By Reginald Banks
THE HEROIC efforts of NHS workers during the pandemic are being undermined by the Tories’ increasing drive towards privatisation.
The Conservative Party has never been a friend to the NHS, having voted against its creation 22 times. They are driven by ideological fanaticism and capitalist greed to privatise more and more services which had previously been run by the government. The NHS is simply the latest in a long series.
To many voters, even those who are conservative in thought, the NHS represents the shining jewel of the post-war settlement. The horror stories of the privatised insurance-based US system have convinced many of the need to have a healthcare system which is free at the point of use. Put simply, privatisation of the NHS is not a vote winner. The Tories have therefore resorted to different tactics to fulfil their commitment to the free market.
Profit at heart
Two important concessions were written into the foundation of the NHS. Firstly a compromise with consultants and GPs ensured that they had the right to practise privately within the NHS.
The second weakness was the failure to nationalise the drug and supply industries. The NHS became a source of guaranteed profit to the international drug companies.
Three years after the foundation of the NHS, its architect Aneurin Bevan, Labour’s Health Minister, resigned in protest at the introduction of charges for treatment by dentists and opticians. Labour introduced an NHS (Amendment) Act in 1949 to provide for prescription charges as well, but the charge was only realised by the Tory government in 1952. Labour under
Harold Wilson abolished the charges but he made a U-turn within three years.
Eventually the Tories increased the pace of privatisation with insurance-based medical care in ‘pay beds’, the growth of private hospitals and contracting out. The flourishing private sector continued to leech off the NHS, using their equipment and poaching staff.
The recessions and falling profits of the 1970s were the backdrop to Labour’s first wave of NHS cuts after its loan deal with the international banks in 1976. For Labour, profitability was given pride of place over workers’ needs. Health workers’ pay was held back and the number of hospital beds per 1,000 people was lower than in 1946, when the NHS was first founded. Labour approved the closure of or cuts to 214 hospitals, of which 143 went ahead, resulting in a further loss of hospital beds.
Enter the market
Starting with Margaret Thatcher’s 1987 government, successive administrations have sought ways to introduce market competition into the NHS. Thatcher introduced the internal market in 1990 – splitting the NHS into commissioners (those who request and pay for treatment) and providers (the hospitals).
In Thatcher’s day they were called health authorities and trusts, but subsequent restructuring has renamed these bodies on multiple occasions. They are currently known as Clinical Commissioning Groups (CCGs) and NHS Trusts or Foundation Trusts.
Further elements of private sector involvement in, and profiteering from the NHS have been entrenched ever since, in particular with the introduction of Private Finance Initiative (“PFI”) contracts under New Labour. Then Labour Health Secretary Alan Milburn joyfully declared, ‘It’s PFI or bust’.
Well, it appears you can have both. South London Healthcare Trust was the first to buckle under the strain of debt. Even giant outsourcing firm Carillion crashed when returns on its contracts failed to live up to forecasts. More chaos will undoubtedly ensue, as hospitals are paying off over £300 billion debts for just £54.7 billion of actual infrastructure build.
The Tories further opened the NHS internal market to external competition with the 2012 Health and Social Care Act, allowing private sector providers to tender alongside NHS providers, cherry-picking profitable treatments and services and leaving the NHS to provide the rest at a ‘loss’. The amount of the NHS budget handed to the private sector continues to rise, reaching a record £9.2 billion in 2018–19.
In the past two years, even the Conservatives have reached the conclusion that some of the changes introduced by the 2012 Act were counterproductive. Their solution, however, opens the door to a far larger incursion by private companies.
The Chief Executive of the NHS in England, Simon Stevens, divided the English NHS into 44 “footprints” which encourage collaborative rather than competitive working. He then announced the introduction of Integrated Care Systems and Accountable Care Organisations, the aim of which is to move towards long-term contracts for the provision of NHS services in large areas of the county by NHS or private providers.
While this reduces competition in the NHS, it provides a potentially lucrative opportunity for large-scale privatisation based on the US model. Each contract would be worth billions, last for 10–15 years and give the provider access to the NHS budget for up to half a million people.
Brexit too has given the government an opportunity to ramp up efforts towards privatisation. During the 2019 election campaign, Corbyn produced classified government documents, which showed that the NHS is on the table in any future trade deal with the US. The giants of the American pharmaceutical industry are already chomping at the bit for more access to the closed market of the NHS.
The underfunding of the NHS throughout successive years has led to increasing delays in patients’ ability to access essential care. Although you can technically access surgical appointments, the waiting lists are absurdly long and it can take over a year to get essential surgery.
This encourages those who can afford it to take out private health insurance—many middle class people already view it as a necessity. As more and more turn to the private sector, the NHS will come to be seen as a service exclusively for the poor. As a result, it will be increasingly easy for the government to privatise the NHS openly without opposition from their voter base.
These moves by the Tory party therefore represent an attack on the working class as a whole. They must be firmly resisted. We call for an end to NHS privatisation, abolition of the internal market, all PFI contracts annulled and the complete renationalisation of the NHS under the democratic control of its workers and patients.
Only the organised struggle of the working class can finally put an end to the scourge of privatisation and deliver an NHS which lives up to its founding principles: comprehensive healthcare from cradle to grave, free at the point of use, and available to all.