Profit motives are driving the government’s public health care policies, says Ellen Hawley who believes we need to open our eyes to what is happening to this ‘national treasure’
Having spent most of my life in the United States, I am in awe of the NHS, and I’m worried witless about what’s happening to it.
The government tells us that by reorganising and dividing and privatising the NHS they’ll give us choice and better care. But that’s not what’s happening. When they privatised Cornwall’s out-of-hours care, it didn’t give us choice, it gave us Serco, whose service was called “substandard” by the parliamentary accounts committee. Three cheers for better service.
What happens when you break up an integrated system, such as the NHS used to be, and introduce profit into health care? You create perverse incentives. Entire systems will be structured around what pays, not what works best for the patient. Once profit comes into medicine, no organisation’s decisions will be made without giving thought to it.
Let me tell you how that works in the United States. My partner used to work as a family therapist for a US health maintenance organisation – one of those for-profit giants that dominate US medical care and that are anxious to enter what they charmingly call the UK market.
When she followed the cases of adolescents who had been referred to for-profit hospitals, she noticed that they got miraculously better when their benefits – the coverage their insurance entitled them to – ran out. If it covered 90 days of in-patient treatment, they needed 90 days. Or maybe 89. If it covered 30, they were ready for discharge in 30. People who worked in the system referred to it as a benefit-ectomy.
It’s not that everyone who worked in for-profit medicine was corrupt. Most of them were good people, stretched to the breaking point by a system whose top priority was neither medicine nor patient welfare. But they could only do what was allowed and if the system said “discharge”, they discharged. If it said “hospitalise”, even if the patient might have been better off treated at home, they recommended hospitalisation.
Because my partner worked for the organisation that was paying the bills, her job was to throw her weight against hospitalisation whenever possible and minimising hospitalisation was often in the patient’s best interests. But not always. When you work in a system, it’s hard to step outside it and look at an individual case objectively – even compassionately.
This kind of pressure leads to organisations playing “pass-the-patient” with cases that will cost them money, and “capture-the-patient” with lucrative ones.
And don’t for a moment think that for-profit corporations aren’t doing that here. They leave the NHS to pick up the unprofitable cases, and it’s called cherry-picking.
Treatment becomes a by-product. Often it is excellent, but often it is not. Patients fall between the cracks while the medical systems that are supposed to treat them argue over whose responsibility they are.
And that’s the people with insurance. People without it would be lucky to have such problems.
I’m not saying that a 100 per cent US-style system will be imposed here tomorrow. But the NHS is in danger. Bits and pieces are being contracted out to private corporations and we’re told this will improve service and save money. But too often the public ends up with poorer service. In the Western Morning News (August 7), I read a headline about “repeated failings of privatised patient transport”. How many similar headlines have we seen?
Does any of this save money? It’s hard to say, since the public don’t have the right to see the contracts involved. They’re governed by commercial confidentiality, which is particularly outrageous when public money is being spent. What I do know is that bidding for contracts is in itself an expensive process, and that if a private corporation wins a contract it may push a public entity out of existence, so that if it provides inadequate service there may no longer be a public entity to return to. Now Serco is withdrawing from its contract early, saying that “delivering out-of-hours care does not fit with our future healthcare strategy”.
But the GP-led out-of-hours group that Serco replaced can’t step back in seamlessly because it no longer exists.
I also know that for-profit corporations need to make a profit and that the money going to profits comes from the money that would otherwise be spent on providing health care. How can any system that has to pay dividends to its investors be expected to cost less? Take a look at the privatised railways. Are they delivering better service or costing the consumer less?
This is dangerous ground we’re treading on.
I have joined Keep Our NHS Public, Cornwall, which was formed recently and is campaigning against the privatisation of the NHS, for adequate health care funding, and for the repeal of the Bill that began these disastrous reforms. We can be found at keepournhspubliccornwall.com or reached at firstname.lastname@example.org. I hope you’ll join us. The National Health Service is not without its problems, but privatisation will destroy what’s best about it. It’s a national treasure, and it needs our help. Now.
Ellen Hawley chairs Keep Our NHS Public, Cornwall