Is this the end of the NHS?

The NHS came into existence on 5th July 1948. It had three founding principles: that it meet the needs of everyone, that it be free at the point of delivery and that it be based on clinical need, not ability to pay. The Coalition's health reforms essentially represent the end of this NHS. It seems that the main aim of the Health Secretary, Mr Lansley, is to hand over the provision of NHS care to private companies. This policy is called “ patient choice. ” Although, the result will be less choice. The new GP Commissioning Consortia will control 80% of the commissioning budget but they will immediately need to cut one fifth of the NHS budget (£20 billion). It also looks as if the GPCCs will take on the debts of the Primary Care Trusts (PCTs), which are being abolished. The inevitable removal of services, because of the cuts, will therefore be blamed on the GPs and not the government.

In effect, GPs have been given no choice but to form consortia (GPCC) which will have the job of commissioning NHS care under the control of a National Commissioning Board (NCB ). The lack of business expertise and commissioning experience means that GPs, inevitably are turning to private health organisations, our local consortia already has close links to one of these companies. As I pointed out in a post last week there is serious and possibly damaging conflict of interests when GPs become both the service providers and service purchasers. This situation will be exacerbated by the need for cuts but also the demands of the new market regulations and the instruction to reduce the level of GP referrals to hospital.


The NHS will no longer be the 'preferred provider' of services. All services will be open to 'market' competition. This sounds like a sensible practice until you realise that that will mean the closure of local hospitals and services. Local hospitals will have to 'make' money or else go out of business. As in all developed areas of private enterprise, the market will create larger, more powerful corporations not more choice for the consumer or patient as some people still insist on calling them. Decisions will be profit rather clinically driven.

The winners will be the shareholders of the powerful private firms standing by to take a share of the budget. Patients and NHS employees will lose out to pay shareholder dividends. Like a new supermarket selling 'loss-leaders' these firms are powerful enough to drive NHS providers out of business in order to dominate the market. The losers will be the patients who will have to travel further for treatment and, almost inevitably will see the 'free' services rationed. As one GP commented to the BBC, "That’s a chilling prospect for the elderly, those with chronic illness and people with mental illness and long-term needs, who are often of no commercial interest to the corporate providers because of their high health care costs."


The other losers, of course are  the NHS staff. They will see thousands of jobs cut and many will be forcibly transferred to the employment to private companies with removal of national terms and conditions and NHS pensions. Why should you care about the 'second rate' health care professionals, to use Cameron's words? All I would say is: did hospitals get cleaner or dirtier when the cleaning contracts were transferred to the private sector? Will paying people less improve the quality of care? Will it encourage the next generation of bright and talented young people to work in health care?


The proposals have even brought criticism from within the Conservative Party. Notably, Stephen Dorrell, the former Tory health secretary and chair of the all-party Commons health select committee, gave a damning response. In the committee's report he stated, that the reforms would create 'significant institutional upheaval' and although 'We share the government's objectives. We also say that this is in several respects not the most effective way to deliver them." Like the rest of us the committee was very surprised that none of these proposals were mentioned during the election campaign. The plans were denounced on Monday by six health service unions - including the British Medical Association and the Royal College of Nursing - as "potentially disastrous".


The point is that for many people, wealthy enough and educated enough, these reforms may not have much of an impact. As usual, it will be the poorer sections of our society who will be most disadvantaged. Is that progress? (Cue Elgar - this is the Oscar winning scene) Perhaps it is sentimental on my part, but those founding principles, the interpretation of which may be at the heart of the NHS's problems, have always struck me as something that was truly inspiring and thoroughly democratic at the heart of our culture. I really think that it sets us apart. The NHS is imperfect, so reform, yes, but, let's not throw those aspirations away.