In March 2012, the passage of the Health and Social Care Act marked the most extensive reorganisation of the structure of the National Health Service in England to date. The longest NHS bill in history, with over 1,000 new amendments, arguably became the most hotly disputed government decision since the elections of May 2010.
The chaotic development of this set of reforms has been well-documented, but underpinning this Conservative-driven thirst for change within the NHS has been an assumption that the pre-2012 NHS was somehow failing. This is simply not the case. The Commonwealth Fund compared similar countries and placed the UK top for care, effectiveness and efficiency, patient confidence, equity and safety. Furthermore, the UK was significantly less expensive than France, Germany and the US. Mortality from cancer and heart disease was falling faster in the UK than anywhere else and waiting lists were rapidly shrinking. This paints a picture of an impressive and effective health service, surely not one that required gross disruption costing £2 billion?
Guardian writer Polly Toynbee argued that the motivation behind these reforms was undeniably ideological. She wrote that: “The very existence of an exceptionally successful nationalised health service is such an affront to everything Conservatives believe in that it’s worth the political risk of demolishing it once and for all.”
The most frequently cited concern with the Act is that it is resulting in the privatisation of our National Health Service. As recently as last month, Clare Gerada, the head of the Royal College of GP’s condemned the decision to allow a huge expansion of the private sector’s role within the NHS. She said “It’s causing the NHS to be split up into thousands of different providers of health services. It’s also atomising the patient into individual parts – their eyes, ears, mental health and so on – which is wrong and unhelpful, and forcing them to interact with multiple different services rather than just their local NHS.” Shadow Health Secretary Andy Burnham fears that the NHS will ultimately be unable to provide its own services with the introduction of so many private providers “fragmenting the NHS and taking it further away from the integration ministers claim to support.”
One may have expected to read trade union bosses such as Unison’s Dave Prentis claiming that “this titanic reorganisation threatens to sink the NHS”. This argument has been legitimised though by the evaporation of support for the reforms both before and after the Bill’s passage through the Commons. The Royal College of Surgeons condemned the shake-up, stating that it would damage the NHS. Furthermore, the British Medical Association and royal colleges representing nurses, midwives and other health professionals have called for the government to abandon its plans and devise new policies for the NHS in England. As many of 92.5% of Royal College of Physicians members (hospital doctors) wanted the bill to be scrapped. The British Medical Journal labelled the previous Health Secretary Andrew Lansley as “mad” and “deluded”, disputing claims by the minister that the reforms would benefit patients. Perhaps most tellingly, influential Tory blog ‘Conservative Home’ attacked the reforms as “not only mangled and bureaucratic but also unnecessary.”
Why then, did the Bill receive such vehement criticism from both political commentators and health experts and professionals? Put most simply, because it could spell the end for our National Health Service. Under the provisions of the bill, the Secretary of State no longer has a duty to provide a health service to all. That power has been devolved to the National Commissioning Board, which is completely unaccountable and has no mechanism for appeals.
The devastating effect of the increasing influence of private companies over the NHS cannot be overstated. There is fear that private companies will ‘cherry pick’ profitable services. Both NHS and private providers are paid by results (e.g. the number of operations done) so diseases that can be treated quickly and easily are more profitable. Long-term diseases that require multi-disciplinary care are more expensive. This means that profit-driven companies will be inclined to focus on profitable diseases whilst cutting down on care for expensive diseases.
NHS providers will be forced to pick up the unwanted, expensive patients but with all the cuts to NHS spending, this will force many more NHS hospitals into bankruptcy. The government is cutting the NHS’ budget by £20 billion whilst simultaneously allowing up to 49% of patients in NHS hospitals to be private patients. This will force hospitals to take on more private patients to make up for their slashed budgets, meaning waiting times for patients who can’t afford to pay will sky-rocket.