[Here are a few excerpts from Colin Leys & Stewart Player, The Plot Against the NHS, Merlin Press; read Colin Leys’ pre-publication lecture I would strongly advise anyone interested in the future of health planning and provision in England to get a hold of this book, and to read it. And send a copy to your MP immediately.]
So in spite of its great popularity Britain’s most famous postwar social achievement was unravelled through a series of step-by-step ‘reforms’, each creating the basis for the next one, and always presented as mere improvements to the NHS as a public service. They were billed as measures to reduce waiting times, to offer more ‘choice’, to achieve ‘world class’ standards, to make the NHS more ‘patient-centred’—anything but the real underlying aim of the key strategists involved, to turn health care back into a commodity and a source of profit.
Each of the so-called reforms involved persistent, behind-the-scenes lobbying and fixing by a network of insiders—inside the Department of Health, above all, but also by a wider network, closely linked to the Department: corporate executives, management consultants, ministers’ ‘special advisers’, academics with free market sympathies and a taste for power, doctors with entrepreneurial ambitions—and the House of Commons Health Committee, packed with just enough compliant back-benchers and deliberately insulated from advice from expert critics of the market agenda. Not to mention a large and growing corporate lobby.
Each ‘reform’ needed its own quantum of dissimulation and occasionally downright lies. The culture of the Department of Health was radically transformed. In place of old-fashioned ideas of accountability and fidelity to facts the priority shifted to misrepresentation and spin. This was accelerated by the fact that from the late 1990s onwards more and more private sector personnel were active inside the Department, often in leading roles.
Unfortunately the marketizers continued to advocate market models of care even when experiments showed that market-based imports were not efficient at all—as with UnitedHealth’s ‘Evercare’ programme, for example. Evercare, which the huge American HMO UnitedHealth was paid a large sum to test in four regions ofEngland, was supposed to reduce emergency hospital admissions for elderly patients by 50%. But when it was evaluated it turned out to be unlikely to cut admissions by more than one per cent. The marketizers had evidently not reckoned with the fact thatEngland’s system of primary care was already accomplishing what Evercare does in theUS, where there is no free primary care. The main lesson the Department of Health seemed to draw from this experience was not to evaluate such experiments. (Page 8)
By 2010 marketization clearly entailed not just the possibility but the longer-run probability of privatization. Yet the fact remains that all the evidence shows that privatization make health care more costly—and worse. The evidence from theUSconfirms what economic theory says, that markets will not produce good health care for all, as the NHS is pledged to do.
A Treasury document published in 2003 clearly outline the reasons why this is so: price signals don’t work in relation to health care; the consumer lacks the necessary knowledge, creating a risk of overtreatment; there is a potential abuse of monopoly power; it is hare to write and enforce contracts for medical treatment; and ‘it is difficult to let failing hospitals go bust—individuals are entitled to expect continuous, high-quality health care wherever they are’.
Why was all this ignored? If the strategists in the Department of Health thought they had contrary evidence or superior theory they should have come out openly and said so. But they were never called on to defend their ideas, precisely because they proceeded so covertly.
A 2010 survey of 20,000 patients in eleven industrialised countries for the US Commonwealth Fund found that the NHS was almost the least costly healthcare system of them all, and at the same time gave one of the best levels of access to care. Other countries not only spent more per head but also charged patients directly, reducing equality of access. OnlySwitzerlandreported faster access to care, butSwitzerlandalso spent some 35% more per head than theUK. OnlyNew Zealandspent less per head, but one in seven New Zealanders said they skipped hospital visits because of cost. To ignore all this evidence and embrace the idea of replacing one of the most cost-efficient health systems in the world, as well as one of the fairest, with one modelled on the most expensive and unequal system (the American), sets a new standard for ideologically-driven (and interest driven) policy-making.
But the NHS has not only worked well, providing high-quality, equal care for everyone, free of charge, at low cost: it is also the historic achievement of millions of people—those who fought to establish it, those who have spent their lives working for it, and everyone who has paid their taxes to build it up over the more than sixty years since it was created. Its founding principles of comprehensiveness and equal access for all have been core values of modern British society. Working to marketize it, and finally privatizing it, without any democratic mandate—without even explaining that aim to parliament of the public, is as close as it gets to being not just unscrupulous, but actually unconstitutional. The question is whether the English people—Scotland,Wales, andNorthern Irelandhaving escaped the plotters’ reach—will accept having this precious part of our heritage filched from under our noses.