accident, CCG, charge, Chris Ham, clinical commissioning group, Department of Health, doctor, emergency, expensive, Freedom of Information, GP, health, healthcare, hospital, insurance, Kaiser Permanente, managed care, Managed Care Organisation, market, MCO, National Health Service, NHS, Personal Care Budget, private, privatisation, top-up, UK, undercut, USA
It is strange that more has not been made of the revelation that one-third of GPs apparently believe a £5 or £10 charge should be imposed on everybody turning up at hospital Accident and Emergency departments.
This seems to be a clear next step towards the marketisation of what used to be the National Health Service, disguised with a claim that it would “reduce frivolous use of the NHS and the growing pressure on emergency departments”.
It seems that a poll of more than 800 doctors found 32 per cent said “fees would be the most cost-effective way of cutting the number of people who go to A&E, who could have gone to their GP or a pharmacist instead or did not need medical attention at all”. Presumably they have already tried simply telling people what to do, then.
The story in The Guardian states that “specialists believe between 30 per cent and 40 per cent of all visits are unnecessary and that many patients could have sought help elsewhere because their illness was minor or not urgent”. That leaves 60-70 per cent of visitors paying extra for services their taxes have already funded!
According to the book NHS SOS (edited by Jacky Davis & Raymond Tallis; published by Oneworld), the plan is to convert the publicly-funded nationwide health service into one of “managed” care along the lines provided by Kaiser Permanente in the USA.
This is based on a flawed use of figures (p.39) so Kaiser is in fact far more expensive, but that didn’t stop then-Department of Health strategy director Chris Ham from defending the claims and allowing Kaiser to emerge as the model for NHS reform. This was seen as particularly useful for those with cash to invest in the company or other MCOs (Managed Care Organisations) as they reaped huge profits – until market saturation, government and employer schemes to keep health care costs down, and a series of scandals made the pendulum swing the other way. Then these companies started lowering patient benefits, increasing premium fees and withdrawing from unprofitable markets, and this is very similar to the current situation in England.
Finally, these firms began to expand internationally, to countries including the UK, where the NHS was seen as a hugely attractive business opportunity.
MCOs decide how services are organised and funded for their clients, through contracts with selected providers and rigorous control of hospital admissions. This seems uncannily close to the work of Clinical Commissioning Groups, which were set up under the pretext that they would allow GPs to control budgets, but in practice allow the money to be controlled by private firms that have been hired by overworked doctors – as was always intended by the Tory-led Coalition government.
Government regulations mean private companies must be allowed to bid to provide as many services as possible. Freedom of Information rules mean they can find out how the public service operates and then undercut its bid. Without funding, the public service will close, leaving the way clear for the private provider to pump up its prices – so they will eat up more and more of the limited NHS budget. But which services do they choose?
They choose those that are easiest and cheapest to provide – the services that provide the most opportunity to make a profit.
Accident & Emergency is not one of those services. It will remain with the public sector providers who are being “continuously cut and squeezed into downsizing, mergers, centralisation and closures”, reducing care to “short-staffed, overloaded, ‘centralised’ units”, covering “only those services that the private sector does not wish to provide” (ibid, p.18).
How can services like A&E continue, if the private operators are taking all the cash? The only answer, it seems, is to bring in health insurance. That is the plan, at least – and the proposed A&E charges seem intended to be a palatable way of opening that door to a public that would once have treated the very idea as anti-British and voted the government that proposed it out of office for a considerable period of time.
Next it seems likely that “top-up” insurance will be offered to people whose complex ongoing conditions qualify them for so-called Personal Care Budgets. The budget money will be limited, forcing patients (or rather, customers) to “top them up” with insurance.
Be very clear on this: You are not looking at the thin end of the wedge. The wedge has already been driven in and England is well on the way to having a privatised health service, with the NHS as nothing but a brand under which taxpayers’ money can be handed out to private firms that handle only the simplest procedures.
The intention, it seems clear, is to allow publicly-funded services to wither over a period of time, in order to soften you up – make you more receptive to the idea of paying for healthcare that once was free but may not even be available in the future if you don’t come up with some cash.
Are you going to sit there and wait for that to happen? Private health care, and health insurance, is far – far – more expensive than the NHS, which was the most cost-effective and efficient health provider in the world until the Tory-led Coalition got hold of it. Don’t believe the propaganda – the service had record satisfaction levels in 2010.
If you’re living in Wales, Northern Ireland or Scotland, don’t think that devolution of healthcare will save you because it won’t. Budgets are already under pressure from Westminster and the Tories will do whatever they can to force regional governments into the same, or similar, patterns.
One of life’s certainties is that you will become ill at some point. Don’t wait until that happens, because it will be too late.
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