I’m really not so sure you need to be any sort of clinical health expert to figure out that the coalition’s proposed health reforms, which were undoubtedly drawn up by one of those unelected “blue sky” (or should that be “head up the arse”) thinkers within the Conservative Party, will be a complete and unmitigated disaster. After all, that’s the sort of outcome we’ve generally come to expect from most of our modern day politicians, who to a man tend to be very big on ideas, but ludicrously short on the detail.
Accepting that most of the elected representatives who inhabit the Westminster Village are by their very nature duplicitous, self serving and smug, it shouldn’t come as a surprise to any of us that our delegates treat the British people like mushrooms, by keeping us in the dark and feeding us all sorts of shit on a regular basis, as this particular strategy certainly suits their own party agendas of enriching the few and impoverishing the many. Not content with having destroyed large parts of our country’s traditional industrial base, sold off most of the nation’s vital infrastructure to private interests, organised mass inward migration to achieve electoral advantage, it should come as no surprise that now they are attempting to remove the last remaining safeguard that the English population possesses, its universal, free at the point of delivery, National Health Service.
Despite their almost obligatory protestations to the contrary, all three major political parties have been equally complicit in helping to bring us where we are today, on the brink of destroying a national health system that even its fiercest critics are forced to admit, is probably one of the most cost effective systems in the entire world. Although the coalition government of Cameron and Clegg are the ones guilty of trying to deliver the coup de grace, through their appointed political assassin, Andrew Lansley, the Labour party and their union sponsors are just as culpable for these criminal acts against the people of England, as they not only failed to rally support to fight the steady encroachment of private healthcare companies into the NHS, but have actively encouraged it since 1997. What a bunch of total hypocrites, Miliband, Burnham and their union paymasters are, protesting coalition plans to commercialise the public health services, when they themselves were so effusive about private healthcare involvement in the NHS between 1997 and 2010. It is perhaps little wonder that our nation is such a total shambles and we are in such a dire financial mess, when we put our trust in such cringing and partisan individuals, who wouldn’t know real political conviction if it sat up and bit them.
It is particularly ironic therefore that it is these same free-market Labour politicians who have been so critical of late over Andrew Lansley’s refusal to release the Health Risk Register into the public domain, so that informed commentators and the general public can make their own appraisal of the potential dangers arising from the coalition’s much criticised, much amended and now publicly derided healthcare reforms. Not surprisingly the coalition have thus far refused to release the risk register, fearing that it will simply confirm what many people already believe, that the NHS will be catastrophically damaged by the top-down reorganisation that ministers promised would not happen, but which the bill proposes should happen, in order to allow commercial investors to gain a major foothold within our publicly owned health sector. According to a number of sources and despite proclamations that the NHS would be safe with a Tory government in charge, it is generally accepted that a number of American private healthcare companies have been preparing for their entry into the English health market for the past 10 years, proving once and for all the lies of both Conservative and Labour leaderships that our publicly owned health services were safe in their hands. Interestingly, even though Labour are in opposition and with some three years to go until the next general election, the current proposals to reform and privatise the NHS could so easily be fatally undermined by Ed Miliband issuing a statement to the effect that as and when Labour are re-elected to office, they would take all health provision back into public ownership. Strangely enough though, there has been no such statement coming from the Labour leader to date, suggesting that even though Miliband publicly opposes the planned reforms, in reality he would do little differently; and in private is wholeheartedly in favour of the reorganisation, just so long as he and his party don’t have to take the political blame for it.
In spite of being ordered to release the Department of Health’s Risk Register by the Information Commissioner’s office, the coalition government are currently appealing that particular decision, claiming that the contents might unduly alarm the electorate and stifle future risk assessments by departmental civil servants, who are traditionally asked to consider the worst possible outcomes regarding specific government plans and policies. However, even though the coalition has refused to publish its own formal risk assessment, a number of independent health specialists and informed commentators have already calculated that the proposed health reforms are likely to run the risk of doing incalculable damage to health service systems, procedures, as well as its physical fabric, along with having a highly negative impact on patient care and choice. It has also been anticipated that rather than reducing costs and the numbers of administrative personnel, there is a real risk that a reformed health service, as proposed by the coalition, would have an even greater financial cost to the taxpayer and will require even larger numbers of people to help run it, both of which would be the exact opposite of the coalition’s stated aims. Even though the coalition has publicly stated that the aim of the reforms is to create a better, more efficient health provision in England, given that the bill clearly states that treatments and providers will be assessed and allocated on the basis of the most economically advantageous tender, it is clear that cost, not quality, or even value-for-money, will be the major determining factor in providing the English population with their ongoing healthcare.
