An Attempt to Placate Opposition and Manipulate Opinion
In January, the government launched its Health and Social Care Bill. This Bill has come under intense criticism from Health Service professionals, health workers and the public. Currently in Committee, it is now being amended following the report of the “NHS Future Forum” published on June 13.
The Bill is very complex, so long that even its contents take up 13 pages, and presents an overhaul of the governing arrangements of the NHS. This has not deterred health workers from dissecting and analysing the report from their own perspective, working out its consequences for the future of the Health Service.
What has been made very apparent is the unashamed pushing forward of private finance and market forces into the NHS. For example, in a recent article for The Guardian, Allyson Pollock, professor of public health research and policy at Queen Mary, University of London, wrote: “Cameron’s twin strategy is to continue with market competition on the assumption that it improves cost-efficiency, and raise new forms of funding by facilitating the introduction of private insurance and patient top-up fees.” Allyson Pollock, who was previously director of the Centre for International Public Health Policy at the University of Edinburgh, continued: “While competition is now proclaimed by government as an unqualified good, the second prong of the strategy – moving to user charges and insurance funds – dare not speak its name.”
The government’s argument is firstly that the “cost of healthcare” is inevitably going to rise as the population ages and the costs of drugs and treatments increase. Secondly, they point to the real concerns people have over the quality of care. Using phrases like “sustainability”, “fairness”, “accountability”, and so on, the answer given is competition, private forms of financing and a redefinition of the state’s responsibility to provide health care.
The speed and scale of the proposed changes has been such that the government has found real difficulty in selling them to the public. In order to condition public opinion, it has attempted to present itself as stepping back, listening, and holding a new round of consultation to improve its plans.
The media has been fully complicit in this manipulation, presenting the government as making a policy U-turn. It has done nothing of the sort, other than reword parts of the Bill in a way that is more open to interpretation, further muddying the waters.
Allyson Pollock is clear on the role of the government’s consultation exercise: “The political horse-trading is over: the Future Forum has given the green light to the Government’s fundamental reforms of the NHS.”
One of the main points raised by the Future Forum was that “the place of competition should be as a tool for supporting choice, promoting integration and improving quality. It should never be pursued as an end in itself.”
This point is raised in the context of the how the reforms of the NHS have been presented. The story goes that the government, motivated by its ideological commitment to the free market, plans to enact a set of sweeping changes. Met by criticism, it holds its consultation. Its so-called panel of independent experts say that competition should not be an end in itself. The government amends its Bill to show that its aim is “to make life better for patients”; it just so happens that competition is the most efficient way to achieve this.
Whose interests is this Bill serving? The monopolies demand that everything pays them tribute. If the NHS or any social programme is not a source of paying the rich, it is declared to be unsustainable. However, it has to be said that it is the plundering of social programmes by the big banks and monopolies that is unsustainable. Rather than deal with this real drain on resources, the government plans to rearrange everything to increase the power of the monopolies to direct the system in their own interests with the aim of reaping even greater rewards, and to put the government, social programmes and public services to this end.
It is this that is the end in itself, no matter how much they try to dress it up with consultation exercises. It is this whole agenda and ideology that has to be opposed. The amendments to Lansley’s Bill must be analysed from this perspective.
The alternative begins with emphatically rejecting the notion that the NHS can be somehow “unsustainable”. The alternative is to look at the issue of funding from a human-centred perspective. The whole purpose of the economy should be to provide for human beings, and this necessarily involves ensuring that people’s health care is provided for and that the conditions are there to live a healthy life. This is the alternative direction to safeguard the future of the NHS.
To elaborate the content of this alternative, rather than “future forums” of disconnected experts, the need is to develop true forums of health workers for safeguarding the future of the Health Service