Decent health care available to all is a fundamental human right. Today, given the level of technological advancement, only profit stands in the way of this demand becoming a reality for the world's population. In 1948 Britain's workers won the National Health Service at a time when the strength of the Soviet Union and the great strides forward made for each member of society under socialism were obvious for all to see. In order to prevent proletarian revolution in Britain the ruling class had to meet the demand of the working class for a universally available healthcare system. Now, with the Soviet Union gone, and a weak and divided British working class, the ruling class feels safe enough to take such services away. The latest overhaul of the NHS promised by the Labour government aims at exactly that. The billions of pounds the Labour government claims to have set aside for modernising and extending the NHS is earmarked to go straight into the pockets of private profiteers instead of into rebuilding the NHS as the properly managed public service it should be.
NHS in dangerously bad shape
At the present time it is clear to anyone that the NHS is in dangerously bad shape. Chronic under-spending which began in the 1960's and continued in each succeeding decade is now painfully obvious, "the price only slowly became visible: a crumbling hospital infrastructure, a shortage of high-technological equipment, grubby hospital wards and unpalatable hospital food" ("In a bad way", Financial Times 29.11.01). Compared with spending on health in Europe, the NHS was underfunded by £220 - £267bn between 1972 and 1998. ("Wanless stirs debate on funding improved NHS" FT 30.11.01). Last year the World Health Organisation rated Britain 18th on its list, based on overall health performance across the world, a performance ranking far below that of countries including France, Singapore, Spain, Portugal and Greece.
The reality for most NHS customers is that the health care they need is just not available. Waiting lists for operations exceed 18 months in many cases. Waiting lists to see a specialist can mean that a condition, treatable at the time of diagnosis by a GP becomes terminal at the time a specialist is seen. In the case of bowel cancer, studies have shown that, due to delays in treatment under the NHS, one in five cases of cancer curable at the time of diagnosis had become incurable at the time of treatment. ("Cash -strapped NHS hospitals chase the private patient bonanza" Observer 16.12.01). Compared with Europe, survival rates for breast and lung cancer cases in Britain are low and women have a shorter life expectancy at birth and at 65 than women in comparable countries. ("In a bad way" FT 29.11.01). Life saving drugs are often simply not available to NHS customers whose NHS Trust cannot afford to prescribe them.
Following a recent tour of the nation's hospitals, Sir Peter Morris, president of the Royal College of Surgeons, was depressed with what he found, saying in an interview with BBC's Radio 4 that the NHS had got worse under Labour in virtually every area "over the last 10 years it really has gone downhill a lot. I can't say that I would be happy to be treated in the NHS" ("Minister defends 'desperate' NHS", BBC News 8.12.01). The lack of resources has led to very low morale among medical professionals who find themselves frustrated and depressed at being unable to do their job properly for want of beds, drugs and technical equipment.
The situation of under-funding has led many NHS Trusts to take on fee paying patients to raise funds, further exacerbating the waiting list crisis and depriving NHS patients of treatment they are entitled to and promised by the government. Last year the NHS earned £340 million by renting out operating theatres, scanning machines and beds to private patients, many from overseas. Overall the NHS has 3,000 beds for private patients making it one of the biggest private medicine providers in the UK. People are able to skip long queues and have treatment instantly with the NHS, provided they are willing to pay. A case in point is that of former British diplomat, Christopher Denne, diagnosed with prostrate cancer. He was told he needed a scan to see if the disease had spread to his bones before he could see a consultant. As reported in the Observer, "the bone scanner at Derriford Hospital in Plymouth was so busy that he faced an eight week wait for diagnosis. However, Denne was told that the NHS scanning machine was reserved for private patients for a certain period each day and was often unused. He paid £180 to have the scan done within 3 days. 'it was the same scanner, in the same hospital with the same people. It amazed me', Denne said" ("Cash-strapped NHS hospitals chase private patient 'bonanza'" Observer 16.12.01)
NHS the last profit-free reserve
Anthony Browne, writing in the Observer on 7th October 2001 condemns the NHS to death with these words "We must abolish the NHS as we know it, abandon our unique obsession that all health care should be free, and become as comfortable with mixed public and private medicine as they are elsewhere in the developed world…The very structure of the NHS ensures that we will never spend enough on health in this country, and it will ensure that far too many patients get appalling treatment. The NHS is the last of the communist-style command-economy state organisations, the largest employer in the free world, paid for by a cheque from the Chancellor, managed by a central government ministry, dictating everything from what drugs to prescribe to what meals to serve, through the daily issuing of thousands of targets and initiatives that are baffling even to those who are supposed to carry them out. The failure of the politically controlled, state funded NHS is sadly as inevitable as the failure of the politically controlled communist economies" ("Why the NHS is bad for us, Observer 7.10.01).
