End the market in Health care

This is a letter to the Swindon Advertiser

Faced with a cut in funding of between £15-£20 billion by 2013-14, Strategic Health Authorities are drawing up plans for passing these cuts down to Primary Care Trusts and to individual trusts below that. The South West Strategic Health Authority’s document, “Progress report on plans for improving quality, innovation, productivity and prevention”(January 7th 2010), explains how it is aiming to implement these “efficiencies”.

Like all NHS structures they are struggling with the consequences of the government’s ‘health market’. Their aim, which is roughly akin to turning base metal into gold, is to carry out cuts in expenditure, improve safety, and improve service to the patients, all at the same time.

Behind the bureaucratic language of the document you can see the difficulties they face. For instance: “challenge is not perceived to be always welcomed within the system”.

Plain English translation: Apparently some people don’t like being expected to do their work with insufficient money and resources!

The SWSHA also bemoans the fact that: “The market structure creates issues, particularly around collaboration and best-practice sharing”.

What a shocker. You set up a health market in which trusts have to compete with each other for patients and they… well, compete with each other and don’t collaborate! Hardly any wonder that “existing incentives do not facilitate a system-wide approach”. Or to put it another way:

“Creating effective and transformational competition is proving challenging with providers feeling particularly insecure.”

Imagine that. You cut their money and providers feel insecure.

The problem here is the ‘health market’. Government dogma is based on the idea that competition will improve the service. This is nonsense. The founding of the NHS was based on the idea of universal provision of healthcare as a public service and not a commodity to be bought and sold.

Today the NHS has to operate as if it is a business whose rationale is to make money. Trusts have to break even year on year, and the amount of work they can do is determined purely by financial considerations, rather than the needs of patients. How else do you explain the fact that the government, from this April is to penalise trusts for doing ‘too much’ emergency work.

If they carry out more emergency work than they did in 2008-9 then, for each procedure above that level they will be paid only 30% of the tariff. Yet the government has been paying private companies a guaranteed amount even if they do not carry out the number of procedures that they are contracted to do.

If the NHS is to be preserved it is necessary to halt this process, abandon the ‘health market’ and stop operating the service as if it was producing goods for sale. The level of cuts which are being proposed across the system can only lead to a steep increase in pressure on resources and a worsening of the service. An end to the health market would be a rational means of saving money since there would be no need for an army of people to police its operation. We need cooperation not competition.

Martin Wicks

Secretary Swindon TUC

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