Friday, 17 May 2013

The coming demise of the NHS.


On May 13th the BBC finally opened the floor to ‘discuss’ the health-care reforms that have been passed and are well under way. The section 75 regulations of the Health & Social Care act of 2012 was passed by the House of Lords on April 25th this year. The mainstream media, whether right or left, failed to give any coverage to this bill passed and yet it concerns us all. Even still, it was nice to hear a bit of noise once the bill had been passed and, effectively, the public was powerless to do anything about legislation already passed. You would have been lucky to have uncovered these proposals via the splutters of outrage on Twitter, or on the blogosphere, or indeed at the outer-reaches of the liberal press. Instead of the crusading press we're told we have, we actually have a cowardly press that let these health reforms pass them by. The intelligentsia and commentariat, with its agenda-setter the BBC, might be best understood as a herd of ‘independent minds’.

Even when we hear talk of the plans there are only banal platitudes about ‘reform’. When at the best of times ‘reform’ is a word to be suspicious of, especially when it is deployed with ease by the incompetent and duplicitous political class of this country. The Health & Social Care act will radically transform the way the NHS works, in fact, it will open the floodgates to private companies and enforces competitive bidding for contracts. That's on top of the hundreds of contracts on health services already sold in 2012. The act will require that all sectors of the NHS which can't be provably delivered by one provider (the state) will be opened up to competition. From now on the only hope of the NHS will be the commissioners, for they are now on the frontline of decisions about privatisation. Yet only if the commissioners can be make the case that this or that service has to be provided by the state. That's assuming the case will even be accepted, your guess is as good as mine.

Once rejected the services will be opened up to the full brunt of market forces. There is also the possibility that the real decisions will not be made by commissioners but by the courts. As Lord Philip Hunt has acknowledged, the regulations will “promote and permit privatisation and extend competition into every quarter of the NHS regardless of patients interests. The Lords reported that many NHS professional institutions believe that the regulations make competition the default approach, whilst imposing a burden of proof on commissioners wishing to restrict competition.” So it's fair to say that the doctors won't have a say in these decisions for the most part. If the doctors don't have a say then the patients certainly have no say in the matter at all. The Chair of the Royal College of General Practitioners has said “The new reforms of which these regulations are a key part remove the legal framework for a universal, publically provided, publically managed, publically planned, democratically accountable health service.”

The Conservatives can claim that this isn't privatisation because the NHS will still exist. Yes it will exist, but as a hollowed out shell where public money is funnelled into the private sector to raise the profits of private health-providers in this country. The truth is that if there are private companies eating away at the public sector then that is privatisation, it is just incremental as a means to the same end. The state bureaucracy will only be supplanted with a private bureaucracy, which will be run on the basis of profit at the expense of the tax-payer and almost certainly the quality of service. Decision-makers at the local level will be at the mercy of changes out of their control as funds are redirected from local services. The decline in services will be sped up, as it has already, to justify further ‘reform’. Gradually the whole edifice built in the aftermath of WWII will be reduced to a mere memory. A lot has already lost, as it was the Major government and its Blairite successors who introduced markets into the NHS by way of ‘performance targets’.

Unfortunately, none of this should be a surprise. The Coalition has cut NHS funding effectively by only increasing spending by 1% while health-costs soared at a rate far higher than inflation. The press would rather whinge about the coming collapse of A & Es. But not about the mass closures of these services and the cuts in funding for those not closed. There is plenty of angry talk to be heard about the European ‘super-state’ that has been imposed on us without referenda, yet how much talk has there been over these changes to the NHS? No one in the public space seems to care. On the horizon there is a free-trade deal with the US that will open the NHS to the full force of American multinationals. The phoney democrats in Parliament are adept at calling for referenda when it suits their purposes. There wasn't any talk of a referendum on the invasion of Iraq, only a couple of million people marched through London and Blair reacted with pieties: we live in a democracy so you can have your protest, but it means nothing.

It is the unfortunate combination of a constitutional monarchy with a flawed form of Parliamentary democracy that failed to stop these measures being passed. Why? Because there are systemic interests shaping the legislative process. As the Daily Mail reported in 2012 Lord Carter, the head of the NHS regulator, as well as the Cooperation and Competition panel, received almost £800,000 from just one of the health firms to which he is entangled. Andrew Robertson has compiled a list of 140 Lords and 65 MPs with what may be direct interests in private health-care. From the list Robertson gauged that this amounts to one out of every four Conservative peers, one in six Labour peers and one in ten Liberal Democratic peers. This is a problem across the board, endemic to the political class and system. According to Dr Eoin Clarke, since 2001 the Conservative Party has received over £8 million in donations from private health-care firms. We may not know the full extent of this until the political class opens itself up to a transparent accounting. But it should be obvious that this is only a part of the problem here.

 This article was later posted on the Third Estate on May 22nd 2013.

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