Mona Kamal outlines the next steps in the junior doctors' campaign, and in preventing the wholesale privatisation of the NHS
Tony Benn once predicted that there would be revolution in the streets if the NHS was privatised. Over the past 30 years successive governments have taken great care to heed that warning and have ensured that the campaign to dismantle our health service, making way for a profit-seeking, insurance-funded model of healthcare, is concealed behind masterful spin and deception.
This process, however, is very much underway and culminated in the Health and Social Care Act of 2012. The main purpose of the Act was providing a legal framework for the wholesale privatisation of the health service that we are now witnessing. In 2014 alone, approximately 40% of the £9.63 billion worth of deals signed went to private firms.
To enable this, the NHS has been fragmented into individual Clinical Commissioning Groups (CCGs) designed to be independent insurance bodies buying up our care from health companies. The CCGs were sold to us as being fronted by GPs, but in reality are controlled by accountancy firms and management consultants – an army of unnecessary intermediaries siphoning away taxpayers' money that should be going directly to patient care, to companies such as McKinsey and Delloite.
A real cause for concern is that the rules governing CCGs drawn up by Tory MP John Redwood, actually incentivise outsourcing to private healthcare companies. This enables them to cherry pick the lucrative high volume/low cost medical procedures, leaving less profitable services (treatment of chronic mental illness for example) to the already overstretched NHS.
Alarmingly, the Act has also abolished the government's duty to provide healthcare that had existed since the inception of the NHS in 1948. Governments now are no longer legally required to provide anything beyond ambulance and A&E services, making it easier for already overstretched local services to deny patients necessary care to cut costs. In 2014 for example, trusts in Devon took the radical step of refusing routine operations for those who are overweight or smokers. Although they were forced to back down, there is nothing to prevent this from happening legally in the future.
All of this is before taking into consideration the looming threat of trade deals such as TTIP, whose purpose is to open up services such as health, education and water to US companies. Being amongst the most lucrative, the NHS is clearly in the firing line and there is a clear risk under TTIP that we see it privatised irreversibly and handed over to corporate America. When one considers that Simon Stevens, who was appointed CEO of NHS England by Jeremy Hunt in 2013, came into his current role after a decade at the top of American private healthcare giant UniteHealth, then this no longer sounds so far fetched.
The relentless attacks on the NHS are now quite visibly being played out on the workforce. One way to cripple the service has been to create working conditions so intolerable as to prompt healthcare workers to abandon the NHS in favour of the private sector, or in the case of doctors in particular, to head overseas. However, attacks are not just limited to this. The threats to nursing students’ bursary and the junior doctors’ contract dispute represent a deliberate ‘deskilling’ of the workforce that is always a crucial phase of privatisation in healthcare (witnessed also with education). This creates workers who are quicker and cheaper to train, bringing down the wage bill to attract the profiteers – at the expense of having less qualified staff caring for patients.
Whilst winning the battle over the doctors’ contract is a crucial step serving to strengthen the position of other workers whose unsociable hours pay is coming under similar attack, it cannot be the ultimate goal. We must not focus on the minutiae of a contract but use the platform we have been given to highlight the wider issue of the destruction of the NHS. This is what the government is anxious to avoid. It should come as no surprise that prior to restarting negotiations earlier this week Hunt tried to insist that the only area that the BMA should be negotiating over is that of Saturday pay. This is a clear attempt to direct attention away the greater issues of patient safety and the sustainability of the NHS and its workforce.
As doctors our priority must be the patients we serve and we must ensure it is their care and their priorities that remain at the centre of decision-making. Inviting the profit motive into this equation will mean a shift from the patient towards balance sheets, shareholders and meaningless financial targets that have little relevance to the patient’s experience and will necessitate cuts to services. This will mean staff shortages, bed closures and other key services withdrawn.
The fight against the pernicious forces of neoliberalism is currently being played out in the fight to safeguard the NHS and ensuring that quality of care is put ahead of profit. That, surely is a fight that we all have a stake in. But the first step must be raising awareness amongst the public as all the destruction wreaked by this government has been achieved almost entirely by stealth, aided by a complicit mainstream media.
An event on 22 May will draw together a broad coalition of NHS campaigns to begin planning around this. There will be two myth-busting information sessions by Dr Youssef El-Gingihy, GP and author of How to Dismantle the NHS in 10 Easy Steps, followed by interactive sessions co-ordinated by junior doctors focusing on specific direct action strategies to raise awareness amongst the public.
There has never been a more crucial time to fight for the survival of the NHS and we would urge all those committed to a just, equitable publicly owned NHS to join us.
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