Some 8 months after the government paused for a ‘listening exercise’ and repackaged some of the measures in its Health and Social Care Bill, there seems to be something missing from the resurgent opposition. The Bill certainly has some heavyweight opponents with the Royal College of Physicians and the Royal College of Paediatricians balloting on whether to oppose it. On Wednesday 7 March the British Medical Association will join the Unite union in a lobby of parliament. Even Deputy PM Nick Clegg, who was representing the government in the listening exercise last year, is now promising amendments to “rule out beyond doubt any threat of a US-style market in the NHS”. This is not so different from the behaviour of the Labour Party which has gone from imposing cuts in government to politely opposing them in opposition.
In all the words condemning privatisation it is hard to find any equivalent criticism of the cost cutting being imposed. This is in marked contrast to last year when 50,000 job losses in the NHS were well publicised. Twenty billion pounds worth of efficiency savings are still being made over the next few years, and it’s unlikely they’ll all be publicised. And it is these savings that are the real threat to our healthcare as well as jobs, pay and working conditions in the NHS.
Unite’s leaflet tells us the Bill “puts profit before patient care and will destroy the NHS”, and its lobby briefing accepts the £20bn cuts that are due to be made as if they were an inevitable fact of life “This is at the time when the NHS is faced with making 20% cuts…” The Guardian’s Polly Toynbee also accepts the need for the cuts in funding – her answer is NICE rationing. That is, a preference for rationing carried out according to the centralised recommendations of the National Institute of Health and Clinical Excellence, as opposed to the government idea of rationing by local GPs organised in Clinical Commissioning Groups (CCGs) with the risk of the post code lottery.
In fact there is no real contradiction once you take into account how the state organises its enterprises. The NHS not only took over a number of small businesses, GPs, in 1948, it has been setting them up ever since. This has allowed it to deliver health care more cheaply than it could have done otherwise and often in scandalously poor premises with abysmal facilities. CCGs and more private sector involvement do not mean less state control, or more power locally, or power for patients, as the government says, since the state not only keeps funding on an increasingly tight leash, it is also ready to step in and take over any institution that threatens to go over budget.
The new Health and Social Care Bill is not going to introduce profit into state healthcare. It’s always been there. Drug companies, banks, construction firms building hospitals, employment agencies supplying temporary staff, and others have all been directly making a profit out of the NHS. While all businesses have indirectly benefited from having the state keep their employees relatively healthy for free, or at least for no direct cost. It is not a change in the law allowing NHS hospitals to treat more private patients that leads to less money spent on other patients, it is the cut in services that leads to more demand for private health, in the UK for those who can afford it, or through health tourism to third world and Eastern European countries.
The other odd thing about the new protests about the legislation is that no-one seems the least bothered by the fact that the reorganisation is already well under way. Primary Care Trusts have been run down, many of their staff made redundant, CCGs have been formed and have started work on innovative ways to manage, and when possible mitigate, the effects of a declining and inelastic budget. Anti-privatisation provides a very convenient smokescreen for this reorganisation.