Chris Blount looks at the narratives surrounding NHS privatisation.
I’m lucky enough to have a number of amazing, inspiring friends and relatives who work or have worked for the NHS. As anyone in this position will know, it’s tricky to meet up with such people without talk turning to their jobs. In this way I guess you could say their profession and dedication to it totally consumes them. Or to put it more positively, they really care about what they do and not just because they get paid.
Back in 2012 when the colossal £3 billion Health & Social Care Act was being proposed by Andrew Lansley, one of these friends said to me that they didn’t understand how such massive changes were needed when patient satisfaction was at an all time high just 2 years earlier, in 2010. They questioned the widely disseminated narratives in the news that were challenging the sustainability of the NHS. There were suggestions that somehow the number of old people had suddenly exploded, the cost of treatments had sky-rocketed, or that mistakes were just too prevalent in today’s NHS. This was the seed which kick-started a debate in my mind and a yearning desire to find out more.
I was struck by how contrary these narratives were when compared to the bigger picture. The ‘bloated, bureaucratic, inefficient, accident prone’ NHS was actually one of the most efficient and cost effective health systems in the world. And costs were shockingly low. According to organizations like the OECD and the WHO, the NHS cost the UK over $4,000 per head per year less than American (predominantly private) healthcare cost its citizens. In fact the NHS cost significantly less per capita than many first world healthcare systems including Australia, Canada, Germany, the Netherlands, Norway, Switzerland, Denmark, France and Belgium. OECD figures from just a few years ago suggested the NHS was also amongst the best for efficiency, access, equity and overall quality. So what was it exactly which made the NHS so efficient and why wasn’t this reality reported?
At a time when our NHS was being cut, fragmented and gradually privatised, it was particularly striking that the private US system and part-privatised Canadian system were rock bottom of the OECD table. These health systems were also both significantly more expensive than ours. In 2009 the US spent twice what we spent as a percentage of GDP on healthcare. Despite this, they still had a shorter life expectancy, a higher infant mortality, less practicing physicians per 1,000 patients and almost 50 million people uninsured. Reportedly, the top reason for bankruptcy in the US is health bills – and keep in mind that some of those unfortunate enough to face financial ruin were undoubtedly insured. On a trip to Boston earlier this year I witnessed what appeared to be the tragic results of such failings. A homeless man, standing on a street corner holding a sign that simply read ‘I have cancer, please help’. In perhaps the richest country in the world, it’s a desperately sad state of affairs. However when you have someone over a barrel for their health, you can pretty much take what you want from them.
Since coming into power, President Obama has struggled hard against rich, influential corporations and negative advertising campaigns to implement limited improvements through the Affordable Care Act. However, more than 13% of Americans still have no cover at all and an unknown number are underinsured. Whilst the UK is still (hopefully!) some years away from this tragic scenario, we should acknowledge that this is the end game. The truth is that we’re gradually bankrupting our health service by looking for answers in the profit-seeking private sector. As the years go by we’re spending an increasing percentage of the health budget on non-clinical costs. The new CCG-led commissioning system will require more and more funds to be diverted away from care and instead spent on lawyers, managers, consultants, corporate bonuses and shareholders. This cost is increasing all the time – 1 in 10 NHS pounds is now spent on non-clinical expenses. If we’re not willing to fight for the NHS, we could ultimately end up in an American scenario where 1 in 3 dollars spent is on non-clinical costs.
Despite all this evidence, in 2012 politicians (largely backed up by sensationalist news media) suggested the NHS was unsustainable, in need of the biggest reorganisation in its history and that private companies had the answer. I suppose we shouldn’t be too surprised given that Andrew Lansley, like many prominent politicians in government, was accused of being bankrolled by a private health company, Care UK. Nor should we be all that surprised that newspapers carrying private healthcare adverts are fiercely critical of the NHS. As a lean, relatively efficient public health service gradually expands into a bloated, fragmented, expensive health industry, we can expect to see more of this corporate back scratching. As the NHA has been kind enough to point out recently, we’ve been down this road before. All you really need to do is ask yourself if you’re happy with the year on year increases in energy bills, water bills and train fares which consistently out pace inflation. Energy bills have recently been rising at about three times the rate of inflation. These sizeable cost increases you pay don’t take any account of the massive multi-billion pound subsidies many of these private companies have taken directly from the government.
