Removing government responsibility for the provision of healthcare amounts to a neoliberal raid on the welfare state, and demands our relenting opposition, argues Oliver Westerman.
Last Wednesday the government’s Health and Social Care Bill passed its preliminary stages, marking the most deep-rooted structural reforms the NHS has ever undertaken. These reforms faced opposition from the British Medical Association (BMA), the British Medical Journal, doctors, nurses, unions and various campaigns. They come gift wrapped in political rhetoric designed to divert attention away from the fact that the National Health Service is about to be handed over to the highest bidders.
Health Secretary Andrew Lansley said: 'Claims that we aim to privatise the NHS amount to nothing more than ludicrous scare mongering. We have made it crystal clear, time and again, that we will never, ever, privatise the NHS'.
But there are questions as to how long will the NHS remain free at the point of need. Will the passing of this bill nudge our health service – among the most cost-effective and fairest in the world – over the edge of a slippery, downward slope towards a US-style system of private health insurance?
The US system has been widely criticised for marginalising those unable to afford insurance, leaving them without access to necessary and potentially life-saving healthcare. It’s a system which has led to 1 in 3 women having caesarean section births because, among other reasons, it is more profitable for medical professionals.
There is huge public concern in Britain about permitting private companies to administer everything from emergency services to necessary, routine care. The bill also allows for the cap on private beds in hospitals to be lifted, meaning many public hospitals could eventually become private, or at least have a majority of private, commercial patients; something that stands to increase, rather than shorten, waiting lists.
There is also an issue within the bill as to where the responsibility for provision of care will lie. Who will be ultimately accountable for any issues in its operation? Before the bill was passed, healthcare provision was the responsibility of the Secretary of State for Health, and quite rightly so, considering £80 billion of taxpayers’ money is spent by that department on the NHS each year.
Government accountability is critical. The campaigning group 38 Degrees, which has sought independent legal advice on the new bill, asserts that it removes government responsibility (or section 3 of the 2006 NHS Act). This leaves Lansley with the role of promoting a comprehensive health service, but shifts the actual responsibility of providing one, into the hands of un-elected commissioning consortia. According to legal opinion, this has the effect of 'fragmenting a service that currently has the advantage of national oversight and control, and which is politically accountable via the ballot box to the electorate'.
It is one thing to significantly work ‘market forces’ into the reformed NHS structure; but to sever political accountability not only makes a mockery of the ‘N’ in NHS, but as Shirley Williams notes, it 'undermines democracy itself'.
These reforms are being passed at a time when the NHS has been asked to find £20 billion worth of cuts, when it is unclear whether installing GP commissioning consortia and expanding private-sector influence will actually make it any more cost effective. As the BMA points out, there seems to have been little consideration as to how it will ensure fair access to healthcare. These changes have the potential to destabilise local health economies.
Although it has still to reviewed by the House of Lords, the focus of this bill is ostensibly orientated towards patient choice, which has been widened to ‘any qualified provider’. It appears to have a fervent ideological motivation: increase patient choice over care by outsourcing, whilst removing government accountability through unelected commissioning bodies.
Implementing a neoliberal raid on the indispensable principles of the welfare state demands our unrelenting opposition and critique.
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