Already a number of national health agencies have claimed that as a result of the proposed changes, some patients, most notably those suffering from long-term illnesses, such as cancer, will be immediately disadvantaged by the proposed new healthcare system, largely as a result of patient treatment being driven by budgets, rather than by clinical need. This assumption generally ties in with the risks associated with the entirely profit driven healthcare companies essentially cherry picking the more routine types of operation or procedure that allows them to maximise income and minimise costs. As a result of this envisaged healthcare outcome, existing NHS hospitals will almost certainly be left to undertake the most expensive operations and procedures, thereby placing an unreasonable strain on their already diminishing financial resources and creating a danger of making them unprofitable, which might well lead to individual hospital unit’s having to close due to lack of money. However, in what can only be described as a sheer act of hypocrisy, sources have accused Lansley of deliberately skewing the supposedly free market by insisting that commissioning groups should pay failing private healthcare providers, rather than their more cost effective NHS competitors, in an attempt to artificially maintain the private sectors profitability. Given that many of the UK’s private healthcare providers are in fact largely unprofitable, having made such significant financial investments as part of their attempts to develop a private model in Britain in the first place, some commentators believe that without the coalition government deliberately manipulating the health market to help sustain them, then many of these privately owned companies could not survive indefinitely.
It has also been suggested that under the terms of the proposed health reforms, the various newly created GP commissioning groups will be able to pick and choose their patients, not just from their own geographical area, but from anywhere in the country. Consequently, it is feared that certain intensive patients will be systematically removed from practice lists, as GP’s and their commissioning committees seek to maximise their income and minimise their expenditure, leaving some gravely ill patients with little option but to hunt around for a clinical practice that is actually prepared to take them on. Such a situation raises the real possibility that some people, through no fault of their own, could well find themselves without any sort of medical cover, simply because they are suffering from expensive and long term illnesses. At the same time, it has also been argued that some GP practices, having reduced their numbers of highly dependent and expensive patients, will seek to maintain their levels of funding by deliberately over-treating some of their remaining healthier patient list. Because patient’s themselves are not experts in clinical diagnoses, they could quite easily be misled by GP’s, who have their own financial agenda, into accepting a range of treatments and procedures that they don’t want, or indeed don’t actually need, which could quite easily lead to what are finite financial resources, being squandered on a much smaller and healthier pool of patients. It is also worth noting perhaps that under the terms of the bill and particularly in using the term “any qualified provider” the coalition is said to be opening the door for public money to be used in the provision of alternative medicine, regardless of whether or not that treatment is found to be have any discernible benefits to patients or to their condition.
It is also feared that the drive for profitability by certain healthcare providers, will not only lead to a lessening of statutory health and safety requirements, but might in the worst case scenario result in a “race to the bottom”, where safety, wages, hours and clinical decision making is based on cost, not on need or on genuine value-for-money. As a result of lower wages, increased working hours and falling morale, there is thought to be a real danger that the actual numbers of clinical mistakes will increase, leading to greater numbers of medical negligence cases being brought before the courts, more public money being paid in legal fees and compensation, which will almost inevitably lead to less money being spent on healthcare, putting even more pressure on increasingly limited clinical resources again. Significantly, it is a matter of record that American healthcare companies are particularly adept at avoiding responsibility for medical mistakes and rely extensively on insurance based schemes to cover the potential costs of any ensuing medical malpractice, a financial cost that is usually borne by the patients themselves.
Such will be the imperative to drive patients along the “for-profit” healthcare conveyor belt, it has been claimed that the safety and well-being of certain vulnerable groups, including children, women, or other at-risk adults might be deliberately undermined or ignored by those providers operating within the newly commercialised health service. Although the current health service is not perfect one, the widespread fragmentation that would result from the wholesale privatisation of the service would almost inevitably destabilize the conjoined reporting that currently exists within the NHS. As a consequence, the welfare of vulnerable patients could well be harmed and they might be left largely unprotected as the various reporting mechanisms and agencies that currently operate within the existing healthcare system are systematically removed in a newly reformed and entirely profit-driven environment.
