
That’s right. Virgin accuses the NHS of ‘predatory pricing’, of pricing in an unfair and damaging manner, because it isn’t adding a profit margin. (Thanks to Eoin Clarke’s http://eoin-clarke.blogspot.co.uk/2012/04/virgin-accuse-nhs-of-predatory.html for finding the extract. The complaint was thrown out, as it should have been!)
So a major private healthcare provider also confirms that private companies are, by definition, going to be more expensive.
It’s a damning picture so far. Lansley clearly admires the US healthcare model so much that he wants to adopt something similar here. Private healthcare providers advise the Tories on health strategy and ‘efficiencies’, including Sir Peter Gershon, the chairman of GHG, a UK subsidiary of a US healthcare company that was fined for illegally trafficking human organs and which is part of the ‘Private Hospitals Alliance’. (http://politicalscrapbook.net/2012/02/general-healthcare-group-nhs-kidney-scandal/)
It gets more damning, still. Let’s compare what the US spends on its ‘efficient’ healthcare compared to what we spend on our system that apparently needs ‘efficiency’. The figures below are from the OECD’s report ‘Health Data 2011’ (http://www.oecd.org/document/60/0,3746,en_2649_33929_2085200_1_1_1_1,00.html). According to this report, total US and UK healthcare spending (stated in US$) per head of population is:
US 7,960 per person
UK 3,487 per person
Yes. The US spends 128% more per person on healthcare than the UK. ‘Ah,’ you might say, ‘but Americans are less healthy, more obese, eat more saturated fats. And they have to pay for it themselves, so they might just choose to spend more!’
Nope. Let’s take out all private spending on healthcare from the numbers and see how they stack up:
That’s right. Your eyes are not deceiving you. Even with a system where the sick have to pay for their own care, the US still spends 29% more per person on healthcare than we do! And add back in what people pay privately – as we’ll end up doing as the NHS gets progressively privatised – and it will cost at least twice as much.
Case closed, I think. Anything more than a passing glance at the facts shows that there is no way that Andrew Lansley’s reforms have anything to do with efficiency, economy, improvement or even our current economic situation. Those are just excuses, since all the numbers, the private healthcare providers themselves, and the global statistics say that the new system is going to be more expensive than what we have now.
So, what are the real reasons? I believe there are at least two options:
Lansley and his Tory pals believe in a small-state Britain where people have to fend for themselves. They believe that if something is government-funded it’s automatically a Bad Thing (with the possible exception of the army – and given their evident readiness to privatise policing, I have doubts even about that!). They’re so committed to this skewed worldview that they believe that even if costs us all more, that’s a price worth paying. After all, they and their backers will save more, and if they get ill they can easily afford it.
Inserting a profit-layer into the process inevitably – as the evidence above demonstrates emphatically – makes the system more expensive. But as this graph demonstrates, private healthcare companies have donated massively to the Tory party, and they want payback. In addition, many Tory politicians have invested in private health providers, and stand to make enormous financial gains from the new system.
My money’s on a combination of both, with greed being the common factor in both cases. Where would you put yours?
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