The 49% myth and the death of the NHS
I’ll admit to being a bit nonplussed by today’s media coverage over the Health and Social Care bill, and the ensuing twitterstorm.
The BBC, for example, announces:
NHS hospitals in England will be free to use almost half their hospital beds and theatre time for private patients under government plans.
A recent revision to the ongoing health bill will allow foundation hospitals to raise 49% of funds through non-NHS work if the bill gets through Parliament.
Yet the removal of the cap on private income was in the bill as it was set out in its first reading to the Commons on 19th January 2011. Clause 150 in that original version announces the end of the caps put in place by Labour:
In section 44 of the National Health Service Act 2006 (private health care), omit—
(a) subsection (1) (restriction on provision of private health services) (b) subsection (2) (cap on private income)…..
The NHS foundation trust does not fulfil its principal purpose unless, in each financial year, its total income from the provision of goods and services for the purposes of the health service in England is greater than its total income from the provision of goods and services for any other purposes.
There are a couple of point to be made on this amendment.
First, it is concerned with resolving concerns about whether the total lifting of the cap would open the NHS up to EU competition law. It has nothing to do with any the core principle about the nature of the NHS.
Second, the BBC is quite wrong to peddle the idea that to use “almost half their hospital beds and theatre time for private patients under government plans.” The amendment refers to income totals, not to bed or theatre time.
It is quite conceivable, therefore, that in fairly short order most beds/theatre time will be taken up by private patients, given that private providers will cherrypick the ‘straightforward’ patients from whom they can extract maximum profit, while leaving the more difficult, less lucrative treatment and care to be picked up by the public purse.
This is evidenced quite clearly in the Lord debate. During the debate Shirley Williams argues for a strengthening of the amendment:
In my view, it would be very helpful if there were “belt and braces”, by which I mean a government amendment which would indicate that, in the case of foundation trusts, the majority of patients should be NHS patients. That is, there should be an unquestionable commitment to having a majority of NHS patients…..It is helpful in this complicated Bill to have some islands of clarity that those who are not experts in the field-again, I include myself-can understand. People could understand the simple concept that a majority of patients should be from the NHS, not the private sector.
Tory minister Earl Howe rejects this proposal:
I cannot agree with her [Williams']… arguments that support the need for an amendment. First, we do not agree that legislation should be used symbolically in this way. Foundation trusts’ principal purpose already covers the point that she raised. Secondly, even if we had such an amendment, it would not make any difference to how the courts interpret and apply EU competition law.
From this exchange it seems quite clear that the government envisages hospitals in which many more than 50% of all patients are private (thus opening up a future narrative for the near future that the NHS-funded minority are scroungers).
Overall, I stick with my initial view, set out in March 2010 when I’d seen the initial bill, that the NHS as we know it is effectively dead. I don’t see major industrial unrest stopping it in its tracks at this stage, and many of the crucial parts of the NHS infrastructure has already been dismantled or will soon be beyond repair.
While of course the left should be doing what it can in the way of rearguard resistance, we should be wary of dilettantism (h/t Leon Trotsky, 1929), and focus on battles that we can win (more around commissioning than around provider services).
Instead to be looking at what a future Labour government should be committing itself to in the form of NHS II, without fetishing NHS I (which has had plenty of faults) and I’ll be writing a lot about that in the near future.
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