NHS workers picket outside the Bristol Royal Infirmary Hospital, Bristol, October 2014. Photo: Ben Birchall/PA

The NHS is a major election issue, but the only thing that will stop its destruction is the mobilisation of a national campaign writes Dr Youssef El-Gingihy

The NHS has become the pre-eminent issue of the election with polling showing that it is the most important concern of voters. The Health & Social Care Act represents the final stage in the conversion of the NHS into a market-based system. The Act paves the way for privatisation and effectively abolishes the National Health Service.

How so you might ask? I can still see my GP or go to hospital and receive care free at the point of the delivery just as Mr Cameron states. On the surface, nothing has changed. Yet below, everything has been transformed. Any Qualified Provider, under Section 75 of the Act, opens up NHS contracts to unlimited privatisation. Cherry-picking of lucrative services leads to unbundling, which means NHS trusts will have much less money to provide comprehensive healthcare in future. Other policies, such as efficiency savings (cuts), reduced tariff payments to hospitals and GPs as well as scandalous PFI debts will manufacture an NHS crisis.

The process of running the public NHS into the ground, whilst at the same time privatising large parts of it, will unfold insidiously. We will be left with a two tier health service – a third class government service for the majority and first class private healthcare for the wealthy. When he founded the NHS, Bevan’s aim was to abolish the commodification of healthcare and ensure that all are entitled to equitable healthcare. In this sense, we are being returned to a pre-welfare state age.

I am a GP working in Tower Hamlets. I gradually became aware of the magnitude of what was unfolding yet I noticed that the mainstream media was failing in its duty to inform the public. That’s when I decided to write a book – How to Dismantle the NHS in 10 Easy Steps‘ – which will be published in July.

Faced with the NHS on this cliff-edge, I went along to The Guardian’s recent Healthcare Debate hoping to hear some answers. This featured Dan Poulter and Norman Lamb – health ministers for the Conservatives and Lib Dems respectively and Labour shadow health minister Liz Kendall. When I asked all three on privatisation, their answers failed to grapple with how to reverse decades of damaging policies. Unsurprising as the 30 year plan to privatise the NHS has been executed by all three parties. Both the Tories and Lib Dems have enabled the Health & Social Care Act, using a smokescreen of patient choice, competition and empowerment of clinicians. 

Whilst David Cameron has accused Ed Miliband of weaponising the NHS, the Tories are trying to defuse the issue. It does not even feature in their main pledges. The NHS has become toxic for them yet again. Meanwhile, the Liberal Democrats have focused on Simon Stevens’ Five Year Forward Review. This emphasises the £30 billion funding gap by 2020, which needs to be plugged with £8 billion more a year in spending. When I pressed Paul Burstow (MP and Chair of the Liberal Democrat Backbench Health Committee) on the dangers of privatisation, he answered that Lib Dem amendments to Section 75 competition rules ensure that CCGs are not forced to tender contracts. In reality, CCGs are terrified of litigation from EU Competition Law and are doing so. 

The Labour Party’s stance is certainly more promising. Andy Burnham has made three important pledges – repealing the Health & Social Care Act, exempting the NHS from the Transatlantic Trade & Investment Partnership and making the NHS the preferred provider of services. He has emphasised that the NHS should be taken out of the remit of both EU Procurement and Competition Law. All of which is to be applauded.

However, probing deeper raises concerning contradictions. Burnham states that he will not subject the NHS to another top down reorganisation keeping the CCGs for example. The CCGs are fundamental to the Act. They are legally obliged to provide only emergency care; much reduced compared to the remit of Primary Care Trusts.The rest is up to their discretion; this is carte blanche for unlimited rationing. We are already seeing this on the ground. The CCGs are supported by Commissioning Support Units, which are to be spun off and privatised. Nick Seddon, Cameron’s health adviser and formerly of Circle, outlined in The Telegraph how CCGs could be integrated with insurance companies. To be fair, when I recently asked Andy Burnham on this point, he was aware that the CCGs pose a grave danger to the NHS as there is nothing to stop them breaking away completely. 

Burnham is in favour of both the Year of Care budget and integrated care. Liz Kendall has also spoken about personal health budgets. PHBs can presumably be topped up by copayments thus opening the door to universal insurance coverage. Again, this will be sold on the basis of patient choice. But patients already have choice – they can get private healthcare. PHBs are a Trojan horse in the dismantling of the NHS – they are being rolled out to 5 million patients by 2018.

The idea of integrating health and social care is the holy grail of modern social policy. However, the concept has been imported from US healthcare. It essentially means minimising specialist hospital care and transferring care into the community. So far so good although the precedent of mental health services is disturbing. Psychiatric hospitals have been shut down with vulnerable patients stranded in the community without enough resources – one of the main factors behind the current crisis in mental healthcare. Integrated care will be provided by GPs and community services but also by independent integrated care organisations, which are springing up.  It will result in the closure of large numbers of hospitals whilst private healthcare infrastructure is ramped up.

If he is true to his word, Burnham will face intense opposition not least from within his own ranks. Alan Milburn for one has been very critical. TTIP is likely to nullify any attempts to repeal the act. Exempting the NHS from TTIP is difficult due to complex legal mechanisms and the fact that consolidating a transcontinental trade agreement, favoured by transnational corporations, will be prioritised by the EU and the US government over other demands. There is only one thing that will stop the destruction of the NHS and that is the mobilisation of a national campaign backed by the British public.

coverHow to Dismantle the NHS in 10 Easy Steps‘ will be published in July by Zero books

Dr Youssef El-Gingihy

Dr Youssef is a GP working at the Bromley by Bow centre in Tower Hamlets. He has also worked collaboratively on a documentary on the NHS called 'Sell-Off’. His book on the privatisation of the NHS - 'How to dismantle the NHS in 10 easy steps' - will be published in July. It tells the 30 year story of how the NHS was converted into a market based healthcare system and how the Health & Social Care Act enables the final step of universal insurance coverage.

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