As costs inflate with the new market and tendering processes, the health budget will inevitably become increasingly stretched. One worry is that this will in a way fracture the public and bring about more of an every man for himself attitude. We’ll blame fat people, diabetics, drunks, drug addicts, old people or anyone who isn’t us! The press will inevitably table various ideas suggesting some people should be charged more or even be excluded from care. One of my friends currently working in the health service predicts that in a matter of years we’ll have an ‘NHS+’ system. If you don’t want to wait for 3 months for a referral or if you want better treatments, simply pay for ‘NHS+’ out of your own pocket! A premium service sold as a kind of ‘bolt on’ to your standard NHS care and a stepping stone to private insurance funded care. Personally I think with Tory led cuts currently running down the health service, people are already losing faith and skipping straight to private insurance providers. It’s critical to realise that no political party will ever propose a ‘big bang’ style, blanket privatisation of the NHS. You will get no honest or obvious signpost that it’s underway. That would be political suicide. However this kind of step-by-step gradual privatisation, combined with a deliberate running down of public confidence in the state run alternative is a more realistic concern. It is happening right now.
So let me ask this: do you have full confidence in your car and house insurance companies to cover your costs completely should you meet with disaster? Are these companies reliable enough to cover your health too? When it comes to the health of you and your loved ones, full confidence is absolutely what you would want. When it comes to the heightened costs of medical care, a cost that can sometimes come along unexpectedly, full confidence is what you may need. As with I’m sure many people reading this, there is someone in my life whom I care about very much who relies on regular help from the NHS. This relatively young person has always led a healthy lifestyle and yet would probably not get full cover if they were American. They’ve never smoked a single cigarette, never taken illegal drugs, drank alcohol only in moderation, carry a healthy body weight and have always led a varied, regular exercise routine. Despite all of this, they were unfortunately diagnosed with an illness new to the family, which requires regular treatment using very expensive medication. You see, that’s how illness works sometimes. It’s not always, as the media tells us, a proportionate punishment for being obese, drinking too much, being inactive or even being too old. Sometimes it’s purely and simply down to bad luck.
It is very telling to me that the same newspapers and politicians who vehemently champion our courageous military, will not support (and often even criticise) our health service and its workers. That to me says something profound and very sad about us. We should, without question, want to invest in and look after our sick. If we can’t find the humanity, compassion and financial support for these people in such desperate circumstances, who can we find it for? Even if they are old, fat or addicted we should want to help those in sickness. It’s what makes us human. The most cost effective way to do this is to buy healthcare as one giant collective rather than as individuals.
You might say ‘But where are we going to find the money from? It’s unaffordable!’ Leading NHS England representatives have recently estimated that the NHS needs an extra £8 billion above inflation. It does sound like a dizzying number to get your head around at first. It is of course also important to recognize that these costs will inflate over time too. However, nothing will inflate health costs like the growing involvement of the profit extracting private sector. So is it possible for this cost to be absorbed by the treasury? Last I looked there were roughly 30 million income tax payers contributing to this pot. £8 billion divided by 30 million income tax payers is less than £23 per month. That’s less than what many people spend on the relative luxury of a mobile phone contract. That £23 calculation presumes we couldn’t save any significant costs from elsewhere in the budget. It also presumes we couldn’t make anywhere near £8 billion from VAT, stamp duty, corporation tax or other revenue streams. If income tax payers took on the entire burden, that’s only £23 for an efficient, publicly owned health service with 8% more money at its disposal. That’s £23 to ensure the sustainability of a more compassionate society where people are not made homeless simply because of ill health. It’s good to have a healthy dose of perspective with our daily headline grabbing hysteria.
Currently, none of the big political parties are promising to find that £8 billion. There’s nothing unaffordable about it though. It’s simply about priorities. So next time our politicians or newspapers tell you the NHS is an unaffordable, wasteful institute or that GP’s are overpaid careerists, or that nurses are lazy and apathetic please take a moment to question them. The founder of our NHS gave us the clear warning that it would only ‘last for as long as people have the faith left to fight for it’. So you can bet those seeking its demise will go to great lengths to strip you of your faith.