[Marxism] British health care system is sicko

Darren Williams dazza1970 at tiscali.co.uk
Sat Oct 20 09:01:15 MDT 2007

"jk68" asked: It's not clear to me what the roots of this crisis in the 
British health care system are. Is there anyone on this list who can briefly 
explain? Thanks.


Most of the problems in the National Health Service (NHS) are the result of 
the creeping privatisation and marketisation of the service, which was begun 
under Thatcher and has been accelerated by New Labour. The Tories began the 
contracting-out of ancillary services like catering, laundry and cleaning 
(and there seems to be a link between the latter and the rise in 
hospital-acquired infections). More significantly, however, they began the 
process of turning the NHS from a cohesive, integrated body - in which 
service provision was planned to meet the health needs of local 
populations - into a loose assemblage of competing 'businesses', linked by 
market or quasi-market transactions. They did this, in the first instance, 
by making hospitals and local doctors' surgeries independent of direct 
control by local health authorities, introducing an 'internal market', in 
which 'purchasers' (health authorities) had to 'commission' local services 
from 'providers' (usually, NHS trusts). To begin with, all the participants 
in this market were public sector bodies, but they were forced to behave 
like commercial businesses. Increasingly, the costs of all the transactions 
between different NHS bodies made up a significant proportion of expenditure 
within the service and the number of bureaucrats, accountants, lawyers, etc. 
mushroomed at the expense of the number of clinical staff. Also, part of the 
aim was that, in due course, private health companies would be able to 
compete with NHS trusts to sell services to commissioning bodies.

New Labour has deepened this process in a number of ways, especially by the 
gradual transformation of hospital and other trusts into 'Foundation 
Trusts', which have even greater autonomy - including the ability to enter 
into partnerships with private businesses and to decide which services they 
want to provide (regardless of the needs of local people).  Service 
provision has also been skewed by the introduction of a system called 
'payment by results', which sets a national tariff for particular surgical 
procedures and thereby introduces a disincentive for trusts to provide 
services which would not prove 'cost-effective'; this deepens the so-called 
postcode lottery' in availability of services. The Government has also done 
everything it can to ensure that private companies (increasingly, 
transantional corporations like UnitedHealth) get a lucrative piece of the 
NHS action. For example, a number of  'independent sector treatment centres' 
have been set up, to carry out elective surgery on NHS patients - supposedly 
to deal with the backlog of patients on waiting lists and with the 
cancellation of elective operations by NHS hospitals as a result of medical 
emergency pressures. However, these private companies are paid for a 
predetermined number of operations and they still get paid for these even if 
they don't actually carry out the operations. In addition, when local 
primary care doctors (GPs) refer patients for secondary care, they now have 
to give them a 'choice' of five alternative providers - at least one of 
which must be in the private sector. And most hospitals are built under 
deals where the finance is provided by a private consortium, which then gets 
to use any 'spare' land for its own uses (eg, building luxury flats) and 
often gets paid to run the new hospital too. Independent experts have proven 
that these deals cost the public more in the long-term but the government 
ignores or rubbishes such evidence.

The recent problems are further symptoms of this process of creating an 'NHS 
marketplace'. NHS trusts are allowed to run up financial deficits and then 
have to lay off staff and/or cut services. Thousands of nurses and other 
health workers were laid off in the last financial year for this reason - 
even though their services are still badly needed.

For more information see the website of the campaign, 'Keep Our NHS Public': 
www.keepournhspublic.com. There are also a number of useful books, such as 
'NHS plc' by Allyson Pollock (Verso 2004), 'The Political Economy of Health 
Care' by Julian Tudor Hart (Policy Press 2006) and 'Health Policy Reform: 
Driving the Wrong Way?' by John Lister (Middlesex University Press 2005).

Incidentally, following devolution in the UK, these problems apply far more 
in England than in Scotland or, especially, Wales which is run by a more 
left-wing Labour administration (now in coalition with the progressive 
nationalist party, Plaid Cymru) that has rejected marketisation.

Darren Williams. 

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