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Don't let them kill off the NHS

“As long as you’ve got your health.” It’s a refrain I remember my mother sharing with her friends and relations as we were growing up in the 1950s, in the days when the National Health Service, established in 1948, was new.

Socialised medicine, offering universal access to tax-funded health care, free at the point of delivery was as good as a revolution for the majority in the UK. Well, almost.

The history books show that the NHS, as part of the welfare state, was conceived of partly in response to the revolutionary aspirations brewing amongst the victorious fighters returning from action in the Second World War.

Now at 65, having reached pensionable age, the NHS is itself ailing.

The A&E unit at Trafford General Hospital, from where the NHS was launched in July 1948, is to shut. Eleven more hospital trusts have joined Mid Staffordshire in “special measures” due to concerns over unusually high death rates and poor care.

From worldwide acknowledgement as the healthcare model to be admired, providing the best care at least cost, the NHS is now falling back in terms of international ratings.  

Amongst the biggest and most complex organisations in the world, employing 1.3 million people, the NHS has been through many reorganisations as it grows and changes to meet the needs of the now aging population, and to take advantage of new technologies.

But the causes of its current sickness are more external than internal.

Since its inception the NHS has been subject to exploitation by private sector for-profit suppliers of drugs, medical equipment, information systems, you name it.  The news that Big Pharma company Pfizer is party to a legal price-fixing scam exploiting loopholes in the cosy Pharmaceutical Price Regulation Scheme that has set “acceptable” profits for years, is just the latest example.  

In 1992, Conservative prime minster John Major’s introduction of the Private Finance Initiative into public sector projects was a key moment in the transition from welfare state to market state. This was taken forward after 1997 by Blair’s New Labour.

Through 30-year leasing contracts with private sector developers, the NHS and other public sector services, deliberately starved of direct funding, became saddled with monstrous debts and are now conduits for the transfer of wealth.

Taxes are collected and passed through the public sector to the private sector organisations. On its way through, the labour of those who work in the public sector become the source of the profits distributed to the shareholders in the private corporations.

New Labour’s introduction of business-type foundation trusts, which set hospital against hospital in competition for private patients, leading inevitably to financial calamity in some cases, was another moment in the transition to the market state.

It seems the previous government turned a blind eye to mounting problems. Now the ConDems are opening up whole swathes of the NHS to the private sector in a further twist of the knife.

In the 10 years leading up to the current great recession, health spending in the United Kingdom grew in real terms by 5.7% per year on average. This came to an abrupt halt in 2010 as health spending dropped by 1.9%, in real terms, with a further 0.4% fall in 2011.

Now there’s talk of an end to the ring-fence protection in England, following the example of Wales, where the health budget has already been cut by more than 20%. Hospitals are shutting, jobs being slashed, services disappearing.

Throughout its 65 years, the NHS has co-existed with capitalist social relations. As in most countries, expenditure on health care has been predominantly through the public sector. The deepening global crisis is rapidly undermining that uneasy co-existence.

Socialised healthcare is a model for a society motivated by the needs of the people. Rather than watch the wrangling over the blame for its decline, we should build new forms of democracy that can convert the rest of the economy to its principles. With goods and services like the NHS under the direct control of producers and users, we could achieve the type of society we need.

Gerry Gold
Economics editor
17 July 2013

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