Transforming England’s healthcare system

Revelations over the past week have cast new light on radical reforms underway in England’s healthcare. As Parliament resumes after its summer break, debate will continue on a controversial Health and Social Care Bill.

Critics have warned that the Bill marks a shift towards privatising the National Health Service, a view the government has strongly disputed. But recent information is likely to intensify fears about the impact of the reforms, whatever ministers’ intentions might be.

On 30 August 2011, the campaigning organisation 38 Degrees published independent legal advice from Harrison Grant solicitors and specialist barristers Stephen Cragg and Rebecca Haynes. These focused on proposed changes in the Bill to the Secretary of State’s duty to provide a comprehensive health service and on rules governing competition and procurement.

The legal experts advised that “It is clear that the drafters of the Health and Social Care Bill intend that the functions of the Secretary of State in relation to the NHS in England are to be greatly curtailed... effectively, the government will be less accountable in legal terms for the services that the NHS provides.

Apparently “there is a real risk of an increase in the ‘postcode lottery’ nature of the delivery of some services, depending on the decisions made by consortia in relation to these subsections. And the intention of the Bill, is that there will be very little that the Secretary of State can do about this in practice.”

In addition, the new commissioning consortia might be forced to let private firms bid to run NHS services: “Recent non-legislative reforms in the NHS have encouraged Primary Care Trusts to open up the provision of an increasing number health care services formerly provided in-house to commercial and social (or ‘third sector’) enterprises.”

The reforms introduced by the Bill will “introduce elements which make it even more likely that domestic and European competition law applies to the NHS... The effect of the application of competition law in the NHS is difficult to predict but potentially brings under scrutiny any collaborative and collective arrangements and the exercise of dominant local purchasing or providing power.”

Then on 4 September, the Observer contained “details of email exchanges involving senior health officials about handing the management of 10 to 20 NHS hospitals to international private companies”, emerging from a freedom of information request by non-profit-making company Spinwatch. Reportedly, “officials at the private sector firm McKinsey, which advises ministers, were in active discussion about bringing in overseas firms” to take over 10 - 20 hospitals, “’but starting from a mindset of one at a time with various political constraints’.”

Another Guardian group article claimed that a workshop at NHS London’s offices in December 2010 was attended by senior figures in the Department of Health and NHS and representatives of German company Helios, who “gave a presentation on ‘what an international player would suggest’. Helios was given an update on the ‘situation for NHS hospitals’ and the ‘specific situation in London’.”

Some may argue that the reforms will increase efficiency while maintaining a health service free at the point of delivery, or even that it is right that enterprising companies should be able to benefit from opportunities in healthcare as in other markets. Such notions however are controversial, even within the ruling coalition made up of Conservatives and Liberal Democrats, let alone the wider public, stoking fears that profit may be allowed to come before patients’ interests.

For Christians, and some other belief-based communities and movements, the debate has even greater significance. Health often holds a special place because it is so closely connected with the value which is (or is not) given to human life and wellbeing. For instance, Jesus is often depicted as a healer, and churches were often involved in creating and staffing hospitals (and still are in parts of the world, especially where a comprehensive state-organised health service which cares for the poor is not yet available).

Even if the government is able to push the Bill through Parliament in its present form, there may be a heavy political price to pay later, especially if there is a scandal involving appallingly poor patient care or failure in coordination during an epidemic or other disaster.

Given the complexity of healthcare, and the number of partners who may be involved in care (including unpaid carers and patients themselves), destabilising the system carries risks – and information now available highlights the potential hazards.

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© Savi Hensman works in the equalities and care sector. A widely-published commentator on political and religious affairs, she is an Ekklesia associate and regular contributor.