The Health and Social Care Bill passing through UK’s Parliament is prompting heated debate. The government claims that this and other reforms to the National Health Service (NHS) will improve patient care. Campaigners fear that they reflect further steps towards privatisation and a fragmented system, which they believe will be harmful to those in most need.
This raises questions not only about what the Bill will, but also what it should, achieve. Should the healthcare system offer more opportunities for profit? What should be prioritised?
Reforming the NHS
Over the past decade-and-a-half, under successive governments, the NHS has been subjected to repeated waves of reform. This has been expensive and, while there have been some positive measures, many of the changes have been of questionable value.
For instance, there has been an increasing separation between those parts of the NHS arranging and paying for services and those providing them. This follows the example of social care, where local authorities often commission care from private providers.
Publicly-owned providers within the NHS have been encouraged to act, to a large degree, like social enterprises. In addition, private firms are now providing some NHS-funded services, and this is likely to grow greatly in the next few years. It has become increasingly common for former government ministers and advisers to take up lucrative positions in firms selling healthcare or commissioning support.
The previous (Labour) government increased spending on the NHS, bringing down waiting times and enabling more patients to take advantage of advances in medical science and technology. However it was widely criticised for frequent reorganisations and excessive emphasis on targets. The current (Conservative - Liberal Democrat Coalition) government, which took power last year, was expected to bring in a period of stability. But the reality was different: even greater turmoil was underway.
The Health Committee of the House of Commons (the main house of the UK Parliament) was not pleased. It declared, “There was a significant policy shift between the Coalition Programme, published on 20 May 2010, and the White Paper, published on 12 July 2010.
The Coalition Programme anticipated an evolution of existing institutions; the White Paper announced significant institutional upheaval. The Committee does not believe that this change of policy has yet been sufficiently explained given the costs and uncertainties generated by the process.”
But government ministers were determined to push ahead. In January 2011, a Health and Social Care Bill based on the White Paper began its journey through the House of Commons. Though Parliament had not yet approved the proposed reforms, radical changes to the health system began.
‘Choice’ and ‘control’
According to the government, its plans aimed to decentralise the NHS, putting more power in the hands of GPs (doctors in community-based practices) and giving patients more choice and control. The idea of giving health professionals more influence over planning local services got some support, though many GPs wanted to stay focused on treating their patients.
However there was widespread alarm that the Bill would, overall, undermine the NHS and also waste money on reorganisation which could have been spent on patient care, at a time when funding was increasingly tight.
After vocal opposition by health professionals and experts, and public mistrust, the government undertook a ‘listening exercise’ and made some changes to the Bill. But this did not satisfy critics.
The campaigning organisation 38 Degrees sought independent legal advice, which confirmed that, even with the amendments, the Bill would reduce democratic accountability and strengthen competition, giving private companies a greater role. Firms which felt they had not been given a fair chance to compete for NHS business could take legal action.
Meanwhile, service cuts were leading to more people taking out private healthcare insurance or paying for certain treatments. In early October 2011, controversy broke out after a GP practice in York wrote to some of its patients stating that the NHS would no longer fund the minor operations they were waiting for and suggesting private clinics which would treat them for a fee, including one owned by the practice itself. But especially at a time when the cost of living is rising, many cannot afford to pay extra on top of National Insurance.
Will patients benefit?
One argument for the reforms is that patients, and society, will benefit. In this view, even if private companies gain financially, it will not be at ordinary people’s expense but through cutting waste and making the system more efficient and effective.
But the evidence points the other way. Though there is much that could be improved in the NHS, a study published in the Journal of the Royal Society of Medicine in mid-2011 found that the UK had the second most efficient health system out of 19 economically developed countries, while the USA ranks 17th. One of the authors commented that “When the present government are talking about competition and choice and the idea that private healthcare might have something really fundamental to offer, all you have to do is compare America, the land of choice and competition, and their results are dismal.” Other research too indicates that the US healthcare system offers poor value.
As the House of Lords has been preparing to debate the Bill in October 2011, healthcare unions and professional associations have continued to voice their alarm.
For instance the Royal College of Nursing stated that “The reforms have the potential to destabilise NHS services by unfairly gearing the market in favour of private providers and preventing integration of services.”
The British Medical Association, representing doctors, warned that “the BMA still believes the Bill as it currently stands poses an unacceptably high risk to the NHS in England, threatening its ability to operate effectively and equitably.”
