In the context of a debate on the situation in the NHS, we publish an article by Phil Bevin to open the discussion.
Why the NHS is dead: our health service was Killed by Labour and the Tories and it’s too late to save it
By Phil Bevin
The NHS is dead and this is something that it is essential for people to grasp. The system of managed care is not the same thing as a public health service at all. The NHS was a single institution. Managed care is a series of separated fragmented entities driven by profit.
To pretend managed care systems can be reformed is misleading. It is the notion that has undermined NHS campaigning for a decade and more, with people pushing the entirely false notion that money is the main issue and somehow in-sourcing is a solution. This is of course not true because the managed care system incentivises the denial of care.
Whether its run by ostensible public bodies being run as private entities or the private sector itself, the incentive is to deny, rather than the provide care, in order to assist prompt the growth of the private health insurance industry, which is happening at pace. What people don’t understand, and presumably why they are upset is the fact, and it is a fact, that our right to healthcare has been removed as an intentional result of legislation pushed through parliament by both Labour and Tory administrations. Until that is grasped, we won’t be able to fight for a new public health system modelled on the now deceased original NHS.
The NHS, once a single organisation that provided comprehensive healthcare free to all, at the point of need, is dead, and the Labour Party is an accomplice to its murder. This is the conclusion I have reached through my own research and studying the work of Dr Bob Gill. Dr Gill is a long-term campaigner against NHS privatisation and has fought tirelessly against hospital closures for many years. He also produced the must-see documentary film, the Great NHS Heist.
In “Sicko UK”, an article published in Consortium News in July 2021, Dr Gill argued:
“The marketized NHS with its bloated administrative and managerial bureaucracy (consuming about 10 percent of the total NHS budget according to 2005 estimates) has continued to expand. The 2012 Health and Social Care Act converted the NHS internal market into a fully compulsory external market with all services up for grabs by the private sector.” [i]
Like so many public maladies, the cancer of NHS privatisation began under Thatcher. This malignant growth then metastasised thanks to John Major, Tony Blair and Gordon Brown’s PFI restructuring initiatives, which mutated the NHS from a single, centralised organisation into a fragmented structure of cells in the form of Primary Care Trusts, which competed against one another in an internal market. It was under New Labour that the NHS was readied for death by privatisation.
The illness became terminal in 2012, with the Passing of the Conservative Government’s Health and Social Care Act. To ensure that their patient not only would not recover but would be dismembered and its parts harvested for consumption after death, the Tory Government appointed Simon Stevens – a former Blair advisor and Director of Expansion for private healthcare giant UnitedHealth – as Chief Executive of NHS England in 2014. Perhaps as a reward for overseeing the snuffing out of the most successful socialist institution in Britain, Simon Stevens was awarded a peerage, becoming Lord Stevens of Birmingham.
In truth, what Simon Stevens oversaw was the managed collapse of the NHS and its replacement by a US-style “managed care system”, constructed in the image of the United States’ inefficient, fragmented and costly insurance-based model.
However, some people and organisations maintain that, although sick, the NHS is not yet dead. Such people sometimes diagnose a different problem as the root cause of the Health Service’s maladies. They claim the issue is more one of neglect or starvation through underfunding than death by intentional dismantling and privatisation. For example, an article published by the King’s Fund titled “Health and social care in England: tackling the myths”, argues that:
“The health and care system is under intense pressure, with rising waiting times, persistent workforce shortages and patients struggling to access the care they need. As a result, patient and public satisfaction with services has dropped significantly, prompting debate and discussion about the future of health and care services.”[ii]
The article makes reference to the failure of Government spending on the NHS to “keep up with demand” and also downplays the expansion of NHS privatisation, boldly stating:
“There is no evidence of widespread privatisation of NHS services. The proportion of the NHS budget spent on services delivered by the private sector has remained broadly stable over the past decade.”
Rather ironically for an article that claims to be “tackling the myths” surrounding health and social care in England, this point is itself easily debunked. For example, an LSE study, which claims that the level of NHS spending on privately provided services is higher than the 7.2% cited by the King’s Fund.[iii]
In a piece titled “Flawed data? Why NHS spending on the independent sector may actually be much more than 7%”, David Rowland claims:
“The presentation of data on NHS expenditure is flawed, writes David Rowland, which prevents policymakers from having a clear understanding of where money within the system is going. He estimates that in 2018/19, the amount spent by NHS England on the independent [private] sector was around 26% of total expenditure, not 7% as widely reported.”
