On January 7th 2008, prime minister Gordon Brown made a key policy speech on the NHS, in which he called for ‘continued reform’ and rejected ‘those who oppose further reform’.
It was a speech crafted for the 60th anniversary of the NHS in which he sought to give the impression that his proposals would extend and improve the NHS.
He devoted a passage to apparently applauding the principles on which the NHS was based.
He said that ‘care would be free of charge’ and ‘publicly funded by taxation’.
It would be ‘more important than ever to pool the risk and share the cost of those (medical) interventions fairly across the whole population’ and insure everyone ‘as comprehensively as possible’, providing ‘a universal service not a minimum service’ to ‘all British people’.
To a superficial listener, it might have sounded as if the NHS was safe in Brown’s hands.
However, the proposals in the rest of his speech contradict these statements.
His proposals were wrapped in deceptive jargon.
1. ‘PREVENTION’
Equals: shift funding out of hospitals; equals: make patients look after themselves at home.
Equals: a drastic reduction in acute hospital services and reduction in care for the chronically sick and elderly.
He laid great emphasis on ‘prevention’ and outlined some plans to increase screening of the population for various illnesses which superficially sounded attractive.
On closer examination, what Brown was bothered about was the calculation that 15 million people suffer from long-term conditions (such as congestive heart failure, diabetes, asthma, stroke, renal failure) and that these people are responsible for many hospital admissions.
He is also concerned that people are living longer and that older patients use more hospital services.
He said that ‘the average annual cost of a person over 85 approximately six times the cost for those aged between 16 and 44’.
Under the umbrella word of ‘prevention’, Brown proposes that patients should be able to look after themselves instead of coming into hospital, eg: ‘We cannot remove from individuals and their families their responsibilities for their own health and that of their children.’
He repeats these sentiments over 26 times in different words which ultimately threaten patients that they will be left to fare for themselves.
2. ‘FAILING HOSPITALS’
‘Is about taking new and decisive action against failing services – whether in hospitals or primary care. . .
‘Establishing a new Care Quality Commission with tougher powers to impose fines and close down wards in the case of poor standards’.
He provides no evidence to support his contention that hospitals are ‘failing’, but repeats this as if it is common knowledge.
District General Hospitals are only struggling to maintain services because of the massive funding cuts made by this government.
3. ‘SPECIALIST SERVICES MUST BE SUPPORTED’
Equals: those who oppose the closure of district general hospitals – because they do not believe sufficient care will be provided in fewer, more distant specialist units – must be opposed at all costs.
‘So we will reject the views of those who say the NHS must put a moratorium on change and reject those who oppose further reform.
‘This would be a massive failure of leadership. If, for example, reconfigurations of services into specialist units proposed by the consultants were postponed or abandoned, this would lead to lives lost.
. .’
4. ‘PERSONAL SERVICE’
Equals: new private providers.
Using a campaign to increase access to GPs out of hours, the government is pushing ahead with replacing the traditional GP surgeries with large private companies – ‘primary care far more open and convenient; with new providers and more weekend and evening access. . .
‘And as primary care plays an every greater part in our healthcare, greater diversity of supply and strengthening the power of our commissioners so that weak GP or community healthcare services can be improved or replaced. . .
‘Taking advantage of support offered by GPs and nurses in the home or on the high street’.
5. ‘ENHANCING CARE’
Equals: shifting costs out of hospital and into new private primary care providers.
‘But for too long in this country the pressures on the hospital system meant funding for prevention and personal service took second place.
‘This is not about shifting costs but about enhancing care.’
6. ‘PERSONAL CARE BUDGETS’
Equals: giving patients insufficient money and making them choose where to spend it and calling this patient choice.
It means amalgamating health and social care so that private companies can receive large contracts for providing both.
‘And where it is appropriate, just as with personal care budgets for the 1.5 million social care users, it could include the offer of a personal health budget, giving patients spending power and thus a real choice of services. . .
