Stuart McMillan on the death of the National Health Service as we know it

Andrew Lansley's plan for the NHS is one that worries many

GPs hate it, many Conservatives back it, and the experts believe that it will ‘do irreparable harm to the NHS, to individual patients and to society as a whole.’ The Health and Social Care Bill, the bill that will change the NHS forever, is lauded and hated in equal measure. But will it really help or hinder the National Health System, or will it even do much at all?

Well, it will do a lot, is the short answer. The New Statesman, purveyor of social-liberalism for the masses, heralded the death of the NHS last week; it’s front cover gave the rather arbitrary dates of 1948-2011. It is arguable that the NHS started with the Beveridge Report all the way back in 1942, and it is arguable that truly nationalised healthcare has been dying a slow death ever since the introduction of Private Finance Initiatives (PFIs) in 1992. Of course, it is arguable that the NHS in all of its main features is still very much alive.

But not for long, if the bill goes through unchanged. The plan to put GPs and clinicians in charge of around 60% of the health budget has recently been suggested by the British Medical Association to be a cover to allow more private companies into the NHS since the GPs and clinicians will not have the time – or may not even want to – manage such huge enterprises.

By abolishing Primary Care Trusts that currently commission treatment, along with the four regional Strategic Health Authorities for an estimated 300 Clinical Commissioning Groups instead there are fears that the NHS will become a patchwork of local care systems with no real structure to keep it performing well and on task. And, of course, by letting in the private companies, an institution built on giving everyone healthcare regardless of their means could be marred by infighting and questions of profitability.

Health Secretary Andrew Lansley and the Government as a whole look to cut red tape, but they could wrap themselves up in something stickier by attempting to jettison waiting times to make sure that patients are properly looked after. Granted, the unhealthy obsession with turnover during the Labour years needs to be scrapped, but there are justified concerns that if waiting times are no longer on the agenda then the NHS could see a return to 90s-level waiting times; far higher than any time during the Blair or Brown era.

Labour is against the bill, and though their tenure saw the continuation of the PFIs the balance was always kept firmly on a national health system whose main objective was the treatment of patients, with private money being used to build infrastructure for public health projects, though the success of the projects is questionable.

The Big Society seems to be attempting to make inroads into health now; by introducing a consumer-led, down-home ideal of a health service that can be good for everyone, run by everyone, but where would the funding come from? What the Conservatives are missing perhaps is that the concept of the NHS is that it is fundamentally incompatible with the Big Society. If it is one thing; it is a machine of the state.

But more likely, they know this already. What we will see if the Health and Social Care Bill goes through, and it probably will even if as a slightly watered down version, is a transformation of the NHS from a state-run national health service to a private-public-consumer mishmash that will still-hopefully-provide everybody with healthcare regardless of their means. Waiting times and quality of service could, feasibly, go either way depending on the success of the new schemes.

The New Statesman’s cover was prescient in one way; what the NHS has been and has stood for is being eroded. But maybe, to see it in another way, this is simply the next stage of healthcare; an Obama-style model for the 21st Century. Personally, it strikes no chord with me. But if it does the job, I’ll live with it. If it does not, the Government will have destroyed one of the greatest public services in Britain and, by the time my children are reading newspapers, nobody will feel in the slightest that they have missed out on one of the greatest institutions currently alive and kicking in the United Kingdom.

Stuart McMillan

Image Credit- Midnightblueowl