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REVIEW:
NHS plc - THE PRIVATISATION OF OUR HEALTH CARE
by Allyson M. Pollock

By Gerry McCartney
Contact the author via the editor by e-mail at christopher.johnstone@ntlworld.com

Universal, comprehensive and free? This is the standard to which the NHS was sold to the British people in 1947. It is now being sold, no, being given, to private companies. It is being offloaded because it is said the NHS can no longer be afforded. Pollock begs to differ.

This book represents the most critical analysis yet of the evolution of the NHS since its inception by Nye Bevan, and is vital ammunition for all those who have dismayed at Conservative and Labour policies over the past 25 years which have served to outsource, downsize, streamline, marketise and privatise the service. Pollock does exactly as her title suggests, and accuses policy makers of betrayal of Bevan's vision.

In contrast to other authors of this persuasion however, she relies on economic and objective evidence where possible to back up her claims, building on her now famous contributions to the PFI, PPP and Kaiser Permanente debates. Her analysis is peppered with clarifying statements reminiscent of socialist manifestos over the decades, which destroy the thin veneer of spindoctoring and help focus debate on the true issues at hand rather than the warm glow of government propaganda.

Her analysis of PFI/PPP is precise. It is more expensive. It locks the public sector in for around 30 years without transfer of ownership at the end. Any required changes during the contract will be charged for as an extra. Operating costs have to be met from revenue not capital funding leaving shortfalls in service budgets. Risk is not truly transferred to the private sector. These points cannot be argued with, and the evidence is presented comprehensively.

In terms of hospital amalgamations her insight is as useful as her fear is small. She lamblasts politicians for using the colleges as figleafs for their closure plans and laments the downgrading of public health and planning functions that would have put public service provision before financial targets.

The real beauty of Pollock's analysis however lies in her comparisons internationally in terms of funding and efficiency. How many of us appreciate that the UK has 176 doctors per 100,000 patients compared with 375 for the EU and 589 in Italy. Similarly the UK has 413 beds for this population compared with 630 in the EU and 920 in Germany. This underlines her argument that although the NHS has been grossly underfunded for decades, it maintains a service vastly more efficient, equitable and effective than comparable systems abroad.

For hoolet readers, the book may disappoint in its lack of reference to the Scottish system, which is now marginally divergent from the rest of the UK. However, in the same way that we looked to the crystal ball of the US in the past to warn of storms to come, we now look to England. Here foundation trusts, LIFTs (local improvement finance trusts), DTCs (diagnostic and treatment centres) and star rating systems are emerging, like spectres drifting towards us. We may point to free personal care for the elderly or a bill mirroring the Welsh model of free prescriptions making its way through the Scottish Parliament, but in our hearts we know that the financial thumbscrews from Westminster turn ever tighter.

To her favour she does devote space to primary care and the interface between local authority services and the NHS. This may not be the sexy ER medicine which attracts charity stunts and column inches, but it is where the majority of the care takes place, and where the unseen swan legs paddle furiously.

In essence the book is essential reading for all who have an opinion, or would like to have an opinion on how our health services are organized and paid for. Not everyone will agree with her analysis, but most will not have considered it. As Edmund Burke said, 'All that is required for evil to triumph is that good men do nothing', and from that it is clear that we all have a duty to inform ourselves on the issues and contribute to the debates as they filter our way.

Published by Verso, 2004, 265 pp £15.99

Other hoolet online articles by Gerry McCartney can be found at:
hoolet edition 45 - Kerr²
hoolet edition 44 - REVIEW: NHS plc - THE PRIVATISATION OF OUR HEALTH CARE

hoolet is the magazine of RCGP Scotland. It is supported intellectually, financially and emotionally by RCGP Scotland.

This issue maintained by Robert Hallam.