This, he claims, is an increase of approximately 23% since Simon Stevens was appointed as Chief Executive of NHS England in 2013/14.”
According to Rowland, the discrepancy emerges because the 7% figure does not include services outsourced to the private sector via local authorities. I explained the implications of this in a previous article, written in 2021:
“As a result of these changes, the Health and Care Bill will level down our NHS so that it comes to resemble the disastrous social care model that’s presently failing our most vulnerable populations. Social care is a mess in the UK. Management of care budgets is farmed out to cash-strapped councils who contract private providers to do the work on their behalf.” [iv]
In my view, that 26% of NHS England’s expenditure is on outsourcing to the “independent” or private sector should certainly be classed as “widespread privatisation”.
However, the real crux of the matter is contained within a short sentence slipped in at the end of the King’s Fund piece, which refers to “a recent rise in the number of people choosing to use the private sector, paying for their treatment, in the context of long NHS waiting lists and times.”
This is a symptom of the killing of the NHS; where a single institution that provided comprehensive healthcare to all, free at the point of need once stood, now resides a fragmented system that encourages the denial of healthcare by design and to the benefit of the private health insurance industry.
As Dr Bob Gill has again made clear:
“ICSs [Integrated Care Systems] are modelled on US Kaiser Permanente ‘managed care’ [a model introduced by President Nixon]. They have been maturing and operational in shadow form for some years previous called Accountable Care and Sustainable Transformation Plans. The name change does not signal a change of heart. Managed care business model is profit maximisation through the denial of care.”
Underpinning this shift from comprehensive care provision to incentivising care denial are changes to the law. Amendments brought in via the Health and Social Care Act 2012 mean that the Secretary of State for Health and Social Care is no longer legally responsible for ensuring the provision of a comprehensive healthcare service in England. The legalisation of care denial was concluded with the Health and Care Act 2022, which removed the obligation for Integrated Care Systems to treat patients seeking care via Accident and Emergency Wards. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9449439/
A system made up of a patchwork postcode lottery of Integrated Care Systems that are not legally obliged to provide treatment, and which are incentivised not to do so, is not the NHS as it was originally founded.
As Rowland’s piece for LSE suggests, the diminished central Government funding stream allocated to healthcare is being redirected away from patients and into the pockets of privateers. The NHS, as an institution, is gone. Its remnant assets – buildings and land – are now being stripped.
The NHS is not sick and does not need saving. It is already dead, killed by alliance between Labour, the Tories and the Private Health Insurance Industry. The only solution now is not rescue but rebirth – a new NHS, founded on the original principle of healthcare as a human right, free to all at the point of need. But neither the Tories nor Labour – both of which receive donations from the private health sector – will reinstate an NHS.[v][vi]
[i] Dr Bob Gill, “Sicko UK”, https://consortiumnews.com/2021/07/14/sicko-uk/
[ii] Charlotte Wickens, “Health and Social Care in England: Tackling the myths”, https://www.King’sfund.org.uk/publications/health-and-social-care-england-myths
[iii] David Rowland, ““Flawed data? Why NHS spending on the independent sector may actually be much more than 7%”, https://blogs.lse.ac.uk/politicsandpolicy/nhs-spending-on-the-independent-sector/#:~:text=The%20presentation%20of%20data%20on,within%20the%20system%20is%20going
[iv] Dr Phil Bevin (PhD), “It’s time for us to step up and fight for our right to access health and social care”, https://www.thecanary.co/uk/analysis/2021/10/03/its-time-for-us-to-step-up-and-fight-for-our-right-to-access-health-and-social-care/
[v] Steph Brawn, “This is how much Labour and Tory MPs get from private health firms”, https://www.thenational.scot/news/uk-news/23568478.much-labour-tory-mps-get-private-health-firms/.
[vi] Paul Knaggs, “Selling Out the NHS: The Shocking Links Between Labour MPs and Private Healthcare Donations”, https://labourheartlands.com/selling-out-the-nhs-the-shocking-links-between-labour-mps-and-private-healthcare-donations/.
Labour Affairs 