Mr Browne's words give some clues as to why it is that the NHS is failing patients in Britain and why the ruling class is so determined to tear it down. Under socialism free healthcare is guaranteed to each member of society as a right and in recognition of the fact that society had advanced to such a stage that the needs of each member of the population can be met through the endeavours of all for the common good. Under capitalism, where profit is the sole determinant of progress, such social provision is not possible. When Mr Browne refers to the NHS as the last "communist-style command-economy state organisation", what he means is that the NHS is one of the last remaining areas which, up until recently, had not been ruled by profit. Given the size of the NHS, "the largest employer in the free world", it was only a matter of time before profit turned its greedy eyes upon the health service and demanded a slice of the pie.
This explains the successfully hidden policy of running down the NHS over a number of decades, slowly but surely, until the point is reached where the NHS is in such an appalling state that private profiteers can waltz in, heralded as knights in shining armour, to save the day. In fact, grim reapers would be a more apt description!
Labour government clears the way for private profiteers
The Labour government continues to paint itself as the defender of the NHS - leave it to the media to declare the NHS is dead! However, even a shallow analysis reveals that the Labour government has sealed the fate of the NHS, and is clearing the way for private profit to take over the provision of healthcare.
The Labour government has allocated an extra £5.5bn to be spent on the NHS this year, promising to modernise the NHS and bring the healthcare standard up to European levels by 2005. However, according to the Institute for Fiscal Studies, it would cost £11bn per year for that goal to be reached ("Minister defends 'desperate' NHS", BBC News 8.12.01). It is also clear that the funds promised will have to go to remedying the maintenance backlog (which exceeds £5bn) caused by decades of neglect, with hardly any funds left over for expansion. Alan Maynard, writing in the Financial Times confirms that the extra funds will be spent on cleaning, painting and replacing medical equipment "some of which would look more suitable in a museum than in a "modern" hospital". He writes "So far so good - but the common characteristic of these investments is that they have no effect on the capacity of the healthcare system to treat increased number of patients more rapidly" ("Blair's gamble on health", FT 4.12.01).
The increased capacity is to come from outside the NHS - to be provided by existing British private health companies like BUPA and through encouraging overseas providers to build facilities in Britain to treat NHS patients. Last year some 150,000 NHS patients were treated in the private sector and it is planned that this number will double in the coming 18 months ("Private hospitals to take more NHS patients" FT 25.10.01). There are no plans for any further NHS facilities to be built, all of this is to come from the private sector. According to Charles Auld, chief executive of General Healthcare - a private health provider also in talks with the government over the role of private providers in public health; "the way to get extra centres built quickly…was for the private sector to fund, build and staff them itself, at its own risk, not through the private finance initiative - but with the operations initially performed by NHS consultants. … We could get something like that up and running in 18 months to two years" said Mr Auld ( "Unions voice anger at deal with BUPA", FT 5.12.01).
The responsibility for management of the NHS is to fall on Primary Care Trusts (PCTs) - made up of doctors, and nurses, who will be responsible for running community services, overseeing the performance of family doctors and, importantly, purchasing care. Patients who have been on a waiting list for more than 6 months will have the option of being treated in private hospitals, along with patients whose operations have been cancelled for whatever reason and not rescheduled within 28 days. Rather than a short-term solution, it is envisaged that more and more NHS patients will be treated privately. PCTs will be given the job of arranging long term contracts with private healthcare providers to cover, for instance, a certain number of operations per year, rather than one operation at a time as the need arises.
With such a shortage of medical practitioners in Britain and such long waiting lists of NHS patients - 5.5 million on waiting lists currently ("A contracting health service" FT 5.12.01), the provision of private healthcare is to become a booming business. There are currently 64 private sector hospitals built or in the process of being completed ("A contracting health service"). Recently, BUPA opened a day surgery solely for NHS patient use. This is the prototype for many more such facilities to come. Plugging the successes of the Labour mission to pass the public health service into private hands, an adviser to Alan Milburn, Health Secretary stated "we had a fight and won over the private finance initiative. We will have a fight and win over this one. We are a monopoly funder of health care. We don't have to be a monopoly provider" ("BUPA to run centre for NHS day case surgery" FT 4.12.01)
Britain's healthcare to rest solely in the hands of profiteers
Therein lies the essence of Labour's plans for the NHS. The increased funding being put into the NHS, to be funded by a possible increase in taxes, is to be funnelled straight into the pockets of private profiteers. The NHS will not provide any new health facilities - all of this is to come from the private sector, paid for by the government. And, as PCT funds go increasingly to pay for operations in private hospitals, less will be left over for the running of the remaining NHS services. It is only a matter of time before these too are closed down and Britain's healthcare rests solely in the hands of profiteers.
