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The NHS at 70 is in danger


By Dr Kailash Chand
GP and honorary vice-president of the British Medical Association
30 June 2018

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On its 70th birthday the magnificent NHS is under threat from an ideology that dictates that private sector is better than public. The service has never been in a more dangerous position than it is now.
A key era in the march towards privatisation was the 1990s.

In 1999, health secretary Alan Milburn started the transition from public to private sector under the disguise of choice and competition. By 2004, the private sector had metastasised to almost every organ of the NHS.

The agenda continued unabated, under the 2012 Health and Social Care Act brought in by health secretary Andrew Lansley. Today the transition wears the disguise of accountable care organisations (ACOs), accountable care systems (ACS), integrated care organisations (ICOs), and so on.

General practice is one of jewels in the crown of patient care. But the Government seems to be pushing for greater private sector involvement, which could change its character forever.

The NHS is being taken over by big business and private healthcare teams, so money that should go into clinical care is instead diverted to corporations and their shareholders.

However, governments that try to shift costs from the public to private purse rarely save – and often increase – costs. For the past 30 years, the leaders of all major political parties have been wedded to the marketisation of healthcare. Do they believe that private healthcare companies would not put profits before patients?

The idea that competition breeds excellence
and market forces drive efficiency is a myth. There is not an iota of evidence that costs go down and efficiency improves when private companies deliver NHS care.

Instead, costs increase and services may well get worse. It is worth noting that France’s system of high charges for services has not curtailed their rising healthcare budget.

The 2012 Health and Social Care Act has diverted resources and attention away from front-line challenges. Today’s wounded NHS is now scarcely able to make the changes it needs.

If this continues, England will have a completely different healthcare system in the near future
– NHS in name only. Things will be much worse
in terms of access, equity, health outcomes and costs.

The NHS will be just a logo; a once-cherished institution reduced from being the main provider of health services in England, with one of the biggest workforces in the world, to an increasingly fragmented and privatised service.

Fewer treatments will be available as cuts start to bite, while wealthier people will be able to top up their NHS provision. The poor, the old and the weak will be routinely disadvantaged. Today’s NHS is on the wrong path, a fast-track to fragmentation and marketisation.

On its 70th anniversary, do we really want an NHS that is obsessed with private companies tendering for work? Or do we want a health service that is passionate about caring for the seriously ill and vulnerable?

It doesn’t have the ability to do both. In the hearts of the public, the NHS is much more than a provider of healthcare – it is a cherished national institution.

Dr Kailash Chand OBE is a GP and honorary vice-president of the British Medical Association. Twitter @kailashchandobe

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