New concerns emerged this week about the privatisation of the NHS.
To be fair, the evidence so far is less about the NHS being privatised - that is, turned into share options and sold off cheaply to raise money that may be used to rescue the rail industry, which was the last company that was turned into share options and sold cheaply - and more about it being franchised out to companies overseas. These companies are desperate to preserve the principles of meeting the population’s health needs while making a profit, which is probably a whole different thing right?
Every time we have a Tory government the prospect of privatising the NHS rears its head; up to now the nation has tended to close ranks around one of its most beloved institutions and cry, “Never,” leaving disgruntled public schoolboys across the Cabinet exclaiming through gritted teeth: “Privatise the NHS? Us? Wouldn’t dream of it.”
Maybe this time the nation may consider saying in one, unsarcastic voice: “OK, tell us how privatisation will work. Be honest, don’t try to dress it up, sell it to us”. Surely, the only point in having Nick Clegg tagged on to your government is to make you look less right wing than usual, so tell us how privatising healthcare would make things better. Because if we are going to change the health service so profoundly, wouldn’t it be good to have a clear, honest and transparent discussion about why?
Maybe the NHS has been drifting towards an ideological amalgam of short-term fixes, political faddism and neoliberalism for the last 20 years. A disparate collection of organisations laced with buzz words like “choice” and “fairness” but motored by bust and boom economics. But, despite what sometimes looks like the best efforts of government, it has actually done OK. Our health service costs less than that of France, the US and Germany; the Commonwealth Fund recently rated the UK highly for effectiveness and care; and mortality rates for cancer and heart disease are falling faster than anywhere. We know there are challenges: Mid Staffordshire Foundation Trust highlights the fragility of some practice, and we’ll still be paying for the private finance initiative when the sun goes down but, thanks to the goodwill and single-mindedness of staff, the NHS has survived and some evidence suggests it has even flourished.
So why the change? To save money? Because in these austere times when we are all told we must all make sacrifices, is the estimated £2bn to implement the Health and Social Care Bill not just a little profligate? To improve care? Nobody seems to be explaining how that might come about and no evidence exists to suggest it will. To improve efficiency? By introducing even more organisations and attendant bureaucracy? Hardly. This health bill is not about recession management or service delivery; it is not about the social imperative of caring for the sick or about making the best care available equally to everyone; it is about politics.
Perhaps the real problem is that no matter who is in government, the health service becomes a political football, driven by ideology but sustained by a workforce that tends to absorb the difficulties and keep things working. Perhaps this enormous and hurried health bill will be a step too far even for them. Because as things stand, the NHS is drifting towards a future that will be defined by economic taste rather than social need. Is that really the best we can do?