Tuesday, July 13, 2010
Announcing his plans, Tory health secretary Andrew Lansley this week said that he wants 80 percent of the NHS budget to be allocated to businesses run by groups of local GPs.
Local primary care trusts and strategic health authorities, which currently buy services for patients, would be abolished.
“These proposals have nothing at all to do with patient care, and everything to do with the needs of big business,” says Gill George, a health worker and member of the Unite union executive.
Lansley claims that his changes would benefit ordinary people by removing key decisions from “faceless bureaucrats” and decentralise power.
But far from making the NHS more democratic, the Tory plans are a ruse for handing yet more of the health service to private firms.
Indeed. The manner in which the ConDem government is attempting to sell neoliberal measures - which are profoundly anti-democratic in taking more and more of the public sector out of the sphere of democratic accountability - as progressive, empowering and democratising, is one of the most insolent and absurd aspects of modern political communication. Privatization, and the neoliberal praxis in which it is embedded, is an attack on democracy. As I have argued elsewhere, this adaptation of the language of progress for regressive ends has a prehistory in the origins of conservative thought, and particularly in the roots of neoliberal ideology.
In this case, the Tories argue that doctors know better than bureaucrats how to run healthcare, and that they intend to entrust decisions over treatment to healthcare professionals. Leaving aside the fact that it will be private firms rather than GPs that take over the running of health trusts - most doctors aren't actually specialists in procurement and health management - this defer-to-the-experts line is in fact a technocratic, rather than democratic, argument, and it runs counter to what makes the NHS a relatively democratic institution. It is because the National Health Service is one of the great achievements of socialism that it has been one of the more democratic aspects of the British state since its inception. This is because democracy is inherently collectivist and egalitarian. Everyone from whatever background has access to treatment when they need it. Relatively impartial information about medical choices is freely available. There is no bill at the end of treatment that would dissuade anyone from seeking treatment just because they're poor, and the tax system that pays for it is modestly progressive. And the NHS is a public good subject to the oversight of elected officials - that's democracy, and it means that 'bureaucratic' oversight is a good thing. In all, for all its flaws, and for all that it has been run down by mismanagement and under-funding, the NHS probably represents the zenith of democratic collectivism in Britain. This is why the NHS is arguably Britain's most popular institution.
The introduction of various charges and, more significantly, various market-based mechanisms has undermined the democratic element of socialised healthcare a bit. The market-based mechanisms contributed to the creation of a 'postcode lottery', for example. But this only marginally undermines the NHS and not nearly enough for the Tories and their Liberal allies. Luckily for them, New Labour began to lay the ground for a new way of running things when they published their plans to break-up and privatize NHS delivery back in 2008. The New Labour argument was always that as long as the treatment was high quality, and as long as it remained free at the point of delivery (well, they did dabble with the idea of charges for appointments with GPs), then there was nothing to worry about. So, they introduced Private Finance Initiatives, using private capital to build new hospital projects, and allowed private firms to compete for cleaning contracts etc. PFIs massively increased costs and ultimately caused the fiscal crisis of 2006, while the privatization of cleaning services led to MRSA. Not to be deterred, Lord Darzi signalled New Labour's determination to continue with privatizing, allowing the funding base to be administered by private firms, and by abandoning the principle of universal coverage set out to entrench legislative principles that would allow them to introduce charges and levies, and restrict care - a freedom which the NHS does not presently have. The basis for restrictions was provided by the disaggregation of NHS service provision into three levels of care: core, additional, and enhanced services. There would be nothing to stop a commercial provider restricting access to care classified as 'additional' or 'enhanced', or charging for it.
Now, radicalising New Labour's proposals, the Tories are going to allow commercial enterprises to administer up to 80% of the NHS budget. They can't very well sell their policy on the grounds of efficiency. Market-based reforms previously introduced have already created new layers of bureaucracy, resulting in - as I pointed out previously - a rise in administrative costs from about 5% of overall budget to 12%. In the private hospitals, administrative costs account for 34% of their total budget. The more the NHS is forced to imitate the private sector, the more administrative costs will rack up. This means less and less funding available for patient care. This is 'efficient' in the sense that Nick Clegg is Noam Chomsky. Coming alongside cuts (don't be fooled by the claims of 'ringfencing' - all local trusts know that cuts are coming and are preparing for it), these reforms mean that the NHS as a service free at the point of delivery, providing quality all-round care for all, is under serious attack. This is being promulgated alongside Michael Gove's attempt to roll back a public, comprehensive, democratically accountable education system. This isn't happening because of the deficit, it isn't happening because people want it, least of all is it happening because of the result of the 2010 general election - please let us be spared that insult. It's an attack on the welfare state, it's an attack on the working class, and it's an attack on democracy. It's time for a democratic revolution.