The NHS is being privatised behind the backs of the public, as NHS for Sale shows, and we must make this central to the fight against austerity, argues Joanne Land
Jacky Davis, John Lister and David Wrigley, NHS For Sale (Merlin Press 2015), xxiii, 366pp.
NHS For Sale is a masterful expose of the ongoing destruction of the NHS. Written by three core members of Keep Our NHS Public (KONP), it is a comprehensive debunking of the myths and lies peddled by those who would destroy the health service. This is key to understanding how the NHS is being destroyed, as it would not be possible if the public were aware of what is really happening. With the assistance of a supine media, the NHS is being disassembled in plain sight.
Every time it is discussed in the media, and invariably portrayed (rightly or wrongly) as in crisis, there comes an immediate chorus of voices about ‘overspending’, the ‘aging population’ and the like - witness the recent coverage of the one billion deficit. These lies have been repeated so often that the public has little choice but to believe them. The fact is that the NHS is being privatised: slowly, insidiously, at such a rate that to bear witness to it is like watching a frog slowly being boiled. All the while, the government is anxiously keeping a twitching hand beside the thermostat, wanting to turn up the heat, but mindful that if the frog were to realise what is going on, it would jump out.
The book opens with a quick primer on what exactly is going on. The centrepiece of the (then coalition) government’s plan to privatise the NHS is the Health and Social Care Act 2012. This Act abolished the Secretary of State’s responsibility to provide a health service. Just this one fact, if fully realised by the public, could be enough to bring down the government. But this is no ‘Tell Sid’ style sell-off. Whilst having formally ended the statutory responsibility to provide, everything appears to go on as before. However, Section 75 of the Act introduces compulsory tendering of services, further enshrining the ‘purchaser-provider split’ that was introduced under Thatcher and expanded under Blair, creating a full-blown market in the NHS: capitalism red in tooth and claw. Services are outsourced, one by one, with the private sector cherry-picking the profitable patient cohorts and contracts. As a result the NHS fragments.
The authors detail how, with each sell-off, the remaining NHS services are destabilized - expertise exits the public sector, which is then left to treat the more expensive cases: the emergencies, the chronic conditions. An example from West Sussex:
‘The staff working in the trust MSK (musculoskeletal) service were also responsible for emergency trauma care in their A&E department, so moving the MSK contract out of the Trust would threaten their ability to staff the emergency services’ (p.163).
Couple this fragmentation to NHS trusts struggling with PFI debt racked up on building hospitals (which can be likened to taking out a Wonga loan rather than a mortgage), and a funding freeze and you have a recipe for complete liquidation.
NHS for Sale is extremely well-researched (two of the three authors are doctors, the third is a health journalist) and comprehensively demolishes the myths with hard facts. A particularly popular myth at the moment is how an aging population is supposedly making the NHS unsustainable, but, as the authors point out, this ‘ignores the simple fact that the costs of care are concentrated in the last few months of life, whenever that occurs’. The truth is that when the coalition government came to power, the NHS was rated as one of the very best and most efficient systems of health care in the world. As John Lister says in the book, ‘the NHS wasn’t broke and didn’t need fixing’. The aim of the private sector is to reduce the NHS to a mere kite-mark, with ‘profit-seeking private companies … treating NHS patients in premises bearing the NHS logo’. This is already widespread and could ultimately become total. The authors detail some of the many concrete examples that show how care provided by companies that care only for profit is often inferior and sometimes downright risky or even dangerous.
So many, many myths. ‘The reforms will save money’ - but billions and billions of pounds are being spent on enforcing commissioning and the market, which bring with them unnecessary layers of management and bureaucracy. ‘The market gives you choice’ – but not if the strain of marketization means that the service you desperately need has closed. As the authors make clear, the ‘reforms’, far from making the NHS more transparent and accountable, mean that vital information is now hidden behind commercial confidentiality agreements. Services are increasingly accountable to no-one but shareholders, with a ‘revolving door’ of corruption as politicians and civil servants move into private-health companies and the lobbying industry – and back again. NHS literature is suffused with ‘management–speak’ which serves to obfuscate the real aims and objectives of these so-called ‘reforms’ – for ‘reforms’, read ‘privatisation’. ‘Reconfiguration’ is another favourite word deconstructed by the authors – another word for ‘cuts and closures’, of course.
NHS For Sale provides an excellent analysis of the privatisation of the NHS. However, the point, as ever, is to change it. It is perhaps unfair to criticise the book on this point as it does what it sets out to do very well. Austerity is mentioned in the text a few times, but there is the risk that the reader could go away only dimly aware that the destruction of the NHS has been brought about by the ideological agenda of the policies of austerity made manifest, and that would be a profound mistake.
The book does acknowledge in places that NHS ‘reforms’ are ideologically motivated, and perhaps this book is not the place for a detailed exposition of austerity in an already fairly weighty tome devoted solely to the NHS. Nevertheless, it is this reviewer’s assertion that the NHS cannot be saved without an end to austerity and that its destruction can only be really understood in that context. When reading the chapter debunking the myth that the Tories would ‘cut the deficit, not the NHS’ it is important to be cognizant that the need to cut our way out of the deficit is itself a myth.
Campaigners have fought long and hard for the NHS, but until the public realise that there is an alternative, that we don't have to live our lives in a society in thrall to the whims of the banking sector, the NHS is doomed. It is that simple. There are still anti-cuts campaigners out there who fail to make the link with austerity.
In the meantime, it is essential that campaigners push constantly for a comprehensive, publicly owned, funded and run NHS – values diametrically opposed to austerity. The Health and Social Care Act must be abolished, but that is not enough - legislation along the lines of the NHS Reinstatement Bill (now more formally the NHS Bill 2015) must be passed. This Bill is currently making its way through Parliament, and is discussed in the book. It is important to note that Andy Burnham, former Secretary of State for Health, refused to back the Bill. It is imperative that Corbyn’s Labour give it its backing.
NHS For Saleis a good weapon to equip yourself with in the fight for the NHS. Given that defeating austerity is core to saving the NHS, it is possible, I suppose, to dismiss NHS campaigning, as ‘single-issue'. I interviewed Ken Loach whilst doing the People’s March for the NHS last year, and he described the NHS as ‘the last redoubt'. The NHS is core, literally, to all of our lives - our reliance on it unites us all, in sickness and in health, for who doesn’t dread being ill? The impending ruin of the NHS may be the one thing that makes society sit up and take notice of how the fabric of our society is being destroyed by a ruling class that just doesn’t care – its only interest is exploitation for profit.
Find out more about NHS campaigning at the links below:
Joanne Land is a founder member and Secretary of 999 Call for the NHS, the group who organised last year's People's March for the NHS, which retraced the steps of the Jarrow Crusade.