The NHS will last for as long as we are willing to fight for it - If the future of our health services was wrested back from the private sector, there would be no need for the threatened round of cutbacks, argues Wendy Savage

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Published: 30 April, 2010

In 1997 the Labour Party came to power promising to reverse the changes introduced by Kenneth Clarke as Secretary of State for Health in 1990 under the banner “Working for patients”. The manifesto stated: “Our fundamental purpose is simple but hugely important: to restore the NHS as a public service working co-operatively for patients, not a commercial business driven by competition.”
When Frank Dobson was appointed as Secretary of State for Health in 1997 he set about dismantling the internal market but was soon relieved of his position, and from 2000 the NHS plan was implemented in which competition was seen as way to drive up standards in the NHS.
Patient choice has been used as a smokescreen behind which the Commercial Directorate in the 2003 introduced so-called Independent Treatment Centres and a new contract for GPs called the Alternative Provider Medical Services contract, which allowed private firms and corporations, often from overseas, to obtain GP practices.
In 2008, £5billion was paid to the private sector for services, which could have been provided more cheaply by the NHS, now that the under funding that bedevilled it from its inception had been remedied by the fulfilled promise made by Tony Blair that the government would bring NHS spending up to the European average.
On March 30, 2010, the Health Select Committee were highly critical of the Department of Health – who were unable or unwilling to give them the costs associated with the real market set up by the current government. The Committee reached the following conclusions:
l Whatever the benefits of the purchaser/provider split, it has led to an increase in transaction costs, notably management and administration costs. Research commissioned by the Department of Health but not published by it estimated these to be as high as 14 per cent of total NHS costs. We are dismayed that the Department has not provided us with clear and consistent data on transaction costs; the suspicion must remain that the Department of Health does not want the full story to be revealed.
l We were appalled that four of the most senior civil servants in the Department of Health were unable to give us accurate figures for staffing levels and costs dedicated to commissioning and billing in PCTs and provider NHS trusts. We recommend that this deficiency be addressed immediately. The Department must agree definitions of staff, such as management and administrative overheads, and stick to them so that comparisons can be made over time. We would go further and say, as does the British Medical Association, that the purchaser provider split, payment by results and encouragement to the private sector to compete with NHS hospitals and GPs should stop at once.
Sadly, the only party which would behave in this way is the Green Party, who even in a hung Parliament will have no voice.
Surveys have shown that what people want is a good local hospital near them, and the “choice” offered by “Choose and Book” of five institutions about which they know little is irrelevant, but primary care trusts (PCTs) were instructed by the Department of Health to ensure that 15 per cent of elective surgery went to private providers.
The direction by the Department of Health, that every PCT should have a GP-led health centre/polyclinic by the end of 2009, whether or not the PCT thought they needed one and the instruction to separate their commis­sioning/purchaser and provider functions by April this year has increased instability and administrative costs. Nursing staff are being encouraged to set up social enterprises, another initiative that has not been piloted and which is unpopular with staff.
What do the three parties say about the market which the Department of Health estimated cost up to £14billion a year in evidence to the Select Committee? They do not mention it as such but state they are willing to use alternative providers and reiterate that they will continue to provide care free at the point of use.
A recent survey showed that three quarters of those surveyed do not want private providers involved in the NHS and the central fact that the primary duty of the private sector is to their shareholders, not to the patients, can not be escaped.
If any of the three main parties were to state clearly that they would eschew the private sector, and abolish the purchaser/provider split, they would gain votes as the NHS is central to people’s beliefs about a civilised society.
No cuts would be necessary if one were to do this, as the resultant savings would be enough to fund
the necessary improvements and extra expenditure expected because of our aging population and medical advances in the next five years.
As Nye Bevan said of the NHS: “It will last as long as there are folk left with the faith to fight for it”.
The market will destroy the NHS ultimately – are there any prospective parliamentary candidates who will fight for it? If so please visit our website www.keepournhspublic.com and sign up to our statement of principles.
• Professor Wendy Savage is an obstetrician and leading campaigner in Keep Our NHS Public