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NHS: A Marketized Solution?

January 18, 2011

According to David Cameron, “These reforms aren’t about theory or ideology – they are about people’s lives.” And it’s true – many people’s lives will be affected by a wholescale reform of the NHS which is almost the exact opposite of Tory campaign claims that ‘We’ll cut the deficit, not the NHS’. The imposition of a new policy by central government, regardless of where that policy places the power, is ‘top-down’, and it is disingenuous of Cameron to claim that they are not, simply because GPs will be saddled with financial administration that many do not want and will be ill-equipped to deal with: GPs are by definition practitioners with a broad knowledge, but not necessarily specialist knowledge of all conditions.

But let’s give Cameron the benefit of the doubt. No other area of public service has been ‘marketized’ in this way, has it? I mean, there has been the privatization of the railways, and yas, and we can all see the benefits of those. Well, we could, if privatized services hadn’t continued to get more and more expensive with precious little improvement of service to show for it (has anyone TRIED to travel long distance by train recently?).

As it happens, one area of public service HAS been marketized in precisely this way, even down to concern with healthcare, and that’s the welfare system. Jonathan Rutherford wrote for COMPASS in 2007 about the link between the US disability insurance company Unum and UK welfare reform. Observant readers will notice that I mentioned Unum in my blog for ‘One Month Before Heartbreak’ as the alleged model for ATOS Origin’s disability assessment programme in the UK. Rutherford’s article confirms this allegation, and points to an even more murky driver of public sector reform – business interests themselves.

Notwithstanding Unum’s nod towards Hitler’s ‘work will make you free’ in their comment that ‘We believe that it is absolutely vital that all employment brokers are properly incentivised to move disabled people along the journey into work and that there are enough of them to do the job’, and proposal that only marketization can drive this ‘workfare’ programme, it is sobering to reflect that the only noticeable effects of this reform have been to divert public funds into private hands and to distress and, in some cases criminalize disabled people.

Placing a profit motive between caregivers and those who are supposed to be their patients will not, and has not in the USA, result in anything other than corner cutting and cost cutting. This will be a LEGAL requirement, as companies are beholden to their shareholders to deliver profit rather than to their customers to deliver services. Competition theory suggests that customers will ensure that quality remains high by refusing to buy substandard goods or services, but the lack of longevity of clothing bought from many high-street shops, and the habitual resort to near-sweatshop conditions for workers in countries with lax labour laws, gives the lie to this idea.

So, Mr. Cameron, you want to ‘have a proper discussion about what really works.’? Well, I suggest that we need to define ‘works’, since the evidence where such policies already exist shows that private sector involvement in public services lead to minimally reduced costs, taxpayers’ money going into the pockets of the private sector (see Rutherford’s closing point about private equity company Arkaga for how much tax they may pay on this), and service-users becoming more and more scared and inconvenienced.

If government policy intends to lead to increased private profit and greater benefits for service providers, then marketization is the way to go. However, evidence suggests that this will be at the expense of service users – the people who will be actually paying for the services. If you think the NHS is poor value for money now, these reforms will not help one bit.

There is no electoral mandate for these policies (which have apparently been planned for, as Cameron says ‘Of course, these changes have to be carefully worked through. And that’s exactly what we have done through our years of preparation in Opposition’). Cameron is clear that the NHS reorganisation is not aiming to save money, since we do not spend more than other countries, and this represents therefore the most blatant evidence that these policies are BOTH about people’s lives AND ideology. Specifically the extension of the latter at the expense of the former.

One Comment leave one →
  1. January 18, 2011 8:41 pm


    Black Triangle
    Anti-Defamation Campaign
    In Defence of Disabled Claimants

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