THE PLOT AGAINST THENHS COLIN LEYS AND STEWART PLAYER The Merlin Press Ltd, 2011 PB, 128, £12.95, 978-0850366792
At the beginning of this review, I declare an interest. I have worked in the US (in the 1970s) and, more recently, in Australia and New Zealand and these experiences, especially working in New York, made me feel passionate about the NHS and the need to preserve its core values
This book clearly describes how commercial organisations and politicians have worked together to undermine these values and to encourage privatisation in the health service in England. The ‘conspiracy’ is unveiled and it is made clear the extent to which the previous government laid the path for Lansley's Health and Social Care Bill.
The image that came into my mind as I read about the interconnections between advisers, private providers, and think tanks was of a spider's web … with the patient as the fly.
The new GP contract in 2004 greatly increased GPincomeand, by making out-of-hours cover optional, opened the gates to fragmentation and private providers. Business ventures between GPs (‘doctorpreneurs’) and private companies abound; but the Royal College of General Practitioners (RCGP) is identified as one of the Bill's most significant critics and Dr Clare Gerada, the Chair of RCGP Council, is quoted as saying that it would mean ‘the end of the NHS as we currently know it’. Fear that complete opposition to the Bill would lead to the NHS being circumvented and even faster privatisation led to the creation of the ‘pathfinder’ commissioning consortia.
GPs signed up to them can be persuasive advocates of the system. I met one at the GP conference last October. He worked in a large consortium spread over four central London sites. Staff were deployed where required and continuity of care did not seem to be a priority. ‘How do you share information about patients?’ I enquired. ‘We have a regular meeting for an hour every week’, he assured me in an upbeat, positive tone. The sort of tone patients/voters hear on the media all the time. It seemed to me that, in such a fluid environment, an hour a week might just be enough to remember who your colleagues were, never mind what complex health problems your patients had.
The situation in Scotland and Wales, mercifully, is very different (I work in Scotland). Here, area health boards have remained in place, foundation trust status has not been introduced, PFI was only used forthree hospital building schemes and only one independent sector treatment centre was opened. However, public reaction was such that, in 2003, the purchaser-provider split was ended and the market option was decisively closed off. The NHS in Scotland is a publicly funded and publicly accountable organisation. ‘Marketizers’ tend to present it as a failure claiming that long waiting lists are due to lack of competition whereas, in fact, since 2005, waiting times have fallen faster in Scotland than England. The authors cite cultural traditions, that is, a strong commitment to social democracy in public life as one of the reasons that the market has been rejected.
The power of health lobbyists is extraordinary: ‘The labyrinthine nature of the private health lobby defies neat description’. A chart, the ‘Marketizer Network’, shows the interconnection between key players, many of whom, like Patricia Hewitt, worked in government, gaining experience in health care provision before taking up employment in the private health sector No one in this web would have been at all surprised by the introduction of Lansley's reforms. ‘The only people likely to be surprised were the public with whom the marketizers had chosen not to share their vision’.
Or they had provided an insight but obfuscated it with careful use of vocabulary … contestability for competition, choice as the mantra, choice determined by cost not quality. Once the competition genie is let out of the bottle, regulation will have, at best, a secondary role. Monitor, the body nominally responsible for regulation, is itself accountable to … no one.
A parallel is drawn with the rail industry, ‘rising ticket prices coupled with declining service, and serious compromises with safety, arising from myriad contracts and sub-contrasts for which no one has overall responsibility’. Except that, no matter how much we value an efficient, effective rail service, we should value our health service more. When Chris Ham, of the Kings Fund, was interviewed on the Today programme in July this year, his vocabulary, ‘productivity targets’, ‘overheated system’, ‘prices’, seemed to fit more with a rail service than a health service.
If what you are looking for is a balanced analysis of the recent history of the health service, this is perhaps not the book for you. The clue is in the title and on the cover; the image of an exhausted, worried nurse leaning into a wall sets the scene. The authors make no attempt to give those who have perpetrated this conspiracy an opportunity to defend their actions. But they do provide a powerful rallying call for those who strongly believe that, ‘the NHS is not for selling’.
- © British Journal of General Practice 2011