‘So one of the main challenges that the NHS faces in the coming decades is that of providing high quality, cost-effective care for the increasing numbers of older people.
‘And it won’t just be the NHS that has to respond to this challenge but our social care system as well. That is why through personal budgets, we are pursuing reform of our care services. . .
‘This will depend on a new flexibility and responsiveness in primary care, and new partnerships with the voluntary and private sectors where they can contribute and innovate.
‘And it means a seamless integration of services between acute and primary care and between health and social care. . .’
7. ‘CHOICE’
Equals: ‘multiple providers’; equals: competition, equals: market.
‘MONEY FOLLOWING THE PATIENT’.
Equals: a money tariff for every procedure (‘payment by results’).
‘Stage two was to widen diversity of supply to create new incentives for better local performance and more choice for patients – a success story in achieving the shortest ever waiting lists . . .
‘This is why giving patients choices through reforms to encourage plurality of provision’, creating ‘a genuine level playing field between competing local providers’ and allowing ‘money to follow the patient are so important. . .’
8. ‘INCREASE THE FREEDOMS AND AUTONOMY OF OUR LOCAL NHS’
Equals: more Foundation Trust businesses taking over primary care as well as secondary care.
‘Improving the management of NHS resources through foundation hospitals and the use of the private sector.’
‘. . . giving hospital clinicians and GPs stronger incentives to work together and allowing Foundation Trusts the freedom to provide primary care services where this is in the interests of patients’.
‘Foundation hospitals able to take over failing hospitals to turn around their performance’.
9. ‘NHS CONSTITUTION’ – We will tell you what you will get and what you will not get.
Equals: minimum standards; equals: rationing.
‘. . . we also need a new articulation of the rights and responsibilities of a modern 21st century health service.
‘So this year we will, for the first time, set out the “NHS offer” to patients as part of an “NHS constitution” – what you can expect to get from the NHS and what we expect . . . in return. . .
‘And with these changes in the NHS, we also want a wider debate on how society as a whole should face up to the new healthcare challenge.
‘It will be founded on greater local control and greater freedom for staff, with the context of the right incentives and minimum standards.’ (my emphasis)
10. ‘COMMISSIONING’
Equals: Primary Care Trusts (PCTs) purchasing care from a plurality of providers, increasingly from the private sector.
‘So we will strengthen commissioning, give more responsibility to primary care professionals and open up primary care; with more providers, new primary care services, and more weekend and evening access. . .
‘And we will continue to open up acute care with, from the spring, the choice of hospital trusts across the private and public sectors in England extending to over 300 – including more than 150 private sector hospitals working as part of the NHS and at NHS cost and standards of quality. . .
‘We will use all the mechanisms available to us to improve our NHS. . . public, private and voluntary providers can all play their part and there will be no “no-go areas” for reform as we seek to deliver the preventive and personal services which will renew and secure the health service for the future.’
Brown’s planned ‘reforms’ are a recipe for an end to the NHS free at the point of use, providing comprehensive care for all.
He proposes a mass hospital closure programme, corporations coming in to run general practice and foundation hospitals; chronically sick and elderly patients looking after themselves at home, and ‘minimum standards’ in an ‘NHS Constitution’.
Inevitably, this will lead to charges for non-core services and the people will not be able to pay.
Universal access will have gone.
Brown’s hatred of all those who reject his reforms is appropriate for a servant of the ruling class.
All over the country there are marches and campaigns in opposition to the hospital closures.
The BMA is locked in a battle to defend GPs against being taken over by predatory private companies.
It is time the health service unions and the TUC got off their knees and fought to defend the NHS. A new revolutionary leadership is urgently required to lead this fight.
Every District General Hospital must be defended with strike action and occupations. We must build popular Councils of Action in every area to carry forward this task.
Central to this struggle to defend the NHS is the bringing down of the Brown government and going forward to a workers government that will nationalise the banks and drug companies, in order to obtain the funds necessary to further develop the NHS.
