The independent health research organisation, the King’s Fund, has published the first part of a two part analysis of the NHS under the Coalition, focusing particularly on their introduction of the controversial Health & Social Care Act 2012. You can find that report here: http://www.kingsfund.org.uk/publications/nhs-under-coalition-government
The findings make damning reading, concluding that the reforms have introduced
• Greater marketisation but claims of mass privatisation are exaggerated (my italics)
• Distracting & damaging top down reorganisation
• Complex & confusing governance & accountability systems
• Problematic absence of system leadership (my italics) making needed major changes more difficult to achieve
• Care Act has created a legal framework for introducing a fairer system of funding of long-term care.
NB but has not yet created that fairer system (my words).
I have grown used to a dumbed-down media “debate” around privatisation which shies away from a deep analysis of the Tory mantra: it’s still free at point of use therefore not privatised. That’s sadly repeated here but is so common, it is not surprising. For example, the BBC hardly ever dares say the word privatisation. Neither reports like this one or core media like the BBC, can now be expected to really examine the political values behind the Act and what the core aim of the “reorganisation” was.
This weakens the first 4 damning findings: greater marketization, damaging (& costly) top down reorganisation, confusing & over-complex governance/accountability, and absence of (strategic leadership – the Act abolished Strategic Health authorities). These aims were explicit in the Bill and were rooted in the Coalition’s commitment to a massive growth in the role of the private sector, although they always add in the voluntary sector too, as if it has the resources to compete.
£11 billion pounds worth of health services have been contracted out, on top of what was already privately provided i.e. another 10% of the entire NHS budget & the direction is upwards. Hospital trusts are now allowed to gain 49%of their income from private patients, a cap which Labour plans to significantly revise down, when re-elected, to return it to much lower historical levels as well as reintroducing the NHS itself as the “preferred provider” instead of an open market of “any qualified provider”.
As far as accountability is concerned, this must be weakened as the private sector’s role increases. And as with East Coast Rail and Hinchinbrook Hospital, Cambridge, private contractors seem to be able to walk away from contracts that no longer generate profits without penalty. Compare this to the NHS’s seeming inability to renegotiate the terms of those PFI deals which have proved to be far more costly than anticipated, even when they threaten hospital trust viability.
And strategic leadership? Well, it was abolished and the new health market would make the right decisions at the best time, wouldn’t it; the old “invisible hand” that can do no wrong. This means a gradual erosion of national standards based on sound scientific and medical research.
In short, the King’s Fund report finds that the Coalition’s “reforms” achieved what they set out to achieve but avoids the nasty political issues of public versus private. It is very important nevertheless. It should embolden the craven media to ask deeper questions about where the NHS will go in the future if left to the Tories and how it might change for the better if Labour forms the next government. But it also depends on you and voters throughout the UK (in spite of devolution!) using this kind of hard analysis to ask those deeper questions.
Less than 100 days to save the NHS. Let’s do it.