Howe’s that?

 You’ve got to admire Lord Howe’s balls. With the Health and Social Care Bill facing its final Common’s reading amid Labour claims that it’s a Trojan horse for privatization, up pops health minister Howe to say the overhaul of the NHS in England presents “huge opportunities” to the private sector, and that it doesn’t matter “one jot” who provides care to NHS patients as long as it’s high quality and free at the point of delivery.

Cameron, Clegg and Lansley are only continuing the Blair project – endorsed by Gordon Brown and successive Labour governments – of introducing markets into the NHS. But where Labour tried to hide its intentions with irritating euphemisms – modernisation, choice, empowerment, diversity, plurality, contestability – the coalition is utterly shameless.

Labour did make improvements to the NHS but very little was down to their market experiment. They increased NHS funding from £35 billion to £110 billion and got results. Waiting times, infant mortality and deaths from cancer, heart disease and hospital acquired infections all went down, and life expectancy rose (especially for the rich). Much of this was down to better living standards and the development of collaborative quality standards for the treatment of common diseases supported by proper funding. And the ban on public smoking helped.

Labour’s market-based PFI system for building new hospitals has proved disastrously poor value for money to the point that many hospitals are no longer financially viable. The NHS IT system is another hideously expensive market failure and the competition Labour forced on the NHS in terms of walk-in centres, polyclinics and independent sector treatment centres has been hugely wasteful. On the plus side, the satisfaction scores of NHS patients treated in private hospitals under Labour were enviably high. Most patients are delighted to ‘go private’ on the NHS provided the comfy MRSA-free surroundings are matched by a competent surgeon.  A significant percentage of NHS work has always been done by the private sector, particularly in psychiatry, and private hospitals will continue to take the overspill when NHS trusts are full. But private hospitals will only flourish in the NHS if large trusts are allowed to go bankrupt, and no government has yet been brave enough to let this happen.

Where the private sector still stand to make a killing in the NHS is providing all the management support guff that inevitably accompanies a massively chaotic reform programme with huge statutory changes. Last year, Peter Martin, the chief executive of Tribal Group plc, ‘a leading provider of commissioning services to the NHS’, read Andrew Lansley’s 2010 white paper read and spotted an “improved flow of service delivery opportunities” that would bring “major changes in structure of UK health markets”. He set out five growth priorities: commissioning for GP consortia, clinical support services, patient management services, informatics outsourcing and hospital management services.

Now the government has helpfully got rid of many of the best NHS managers by announcing the abolition of PCTs and SHAs, the private sector is primed to step in. GPs and other clinical staff may form themselves into consortia but they haven’t got a clue how to go about becoming statutory bodies or how to restrict and ration care on a corporate level when their professional duty as doctors, outlined by the GMC, is to make the individual patient their first concern.

Clare Gerada, chair of the Royal College of GPs, has advised GPs to resolve this conflict of interest by ‘seeking legal advice’ (not cheap). As Dr Gerada put it: ‘GPs must not be involved in rationing decisions except in an advisory capacity at a very high level.’ But the whole point of the reforms is to pass the buck for rationing in difficult times from politicians onto front-line doctors while allowing the private sector to provide ‘management support.’ In the US, the cost of administering market-based healthcare – making and monitoring contracts, billing, contesting, auditing, legal advice and disputes, fraud, corporate salaries and dividends etc etc – takes up 20% of the budget. That’s where the private sector will make its money from the Health Bill.  

MD