The proposed NHS “reforms” (i.e. counter-reforms) have been outlined in the policy paper “Equity and Excellence: Liberating the NHS” and are currently under consideration in the form of the “Health and Social Care Bill 2011”. From the content of the policy report and the bill, however, it is clear that “liberating the NHS” is in fact a euphemism for “opening up the NHS to privatisation”, since the proposals seek to introduce the market into the NHS and allow private firms to have a greater influence and involvement in the provision and management of health services.

In a paper entitled “English NHS Embarks on Controversial and Risky Market-Style Reforms in Health Care”, Professor Martin Roland, the Chair in Health Services Research at Cambridge University, states that, “The scale of change envisaged is immense, creating major challenges in implementation, with unpredictable implications as to how the reforms will eventually alter front-line services and what effect they will have on quality and cost.” In other words, the coalition government is not making these proposals in the interests of patients.

Professor Roland goes on to say that, “The challenge is compounded by a virtual freeze in NHS funding after several years of budget increases of 6% per annum and by the need for £20 billion in real-term savings over the next 5 years to accommodate inflation in the costs of medical products and services.” Let us remember that the Tories promised to protect NHS funding in their general election manifesto in 2010.

The NHS has not been left unchanged since its inception in 1948. Both the Tories under Thatcher and Major and then the New Labour government under Blair, sought to introduce the market into the NHS in various guises. The most central part of the current proposals – the intention to allow groups of GPs to manage part of the NHS budget – was actually first proposed in a reduced format by the Major government, but was quickly scrapped due to unpopularity and infeasibility. It was Thatcher who introduced the “internal market” into the NHS in 1991, and Blair who encouraged the outsourcing of medical services and support to the private sector, including the use of Private Finance Initiatives (PFIs) that allowed private companies to build and manage hospitals. The PFI schemes were shown to be a complete farce by the credit crunch: as banks refused to lend, private companies found that they couldn’t finance PFI projects, leaving taxpayers to pour billions into the chasm of funding that emerged.

The most dramatic change that has been proposed is to allow “consortia” or “commissioning groups” of GPs to manage upto 70% of the NHS budget, a total of £80bn. The supposed aim of this measure is to eliminate bureaucracy within the NHS and give control of the NHS budget over to staff. However, Professor Roland concludes that, “Management support for general practitioner commissioning groups will come either from the former staff of primary care trusts [public bodies which currently manage the NHS budget] or from a range of private-sector organisations. The risks of this are clear: general practitioners don’t necessarily want to hold budgets, they may not have the skills to manage budgets, and they will need extensive management support.” In other words, one set of publically accountable bureaucrats is to be replaced by a set of unaccountable private bureaucrats, many of whom will be the same people! The proposal is clearly, therefore, simply a means to open up the NHS to private companies, similar to the academies and “free schools” that are being introduced in education.

It is undeniable that a layer of needless bureaucracy, including a vast army of extremely well paid management consultants, exists within the NHS and public services in general. It is also correct that NHS staff should have a say in how the service is managed and run. For example, the New Labour government too often set arbitrary targets for performance that were imposed from above, not too dissimilar to the Stalinist “Five-Year Plans” or Maoist “Great Leap Forward”. The solution is not, however, to introduce the market and privatisation, or to simply hand over control of budgets to small, elite sections of staff. Why should it be solely GPs that are given control of the NHS? Why not include nurses, doctors, and all health care professionals – the people who really understand how the NHS operates? And what about patients and the public at large who must use these services? Instead of having well-paid managers and consultants, the NHS should be run by the workers in the hospitals, the trade unions in the health sector, and elected state representatives.

The second big change to be introduced is that of health care provision. The new policy aims to convert all hospitals into “foundation trusts” – freestanding legal entities that are not centrally managed and that have the freedom to raise public and private capital. In addition, the proposals will allow “any willing provider” (i.e. any private company) to bid for and deliver NHS services, provided they meet a certain standard of quality. Allowing these providers to compete on the basis of price has not yet been ruled out. The former hospital regulator “Monitor” will be expanded to become an economic regulator by setting maximum pricing.

According to Professor Roland, “The hope of the new government is that providing information on quality will ensure that market forces drive up quality in the absence of centrally defined targets or price signals.” He goes onto say, however, that, “The UK government is faced with the paradox of wanting the health care market to be driven by a public that has not been particularly interested in health care choice and using institutional structures that in the past have proved ineffective in promoting markets.” The message is clear: the vast majority of people are not interested in an abstract idea of “choice”, and competition and privatisation will not help improve either the cost or quality of health care.

The figures speak for themselves. In the UK, 82% of healthcare funding is public, compared to 45% for the USA. In addition, the total healthcare costs as a percentage of GDP are 8.4% for the UK, almost half of the value for the USA. Despite these reduced costs, the life expectancy in Britain is greater, the infant mortality rate is lower, and there is the same number of physicians per population. In other words, thanks to our nationalised, publically funded, universal health system, the UK provides better healthcare at a lower cost than the privatised, insurance based US system.

Far from needing more marketisation of the NHS, it is clear that we need fewer markets and greater integration within (and between) public services. It is the integration of the various sections of the healthcare system that leads to improved efficiency, communication, and economies of scale. Healthcare professionals already complain about not being able to gain access to vital information and resources due to the breakup of the NHS and the outsourcing of services to private companies.