COMMENT: Can the NHS survive the cuts?
As the biggest changes in NHS history officially come into effect, what can we expect?
In 1948, the NHS was founded on the fundamental principles that care should be free and available to all on the basis of need. It was the first health service of its kind in the Western world. Since then, successive governments have insisted on continual complex reorganisation, which has led to a sense of apathy amongst the public as the service received at a personal level has often appeared unchanged. So when the Conservative government announced plans for the biggest overhaul of the NHS since its creation, despite pledging in their pre-election manifesto that there would be no top-down reorganisation, this did not gain the attention you might imagine. The 367 page Health and Social Care Bill (which is longer than the 1948 Bill that created the NHS), did however receive significant opposition and scrutiny from the British Medical Association, campaign group 38 degrees whose “Save our NHS” petition garnered over 600,000 signatures, and Lords and MPs including our local Liberal Democrat, Greg Mulholland. As a result, the Bill’s progress through parliament was stalled for a year during which time over a thousand amendments were made. Yet a lack of clarity about the Act and significant concerns about its impact still remain.
The two most widely publicised aims of the Act are to reduce bureaucracy by scrapping various administrative organisations and empowering GPs by putting them in charge of 80% of the budgets. Although welcomed in principle, the changes have paradoxically resulted in the replacement of three layers of administration with seven, and concerns about conflicts of interest, as over one third of GPs having financial stakes in the services that they are supposed to be commissioning. In addition, leaked government documents highlight that private companies are likely to take over the role of commissioning as GPs lack the time.
All health services will also be up for grabs by private companies – already Virgin Care is running over 100 services across the country under the NHS brand. But as the NHS becomes fragmented and difficult to regulate, it is inevitable that quality of care will be compromised by private companies aiming to maximise stakeholder profits. And waiting times too will be affected, as the cap on the percentage of private beds offered in NHS hospitals is raised from 2% to 50%.
Even more worrying is that the duty of the Secretary of State to ‘provide’ a comprehensive health service has been removed, thereby opening up the possibility of a reduction in the number of services being provided for free. The removal of area-based responsibilities also allows for the exclusion of those, such as the homeless, who cannot register with a GP from receiving health care. In short, the reforms pave the way for the reversal of the NHS’ founding principles of free care to all based on need rather than ability to pay.
In an attempt to justify these changes, two key messages have been circulated. Firstly, that the NHS is too expensive: It is true that health care is expensive, but in comparison to other health systems with similar outcomes, the UK actually spends a smaller percentage of its gross domestic product. Furthermore, these changes are estimated to cost £2 billion, which even the Conservative-led cross parliamentary health committee has said is unlikely to save money in the long run unless standards of care are reduced. Secondly, that the NHS is failing: Numerous studies from between 2009 and 2011 shows that levels of satisfaction and accessibility were actually at an all time high and health outcomes were improving. However as these changes come into effect the public are likely to start believing that change in the form of privatisation is necessary.
So what can we do? Parts of the Act are still subject to influence – only last month the government agreed to re-write a section on competition rules after significant criticism. Organisations such as Keep our NHS Public, 38 degrees and the National Health Action Party are highly active. However, private companies are able to spend millions lobbying the government in their quest to profit from healthcare; thus opposing them is not an easy task. Active public support through marches, signing petitions and letter-writing is therefore essential to save our NHS.
By Prianka Padmanathan