Headlines about the NHS at breaking point have been written for years, but now the truth is far graver, says Professor Allyson Pollock, clinical professor of public health at Newcastle University
What happens in the National Health Service matters to everyone, and not just because almost everyone in the UK relies on it in some way.
For decades now, our health service has been subject to an ideologically driven campaign of privatisation – and what politicians can get away with in the NHS, they may look to pursue in other public services, including the fire and rescue service.
There has always been a two-tier system in the UK, where those who can afford to pay, or who have medical insurance, can go private. But after more than 30 years of reducing public capacity, increasing marketisation and promoting private health care, what now exists, especially in England, is a two-tier service which increasingly resembles American health care.
There is a blurring of public and private provision and funding as patients use the private sector to queue jump.
PRIVATISATION GROWING
Multinational corporations and private equity investors have now well and truly penetrated every part of the NHS and the problem of privatisation is growing with, NHS hospitals now actively advertising private health care.
Covid exposed the major shortages across NHS and social care. The number of NHS beds more than halved from 299,000 in 1987/88 to 141,000 in 2019/2020.
NHS hospitals including University College London Hospitals (UCLH) are turning over some of their beds to private companies via joint ventures such as HCA Healthcare UK (Hospital Corporation of America), which describes itself as “the largest private health care provider in the world, and the largest provider of privately funded health care in the UK”.
Tens of thousands of staff are working across public and private sectors on a fee-for-service basis or as employees of private companies exacerbating the critical shortage of NHS staff. There are now 40% fewer nurses than 10 years ago.
Many medical doctors have equity shares in joint ventures with private hospitals, such as HCA and other private health companies. Instead of rebuilding the NHS, this government is pouring money into the private sector.
Additional contracts valued at £10bn were awarded in the summer of 2022 to 52 private companies in order to help reduce waiting lists.
FEEDING SHAREHOLDERS
That same year, NHS England planned for a 20% increase in the use of the private sector in comparison to 2019/20 levels; these contracts are a lifeline for private hospitals, especially for those whose profits were falling before the pandemic and who rely on NHS funding to feed shareholders.
NHS dentistry and long term social care gives a taste of what is to come – decreased access, more corporate provision and out of pocket payments; and fewer services for those with the greatest needs.
It’s already happening: people are extracting their own teeth because of the high costs of dental care. Eye doctors worry that the privatisation and loss of NHS eye services will be followed by an epidemic of blindness.
The 2012 Health and Social Care Act ended the duty of the health minister to provide key health services throughout England. It shifted care away from planning services and the workforce on a geographical basis, and introduced virtually compulsory commercial tendering, giving companies more say over services.
Many politicians who voted for increasing marketisation of the NHS had a financial interest in doing so
The 2022 Health and Care Act went further still, handing control of public expenditure and decision-making to networks of NHS and private providers which resemble US health maintenance organisations in several respects.
Many of the politicians who voted for the dismantling and increasing marketisation of the NHS had a financial interest in doing so, owning shares in private healthcare companies or receiving donations from them. Private healthcare companies have directly donated almost £1m to the Conservative Party over the past 10 years.
GROWING UNFAIRNESS
Higher costs, more waste, lack of access, growing unfairness and poorer outcomes are well-documented effects of marketised two-tier systems – with the US being a good case in point. The USA spends far more on its healthcare system than other developed countries, but performs poorly on life expectancy and infant mortality.
The Labour Party is, sadly, silent on the need to end privatisation and rebuild NHS as a public funded, publicly owned and accountable system of care. Instead, it continues to endorse the use of the parasitic private sector. If we are to save the NHS, this will have to change.
It is up to the people – and their trade unions – to rise up and fight for the NHS. The past year has witnessed a number of big industrial disputes, as doctors and nurses demonstrate their desperation and frustration at falling pay and chronic staff shortages.
The task now is to draw these movements together and bring pressure to bear on the political system.
We must demand that an incoming government reinstate the NHS as a planned system of universal public health care throughout England, available to all on the basis of need, not ability to pay.