Four hundred public health specialists, including Professor Sir Michael Marmot (chosen by the World Health Organisation to chair a commission on factors affecting health), and forty directors of public health, wrote to the House of Lords urging them to reject the Bill, which would do “irreparable harm to the NHS, to individual patients and to society as a whole".
It would, they say, “fragment patient care; aggravate risks to individual patient safety; erode medical ethics and trust within the health system; widen health inequalities; waste much money on attempts to regulate and manage competition; and undermine the ability of the health system to respond effectively to communicable disease outbreaks and other public health emergencies.”
It is highly probable that the Bill in its present form, if it becomes law, will have a damaging effect overall on health, causing considerable suffering.
Should profit matter more than patient care?
If giving the private sector more opportunities to profit from the NHS is likely to be damaging to patients overall, should it nonetheless be supported on the grounds that successful businesspersons deserve the chance to prosper?
Should the interests of senior managers and investors in major corporations (who some believe are the most enterprising in society) outweigh the wellbeing of ‘common’ people?
The answer that people give will depend on their values. Some, even among those keen to reward business success, would balance this against the practical need to try to keep society running smoothly, enabling sick and injured workers to be back on top form as quickly as possible and reducing the risk of unrest.
Those committed to universal human rights are highly likely to answer ‘no’ and argue that health for all should be prioritised over profit for some.
The Preamble of the Universal Declaration of Human Rights states that “recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world”. Article 25 includes “the right to a standard of living adequate for... health and well-being... including food, clothing, housing and medical care and necessary social services”.
Faith perspectives on health
For people of faith, there may be additional reasons to say ‘no’. In Christian tradition, for instance, health – bodily and spiritual, personal and social – has an important place. People are interconnected with one another, other creatures and the Divine, and no-one can prosper entirely through his or her own efforts and ingenuity, or pass through life with no obligation to others.
God is portrayed as a loving giver of good things, who nourishes and refreshes humans and animals (Psalm 104). Humans too are invited to be generous and just, not enriching themselves while others are left in need but rather sharing with and caring for others (Leviticus 25.35-38, Matthew 5.43-6.24).
The prophet Ezekiel’s visions include a river, on the banks of which are “all kinds of trees for food. Their leaves will not wither, nor their fruit fail, but they will bear fresh fruit every month, because the water for them flows from the sanctuary. Their fruit will be for food, and their leaves for healing" (Ezekiel 47.12). This a theme to which the book of Revelation, in the New Testament, returns: the heavenly city contains the tree of life and the leaves are for the healing of the nations (Revelation 22.2).
Healthcare is celebrated in Ecclesiasticus 38 (in some versions of the Bible, and included in the Deuterocanonical books in other traditions):
Honour physicians for their services,
for the Lord created them;
for their gift of healing comes from the Most High,
and they are rewarded by the king.
The skill of physicians makes them distinguished,
and in the presence of the great they are admired.
The Lord created medicines out of the earth,
and the sensible will not despise them.
Was not water made sweet with a tree
in order that its power might be known?
And he gave skill to human beings
that he might be glorified in his marvellous works.
By them the physician heals and takes away pain;
the pharmacist makes a mixture from them.
God’s works will never be finished;
and from him health spreads over all the earth.
Jesus is often portrayed as a healer in the Gospels, freely helping those who seek his aid and showing concern for the poor and marginalised. In the New Testament his followers follow his example, caring for and healing the sick.
Responding to the Bill
Whatever the intentions of the Health and Social Care Bill, in its current form it is likely to be harmful to the NHS. It deserves to be opposed by those who believe that healing should be prioritised over profit.
Many people have already got involved in campaigning against the Bill, from writing to members of the House of Lords to taking part in protest events. It is clear that many parliamentarians – even within the Coalition – are worried about the Bill’s impact, but some will probably vote as the government tells them, whatever their own misgivings. Whether ministers can push the Bill through Parliament with only minor changes may depend on the level of public opposition.
Also on Ekklesia:
* Betraying disabled people and welfare (research) - http://www.ekklesia.co.uk/node/14675
* More on the NHS: http://www.ekklesia.co.uk/tags/2630
© Savi Hensman works in the care and equalities sector. She is an established Christian commentator on politics, beliefs and society.