The new Health Minister Patricia Hewitt has just announced that the government is to stump up £3 billion extra for operations. Good news? Not entirely – the entire wad is to be passed over to the private sector.
Now anyone who knows someone waiting for a ‘routine’ operation such as a hip operation is aware of the discomfort and deterioration in the quality of life they feel while they are hanging around waiting around for the hospital to call them in. If the government is providing £3 billion to cut down waiting lists, then that’s good news for these people. But why does it have to trickle through the greasy fingers of private capitalists? By the way, New Labour’s target is quite modest. They hope to get the waiting lists down to a maximum of 18 weeks after GP referral by 2008 – not exactly a socialist utopia.
If Hewitt wants to use empty beds in the private sector to cut waiting lists, then that’s hard to argue about if someone you care for will get the benefit. All the same we can legitimately ask why, after eight years of a Labour government, people are still waiting for ages to be operated upon. And, if the private sector is hanging around with time on its hands, then we should be able to screw a good deal out of them.
But that’s not what is being proposed. Hewitt is going to shell out £3 billion to the private sector to build new hospitals, called independent treatment centres, to carry out the operations. These are conceived as factories doing hip operations and other routine forms of health care. What happens if there are complications? Then they'll chuck you straight back to a National Health Service hospital. Aftercare? Back to the NHS for that. Where are they going to get their skilled staff from? Don’t be silly. They'll poach them from the NHS. Or, if they're not allowed to do that, they'll bring them in from abroad. They're not so stupid as to pay their own training costs. What else is the NHS for, if not to subsidise greedy capitalists prowling around the health care ‘industry’? The NHS already has a poor reputation overseas for hoovering up trained health professionals from poor countries to work here. This will make things worse.
This private health care is really just ‘cream skimming’ or ‘cherry picking’ – collecting the bits that are easy to make money out of and leaving the NHS to do the loss-making stuff. The inevitable consequence of this policy is that parts of our health service are going to get into serious financial difficulties. And, under the restored internal market, they will go to the wall.
New Labour argues that it makes no difference who ‘delivers’ health provision. The basic principle of the NHS is that it is free at the point of use, a principle of pure communism. And that will still apply. Whether health care is provided as a public service or by profit-makers is neither here nor there. If they allow private and public provision to compete, then we'll see who’s cheapest and most efficient – and that’s the one we'll use.
The Real World
That’s the theory. As we’ve already seen, it’s not the real world. The private sector relies on public provision to give them all their trained staff. And they don’t want to deal with any ‘complications’. They haven’t got the skills to do it anyway. And where’s the money in that? For the same reason they're not interested in chronic conditions. They're certainly not interested in mental health. And they haven’t yet figured out a way of making money out of accident and emergency – given that it’s a free, universal service.
The other area where our money is being hurled at private capitalists is diagnostic procedures. Two million scans are to go out to tender. Where will these firms get the radiographers and radiologists from if not from poaching them from the NHS, where they are already in perilously short supply?
New Labour says it is introducing competition into health provision. It’s a funny sort of competition, where the public sector has one hand tied behind its back. These independent treatment centres are being offered five year contracts with a guaranteed number of patients. And they'll be paid a premium over and above NHS hospitals for doing the same operations. Thank you, New Labour, for forcing us to pay higher taxes so your friends in the private sector will do OK.
The Tories introduced an internal market into the NHS. Capitalism had utterly failed over centuries to develop a universal free health service in this country or any other. So that was the model the Tories aspired to. They divided the service into providers (suppliers) and purchasers (customers). They wanted to introduce an internal market – actually a pseudo-market in an environment where market relations are ridiculous. Health provision must be about co-operation in the care of the sick, not competition as to who can make the most money.
Labour has reintroduced the internal market they were committed in opposition to abolish. Foundation hospitals have been floated away from the service. They have budgets. They can make a surplus if they do well. They could also go broke. Foundation hospitals are really too new to have been properly tested. Nevertheless the government is going full steam ahead with Blairite ‘reforms’ to enormously increase the number of foundation hospitals from 31 to all 300 with acute facilities – really as an act of faith. Fortunately the smaller Labour majority will give Labour rebels a real chance to kill this proposal stone dead – if they've got the gumption.
If a hospital makes a surplus, then that is supposed to be a sign it is efficient and should expand its operations. All the hospitals I know are in towns surrounded by houses and have no possibility of just building a new wing. Of course the reason they are in populated areas is because they are, in part, an emergency service.
Hospitals are now organised as NHS trusts. Doctors are grouped into primary care trusts. Hewitt wants to let patients choose what hospital in which to have an operation. Since patients are not usually well informed about medical matters, in practice General Practitioners in the Primary Care Trusts will make a suggestion. They won’t necessarily select what’s best for their patient. Under the new rules they'll have to make sure the new independent treatment centres are full so they can make money out of our NHS.
Under the restored internal market, real money will follow the patient to the hospital. This is called Payment by Results. There will be successes and failures. If hospitals continue to lose money, Hewitt has made it clear she will watch them go bust. How that will help the queues and shortages endemic in the health service is not obvious.
NHS trusts have not really worked so far. Nearly one third have deficits. Nine owe more than £10 million, 14 others more than £5 million and 39 more than a million pounds each. Charing Cross Hospital is to close because it has been making losses. Charing Cross is a teaching hospital. The private sector will use the trained staff nurtured at great expense there as a freebie from the NHS. Charing Cross has been undermined by the growth of private treatment in routine operations. Before, it used to do these ops in-house to generate a surplus to subsidise the loss-making activities any real health service is necessarily involved in.
For the government ‘choice’ is a mantra. They see providing health care as like a ‘consumer’ walking round a supermarket. It’s not. If you’ve had a heart attack, you don’t want choice. You want them to save your life. You want your local hospital to be as good as any other in the land. And you don’t want the private sector sucking the service dry. In any case for choice to be a reality, there would have to be spare capacity. We would have to pay taxes so that beds stayed empty with staff on hand in case patients chose that hospital. Is that a sensible use of resources?
The irony of New Labour’s attempt to introduce market mechanisms into the health service was shown during the election. The government imposes standards (for instance in relation to maximum waiting times), then draws up league tables to judge performance and imposes targets for improvement. So Tony Blair was astounded to discover that patients couldn’t book weeks ahead for routine check-ups because that wouldn’t look good in the league tables (long waiting times). The administrators know this is ridiculous, but they have to do what looks good in the league tables, not what’s best for the patient.
In the attempt to introduce a market where no market can apply, the Blairites produce the opposite. Like factory managers faced with impossible targets under Stalin’s five year plans, health administrators spend all their time doing fiddles to achieve the targets, even though they know this is ruining the health service.
If the money going into the NHS all seeps out to private capitalists, it will all have gone to waste. If they try to turn your local hospital into a medical version of Wal-Mart we'll all lose something precious. Let’s keep our health service public.