When I first started my training as a student nurse last September, my only gripe was the often repeated suggestion that I could now find a “nice doctor to marry”. However, a year later and the coalition government have dished out much bigger concerns. This includes £20 billion worth of cuts to be made by 2015, along with the recent passing of a highly radical and costly Health and Social Care Bill, which promises to radically restructure and ”liberate” [read: sell off] the NHS. These changes are to occur despite David Cameron’s pre-election catch phrases: ”No more top down re-organisation of the NHS” and ”I’ll cut the deficit, not the NHS”.
At over 400 pages in length, the Health and Social Care Bill is longer than the Bill that founded the NHS in the first place. This not only highlights its radical nature, but also makes it very confusing. So, in simple terms, here are some of what I believe to be the biggest issues:
1. The NHS reforms abolish the government’s legal duty to ensure comprehensive health care. Instead, this responsibility is to be outsourced to hundreds of GP consortia, who will not be democratically accountable.
2. These unaccountable consortia will now receive 80% of the NHS budget, and will be responsible for both providing and commissioning (buying) health care services. They will be free to generate profit and give themselves bonuses by under-spending this budget; to pick and choose their patients; and to introduce charges and private health insurance for some services, such as minor operations.
3. The Bill also continues to promote increased competition, as private companies are encouraged to bid against NHS providers for an unlimited proportion of commissioning contracts. This will lead to ever-increasing numbers of fragmented services run by private providers of varying quality: a postcode lottery for patients. There is also the risk that private companies will “cherry pick” the profitable services and patient cases, leaving an increasingly destabilised NHS to pick up the pieces. Allyson Pollock, former director of the Centre for International Public Health Policy, notes that: “Several decades of research show that the impact of choice and competition on quality, efficiency and outcomes in healthcare is unproven”.
4. Finally, the Bill lifts the cap on the number of private patients that NHS hospitals are allowed to take. Indeed, with huge cuts, hospitals will be forced to take more and more private patients, leaving those who can’t afford to pay with longer waiting times and substandard care. Therefore, while the NHS will remain largely free at the point of need, it is easy to imagine how people will increasingly feel the need to pay for part of ,or all of, their care. Indeed, the government have already talked about expanding the NHS “top up fees” system, whereby patients can pay for part of their NHS care.
Furthermore, the cost of implementing these reforms will be £3 billion. That’s £3billion that could go into improving elderly care, researching new treatments, or tackling infection rates. Instead, along with the £20 billion reduction in the NHS budget, this Bill will mean fewer services, and over 50,000 frontline jobs to be cut. The government calls these cuts “efficiency savings,” but I’ve seen first hand that fewer, stretched staff, mean more pressure sores, more infection, more malnutrition and more mistakes, thereby slowing everything down and making patients suffer.
Unsurprisingly, it’s women who will feel the impact of these cuts more harshly than any other group, with services that women rely on being axed. Many ante-natal classes are now no longer provided by the NHS. Moreover, a recent report by Senior Midwives revealed that mothers and new-born babies are being put at risk, as a third of all maternity units in England are being forced to axe staff as part of the NHS cuts. Women will also lose out when it comes to cuts in staff numbers, as women make up 78% of the NHS workforce.
The scale of the threats posed by the Health and Social Care Bill, as well as the cuts to NHS jobs and services, has prompted a wave of opposition. Professional bodies and trade unions have voiced unprecedented concern, and health workers and service users have taken to the streets in a string of protests. A group of us student nurses have joined this opposition by marching with 500,000 people in the demonstration, March for the Alternative; by putting pressure on our unions; by organising demonstrations between hospitals; and by joining the creative actions of NHS Direct Action and UK Uncut.
At the time of writing, the House of Lords is reviewing the Bill. The lobbying group 38 Degrees have raised enough money to bring a group of independent legal experts to meet with the Lords and hope to persuade them to change its most damaging aspects. To find out more and to join their campaign, go to: www.38degrees.org.uk/nhs
The NHS will last as long as there are folk left with the faith to fight for it - Nye Bevan (founder of the NHS).
Rebecca Newman
Comments