Where the NHS is heading

This appeared in Guardian letters, 21.1.12

Where the NHS is heading

Guardian letters, 21.1.2012

One element missing from current discussions of the Health and Social
Care Bill is a straightforward account of what will happen if it becomes
law. From a detailed study of the Bill and the academic and policy
literature about it, plus many discussions with experts, I have
distilled this simple scenario of England a few years after the Bill’s

If the Health and Social Care Bill is passed and fully implemented, the
NHS will no longer be a provider of services, as GPs, hospitals and
community health services will all be outside the public sector. The NHS
will simply be a publicly funded budget and a brand name for a
subcontracting operation for competing private organisations, subject to
European competition laws which will allow private companies to
predominate over other (eg third sector) providers.

Since competition and collaboration are incompatible and in any case,
cooperation between providers will be punishable by law as
anti-competitive, coordinated services for people with chronic or
complex conditions will break down and disappear except within the
restricted framework of tied providers under the so-called “integrated
care” model developed by the US health insurance industry.

Because the post-credit-crash health service has a more or less fixed
budget it will increasingly be the case that services judged to be ‘of
lower clinical priority’ will no longer be provided free and will be
charged for (or alternatively people will go private). These
increasingly common NHS charges will create a demand (ie a market) for
health insurance, which will mainly be affordable by the most affluent
and which will also drive up costs because of administration fees and
private profits.

The trigger for the roll-out of top-up insurance will be the impending
introduction of personal health budgets, which represent a first step
towards user charges. Clinical commissioning groups will operate on an
individual basis so as to be compatible with the insurance companies,
unlike the traditional GP service which is population based and pools
risk across the whole country. Illness will begin to cause bankruptcy as
is common in the US. Inequalities will increase enormously. Large
amounts of public funds raised through taxation will be redirected as
profits for the private companies which will provide NHS services and
NHS commissioning support, and direct NHS charges (or health insurance
payments to cover these) will become a normal item of household expenditure.

Dr Alex Scott-Samuel, Liverpool


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