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An acceleration in the NHS privatisation will only hasten its disaster
The promotion of Jeremy Hunt to Secretary of State for Health marks a return of the Conservative Party to a state of permanent toxification of their Party. A ‘hard-won’ victory of David Cameron had to be to appear ‘compassionate’, and to detoxify his politics. In an issue so politically sensitive, David Cameron’s decision was bound to be ‘make or break’, and this is a decision he will inevitably regret.
The separation of the ‘induction’ and the ‘implementation’ phases by Downing Street is purely a strategic one, necessarily a cosmetic one, but substantially an illusory one. The ‘induction’ phase was an unmitigated disaster, for the reason that this was a textbook ‘how not to do a strategic change’ in management. The strategic change failed to take account of the solid foundations of the public sector ethos of the NHS public sector, and, most specifically, failed to understand the organisational culture of the NHS in terms of its key attitudes and values. The privatisation of the railways industry showed how that there was a relentless fragmentation of the implicit and explicit knowledge of that sector, meaning information and skills could no longer easily be shared, and people came disillusioned with the fragmentation. That is why it is impossible to divorce the ‘implementation’ from the ‘induction’ phase, as this strategic change does not have any support from the medical Royal Colleges or the British Medical Association.
The goal of the implementation is fundamentally at odds with the proposed mission of the people within it. Doctors, nurses and health service never undergo their protracted training to make money – there are easier ways of making money. They resent people who do not have any knowledge or wisdom about their field, making powerful decisions about how they should do their job, in much the same way that a policy director of a national charity might have no medical training but feel all potent in making policy decisions that affect the health of the nation. The private health entity has to maximise shareholder dividend by law, and Jeremy Hunt has made his views known about the NHS previously.
Hunt had also previously made his views and beliefs known about BSkyB, and it was this lack of trust which fundamentally destroyed Murdoch’s business hopes, as there was a seething sense of mistrust by the general public. Hunt has made his anti-NHS feelings known about the NHS, and Andy Burnham and Labour apparently wish to put the ‘N’ (national) back in NHS. If Jeremy Hunt seriously wishes to accelerate the speed of these ‘reforms’, this will be a guaranteed way to ensure disaster. What should have happened was for clusters of change experts to discuss the implementation of the privatisation of the NHS in small groups such that the organisational structure and culture of the NHS could gradually change, given that this was their desired mission. Inflicting this change at high speed will mean that this comes a crashing halt, and the privatisation of the NHS will result in being a massive political disaster.
The implications for David Cameron politically are massive. David Cameron failed to win the 2010 General Election, and yet has tried to embark on a privatisation of the NHS costing millions when the public cannot afford it. It does not carry with it the goodwill of the nation, and even some Conservatives are terrified about it on nostalgic grounds. It may act as a perfect sop to the ‘hard right’, but ultimately a conversion of the NHS into a neocon or neoliberal conglomerate is not a vote-winner in the long term. In fact, the reverse. Both the major parties are mistrusted on the economy, with a cigarette paper in their popularity. However, Labour is consistently ahead in terms of trust on the NHS. Jeremy Hunt is already much despised politically for his handling of press regulation and Leveson, and, while he might appear as a ‘Mr Nice Guy’, he is the perfect agent for killing the Conservative Party for a very long time indeed. Hunt has a tendency of wishing to be seen to do everything ‘by the book’, but the implementation of the privatisation of the NHS is a complex strategic change. It is not a case of presenting it in terms of excellent PR skills, on account of its fault being thus far a failure of communication (this is how people tried to explain Lansley’s failure). The strategic change requires the guts of somebody who understands business or competition law, and Hunt lacks the necessary skills or experience for this. He is the ultimate in pen-pushers, a culture that is threatening to strangle the NHS and medical charities at large.
The business model of the company, albeit in the NHS, is not in the national interest
In the new-look National Health Service, certain providers, whether they be private-limited companies or public-limited companies, will be guaranteed work from being able to charge the NHS however they wish to produce their services. They can choose to opt out of all sectors which they consider to be unprofitable, and ‘cherry pick’ what type of work it does. They are mandated by law to maximise shareholder divined.
The UK needs the structure of a National Health Service, with a clear direction about the prioritisation of clinical services at a national level. Otherwise, unprofitable health services will go insolvent and disappear from the NHS, unless the NHS is rigorously regulated.
With the progression of the new Health and Social Care Act, the horrific effect will be, unfortunately, to penalise areas of the UK where health inequalities are known to exist (for example coal miners developing emphysema or chronic obstructive airways disease through their work, or British-Bangladeshis having a high prevalence of heart attacks or strokes in Tower Hamlets through a genetic predisposition to cardiopathic traits such as hypercholesterolaemia).
We have seen precisely this problem with markets before. “Oligopolistic” markets are where there are few competitors. If an oligopolistic market then exists, the customer (or patient as he or she should be known in the NHS) may come last, as the need for shareholder primacy takes over. In gas or water, markets also privatised by the Conservatives, there is actual little competition for the consumer, prices are high, the quality of the service has not vastly improved, and shareholders have made a massive profit. Unfortunately, health is the perfect market where this deception can take place, as metrics appear in health reports, which emphasise waiting times or bed days, as the number of patients with ‘hidden’ problems, often unprofitable to treat, such as dementia or depression go unnoticed.
The real workers in the NHS are doctors, nurses and other healthcare professionals, many of whom have difficulty in defining an ‘excellent outcome’ in the NHS even after a lifetime of dedicated hard work often with unbelievable stress and experience. These healthcare workers and employees need the protection of the Unions, particularly over employment rights, and need to feel valued in the NHS. It’s completely wrong if they should become merely ‘disposables’ for venture capital companies to generate a profit; the fact that reports of running roughshod over UNISON exist, and the fact that the Medical Royal Colleges have been steadfastedly opposed to the reforms, means that this is a very dangerous path for the NHS to go down.
Shibley is a member of Labour, and a member of the Socialist Health Association. He has postgraduate degrees in medicine, natural sciences, law and business.
