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.
