By Allyson Pollock
20 February 2011
The government has sought to sweeten the pill by presenting the changes as being GP-led; they tell us that as Primary Care Trusts are abolished they will be replaced by GP consortiums, led and operated by GPs. This is of course a horrible and grotesque fiction. The outspoken chair of the Royal College of General Practitioners Clare Gerada is furiously opposing the changes, along with the BMA, RCN, NHS Confederation, and numerous other royal colleges and think tanks, medical students, nurses and doctors. The reality is that GPs are neither trained nor skilled in planning and providing health services for the whole population; their duty is to care for the patient. They know this, but have no choice now but to allow their practices to join consortium or find themselves taken over by the private sector. But they also know the new consortium will over time be run by shareholders for profit and in time so will all the services.
GP practices already have to compete for commercial contracts; soon these contracts will specify what services they can and can’t provide and determine which patients they can accept. The conflict between shareholders’ demands and patients’ needs will be ever evident to patients and public in day to day practice and services provided.
The government is determined to open up the NHS to the market place and very soon the 100 billion pounds of taxpayers’ funds will be lining the pockets of new equity investors and the shareholder returns of American and British health care corporations, just as they do with PFI, pensions etc. These reforms are driven by pure market ideology, without a shred of evidence that they will benefit the British population as a whole. On the contrary, all the evidence shows that if you create a US healthcare system the result will be denial of care and exorbitant costs for the taxpayer and the patient as private sector providers hold the government to ransom.
Under the proposals laid out in the Health and Social Care Bill, the secretary of state is in effect abolishing his duty to provide and secure comprehensive services for the whole population, while the mechanisms which enabled that to happen would also be repealed. The new consortium would have no duty to provide and secure comprehensive care as they would no longer have responsibility to all patients and residents in a defined area. Instead, local authorities may end up becoming providers of last resort when patients are denied or cannot get care. And as for the new consortiums, they are to be granted extraordinary new powers: the power to deny care, to close and erase NHS services and to introduce charges, top up fees and sell private health insurance. The private sector providers too will have extraordinary new rights. The right to fair and equal treatment will no longer be for patients but for the benefit of investors, who will use competition policy and trade law to demand a right of entry and a right to ensure that their services can continue to operate profitably.
If the government can retreat on the privatisation of England’s forests, it can still do the right thing by the National Health Service. On the other hand, if the Health and Social Care Bill goes unamended, it will spell the end of Bevan’s dream and a return to fear.
To learn more about the campaign against the Coalition's healthcare reforms, visit Keep Our NHS Public.
Allyson Pollock is professor of public health policy and research at Queen Mary, University of London and the author of NHS plc, on the privatisation of our health care under New Labour.