Apocalypse NHS

We have reached a critical moment in the slow and painful death of the NHS. Over the last few months the government has set in train three highly significant developments which will determine the post-reform agenda for the health service. Rather than allow a desperately needed period of stability and consolidation, they herald further sweeping changes which will, inevitably, spell the end of the NHS as we know it.

First, a major review of public spending has been initiated, with the health service firmly in the government’s sights. Already a range of new health service charges has been suggested, including extending prescription charges to pensioners and children, an annual personal charge to cover the cost of medicines, nightly ‘hotel’ charges for staying in hospital and a fee for visiting the GP. At the same time Treasury ministers have continued their repeated assaults on the idea of universal welfare entitlements, such as child benefit, and proposed the effective abolition of NHS dentistry for all but the poor.

Second, and less well publicised though equally significant, is the relaxation of Treasury restrictions on private sector investment in NHS trusts and ministerial encouragement for a much greater role for the private sector in running the NHS.

Third, a fundamental review of the role and organisation of health authorities and the NHS Management Executive is underway, with the aim of further devolving power to local level - and distancing the problems of the health service from the minister’s desk. The expansion of autonomous ‘agencies’ within the NHS is likely to be a key component of this management shake-up. In the Whitehall and other welfare services, agencies are being established with the explicit aim of privatising public services. There is no reason to suppose that the NHS will escape this development.

Taken together these initiatives are evidence of a striking continuity in government policy - to commercialise the NHS, as fast as politically possible, through a combination of patient charges, increasing privatisation and a reduction in central control. The next steps are clearly visible: the progressive blurring of the boundary between NHS trusts and the private sector, so that health service units can eventually drift off into the private sector without any fuss, and at the same time high patient charges and a cash-starved NHS pushing all who can afford to go into the arms of the private medical insurers.

While the NHS will be pushed as fast and as far down the road to complete privatisation as is politically feasible, its final destination still remains uncertain. The mother of all political crises would be provoked by any attempt in the short-term to create an overtly two-tier service. This may be some time off, though recent events in New Zealand, where the world’s oldest national health service is being replaced by private insurance for the better-off, show that it may be closer than we think.

If these trends are not successfully challenged, then the door to a fully privatised, two-tier service will open ever wider. The inability of the Labour party to seize the initiative on health, or even be clear on its policy for health care, does not give grounds for optimism. The NHS can only survive if this steady push to privatisation is challenged at every turn and the strong public support for a comprehensive public service is effectively mobilised.

We have already travelled a long way on the twisting road which leads to a private health service. Time is fast running out for the NHS.