There was hardly any outrage in the air when the Health and Social Care act of 2012 was passed. The act stipulates that NHS doctors take control of their budgets as well as permit them to buy services from private companies. Another stipulation is to allow hospitals to use up to 49% of hospital beds and theatre time to generate private income. The section 75 regulations stipulate that the sectors of the NHS which can’t be ‘provably’ run exclusively by public provision will have to face competition from the private sector. Lord Phillip Hunt said that the regulations will “promote and permit privatisation and extend competition into every quarter of the NHS regardless of patients interests.” He added that the reform will make privatisation the default position as the burden of proof is placed on the shoulders of any commissioner opposed to private health provision.
The Chair of the Royal College of General Practitioners has stated that these reforms “remove the legal framework for a universal, publically provided, publically managed, publically planned, democratically accountable health service.” Concurrent to these reforms the Coalition has been underfunding health services. In the first budget of the Coalition government, George Osborne announced a 1% increase in funding for the NHS. Yet that amount falls short of the pace at which health costs rise, which is sometimes 2% or 3% above inflation. There is a correlation to this policy. Waiting lists increased by 43% from 2010 to 2012. Fortunately for David Cameron the media has yet to raise more than a whimper of questions about these reforms. It was Lansley who claimed that the NHS has to face cuts for a shortfall of £10 billion to be avoided. Then this year came talk of a £30 billion shortfall at the end of the decade. The government’s prescription: cuts, cuts, cuts.
This is the apogee of decades of health-care policy in this country. The Thatcherites first introduced private companies in the area of cleaning services and even went further to provide contracts to private companies willing to invest in the construction and operation of services. Public-private partnerships were established, effectively subsidising private companies with tax-payer money. The cleaning contracts commissioned from the private sector have led to rising costs for hospitals and a decline in hygiene standards. Out of this came the rise in MRSA. New Labour continued and furthered these developments. The performance targets based on market standards were expanded and health-care professionals were left jumping through even more hoops. The rhetoric of New Labour was decentralisation they offered to ‘free’ hospitals from central control and allow local people to ‘own’ their own hospital.
As of 2005 the UK government was looking to shift 10% of the work of existing NHS organisations to the private sector. The NHS signed contracts with eight different health-care providers to set up fast-track treatments centres to treat 250,000 patients over five years. The programme forced some NHS hospitals to close down wards. In 2011 Andrew Lansley was forced to admit that 60 hospitals were on the “brink of financial collapse” as a result of public-private partnerships first started by John Major and expanded under Blair. The hospitals could not meet the high payments being demanded by private companies. The cost of these gluttonous companies feeding off of the public health service has been bared all along by the British tax-payer. Care homes for the elderly have been privatised just as prisons and now the post office have been. The pig-out goes on.
Yet these developments are not unprecedented around the world. In Canada it was the Conservative Mike Harris who introduced the public-private partnerships in Ontario to open up public assets to corporations in the financing of new facilities and the operation of support services. Diagnostic clinics for MRIs and CT scans were opened up to private companies. Many have introduced all kinds of hidden costs, with one place even charging $100 for an orange juice. These measures were expanded and deepened by Liberal and Conservative administrations. Almost 30% of Canadian health expenditure came from private payments in 2010. More and more there are user fees for those without private insurance and physicians can block treatment if you don’t pay up. Private health-care payments account for 3.1% of Canadian GDP. The spread and scope of private clinics is being expanded still.
Meanwhile in Australia the government of Tony Abbott has confirmed that they will be pursuing the privatisation of Medibank and has not ruled out any further privatisation schemes. Just as the British health system has been underfunded the Australian equivalent has endured cuts in the number of public hospital beds from 74,000 to 54,000 from 1983 to 2009. Effectively this means a 60% cut when the growth in population is taken into account. The Rudd government excluded from the commission’s review, the current 30% rebate for private insurance, which currently costs $3.7 billion annually, so as not to antagonise the insurance companies. The successive Gillard government initiated an austerity programme leading to cuts being set to health budgets in New South Wales of $3 billion, $1.6 billion in Queensland and $616 million in Victoria. So the incremental process of privatisation is not contained to this tired little island.
The forces behind these shifts are not just national but international. The yet to be finalised free-trade deal between the US and the EU may well have troubling implications for the future of universal health-care throughout the EU and not just in the British Isles. It looks like the agreement will open up public services – including health – to private investment and ownership. It would appear as though the Bolkestein directive has only been reconstituted in its mission to see the European Union become a mere managerial edifice for a liberal market economy. At the same time we can see Obama has initiated a series of conservative health reforms in one of the few civilised countries without universal coverage. In the sectors that have profited from the chaos of the American situation there are keen eyes for the potential gains in plundering the NHS. We have been denied a debate on the privatisation of health-care, but as we aren't going to be given one. We should decide for ourselves what kind of society we want to live in and take action.
This article was originally written for the Heythrop Lion.