Lord Darzi (an eminent surgeon and now an unelected junior minister for health) unveiled his report on the state of the NHS to 800 selected guests at the Royal Horticultural Halls in Westminster on Monday 30 June.
The report was aired on the eve of celebrations to mark the 60th anniversary of the founding of the NHS amidst a general orgy of mutual backslapping by ministers and executives.
The stated goals of higher quality in care and medical leadership are to be supported, but how does Lord Darzi intend to achieve them?
The key theme of the report is ‘choice’. Patients will be able to choose which GPs to see in the community, which hospital to take diagnostic tests in, and which hospital to be admitted to for surgery.
How is the patient to make this decision? Through league tables and satisfaction surveys. Hospitals and surgeries that perform well will be awarded bonuses, whilst those that do not will face fines and an ever-tightening budget.
The focus of Darzi’s vision for the NHS is ostensibly the quality of care over the quantity. In real terms, this means a steady erosion of the treatments that can be expected to be provided free of charge at the point of delivery.
Already, certain drugs are deemed too expensive for the NHS, no matter how much the patient may need them. This is just the tip of the treatment iceberg.
Unsurprisingly, the report is essentially a gateway for privatisation. Further use of ‘market forces’ will serve as evidence for the ‘need’ for greater private investment and the withering away of free health care as a right.
The new NHS constitution is an example of this. The fact that the constitution can be rewritten every 10 years means that the deterioration in the level of service provided can easily be justified, and ever more pressure placed on the individual to use their supposed choice to insist on private health insurance.
After all, this will be the only way under the current government’s plans that the citizen will be able to have access to expensive treatments or diagnostic tests.
The review of the constitution every decade is also an additional erosion of the government’s commitment to health care free at the point of use, as it provides a legal base and opportunity for the revoking of the NHS by any future government.
Further evidence of this is Lord Darzi’s proposed “personal health budget”, again proposed in the guise of ‘empowering the patient’ with choice in what services they receive. However, in an NHS concerned with reducing the quantity of services it provides, the budget is all too likely to be limited, particularly in regard to complicated and long-term illnesses, which have been seen in the US to be insufficiently lucrative for the healthcare insurers and ‘industry’.
Darzi suggests making these budgets available as a “direct payment”, further pushing service users to find private solutions to their healthcare needs, particularly in the community and social care spheres.
Primary care has been especially singled out by Lord Darzi for cooperation between the NHS and private sector (cooperation meaning an increased dependence on private investment), further narrowing the scope of the NHS and subjecting its provisions to the surgical knife of the profit motive.
Lord Darzi believes that the time has come to address the issue of ‘quality’ in health care because the Labour government has now “done the investment”. Darzi tells us that there are now enough doctors and nurses, that waiting lists are being removed, and that it is now time to focus on the quality of their work.
The investment has indeed been huge. Unfortunately, the money spent has done almost nothing to remedy years of underinvestment, but has instead flowed directly into the pockets of the drug companies and the multitude of private profiteers who are making fortunes by providing extortionately-priced (and often poor-quality) ‘services’ to the NHS, whether they be cleaning wards, sterilising surgical instruments or building new hospitals.
The Healthcare Commission reported on 9 July that “one in ten wards were severely short staffed” in maternity services. The BMA reported this April that the “shortage of Junior Doctors put patients at risk”.
Meanwhile, a leaked 2007 Department of Health review warned of a national shortage of 14,000 nurses. Incidentally, the same document also proposed radical changes to doctors’ gradings, local bargaining to reduce nurse’s pay in low-wage areas and the deliberate use of unemployment to “create a downward pressure on wages”.
The reality of Labour’s investment in the NHS is the pouring of millions of pounds into capitalist pockets, especially through the notorious PFIs (see Proletarian 23), certainly not an investment in the quality or quantity of the health care provided to the end user.
> Privatisation and fragmentation of the NHS has resulted in a debt that we continue to service – April 2008