The 2012 Health and Social Care Act (HSCA) has opened the NHS back door to privatisation. The effect on senior managers of NHS hospitals is that, whether they like it or not:
“they are being forced to act more and more on the logic of private hospitals and commercial businesses. The first line of attack in this crusade has been to look for ways to duck out of providing services – such as A&E – which do not offer guaranteed returns.” (NHS SOS, p30)
Monitor, the national health market regulator, advises hospitals which are seeking Foundation Trust status, as required to by the HSCA, to cut back or close services that do not “contribute positively to the financial balance sheet”, such as A&E. (NHS SOS, p 30).
This is why the HSCA removal of the duty of the Secretary of State for Health to provide or secure a comprehensive health service is key to dismantling the NHS. It provides opportunities for global healthcare companies to take rich pickings, by providing the profitable elements of healthcare, and leaving the NHS to pay for all the loss-making services.
The people who designed the NHS, as part of the 1944 Beveridge Report, recognised that social fairness in health care depended on sharing the risks and costs of care across the whole society – from rich to poor, from healthy to poorly, from urban to rural. Services were integrated so patients couldn’t be denied healthcare or passed between agencies anxious to save money avoid taking responsibility for patients with expensive health care needs. Everything was paid for out of taxation.
The Secretary of State for Health had a core duty to provide or secure this comprehensive health service. This compelled the Secretary of State to provide health services according to need, and not to leave the provision of health services to market forces and organisations that were not democratically accountable. This duty, which the 2012 Health and Social Care Act repealed, was essential to the NHS.
Now that duty has gone, private healthcare companies are free to cherry pick the profitable elements of the NHS – the elective surgery and so on – while leaving the bits that are risky, complex and unprofitable to the NHS. These risky, complex and unprofitable bits are emergency care and healthcare for the chronic sick and the elderly. With profitable work being creamed off by private healthcare companies, the NHS is less and less able to subsidise its unprofitable work with money from its profitable work.
The NHS is also facing year on year cuts to its funding, of 4%/year over four years, via so-called efficiency savings.