The Health Act leads us ever farther in the direction of charging and universal private health insurance. Photograph: Alamy
he NHS has been legally abolished. Perhaps most controversial is the opening up of NHS contracts to unlimited privatisation. Last year alone, out of £9.63bn worth of NHS deals signed, £3.54bn (nearly 40% of them) went to private firms. Private providers are cherry-picking lucrative services to boost their profits leaving the NHS with less money to provide comprehensive care. This neatly ties in with the next aspect of the legislation.
Clinical commissioning groups (CCGs) are now only legally obliged to provide emergency care and ambulances. Beyond this, the CCGs can provide services as they deem to be appropriate. This translates into unlimited rationing. We are already seeing the rationing of hearing aids and cataracts. Devon CCG announced that all routine surgery would be restricted for obese patients and smokers. And routine shoulder surgery would be restricted for all patients.
This is convenient in view of significant cuts. We’ve already had £15bn to £20bn of what are euphemistically termed efficiency savings. Simon Stevens’ Five Year Forward View asked the government for an extra £8bn each year but the flip side of this is a further £22bn in efficiency savings. Never has the NHS undergone such a funding squeeze since its inception. Yet we spend significantly less on the NHS than the EU average and well below the likes of France, Germany and the Netherlands. Out of the G7, only Italy has the same level of spending.
The Health Act also severs the government’s responsibility for the NHS devolving it to a series of bodies. The Manchester experiment is the next phase. Devolving health and social care spending to regional control is actually the dismantling of a national health service under the guise of localism. There is nothing to stop the CCGs breaking away completely. Commissioning support units (CSU) are to be spun off and privatised. The likes of UnitedHealth and Serco will be in the running to take over these crucially important bodies.
The merging of health and social care also raises the prospect of healthcare becoming more like social care – means-tested. The rolling out of personal health budgets will be extended to 5 million complex patients by 2018 and is likely to lead to top-up payments ie co-payments and therefore private health insurance. Integrated care, transferring specialist hospital care into the community, will mean a massive programme of hospital closures. North-west London is already in the eye of the storm. . There are 66 hospitals up and down the country facing closures of some kind. Tens of hospitals are running into deficits with scandalous Private Finance Initiative (PFI) debts as a major factor combined with cuts to hospital tariffs.
Meanwhile, general practice is imploding – 656 surgeries have been merged, taken over or closed completely since 2010 largely due to chronic under-funding and under-investment. Smaller GP practices will close or be forced to merge into federated organisations – a corporate model. This will be the likely precursor to privatisation of general practice with buy-outs and take-overs of these federated organisations. Whole swathes of out-of-hours care have already been outsourced and GP surgeries are being run by private companies. Virgin Assura claims to look after some 3 million patients in their network of 30 surgeries.
So how will this brave, new world look? The 21st-century health service in England will have CCGs (supported by privatised CSUs) acting as insurance pools. They will commission care increasingly from private providers with the NHS budget translating into a funding stream. In effect, the NHS will become a state insurer along the lines of Medicare in the US. Meanwhile, more patients will have personal health budgets, supplemented by insurance in the future, thus making them self-paying consumers in a market-based system. The Health Act is a one-way road leading to charging and universal private health insurance.
Should we be surprised? Back in the 1980s, Conservative MPs Oliver Letwin and John Redwood set out their vision in a think-tank paper with the ultimate aim of introducing universal private health insurance. The policies of the past 30 years have adhered to this vision with remarkable fidelity. The revolving door spins smoothly between the lucrative pastures of private healthcare and the Department of Health and top tiers of NHS management – to give one salient example, NHS chief executive Simon Stevens’ last job was as a UnitedHealth executive. Jeremy Hunt is officially on record as saying that the NHS should be privatised. Back in 2005, Hunt co-authored a book called Direct Democracy,which called for the NHS to be dismantled. David Cameron’s health adviser Nick Seddon, formerly of private healthcare company Circle, suggests that CCGs should be merged with private insurance companies and those who can afford to should contribute to their healthcare. David Cameron states that he wants to turn the NHS into a fantastic business. He vows that he would never privatise the NHS because it looked after his family while his government sets about doing exactly this.
I value the NHS not just as a doctor. I was looked after by the NHS as a patient and I watched it save my father’s life. Along with millions of citizens, I marvel at the wonder of the NHS – an egalitarian, democratising leveller. Every person, from prime minister to pauper, is treated the same way; as a human being. In a world replete with injustice and inequality, the NHS remains a bastion of fairness; a beacon for the kind of society that we may one day be able to create. The British public have not given their consent for the destruction of the NHS. It’s up to each and every one of us to fight for the NHS and preserve it for our families, our children and all time.
Youssef El-Gingihy is the author of How to Dismantle the NHS in 10 Easy Steps published by Zero books.