Sunday 23 December 2012

Why a privatised NHS does not concern me

For months now The Guardian has run a hostile campaign against the NHS reforms introduced by (former) Health Secretary Andrew Lansley. However, some dissenting voices are now emerging. In an opinion piece two days ago, the Guardian commentator Ian Birrell admonishes critics of NHS reforms that their caricature of the changes in the English NHS risks missing the most important point: the NHS was established in different times to tackle different problems. If it does not change, it will fail to address the new challenges to provide health care to millions in the UK.

Birrell argues that the main difference between the original NHS and any health care provider in the 21 century is not whether or not services are supplied by private or public organisations. Rather, the main difference lies in the problem it faces. At its inception, the NHS was to tackle infant mortality and infectious diseases. To do this, the newly formed NHS board embarked on a large scale hospital building programme that lasted into the 1980s. Hospitalisation of patients was thought to be the most appropriate care.

The programme had some success as the health of communities across the UK improved significantly. However, it also created monster organisations that were difficult to steer. Change in order to address new health problems was practically impossible to introduce, and staff morale dropped markedly due to scandals of mistreatment of patients. Despite the claim that the NHS was 'centrally controlled', it was was in fact a supertanker without a skipper.

Repeatedly, politicians tried to force the NHS to be more susceptible to steering by forming organisational sub-divisions, such as local boards (Wales for example has a long history of re-organisations of NHS health boards, their number ranging at some point from 22 to now 7).

Exasperated by the resistance of the NHS to respond to the need for change, Tony Blair's government then practically sliced off large parts of the service into semi-private providers, NHS foundation hospitals, that were operating free from central control.

Andrew Lansley's reforms were only the logical extension of the reforms introduced by the previous government: devolving the main bulk of the NHS budget to GPs operating in the communities and commissioning the services they need for their patients.

Critics are scathing about the alleged privatisation of the NHS. But, as Birrell argues, this misses the point. The NHS will remain free at the point of use. GPs have always been private contractors, ever since Aneurin Bevan decided to buy their approval to the introduction of the NHS by 'stuffing their mouths with gold'.

What has changed however is that the location of care has shifted from hospitals to communities. While some surgical procedures will always require hospitalisation, most after-care is best delivered for patients in the communities. This is not just a question of cost. It is above all an issue about the quality of care. It matters little whether a public or private organisation offers this care.

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