Is the NHS being privatised?BMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l6376 (Published 05 November 2019) Cite this as: BMJ 2019;367:l6376
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Technically the NHS was privatised at its inception when GPs became private contractors (with small contracts that reflect but are probably not included in the 7.9% figure quoted for NHS funds to private contractors being paid since 2012). Since 1948 various moves have been made further to commercialise the overall service, PFI being the shining example. The NHS is already 'on the table' with companies able openly to bid for GP contracts with the NHS and pharmaceutical companies able to charge large premiums for marginal improvements over much cheaper products.
A universal free 'at the point of use' service that is generally treasured by all political colours (though the means and level of funding is a source of constant argument) is the prize but is in grave danger of becoming unaffordable by sacrificing inclusivity on the altar of quality.
If we are truly to take the NHS "off the table" we need to look at what might remain on it (for example, the various parts that are already in private hands such as GP contracts with gold plating on property and pension deals). Unfortunately, despite the crocodile tears about "our NHS" the BMA that represents one of the highest value closed shops in the country (BALPA may compete) continues to resist private enterprise that might reduce costs by, for example, paying doctors' salaries on the basis of objective job evaluation rather than on qualification, time served and hours worked.
Clinicians measure quality while politicians measure costs but the market resource that governs the system is patient time: it is hardly surprising that, for patients who value their time over personal costs, that services provided (often by BMA members) on the basis of patient payments will not be opposed by the politicians at the centre.
What is truly remarkable is the seemingly endless patience and frugality of patients who often wait weeks for a GP then months to see a specialist.
Competing interests: I am a former BMA Council Member
On recieving my BMJ, I turned to the 2019;367:16376 "Gareth Iacobucci assesses a familiar claim from the Labour Party that the Conservatives are planning to sell off the NHS" and "Is the NHS on the Table after Brexit?" by Professor Martin McKee.
I fear that (at least in its printed form) the professor's article is more soundbite than detail. There's actually more detail in the online version of the same article, so perhaps my criticism is for the editor, but I still feel the true threat is being downplayed.
I look to Professor McKee's public health expertise, but don't share his sanguine view of the politics.
He gives figures for spending on health care in the UK and US showing that the US spends on average more than twice as much "per head" as the UK, and the article appears to suggest that this figure, along with the likely 10 year timescale required for complex negotiations, represents a metaphorical brick wall which can limit the threat.
An unscrupulous privateer, however, would see the numbers as an indication that human beings in the UK are not being squeezed hard enough. These corporations surely stick to the ideology of the cancer cell and will breach that particular wall.
The question could also be broadened to ask "is health on the table?" and I would say that it certainly is. Human rights, air and water quality, food standards etcetera are all "non-tariff barriers" in the language of Neoliberal trade deals. They also tend to concentrate wealth.
Iacobucci looks at figures for both forms of privatisation: self-pay and NHS spending on private providers.
So far so good, but that's about what happened in the past and the question was about what is planned for the future.
To predict what any political candidate will do in the future we can use the skills we learned in making medical diagnoses. The hardest and most reliable 'clinical sign' here is money.
The evidence-based rule is that any politician will protect the interests of his or her funders. Conversely a big funder is bound to support a politician who will protect their interests. By funders, I mean any individual or organisation from whom substantial sums of money are obtained. This could be donations to a political party, campaign, or constituency office, and also any income that the politician receives as a shareholder, advisor, etc. in cash or other benefits.
To put it another way, it is simply not credible that a politician, or party, with financial interests in privatisation intends to protect the NHS.
As one who opposed TTIP a few years ago, I knew that the negotiations were driven by US agribusiness giants and health privateers. Politicians with interests in big busineses such as Circle Health led the negotiations forward.
We know that, at the very least, TTIP would have "locked in" the health privatisation already made.
Government ministers are falling over themselves to negotiate "our own trade deals" after leaving the EU. These are likely to contain ISDS which shifts power from the UK government into private hands.
If your candidate tells you that a new "trade deal" will not harm the NHS, food standards, human rights, etc. ask them what provisions exist in the agreement to prevent this, and what penalties there are for parties who break these rules.
If the answer is that it is a secret, or that such provisions will surely not be needed, then we can draw some plausible conclusions.
Think of CETA, which politicians are afraid to mention, calling it simply "the Canadian deal" (a bit like "The Scottish Play" is, for superstitious actors). Clauses along the lines of "If either side is found to be abusing human rights, they loose their privileges under the deal" were rooted out because they're non-tarriff trade barriers.
"NOBODY is suggesting we leave the single market" asserts Boris Johnson, on the Today Programme in 2016. I am bringing this up, not to talk about Brexit, but because the statement that we can leave the EU but remain part of the single market is a useful template.
This assertion was made by the well-educated, well-informed, politically astute Johnson, who is also documented to be a man of "great imagination".
So, when he says he can strike a "trade deal" that contains ISDS but doesn't harm the NHS, Johnson is again engaging his superior imaginative mind.
Competing interests: No competing interests
It surely is a local issue, ģood enough for electoral points and gains. The data on the number of operative procedures cancelled appears sizeable enough to bring thoughts of 'change'. The situation and solutions the world over bear many similarities. The overcrowding in public hospitals, waiting lists and postponement/cancellations is rather a regular affair; the government/public sector hospitals are criticised for inefficiency in dealing with large numbers of patients in a timely manner.
The only option is privatisation where there may be no ceiling on investigations, procedures and costs in lieu of relatively prompt and satisfactory services. Mixed pattern appears to be the easy way out and some PPP (public private partnership) have worked well; in either of the situations, commonality is efficient administrative and managerial competence.
Dr Murar E Yeolekar, Former Dean/Director, Mumbai
Competing interests: No competing interests