Privatisation Of Health Services In England

Vol 23 No 1

Category: ,

Implications For The Working Class And Poor

 The situation facing the National Health Service (NHS) in England was described recently by the chief executive of the British Red Cross as “a humanitarian crisis”. The British Red Cross has been providing support as dozens of hospitals and the ambulance services struggle to keep up with demand. He said his organisation was on the “frontline” as they had to “help get people home from hospital and free up much needed beds”. There were press reports of patients dying in ambulances queuing up outside Accident and Emergency departments (A&Es), waiting to discharge their patients to the care of the clinical staff.

The Prime Minister of the Tory Government, Theresa May in reply to questions about long waits for emergency care and patients left in corridors of hospitals, dismissed the Red Cross statement as “irresponsible” and “overblown” and simply a situation of increased demand in winter, which would soon ease. She was not prepared to admit that the acute shortage of beds was due to her policy of underfunding the NHS. Jeremy Corbyn, the Labour leader accused her of being “in denial”. Cancer patients requiring surgery have their operations cancelled because of lack of beds and patients in A&Es have to wait for long hours as the staff try to cope with the growing number of emergency cases. Some older patients fit to be discharged from hospital remain there because the social care they require at home cannot be provided for them . It is clear to millions of people throughout the country that the NHS as well as social care are in crisis.

The NHS was launched by a post second World War Labour government in 1948, voted into office by a population that had not only suffered the ravages of war but the pre-war years of depression and unemployment. The NHS, publicly funded through taxation, publicly run , free at the point of use, supplanted the market system of private healthcare. The Conservative and Liberal parties conceded that the health service, operating within the capitalist system, was a necessary concession to the working class to ensure perpetuation of the system . Aneurin Bevan, the Minister of Health, and key figure in the introduction of the NHS, had to concede contractor status to the GPs, allowing for some private practice as well as part time contracts for consultants, also entitling them to treat private patients.

The mass of the population welcomed the NHS. The fears of millions before the NHS, when they fell ill and could not afford to call in a doctor because of the expense of medical bills, were replaced by the sense of security with the provision of free healthcare. The NHS developed a reputation for excellence and doctors from the ex colonies flocked to Britain to work in the hospitals and further their postgraduate training. There were problems however at the inception of the NHS such as insufficient funds for building new hospitals. The shortcomings of the NHS over the years , the waiting lists and inefficiencies, the withdrawal of free prescriptions, free spectacles and free dentures arose from inadequate funding . Inequalities in healthcare suffered by the working class, the poor, socially deprived and elderly, although reduced have not disappeared in the NHS .

 In spite of the fact that the resources spent on the NHS compare very favourably with the wastefulness of private health systems such as in the US, right wing forces, particularly in the Tory Party, remained unreconciled to public funding of the NHS. Following the end of the post war boom in 1973-4, they called for marketisation of the NHS. Margaret Thatcher’s government together with President Reagan in the USA embraced neoliberalism in the 1980s . In Britain, Thatcher pursued market driven constraints on health spending and market style reforms, including competitive tendering for catering and cleaning services and an internal market with a purchaser/provider split. The Labour government led by Tony Blair, elected in 1997, discarded many traditional Social Democratic policies and was won over to the “Third Way”, embracing a neoliberal agenda. Although his government did at some stage increase spending on health, he later promoted the use of private capital to finance the building of almost one hundred new hospitals through the Private Finance Initiative. He also formed a “partnership” with private sector providers treating NHS funded patients in Independent Service Treatment Centres (ISTC). One of the providers running an ISTC was a private South African company, Netcare

In 2010, a Tory/Liberal coalition government introduced a policy of austerity, which included big cuts in public services such as the NHS. In 2012, its Health and Social Care Act was passed by parliament, removing responsibility of the Minister of Health to provide health services for the population. Instead, there is now a market in healthcare with commissioning of services from the private as well as the public sector. The amount of NHS funds that have gone to private health companies, has more than doubled from £4.1 billion in 2009-10 when the Labour Party was in power to £8.7 billion in 2015-16. The Tories are pursuing a twin track strategy of underfunding and privatisation to destabilise the NHS. With further drastic cuts planned, the Tories are aiming to replace the NHS with a two tier system of healthcare. Those who can afford it will be taking out health insurance, while the workers and poor will have no option but be treated in a rump health system, which is inadequately staffed and resourced.

Opposition to the Tory plans for the NHS is growing all over the country. Health Campaigns Together, an alliance of organisations embracing local and national NHS campaigning organisations, trade unions, political parties such as the Labour Party and pensioners organisations, together with the People’s Assembly are organising a big demonstration in London against the Tory policies on the NHS. This is part of an ongoing struggle to save the NHS and a return to its founding principles.