The working classes were getting less time, poorer explanations, and possibly worse treatment in the NHS
In 1946, the Welsh MP Aneurin Bevan, in his capacity as health minister, navigated through the British parliament a bill creating a national health service which would be funded by the state from general revenues, available to all, and free at the point of delivery. In the same year, Sir Joseph Bhore proposed that India create such a service. Much of his report now lies under 66 years’ worth of dust. The British National Health Service (NHS) opened in July 1948.
The Conservative Party, who voted against the NHS, are now, as coalition leaders, doing their best to privatise the service, without any mandate to do so. The Tories grudgingly tolerate the contributory cash benefits which, while not generous in a politics dominated by Anglo-American financialism, stem from liberal political thought and require the participation of workers, employers, and the state; but they loathe the genuinely socialist thinking behind the NHS, the jewel in the crown of the post-war British welfare state and probably the most highly valued institution in the country.
Colin Leys, author of the acclaimed book Market Driven Politics, and Stewart Player brilliantly expose the strategy whereby the current government is wrecking the service, and they rightly locate the policy’s origins in the respective governments of Margaret Thatcher and Tony Blair. Thatcher hated the NHS; when the Black Report of 1982 revealed that, far from being a burden on the service, the working classes were getting less time, poorer explanations, and possibly worse treatment than middle-and upper-class patients, she did not call for new attitudes in the NHS but instead suppressed the report for 14 months. Blair, an even more extreme right-winger than Thatcher, apparently redeemed decades of Tory underfunding, but exacted a terrible price — privatisation by stealth.
Every opportunity was exploited. One Labour health minister, Alan Milburn, was excoriated for awarding GPs huge pay rises following a report by the management firm McKinsey, but the real aim was to end out-of-hours duties for GPs, thereby enabling government to give corporations contracts for GP services. Private providers, some based in the United States, that exemplar of public health services, walked in through that particular door.
The terms were rigged to favour the private providers, and were based on the lie that if the state is paying then it does not matter where a private or a public body provides the service. The private providers, including insurers, wanted only young, healthy, and wealthy members of the professional classes. Yet many private treatment centres or polyclinics failed to earn their keep; the policy was abandoned in February 2011. As to new hospitals, these were to be built only under the infamous Private Finance Initiative or PFI, the British form of Public Private Partnerships.
The state indemnifies PFI contractors for decades, against almost every risk. At least one former hospital was demolished and rebuilt under PFI; in one case the public health trust concerned were committed to paying nearly £0.9 million a year for 30 years.
Worse still, many of the private companies are already suspect; South African prosecutors have charged Netcare with organ trafficking. Secondly, outsourced treatment, particularly in the policy’s early days, was often very bad. One, already desperately overworked, German doctor with poor English even killed a patient with a vast overdose of a drug. As a result, NHS specialists were employed wholesale in such services and in the so-called Independent Sector Treatment Centres. Today, patients are being invited to buy particular services, which many GPs have started to provide themselves as the NHS closes its own.
Privatising the service therefore amounts to destroying it. The NHS, of course, does not claim to be perfect, despite its achievements in patient care, in research, and in teaching; advances in high-tech surgery have meant the relative neglect of geriatric medicine and long-term management of chronic conditions, both crucial as longevity increases. Secondly, although patient approval is almost always very high, staff attitudes towards patients or colleagues have occasionally slipped; victims of racial discrimination have sometimes received heavy damages. Furthermore, the hierarchies — also identified in India as a consequence of the Bhore report — which elevate doctors above all others have been criticised. Yet all of these issues can be and are addressed within the NHS.
Leys and Player augment policy and financial analyses with a superb account of the political nature of the attack on the NHS. They also note that many elements of the attack have not been replicated in Scotland or Wales, where the regional assemblies, which have substantial powers, have explicitly cited the evidence on costs and quality in resisting many of the most destructive policies imposed on the English NHS. It may not be a coincidence that both those regions have hybrid electoral systems, which produce assemblies far more representative of public attitudes than the simple majority system used for the House of Commons. Nevertheless, in March 2012 the national parliament overrode widespread public disquiet and voted for a highly controversial NHS reform bill. We may yet have no option but to say, Joseph Bhore, Nye Bevan, and the NHS: Requiescant omnes in pace.
THE PLOT AGAINST THE NHS: Colin Leys and Stewart Player; Merlin Press, Crane Street Chambers, 6 Crane Street, Pontypool NP4 6ND, Wales.