In the event that participating private operators were unable to make an acceptable profit for their shareholders, there is also thought to be a real danger that the owners might simply choose to close their businesses and walk away, leaving patient care to be picked up by other local NHS units, who would already be operating on highly stringent budgets. An added concern is also that some of these same private operators might try and recoup some of their monetary losses by refinancing their businesses and passing on their accrued bad debts to another supplier, as was thought to be the case with Southern Cross care homes. By creating a wholly commercial healthcare environment through their reform bill, virtually all of those involved in the sector will have to pay for services that presently don’t figure on their balance sheets, including items such as advertising, marketing and promotion, which would not ordinarily be a cost associated with general healthcare, but which under the coalition’s competition plans would be a necessary part of each provider’s business model. That being the case, it would unsurprising if such services and their associated costs inevitably led to a number of smaller, less successful providers struggling to compete against their larger, privately financed competitors. No doubt a significant failure rate amongst the competing healthcare providers will already have been anticipated by the coalition as part of their planning, although any expectation that the remaining healthcare companies will simply step in to rescue patients abandoned through these business closures, will almost certainly add to overall health costs, leading to extra taxpayers money having to be used to try and limit the damage caused.
It is already evident that a number of American based private healthcare companies are poised to take advantage of the proposed reforms to the NHS, with one business in particular reportedly trying to sign up a number of English GP commissioning groups, with the promise of a 5% return on any profit derived from patient’s referred to their private medical facilities. By essentially offering a 5% “bounty” on each of their patient’s heads, there is a real danger that some GP’s will be tempted to put their own financial interests before the actual health and wellbeing of their patients, which could seriously damage, if not completely destroy, the relationship of trust that currently exists between the two parties. By turning the sick, the infirm or the dying into little more than commercial commodities, any pretence of “care” would finally and irrevocably be removed from the English healthcare system, thereby turning our medics into nothing better than stereotypical used car salesmen; with a reputation to match. Even though such commercial arrangements may be deemed to be morally repugnant, most experts who have studied the current healthcare bill agree that there is nothing illegal in such practices, despite claims to the contrary by members of the coalition government. Given that Andrew Lansley is reported to have spent several years constructing this health reform bill, the fact that no restrictions have been placed on such questionable transactions between GP’s and clinical providers, can only lead one to the conclusion that such immoral behaviour, is entirely acceptable to and has been foreseen by its architects, despite what they say in public. That said, the fact that in its initial form the new health bill essentially removed Andrew Lansley’s duty to provide and protect our existing health service, it should come as no surprise that he and his parliamentary colleagues did not concern themselves over the long term effect of the legislation, or indeed any infringements or illegality that might arise from their deliberate removal of such statutory obligations.
Of course, one of the most acclaimed benefits of the coalition’s undeclared reform of the NHS is purported to be the savings that such a reorganisation will produce, not least by removing much of the so-called wasteful bureaucracy and administration that is believed to make the current health service so inefficient. However, in reality there is thought to be a real danger that rather than saving money, the proposed reforms will in fact, cost far more to administer than it does at present. When one considers that the present day PCT’s and SHA’s, which number around 150 separate organisations, will be replaced by several thousand individual GP commissioning groups, it seems fairly evident that irrespective of the model, both systems require large numbers of bureaucrats and administrators to run them. Presently, the health service’s existing PCT’s and SHA’s tend to employ management and clerical staff from within the industry, whereas there is already some evidence that a number of the larger private auditing companies and accounting firms are contacting the various prospective GP commissioning groups to offer them their administrative, financial and back office services at far higher rates than would be usual within the NHS itself. If that indeed proves to be the case, what with new billing and payment systems being put in place, then it seems highly unlikely that there will be any substantive savings in terms of overall administrative costs, suggesting that more public money, rather than less, will be spent on the supposedly wasteful bureaucrats and administrators, thus leaving much less money to be spent on frontline patient care.
