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| Unhealthy reforms will hurt
the NHS |
Market forces should have no place in our National Health Service
says Dr Peter Fisher
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University College London Hospital (UCLH) which reopened
in June this year
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THE National Health Service stands at a crossroads. For nearly
60 years Britain has enjoyed an NHS that strives to be comprehensive,
accessible and high value for money. Now, government reforms threaten
both the ethos of the NHS and the planned and equitable way in which
it delivers care to patients.
All has not of course been perfect in the past, but deficiencies
have been largely due to two factors, the chronic underfunding in
relation to other developed countries and the obsessive tinkering
with the structure pursued by governments over the past three decades.
The former is now finally being corrected but the costly and disruptive
reorganisations continue unabated and their nature is changing our
healthcare system from one based on planning and cooperation to
one reliant on market forces. These of course have their place in
many aspects of society but are alien to a caring service.
The good intentions which lay behind the massive increase in investment
in the NHS are in serious danger of not being achieved because of
the ways in which much of it is being squandered.
The limited internal market of the early 1990s doubled the administrative
costs.
We are now to have a system where every item of treatment is counted,
costed, billed for and paid for. The financial implications of the
bureaucracy required are enormous.
Why is it being done? Because someone has decided that the traditional
system whereby a health organisation had a budget with which to
provide services to the relevant population is old fashioned. If
competition is good for supermarkets it must be good for everything
else. Echoes of the much derided “one size fits all”?
Some will succeed and some will fail, but closure of a hospital
is of a different order to closing a shop.
It is the same error as was made by the Conservatives, of basing
a system around elective surgery – which can be fairly readily
costed and counted and gives results in waiting list figures which
are politically useful. Important as this type of care is, it is
only one aspect of the work. A market system inevitably means hospitals
being forced to concentrate their energies and resources on elective
surgery to the detriment of other patients.
If this competition was between NHS institutions it would be destructive
enough but the new factor is the ever closer involvement of the
private sector.
There has been an acknowledged shortage of capacity and of staff
in the NHS exacerbated by the steady reduction in hospital beds
enforced by both governments against professional advice.
When the increased spending was announced it was clear that it would
take time to build up capacity. A number of measures were introduced,
including use of spare facilities in the private sector. This was
presented as a pragmatic short term measure but it is now abundantly
clear that it is nothing less than an ideologically driven plan
to have a mixed private/public system in perpetuity.
Why otherwise would overseas for-profit companies have been induced
to come here by lucrative long term contracts and with the promise
of guaranteed income, whether they were sent patients or not? There
are glaring examples of how the NHS has been forced to patronise
these providers despite awareness that they were destabilising the
NHS facilities which also have responsibility for the more difficult
cases and the training of staff.
Both in the short and in the longer term this use of profit making
companies means diverting taxpayers money from the NHS to shareholders.
Spending on the NHS has doubled since 1997. There have been improvements,
notably in waiting lists – hardly surprising given the scale
of the investment. What is puzzling to most people is that we also
have one third of acute hospitals in deficit, having to reduce services
and freeze vacancies.
These disastrous policies are being presented as ‘reforms’
or ‘modernisation’ and ‘all about choice’.
But cuts are happening all over the country and threatening the
first choice of the vast majority of people – to have reliable
accessible services in their own locality without the need to ‘shop
around’.
Ministers deny that this is privatization because treatment remains
free at the point of use, but when they leave office, as one day
they must, it will only need a tiny change to bring frank privatisation
in all respects.
What can we do to ensure that our NHS is safeguarded and our money
spent wisely?
For a detailed explanation of the urgency of the situation and to
find out how you can help, visit the campaign website at www.KeepOurNHSPublic.com
• Dr Peter Fisher is the President of the NHS Consultants
Association |
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Look for vintage not barcode
WE are in the middle of a revolution in food. Farmers’
markets and small shops specialising in naturally produced and seasonal
produce are challenging the supermarkets.
When it comes to wine, however, we are going in the opposite direction.
FULL STORY...
... and another thing....
Typical isn’t it? You leave the country for a few days
and when you get back everything you thought you knew is wrong.
FULL STORY...
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