David Cameron's bright idea: privatising the NHS

It’s curious to be sitting in the Accident and Emergency Department of our local (NHS) hospital, waiting for someone to see my wife for a sports injury she received this morning.

No one has asked us to provide evidence of ability to pay. The treatment will be delivered based only on the state of her health, the extent of her injury, and not her financial status.

No one stands to profit financially from her care. I’ve just heard a nurse explaining to an East European couple that they would not be receiving antibiotics. There is no financial incentive to prescribe any particular medication, and so it’s possible to get strict about what drugs are handed ou.

Sadly, Britain seems to be trying to move away from this admirable model, with doctors warning that the principle of service being free at the point of care is unlikely to survive more than another ten years if there’s no let up in the pressure on the NHS. It’s hard to overstate how shameful that is: the notion that when we’re ill or hurt, we can count on care immediately whoever we are and whatever our social position, is precious. It seems extraordinary that anyone can seriously question it or want to do away with it.

This isn’t to say that a health service has to be based on it. The United States, for instance, takes the opposite approach: there is no presumption of treatment without payment. I’m always impressed by the number of Americans I’ve known who assure me that the system is the world’s best, whereas it’s my feeling that it’s simply the world’s most expensive.

US Healthcare leads the world.
At least in expenditure

Far too much of the US population has no cover at all, a lamentable state of affairs Obamacare is only beginning to address, and a great many more have no adequate cover; highly expensive care is often provided, but it’s often entirely inappropriate: costly hospital treatment for conditions which could have been dealt with far more cheaply by a GP if one had been available earlier; and no follow-up after hospitalisation, so there’s a high risk that the underlying condition will continue to get worse and the patient will be back in hospital before long.

Considering how much it costs, that’s a damning indictment of the US system.

Which leads me to wonder why it is that some in Britain, most deplorably many in government, are so keen to see us move in that direction. And yet they do. Increasing numbers of services are being put out to tender to private companies. Currently £5.8 billion worth, a 14% increase over last year. And yet there’s no evidence that they’re provided either better or more cheaply than by the NHS itself: one of the biggest privatisation companies, Serco, was involved in a major scandal when it was forced out of its contract to provide out-of-hours GP services in Cornwall. And then just a week ago, it announced that it was going to see out the contracts it still has left and then withdraw from the UK market for healthcare services. It has racked up multi-million pound losses, and has had enough.

So privatised services aren’t particularly good. They aren’t particularly cheap. And they don’t even generate much of a profit for their providers.

Not that they don’t try to make one. When Care UK took over services to people with severe learning difficulties in Doncaster and absorbed a group of employees from the NHS, their first move was to cut wages by up to 35%, leading to a long-running strike. If profits don’t come, it certainly isn’t for want of trying. 

Why are they so hard to achieve? Because the NHS runs a tight ship: Britain may not have the world’s best health service, but many studies have found that it has the most cost-effective. In the profligate environment of the US, healthcare service companies can make a fortune, but over here it’s a lot more difficult.

Why then is the government so intent on maintaining the headlong drive towards privatisation?

There’s much debate about the nature of politics. Should it be oriented towards personalities, image, soundbites, charisma? Or instead towards ideologies, principles, fundamental philosophy?

Well, image gave us Cameron, a man whose incompetence as Prime Minister is only rivalled by his indolence. With a major crisis in Iraq he had to be called back from holiday – twice. He seems not to understand that he has a post that requires not just a full-time commitment but a lot more dedication than ordinary jobs. Dubya was like that, too, taking sixty or seventy days leave a year and working short hours. That’s the man who took us into the Iraq War, for God’s sake (and he probably thought it really was for God’s sake).

As for ideology, well that’s just what’s leading to NHS privatisation. It makes no sense: it benefits no one, not patients, not the taxpayer, not even the privatising companies. But that same Cameron has made up his mind, as a matter of principle, that it needs to be done. Against any evidence. As a matter of sheer belief.

In the debate between image and ideology, I choose neither. Competence, pragmatism and a willingness to take evidence into account, are the qualities that matter. And we need them badly, especially if we’re to save the NHS.

An old man has just been discharged in the hospital.

“Would you like a taxi home?” asked the nurse. “We’ll pay for it.”

The gesture would cost under £10. A trivial sum. But what a difference it would make to a lonely old man, worried about his health.

Money alone can’t measure the value of a health service ready to provide such care to that man. We need to hang on to it as though our lives depended on it. 

Because they do.