This week’s announcement that the NHS may no longer prescribe certain items, including gluten-free foods and medication for upset stomachs, travel sickness and haemorrhoids, may sound reasonable. There will be many members of the public who will be in agreement. Some doctors will also be sympathetic because they do not feel it is appropriate to prescribe such items.
However, this conversation misses the point entirely. We have become so accustomed to a bogus debate about patient abuse of the NHS that we are overlooking the real exploitation happening in the NHS. If we want to look at savings then we should be examining the huge profit margins of pharmaceuticals at the expense of the NHS. But it is not just big pharma. Private healthcare, multinational corporations and banks are profiting from the NHS budget to the tune of tens of billions of pounds annually.
The principle of outsourcing means that the private sector cherry-picks profitable services, siphoning off money that would otherwise be spent on patient care. The cost of Private Finance Initiative (PFI) hospitals will reach up to £80bn (with PFI2 ongoing) alongside billions spent on management consultants, big four accountancy firms and lawyers. The cost of running the NHS market was previously estimated at between £4.5bn and £10bn per year.
It is therefore convenient to deflect the blame for the NHS crisis on scapegoats such as overprescribed, hypochondriac patients. Prescription cuts are the thin end of the wedge. Rationing is being significantly ramped up. Some Clinical Commissioning Groups (CCGs) are coming out with consultations to restrict care. Many treatments previously available on the NHS, such as cataract surgery, hearing aids, hip and knee replacements and those for varicose veins, are being increasingly restricted. CCGs are also looking at restricting care for certain groups of patients, such as the obese and smokers.
This is all part of a much bigger picture of cuts and privatisation. The NHS will have endured around £40bn in cuts by the end of this decade and the pressure is showing. At the same time, the NHS is increasingly being privatised.
During the last parliament, the Coalition government brought in an NHS privatisation act – the Health and Social Care Act 2012 – axing governmental responsibility for the NHS, undermining the principle of comprehensive care, opening up NHS contracts to potentially unlimited corporate takeover and enabling most NHS hospitals to make up half their income from private patients.
The Conservative Government is now consolidating privatisation with a drive towards US-style healthcare, known as accountable or integrated care. This is being brought in through the vehicle of Sustainability and Transformation Plans (STPs) sold as care in the community. STPs will actually translate into £22bn of cuts by 2020, accompanied by hundreds of GP surgery closures and tens of hospitals facing service downgrades and closures.
This restructuring of the NHS is paving the way for private healthcare by creating economies of scale through networks of GP surgeries and chains of “super hospitals”. One of the reasons for this is corporations have found that NHS contracts are not as lucrative as hoped.
At the same time, personal health budgets are also being rolled out to patients subsequently enabling insurance top-ups and co-payments, while the workforce is being redesigned to reduce overheads through worse pay and conditions, again in preparation for further privatisation. Hence the junior doctor contract dispute with new contracts to follow for other NHS staff.
It is therefore alarming that the House of Lords quietly launched a NHS Sustainability Committee last year stacked with members sympathetic towards the current privatisation drive.
It is not unrealistic to imagine that the committee will arrive at a set of recommendations including charging and insurance as solutions to the bogus debate around NHS affordability. One possible scenario would see the government adopt these recommendations. The “independent” cross-party status of the commission would effectively grant the Government a get-out-of-jail card to avoid political and electoral suicide.
Such recommendations would then be implemented so incrementally that they would hardly be noticeable to begin with. The committee is due to submit its findings shortly. As citizens, it is up to all of us to ensure that they do not arrive at the wrong conclusion.
Youssef El-Gingihy is the author of ‘How to Dismantle the NHS in 10 Easy Steps’, published by Zero books