A guest post by Dr Nancy Burge
Did you know that in England the Health and Social Care Act of 2012 made the most fundamental change to the English NHS in since its inception by removing the UK government’s obligation to provide universal healthcare?
Did you know that in England the biggest contract ever tendered in the history of the NHS in England is a £1.2 billion pound deal to sell off cancer services and care for the dying?
And did you know that over 200 Westminster MPs and members of the House of Lords have financial interests in health care companies in England?
The privatisation of the NHS in England is now rapidly increasing. With the Health and Social Care Act of 2012, for the first time since 1947 the Secretary of State not only abdicated his responsibility to provide healthcare for all in England but has got the legal powers to introduce a market, allowing providers to pick and choose which patients will get care and what will be charged for and also to introduce insurance structures similar to those in the USA.
Michael Portillo confirmed in a TV interview that these plans were deliberately kept out of the Conservative manifesto because of the risk of losing votes. And it’s not just the Conservatives who are in on this plan. Andy Burnham, Labour’s Shadow Health Secretary, signed off the privatisation of Hinchingbrooke Hospital during Labour’s final year in power and told Holyrood magazine, “Let’s get health policies that can be consistent across England, Scotland and Wales”. But with an impending election he has changed his mind and calls for a pause in privatisation. In his latest speech Andy Burnham now says “If things stay as they are, the competition framework foisted on the NHS will in the end break it up. It won’t survive five more years of this.”
In England entire NHS hospitals are being turned over to private companies. Healthcare services are now being split up into smaller chunks. An explosion of new private providers are waiting to cherry-pick the most profitable services ranging from mental health services, GP and Out Of Hours services, to diagnostics such as blood tests, x-rays and scans. Ambulance services are now being run by bus companies. No one really knows yet how the financially less attractive services will be run in the future. And how can we be sure that any of these services are being run for the good of patients rather than the profit of the shareholders?
Do you remember the catchphrase of the NHS that it provides “care from cradle to grave”? Well, the whole range of services from maternity services to care of the dying is all going out to tender in the Great British NHS Sell-Off. The largest contract in the history of the NHS is a £1.2 billion deal for providing cancer services and care for the dying. So some of the sickest patients in England will have their treatment dependent on a provider whose bottom line will be profit.
Why this isn’t in the newspapers. How can this be happening right under the noses of people in England?
It is because these private healthcare providers are allowed to hide their true colours under the existing badges and logos of the NHS. All you will see in these privately-run clinics where doctors and nurses wearing NHS identity cards on NHS lanyards treat their patients, are the usual NHS signs. Sir Richard Branson’s Virgin Care says “as we are providing NHS services, NHS brand guidelines require us to ensure that the NHS is the primary logo”.
Companies such as Virgin, Serco, Harmoni, Care UK, and Ramsay Health are hoovering up the healthcare contracts. Yet this massive privatisation process is going on totally under the radar because of the branding rules. And because of EU anti-competition laws it will be difficult to reverse.
But what has all this got to do with the NHS in Scotland? If the NHS in Scotland has been functionally independent since 1999, surely we are ok?
Without devolution NHS Scotland would have been repeatedly reorganised by the Westminster Government of the day, regardless of the special needs of Scotland. And since 1999, we have had free prescriptions, and free personal care for the elderly since 2002. Scotland was the first country in the UK to introduce the smoking ban. We have a separate contract for GP services in Scotland. We have Health and Social care now working together to provide a better service and save money. NHS Scotland has always a separate pension scheme. There is also a separate pay structure which meant that Scottish NHS health care workers got the recommended 1% pay rise denied to those in the English NHS. And the loophole which would have allowed private providers into Scotland was finally blocked by Nicola Sturgeon in 2011.
So won’t all this good stuff just carry on, regardless of what we vote on 18th September? Why do we need to vote YES to save the NHS?
A No Vote will allow Westminster to control the overall level of Scotland’s budget and continue to make decisions that directly affect poverty and health in Scotland through the tax and benefits system.
Westminster can still force changes on the Scottish NHS because of its tight hold on the purse strings. The status quo is really is no longer an option where the NHS in Scotland is concerned.
Currently, Westminster gives Scotland a fixed percentage of the public expenditure of UK as a whole, known as the Scottish Block Grant. The Scottish Government chooses to spend about 40% of the Scottish Block Grant on running NHS Scotland. Up to now the Barnett formula has guaranteed Scotland a fixed percentage of the total of public expenditure in the UK. As public expenditure fluctuates in in the UK our proportion is fixed. When it goes up, we get more –but when it goes down, we get less. The Barnett formula has now only been guaranteed for one more year. After that Westminster will decide how the money is to be divided up based on their assessment of the needs of the four nations. I believe that is a fair assumption that our proportion will be smaller.
But how does this affect Scotland? I thought that devolution meant the Scottish NHS was safe?
The privatisation of the NHS in England threatens NHS Scotland not only because of its knock-on effect on our funding but also because it exposes us to the proposed Transatlantic Trade and Investment Partnership agreement.
As private sources begin to replace public expenditure on the NHS in England, we can see that the amount of public money being spent on health will decrease. And so, as the total UK public expenditure goes down, the consequence to Scotland will inevitably be a decrease in our funding. There will be an even smaller funding cake for the four nations to share. And with the planned loss of the Barnett formula in a year, Scotland is likely get an even smaller slice of this even smaller cake.
But privatisation of the NHS in England puts Scotland’s NHS at risk in another way. The Transatlantic Trade and Investment Partnership or TTIP is an additional threat to Scotland’s NHS. This trade agreement between the European Union and the USA requires that state services to be open to competition from American multinationals. It applies where privatisation is already established, unless there is an existing state monopoly. When the UK Health and Social Care Act introduced a private market in health provision in England, it opened whole of the UK to TTIP. After a No vote, private providers and insurance companies could argue that Scotland is only a region of the UK and cannot be exempted from competition for health provision.
So only by becoming an independent state can Scotland can protect the Scottish NHS.
Let’s just look closely again at the two very different paths taken by the NHS in England and in Scotland over the last few years.
There is now a market economy in healthcare in England, using private providers whose bottom line is profit.
In Scotland, since devolution the Scottish government has worked to keep NHS Scotland true to the founding principles of the NHS, by continuing to provide and improve its unified, publicly funded service, free for all at the point of use.
A few days ago, First Minister Alex Salmond proposed that an Independent Scotland should “guarantee that not only will the NHS be kept in public hands, but that the services that are free to access today will be free to access in the future.”
A vote for YES really will give us the chance to protect our beloved NHS in the new nation of Scotland for generations to come.
On the 18th of September this NHS doctor will be voting YES – I really do hope you will too.
Nancy Burge is a GP in the Isle of Skye