US Health Maintenance Organisations (HMOs) have long been foraging abroad for new business growth opportunities. Big pickings are worth careful preparation and to open up the UK health market the HMOs have been shaping the UK Department of Health’s thinking for more than a decade, advising it on ‘reforms’. Their biggest potential payday has been approaching – but UK public resistance may yet intervene.
Cambridge MP Andrew Lansley, the Secretary of State for Health, is a man on a mission. He says he wants to “liberate” the NHS. He wants us to believe that the NHS is bedevilled with problems: money-wasting; inefficiency; inadequate standards of clinical care; a culture which stifles change and innovation. He says the only solution is to dismantle the NHS by using the big syringe injection of markets, competition and privatisation.
Mr Lansley, however, chose not to share this mission with the Cambridge or UK electorate during the General Election or in the Colaition agreement. He and his colleagues assured us “the NHS is safe in our hands” and there would be “no more top-down re-organisation”. Now we face the prospect of the biggest ‘reform’ of the NHS since its creation in 1948 - a reform for which the coalition government has no mandate.
Mr Lansley has a vision of a liberated NHS. It’s all about freedom. GPs will be free to tell patients their treatment is no longer available - or available on a waiting list of months or even years, as it was in the 1990s. Patients will be free to try and transfer to another GP consortium, free to take out private insurance - or for those with a chronic condition and money to spare - free to top up their personal budget out of their savings. Hospitals liberated from state control will be free to take unlimited private patients to balance their budget as the cap on private work is abolished. If bankrupt, they will be free to close or be bought by a private management consultancy. Commercial companies will be free to both provide and commission services, free to increase their profits, free to use EU competition law to enforce ‘fair’ competition and free to cite commercial confidentiality to ensure secrecy. GP consortia (with £80 billion of public money) and the regulator, Monitor, (appointed by the Secretary of State with a priority to promote competition) will be free to operate behind closed doors without adequate public accountability. Orwell would have a fieldday with Lansley's defintion of freedom.
Like most people on a mission Lansley has a cavalier attitude towards evidence. To demonstrate the claimed underperformance of the NHS he repeatedly distorts data on cardiology and cancer survival rates. Even when corrected - by authors of the research he cites – he repeats these claims. Then there is wild interpretation. The fact that most GP practices have joined consortia is interpreted as “support” for his plans. But as the chair of the BMA commented recently: “just because you get into the lifeboat, does not mean that you wanted the ship to sink”. Lansley also repeats claims for which there is no evidence. The mantra of “patient choice” as the centrepiece of reform is not supported by research. In general, patients simply want good quality local services.
It is difficult to know whether we are receiving lies, spin, incompetence or some combination of all three. Take the crucial question of price versus quality competition. Lansley's official position is that competition will be based on quality not price. We are also told that there may be price competition in "exceptional circumstances". But tucked away in the Operating Framework is a reference to providers being allowed to offer services at less than the published tariff price. This looks like price competition.
Lansley’s mission is not driven by evidence but a discredited ideology of health markets. He ignores the catalogue of cost and failure which characterises privatisation in the NHS to date. Here are just two examples. The PFI policy to build new hospitals, such as the Norfolk and Norwich University Hospital, will cost on average six times more than the building costs and have to be paid for from hospital budgets for 25 to 30 years. This is well exposed in evidence collected by former UEA lecturer Dr Chris Edwards. Currently the hospitals most in debt are those which have to repay a PFI. The mammoth, failed IT programme Connecting for Health is estimated to cost £12 billion.
Private-for-profit companies have been busy trying to secure a place in the NHS and it is enlightening to have a look at the company the Department of Health has been keeping. One such company is United Health, a US based, $ multi-billion HMO and a major player in the global health business. In the US they have a reputation for corporate malpractice against both shareholders and medical insurance policyholders and high administration (transaction) costs. In the UK their two projects: Evercare (designed to decrease emergency hospital admission of the elderly by 50%) and Integrated PCT Pathways for Cancer Patients, proved clinically ineffective. Their reputation and failures have not prevented them from benefitting from the revolving door between the Department of Health and HMOs. In 1997 one of their vice-presidents was appointed as Director General of the Commercial Directorate. Simon Stevens, Blair’s senior policy adviser until 2004, was immediately appointed as head of their European operation. But they have recently sold their GP practices to concentrate on commissioning and have published The Essential Guide to Commissioning. So much for Mr Lansley’s claims that private companies can solve the problems of the NHS.
This country is now faced with a Health Emergency - it is called the Health and Social Care Bill. The scale, scope and speed of change risks at best chaos and at worst creating an NHS which is a mere kite-mark. American campaigner Michael Moore, maker of the film Sicko warns: “Don’t copy the US”.
This Bill has attracted widespread and mounting opposition from a wide range of health professional organisations such as the BMA ,the Royal College of Nursing, the Royal College of Gps and campaigning organisations such as 38 Degrees, London Health Emergency, Spinwatch and Keep our NHS Public. This momemtum must be maintained if the Bill is to be defeated.
This country is one of the richest in the world. It is also one with shocking levels of inequality. All the more reason for building on the achievements of the NHS as comprehensive and universal, free for everyone, publicly provided and publicly funded. We must act before it is too late and capitalise on the overwhelming opposition and resistance which this Bill has attracted.
Jan Ainsley is organiser of the Norfolk branch of Keep Our NHS Public Contact: firstname.lastname@example.org.