As things stand, the NHS is almost wholly dedicated to providing a comprehensive healthcare service, free at the point of delivery to everyone who is resident within the UK, with an option for individuals to take out and receive private healthcare provision, should they wish to do so. As a rule of thumb however, free public healthcare is provided by NHS hospitals, whilst private healthcare is carried out in private hospitals, as is the case with a number of providers such as BUPA and Circle Healthcare, etc. Under the terms of the proposed health reforms though, it has been specifically stipulated that existing NHS hospitals and trusts can, should they choose to do so, use up to 49% of their total capacity and resources to treat privately funded patients. The obvious risk that such arrangements might pose to the overall health and welfare of the publicly funded patients has not been lost on those health professionals who are bitterly opposed to the new bill. Because NHS hospitals will be forced to become self financing, in order to survive in the new economic climate, they will inevitably seek to increase their incomes from the private sector, but at a direct cost to those who are funded from the public purse. Because of these new financial imperatives there is thought to be a grave risk that private patients will receive priority over their publicly funded counterparts, not only in terms of personal care, clinicians time and catering, but more importantly in terms of surgical schedules, with NHS patients being pushed further and further down the waiting lists, as privately funded patients are given priority in virtually all aspects of clinical care. As a result, not only will NHS patients have to suffer for longer, but in all likelihood their medical outcomes are bound to worsen, leading to greater levels of impairment, contamination and perhaps even overall mortality. Previous privatisations by government have already proved that rather than improving efficiency or performance, commercial competition in a marketplace not only leads to a lack of choice, but a greater lack of accountability, corner-cutting, higher risks, worse outcomes and far less value-for-money than had been the case to begin with. The wholesale privatisation of Britain’s transport systems, utilities and industrial infrastructure has proved that point without doubt; resulting as it has in the British public paying far higher charges for what are generally much reduced and far more inferior services.
As a direct result of the coalition’s poor planning and complete lack of consultation with the various public health care bodies and their employees, it is now generally accepted that the Health Reform Bill has become so complicated that only the best legal minds would be able to understand it. As a result, there are fears that each and every one of the thousands of individual GP commissioning groups will have to take expert legal advice to understand how the bill works for them, which will not only result in extended patient waiting times, but also require each group to pay out tens of thousands of pounds simply to interpret the bill, monies that might otherwise be spent on healthcare. That is always assuming of course that implementation of the legislation does not actually end up in the courts, as commissioning groups spend even more public money trying to determine what they can and can’t do, under the terms of the new bill. In addition to these possible expenses, it is also reported that even more healthcare money will be paid to the individual members of each commissioning group, most of which it is claimed will be headed by an unaccountable and unrepresentative commercial director, whose main priority will be to maintain the financial integrity of the particular GP group, rather than anything as mundane as patient’s welfare.
Perhaps the greatest risk to patients however, is the abrogation of the Health Secretary’s powers to oversee and regulate the English health market, a duty that the coalition have handed to the purportedly independent body known as “Monitor”. However, the fact that the chair of that particular body has long-standing private commercial interests with a number of the incoming private healthcare providers and who the Department of Health still regards as an unbiased arbiter, does not inspire confidence in the ability, or indeed likelihood that this so-called independent regular is anything of the sort and might be likened to the gamekeeper turning poacher, which will be a complete disaster for the system as a whole.
It doesn’t take a genius to work out that the reason for the coalition’s reluctance to release their own Health Risk Register, has little to do with their civil servant’s feelings, but is first and foremost about the real and potential risks that the Health Reform Bill poses to the English health system generally. If any further proof were needed regarding the dire risk that the health bill poses to the nation’s welfare, one has only to look at dentistry and ophthalmology, where tens of thousands of English people are now living with rotten teeth and failing eyesight because they can’t find such services free at the point of delivery; and don’t have the financial resources to meet the exorbitant rates demanded by the multiplicity of private dentists and opticians who are exploiting the failure of successive governments to control pricing and availability. It is clear that the current Health Reform Bill is simply the final step along the road to completely privatising the entire healthcare market in England, thereby bringing us into line with perhaps one of the worst and most corrupt healthcare systems in the world, that of the United States. As things stand, this Charlatan’s Charter that Cameron, Clegg and Lansley laughingly call their Health Reform Bill isn’t really about managing any sort of potential risks at all, but is really about one overarching cataclysmic certainty, that will cost more, deliver less and leave a great deal more dead and injured along the way.