To an individual patient, treatment in a first class private hospital in comfortable surroundings with the most modern equipment is far preferable to treatment in a shoddy NHS hospital. This is not a viable long-term solution to Britain's healthcare crisis however, and undoubtedly funding for such treatment will not continue far into the future. Rather than providing free healthcare as a service to the population through the NHS, PCTs will be paying private companies not just for the care they provide, but also a vast sum by way of profit. This is undoubtedly more expensive and also does not guarantee patients will be provided with the best healthcare possible. As is the case with those people who currently pay health insurance, healthcare is readily available to "healthy" people and for less serious complaints. People who suffer life threatening illnesses and who require a much greater amount of care, cancer sufferers for instance, find it much more difficult to obtain treatment and are often unable to obtain health insurance. It is these people again who will miss out on the treatment they require under the current system, simply because the profit margin achievable for treating such patients is considerably less. The current initiatives focus on private hospital treatment of less serious complaints, such as the BUPA day surgery project mentioned above and proposals to fly over surgeons from Europe to perform operations in NHS or private hospitals on NHS patients. At this stage it seems that the more seriously ill will remain in NHS hospitals, already dire and with an increasing lack of resources. Nicholas Timmins writing in the Financial Times puts the question thus: "any fool can devise a health system to deliver good non-emergency care to the middle class and articulate. It's called BUPA . The real test is whether it provides as well for the needy and inarticulate, for the costly absolute disasters, for the mentally ill and handicapped, and for those with long-term crippling disease" (Breaking through the healthcare class barrier FT 3.12.01).
A large number of jobs are also at stake as a result of private company involvement. Under capitalism, as is well known, profit margins must be kept as high as possible and costs, including wages and employee benefits, must be kept as low as possible. Already on poor wages and with terrible working conditions, NHS employees stand to suffer far worse in the employ of private companies. The government has faced harsh criticisms from unions over its plans for the NHS, with John Edmonds, general secretary of the GMB union describing the decision to pass responsibility for healthcare onto private companies as a "deliberate slap in the face" of public employees, "It is clear there are people in Downing Street and the Department of Health who care more for the well-being of private health companies than they do for the well-being of the people who elected them" ("Unions voice anger at deal with Bupa" FT 5.12.01).
However the unions have proved unable to mount an effective opposition to the privatisation of the NHS, cushioned as they are from the harsh blows of capital experienced by the workers they claim to represent by fat salaries and privileges heaped on them by the ruling class in order to buy their subservience. UNISON recently struck a compromise with the government, which will mean that lower grade NHS staff - cleaners, cooks, porters and laundry staff remain NHS employees in 3 pilot PFI schemes. UNISON welcomed the deal, general secretary Dave Prentis calling it "a step forward in protecting our members and keeping them where they belong". However, it is clear that this compromise represents no more than a semblance of victory. The Business Services Associations, representing 19 PFI contractors, insisted the deal be confined only to the 3 pilot schemes and further stated "we cannot allow this model to become the accepted norm for future PFI projects, either in the health sector or otherwise…if it does, the whole future of the government's drive for high-quality public services is under threat" ("Union deal 'threatens' private funding initiative" FT 23.11.01).
In the name of a commitment to modernising and expanding the NHS, the Labour government has paved the way for private profiteers to reap massive profits at the expense of the British people and most notably the working class. Far from rejuvenating the NHS, forcing PCTs to pay scarce finances to private companies for treatment of NHS patients means that the NHS's already poor resources will be further depleted. Ultimately what remains of the NHS will also be dismantled and private companies will become the sole providers of healthcare. Once again it is the working class who will bear the burden of the loss of the NHS - through loss of jobs for a large number of public employees and through loss of health resulting from inability to afford health insurance. It is a sick system that refuses to allow a decent standard of living to the working majority of the population.
FIGHT FOR SOCIALISM!!
-------------------------------------------------------------------
Comments on this article? E-mail the editor
-------------------------------------------------------------------
Go to Back issues 2001
Return to Homepage