On 9 June 2011, I attended a medical networking
event at the Oxford and Cambridge Club in London. At the end, a man with an
American accent stood up and spoke about how backward our NHS was, and about
how everything was about to change as we adopted a ‘modern’ US style healthcare
system.
Having worked in the US and experienced
first-hand the striking contrast between both systems, I stood up and
responded. The NHS is an excellent model for cost-effective universal
healthcare, promising equal access to high quality healthcare without fear of
bankruptcy when patients are at their most vulnerable. The US, despite all its
innovation and technology in various cathedrals of excellence, spends far more
on healthcare with worse outcomes and denies healthcare to its weakest.
Less than four years later, that vision of a US style
healthcare system is being realised in the UK at a faster pace than many of us imagined
possible. The NHS has been reorganised
and is now on its knees with flat-line funding since 2010, morale at an
all-time low and more threatened ‘efficiency’ cuts. The Health and Social Care Act
passed in 2012 set this government’s agenda for disruption of the NHS. It had two main
effects.
A. Control of the NHS budget was handed to GP-led Clinical Commissioning Groups
(CCGs) that were doomed to fail without adequate support. CCG support services have sprung to
their aid, so that many jobs previously done by the NHS for the
NHS (eg. the design of future services) will now be carried out by
companies like KPMG, McKinsey and US health insurer United Health (1). Note that in 2010, KPMG’s head of global health believed that ‘in
the future, the NHS will be a state insurance provider and not a state
deliverer of healthcare’ (2).
B. CCGs are also being forced to open
up every part of the local health service to private companies. Time-consuming tendering processes in which the NHS is no longer the preferred provider will lead to expensive bidding contests. In the US, administrative
costs account for 20% of healthcare costs compared to 7% in the UK (prior to
the 2012 Act). Private organisations will cherry-pick profitable
services, leaving NHS providers to mop up less profitable work.
In order to save the NHS, the Health and
Social Care Act 2012 must be revoked. The NHS must become the preferred
provider of healthcare services to protect it from competition. We must resist
changes that will make the NHS even more expensive and unaffordable. Electoral
promises to pour £8 billion into the NHS mean nothing if the money flows out of
the NHS and into private hands.
Add to this equation the impending TTIP
(Transatlantic Trade and Investment Partnership) between the US and EU which would make it impossible to reverse these changes, and the future
of the NHS starts to look very bleak. Cameron has described fears that TTIP
might damage the NHS as ‘bogus nonsense’ (3).
If like me you regard the NHS as a national
treasure to be defended from global corporate interests, and if you
agree that all of us (and especially the most vulnerable amongst us) should
have access to healthcare free at the point of delivery without fear of
bankruptcy, then please consider all of the above when casting your vote
tomorrow.
Vinod Achan
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To see my 'Elevator Pitch' on NHS reforms in 2013, see here.
