Interview

Public money for private gain

New Zealand’s shadow secretary of state for health, Leanne Dalziel, spoke to healthmatters about her fears for the NHS

If a Conservative government is returned at the UK’s next general election the gloves will be off over the future of the NHS, New Zealand shadow secretary of state for health Leanne Dalziel told healthmatters.

The period of organisational quiet being experienced by the NHS is only the calm before the storm. And if a Conservative government is returned at the next election it will mean the end of the NHS.

This was the stark message given to healthmatters by shadow secretary of state for health for New Zealand, Leanne Dalziel, at the end of a fact-finding trip to the UK.

During her visit she met health minister Gerald Malone, and a range of people involved at different levels in the NHS - including a trust chief executive, fundholding and non- fundholding GPs, hospital doctors, and a CHC vice chair. She also met representatives of health policy institutions, hospital doctors, executive members of Unison, and a number of health journalists.

In an exclusive interview, Dalziel told healthmatters that in her opinion, the NHS reforms of recent years were ‘only the beginning, not the end’. If the Conservatives are re-elected, then ‘You ain’t seen nothing yet’, she said. ‘I don’t think there will be wholesale contracting out to the private sector in the run-up to the next general election, but I do think there will be afterwards.’

The government knows that it has a serious electoral problem over health, and it is ‘playing down the issue’ now-given that there could be an election at any time, she suggests. ‘The same thing happened in New Zealand, prior to the 1993 election, [the National Party] changed the minister of health and put in somebody who was able to placate the electorate. He wasn’t seen as a right-wing ideologue.

‘I think that you are seeing the same thing here. But if the Conservatives get back in, it’s ‘gloves off’, and you are talking about losing the NHS. I think it really is on the line.’

Dalziel bases her views on what she has observed worldwide, her experiences in New Zealand, and the information she has gathered in the UK.

What has been happening in the UK has been happening elsewhere, she says. There has been an exchange of ideas, views and experiences among politicians, and companies around the world have not been slow to notice the opportunities for rich pickings.

‘At the end of the day, it’s about making public sector money-raised from taxation-available for private profit,’ she contends.

‘In the UK, you’re talking about £40bn that has been tied up in the public health sector. The ‘reforms’ are not about efficiency or effective healthcare. They are about freeing up public money for private gain.’

The Private Finance Initiative is one way this is being introduced through the back door, she feels. Visiting the private hospital outside Glasgow run by the Healthcare International was ‘an experience’, she admits. ‘The hospital has 260 beds, but there are two floors that are empty shells.’ In two years, the hospital has treated only 6,400 patients. About £37m of taxpayers’money went into building that hospital-and not a penny of that has been repaid. Imagine what could have been done if that £37m had been invested in public health facilities in Glasgow, she says. While not being specific about her discussion with the health minister, Dalziel does say that the UK health reforms have been ideologically driven.

‘There is an assumption that competition leads to efficiency, she says. ‘But no one can prove that is the case in the health service.’ Various people in the UK have argued the case for evidence-based medicine. But they don’t argue for evidence-based health policies. There was no piloting of fundholding, she points out.

‘While it sounds very attractive to get a private hospital to do 200 hip replacements, if you take the work away from an NHS trust hospital it increases hospital’s marginal costs.

‘All of the services that support hip-replacements also support everything else the hospital does-so you are actually increasing the cost of healthcare for the NHS and creaming off the best for the private sector.

‘Once you separate the purchaser from the provider, and you tell the provider that they are in a market along with anyone else to provide services, then you will see more and more contracts going to the private sector. The private sector will undercut the public sector for easy work.’

But all is not yet lost, Dalziel feels. The public hasn’t yet given up on the ideals of a public health service. ‘And nurses still call people ‘patients’-they don’t call them ‘finished consultant episodes’, or ‘revenue generating units’, as they were described in one paper in New Zealand.’

There is a view that people in the health service have been restructured so much they don’t want any more re-structuring. But you could restore the fundamental principles of the NHS as they were in 1948, she feels.

‘I think you could strengthen it too, so that to could not be undone again by any future Conservative administration. ‘But that really will require a change of government’.