One of the great things about growing old is that life becomes much simpler. Those raging passions of youth give way, very gradually, to an acceptance that, in the grand scheme of things, we are pretty insignificant. Imagine my surprise when I found my blood pressure rising and my normally equitable mood being replaced by a growing sense of outrage. What exceptional event caused this? Well, it was the Health and Social Care Act, 2012.
I am not sentimental about the NHS, or any other public body for that matter, and believe that we should constantly be trying to improve our services. What worries me is that ideology seems to be driving this, rather than evidence-based decision making. Some commentators say that the Health and Social Care Act, 2012 effectively lets the private health care sector take over the NHS. The secretive Section 75 of the Act ensures, among other things, that it will be prohibitively expensive for any future government to renationalise it. But, as Polly Toynbee says, ‘the LibDems still have a chance to stop this becoming the most indelible legacy of their time in government‘.
This all seems to have taken place without mention in the coalition agreement and a severe lack of public debate. I have lived in many countries, including the USA and Germany, and have sampled what national healthcare can provide. The German model, which does include the private sector, seems to function quite well. The USA model, which is more expensive with poorer outcomes, is not the one that we should attempt to imitate.
We should, of course, be looking to improve safety and quality of care, to improve efficiency and value for money, but whether the use of private providers and the profit motive is a suitable vehicle for this must, based on the USA model, be in doubt. While the NHS will remain ‘free at the point of contact’, the cost will still be paid by the taxpayer, only now we will have to pay for the cost of the treatment together with profits for the private sector. The NHS has been using private funding and services for a number of years, just look to the PFI débâcle and Serco’s out of hours general practitioner service in Cornwall, but this new bill leaves the door open to expand this with the clause, ‘the making and recovery of charges is expressly provided for by or under any enactment, whenever passed‘.
For all its faults, the NHS is an institution that is valuable to us as a nation and probably one that deserves getting our passions aroused. A good starting point would be to get the Department of Health to publish in full its own assessment of the potential impacts of the Bill. Perhaps then we would not have to rely so much on other professional bodies, such as the Royal College of Physicians, to publish quite damming risk assessments (PDF). It may well be that ‘market forces’ are the way forward but, as with everything, there must be risks involved. What are these risks? How can we mitigate them? How can this new model, which often costs more while delivering less, be allowed to pass uncritically? Give us the evidence so that we can make informed choices rather than just accepting our fate.
* Anthony Hawkes worked mainly in the oil industry around the world. Since retirement he has become a Human Rights Activist and joined the LibDems to start fixing the world. He blogs at Crustry Old Codger.