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Is the Government Privatising the NHS?

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The new government proposals for the NHS have lurked only in the shadows of the news throughout the majority of this year – surprising since if implemented these would be the most extensive reorganisation of the service since it was established. 

However, with the bill this week passed in the House of Lords and due to begin the committee stage with the House at the end of the month, news and analysis on the proposals and what they could mean for the future of healthcare in the NHS has begun to pick up pace.

Many have been lobbying against the bill, calling it an effective privatisation of the National Health Service and accusing the bill of offering too much power to GPs; equally, these responses have been met by other GPs claiming that the plans are a natural conclusion of the GP commissioning role that began with fundholding in the 1990s.

But what are these plans, how will they affect the way in which the NHS is run, and in what ways should we respond to the proposals? Are the government really privatising our health service? 

The Health and Social Care Bill 2011 sponsored by the government Department of Health and the Health Minister Andrew Lansley is paraphrased on the parliamentary website into five main points.

These are: establishing an independent board to provide commissioning guidance; increase GPs’ powers to commission services on behalf of their patients; strengthen the role of the Care Quality Commission; develop the body that regulates NHS foundation trusts into an economic regulator to oversee access and competition in the NHS; and, cut the number of health bodies by a third – including Primary Care Trusts and Strategic Health Authorities.

In reality, in plain English with jargon aside, Mr Lansley’s plans would increase competition and put GP-led groups in control of buying care in their areas – creating an independent NHS board to reduce administration costs.

The proposals also abolish NHS Strategic Health Authorities (SHAs) and Primary Care Trusts (PCTs). Strategic Health Authorities can be described as regional subdivisions of the Department of Health. Primary Care Trusts are explained by the NHS as ‘the care provided by people you normally see when you first have a health problem’ and can include doctor and dentist surgeries, the pharmacist, the opticians, NHS walk-in-centres, and the NHS Direct telephone service.

So what does this mean in practice?

Chairman of the British Medical Foundation Hamish Meldrum argues that the proposals could mean that hospitals would have to resort to treating wealthy patients from abroad in a bid to raise more money.

He told The Guardian that it is a ‘philosophy that relies on a market-based health system. Trusts are being encouraged to concentrate on profitable areas of work rather than the most essential […] like mental health, accident and emergency and care for the elderly.’

Others have expressed concern at greater powers and administrative responsibilities of local GPs, and articulated worry over the fact that the Department of Health has stated that by the end of this month, every commissioner must find at least three outside providers for diagnostic tests, audiology, primary acre psychological therapies and other services.

The fear is that GPs and commissioners would be directed and motivated toward acting in the interests of patients as well as financial gain, as opposed to in spite of. With GPs working with private outside providers there is no guarantee that they would be acting only in the interest of patient care, and not be absolutely separated from making decisions based on financial, economic and strategic influences.

The government, however, have said that the changes are necessary in order to cope with the demands of an aging population, obesity, and costs of new drugs.

The cost of maintaining the National Health Service in the current economic climate is not possible it seems.

Although it would probably be hard to maintain that the government is not partly privatising the health service when the core concepts of the proposals rest on promoting more competition and private sector involvement, it is not doing so in the way that many people refer to by using the expression ‘privatisation’. The government is not – as Rafael Behr points out in The New Statesman – selling off the NHS in the way that BT and BA were sold off in the eighties.

Furthermore, the bill does in fact abolish the current cap on trusts’ income from non-NHS sources which previously have been set significantly below ten per cent at a minimum.

Doctors and GPs wrote a letter to the Daily Telegraph in May this year expressing their support for the bill, yet despite this the government still faces major opposition to the reforms. 

However, the ways in which this will ultimately affect the running and practices of the NHS still seems uncertain.

 

END NOTE: If you haven't already, check out rapper NExtGen's youtube hit about the proposals. It criticises Andrew Lansley's proposals and went a bit viral. We can't help thinking of it everytime we hear Lansley's name...

 

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