‘Gradual’ is not the right word to describe the current pace of change within the NHS, as recent years have seen the Service subjected to massive reform under the mantra of modernisation. While it’s definitely the case that demographic changes present our social healthcare system with questions to answer in respect to its future, the belief that a heavy programme of privatisation can serve as even a small part of the needed solution is very wrong.
It is exactly this that has arrived in the wake of the Health and Social Care Act 2012. Indelible contracts worth over fifteen billion pounds have been agreed between the government and private firms, signing over irregular patches of the health service to the governance of companies driven by a basic need to extract as much profit as possible from the patients sold to them. Justification is found in the idea that, taken together, a profit incentive and competitive market necessarily raise both quality and efficiency – the theory goes that, were a company to provide a poor service, they would not be re-commissioned, whilst running an inefficient service risks a loss of profit.
But this account is not a decent representation of privatisation’s reality. What we actually see is a pronounced decline in the quality of public services relegated to the private sector, accompanied by inexcusable rises in their cost. When non-emergency ambulance services in Greater Manchester were handed over to Arriva Transport Solutions (a subsidiary of the ubiquitous bus company), 8,460 patients were made to wait for more than two hours. The level of complaint over poor care spiked, matching past responses to privatisations in other public services, and indeed other areas of the NHS.
Most worryingly, the first services to follow down this route are often the ones most relied upon by the vulnerable sections of our communities – both therapy for those with mental health problems and palliative care for the elderly and infirm are two services most likely to be ran by private companies.
The overall trend towards privatisation should not come as a surprise – what began in the 1980s has continued regardless of which neoliberal political party holds power. Local councils are evolving towards a point where their only meaningful function will be the oversight of tendering – the same can be said for the NHS’ new clinical commissioning groups. These bodies composed of GPs and other clinicians have had responsibility for the management of the NHS shunted upon them. As you might expect, this has led to a tripling in the amount of public money spent on private management consultancy firms – the same ones who assisted the Conservative Party in writing the bill that brought about this change.
If the removal of public services from democratic control is not worrying enough, the covert regulations imposed by the European Union remove any prospect for reversal. Corporate rights are entrenched at the expense of democracy in the ‘investor protection’ clauses of EU trade arrangements. Once a service is privatised, it becomes illegal for it not to be. That said, pessimism of the intellect must be paired with optimism of the will: if a solution exists, its realisation will depend on what we the public are prepared to put into achieving it.