Watch the video of Allyson Pollock’s talk at TEDxExeter 2014.
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Video and Live blogging
Now, after a delicious locally-sourced (where possible) lunch, we are back for the first afternoon session, on the subject of health.
Allyson Pollock is a professor and writer on the privatisation of the NHS. She’s going back to the beginning, of the formation of the NHS in 1948. There were two main controversies: that it was unaffordable and that people would abuse it. Neither came to pass. Beveridge designed the NHS to combat the 5 Giant Evils of ignorance, idleness, disease, want and squalor. The key to the welfare state as a whole was redistribution, and that was fundamental to the NHS.
The architects also wanted to keep private interests out. There were few private interests back then… only the doctors voted no, but were fought off. Now they are the NHS’ staunchest supporters, and many protested outside parliament when the Health and Social Care Act 2012 was passed in the Commons.
She has brought along copies of both acts. The 1948 Act is a slim pamphlet. The new Act is a weighty tome.
The new Act will remove the duty of the Secretary of State for Health to provide health care for all. That takes two pages; the other hundreds of pages regulate the new market, to determine who will get care and how it will be provided.
Risk selection is the basis of a market – how it is identified, priced, allocated and transferred. All this results in fragmentation, not integration. This is the main thing to remember from her talk.
Structures absolutely matter, as an engineer will tell you, and they follow functions, such as the duty to provide healthcare.
In the old system, the unit was the region. Everyone in the region was covered. In the new market, the unit is the insurance fund. Not everyone is covered, because not everyone can afford to pay.
The nationalised NHS was simple, and it was easy to see who was in charge. Powers were delegated vertically. Areas were contiguous, so no-one fell through the gaps. The new NHS is a rats nest of bureaucracy – commissioning groups (CCGs) and regulatory bodies. It’s difficult to see who is in charge, and CCG structures are no longer area-based but insurance-based. Groups who can’t get access to GPs – such as asylum seekers or homeless people – will be excluded. Older people are at risk of being excluded by entrepreneurial GPs or if they have chronic conditions for which care is no longer funded.
Services are being broken up across the country and put out to tender to commercial companies. There is a complete loss of planning on the basis of need. It’s about choice, but it’s not for patients to choose but to be chosen. The new commercial providers have the power to decide who gets access to care. The NHS is now just a logo providing money – £112bn per year – surrounded by companies like RBS, Virgin, PWC, Circle, Netcare. Many companies have no background in providing health care at all, others are based outside the UK.
Markets cost more, and the cost of health care as a % of GDP has increased dramatically. The US is an exemplar of inefficient market-based healthcare. Inefficiencies include billing, admin, profit, so only 60% is left for providing care and medicines. In the old NHS, only 6% went on admin etc. Then there’s also the waste of providing treatments that are not needed, missed prevention of illness, inflated prices of care and medicine.
What do we need to do? It’s our NHS. We can support David Owen’s NHS Reinstatement bill. Campaign to give the Secretary of State back the duty of providing health care for all. Campaign against hospital closures. Aneurin Bevan said the NHS will be there as long as there are folks left to fight for it. It’s our fight now.
Allyson Pollock is Professor of Public Health Research & Policy at Queen Mary, University of London. She is one of the UK’s leading medical intellectuals, and undertakes research and teaching intended to assist the realisation of the principles of social justice and public health, with a particular emphasis on health systems research, trade, and pharmaceuticals.
She trained in medicine in Scotland and became a consultant in public health. Among her previous roles she has been director of the Centre for International Public Health Policy at the University of Edinburgh and director of research & development at UCL Hospitals NHS Trust. She is the author of NHS plc and co-author of The New NHS: a guide.