Thinking again this morning about the Health Bill it struck me that what the government is hoping to do is to move from an NHS that said ‘We will provide all the healthcare you need and you will only pay those charges that have been agreed in advance by parliament.’
To a system that says ‘We will give your GP a sum of money and (s)he will do the best (s)he can to shop around on your behalf to get as much and as good a care for you as possible.’
That, of course, is an attractive shift for those in charge of government spending because it enables them to fix, or reduce public spending. Unfortunately it moves the risk of costs associated with healthcare from the state to the individual. This is likely to lead to hardship, and a basically unfair society. Bear in mind the fact the commonest cause of bankruptcies in the USA is healthcare costs. It makes far more sense to pool risks where those risks are very variable and unpredictable.
There is of course a lot in this Health and social Care Bill. At 420 pages it is the longest bill in the history of the NHS. I shall not repeat here all my issues with it, things like fragmenting care, breaking up services, privatising, challenging the doctor’s fundamental ethical obligation to do the best for their patient, or the risks to Public Health. I have written about these before.
I want to focus here on the fundamental ideological shift from an NHS that provides all the healthcare you need, to one that buys in the market what it can buy.
This is, of course a significant cultural shift for the country and in order to drive it The Lansley plan proposes a number of things.
- The NHS will progressively cease to be a provider of care.
- NHS hospitals will be made independent, expected to compete, attract private patients and allowed to go bust.
- NHS hospitals will be regulated by Monitor until 2016, then cast adrift.
- GPs in their commissioning role will be offered some support initially from the remains of the PCTs who have been doing the job, but again by 2016 that must cease, they must buy in whatever support they can from the private sector.
- In case anyone should notice that the financial squeeze is starting to mean that they are being denied healthcare and think of complaining to the Secretary of State, the right of appeal to SoS is removed,
- and just to make doubly sure his power to intervene was also to be removed, he would no longer be responsible for the NHS
- and could not set up new services in places where there was a need.
- As more people looked at Andrew Lansley’s cunning plan all sorts of additional problems became apparent. We would loose the ability to plan healthcare or manage epidemics or civil disasters. There would be no provision for education and training. etc. etc.
First Nick Clegg and then our MPs extracted some concessions, though many of the concessions offered seemed to have disappeared by the time the Lansley produced his amended bill. Our peers have worked hard and look like getting more concessions.
BUT all these concessions relate to secondary issues as indicated by the bullet points above.
The fundamental philosophy remains. The concessions that we do win are likely to be ‘sticking plasters’ offering partial protection or delay.
So instead of the NHS being wiped out in 5-10 years the decline will be more gradual and there will be a least some elements of the NHS left when we get to the next general election. Though whether any political party will have the guts of Lloyd George, Beveridge and Bevan and the courage to rebuild the NHS I rather doubt. We need to remember the the trend to market competition and privatisation has extended through Thatcher’s Tories to Blair/Brown’s New Labour.
So have our peers done enough?
They have certainly done a lot and if they get the concessions that we expect they will have protected the NHS from total and rapid annihilation.
But, I am sorry, we have not yet done enough. We need to fight on.
The NHS is worth fighting for.