Something very dangerous is happening to our NHS. It is called the Health and Social Care Bill. It will implement radical changes to the NHS – changes that will turn the NHS into a market driven, profit based service.
Patients will become commodities and profits will come before patient care. Illnesses will have price tags attached to them and if you are unfortunate to have an ‘expensive’ illness then you may be at a disadvantage.
This legislation wasn’t in the Conservative or Lib Dem manifestos and was sprung upon a shocked electorate and medical profession last July. It is currently making its steady way through parliament with little sign of any major changes. Last year the independent Commonwealth Fund recognised the UK as having a very efficient healthcare system – out of the USA, Germany, Netherlands, Australia, New Zealand and Canada the NHS came second behind the Netherlands in terms of quality, efficiency, access to care and equity. Does that report make it look like we need a radical and damaging shake up of the NHS? Absolutely not.
The proposals from the Conservative-led coalition open up healthcare to the private sector in a much bigger way than Labour ever did. The legislation explicitly states that ‘Any Willing Provider’ can move into healthcare and undercut the NHS on price. It will truly be a race to the bottom. The lowest price will win contracts. Large multi-national healthcare companies will be able to loss-lead and cherry-pick the easy and profitable healthcare leaving the complex and expensive care to the NHS. Local hospitals will be destablised and services could be lost for good. There will be no going back from these changes. Nothing so radical has been proposed since the NHS was born in 1948.
Local clinicians will not be allowed to preferentially select local NHS services. ‘Monitor‘ will not allow doctors to preferentially choose the NHS over the private sector if the private sector offer a cheaper service (and they will because they have the resources to loss lead). Monitor will, in their own words, be the ‘economic regulator for health care’. Social enterprises, local NHS services and charities will have no chance bidding for contracts against these enormous profit hungry city based companies. The contract bidding process is complex, expensive and made ready for large companies to easily partake in and win.
What are we doing to the NHS so beloved by us all? Why are we allowing this government to turn the NHS into little more than a well-known logo. As a doctor I cannot stand by to see the NHS reduced to a supermarket style race to the bottom based on the cheapest price for an operation. It is well recognised that competition on the basis of price reduces quality – we must focus on improving healthcare for all and not trying to get the cheapest possible option. It isn’t such a big step from this to a USA style insurance-based health service. There will be no going back from there. Those without insurance or a decent income will not be able to afford healthcare and we will see a two-tier healthcare system and, like it is in the USA, if you have a serious or chronic illness you would have to sell your home in order to pay your healthcare costs. I honestly believe this Health Bill could bring this horror story to England (these are English only reforms).
So let’s campaign for clinically led (GP and consultant) commissioning without these ideological policies that will irrevocably damage the NHS. We can improve the NHS with commissoining but what we don’t need is this damaging bill. Colleagues – speak out about this pernicious government policy that will damage our NHS forever. Tell your work colleagues. Tell your family. Tell your MP. Tell anyone. Time is running out for the NHS as we know it.
David Wrigley is a GP in Carnforth, Lancashire. He’s an active member of an NHS led locality commissioining group and an elected member of the BMA UK Council.