Assess the claim that the NHS is being privatised by stealth.

University Degree Subjects allied to Medicine

The National Health Service was set up in 1948 to provide healthcare for all citizens, based on need, not the ability to pay. It is made up of a wide range of health professionals, support workers and organisations.

The NHS claims to bring about the highest level of physical and mental health for all citizens, within the resources available. They claim to do this by, promoting health and preventing ill health; diagnosing and treating injury and disease; caring for those with a long-term illness and disability.

The NHS is predominantly funded by taxation, and the level of GNP devoted to health care is the lowest of any comparable developed country at 6.7% of GDP (NHS Support Federation 1999). Because the NHS is funded by the taxpayer, it is accountable to Parliament. It is managed by Department of Health - which is directly responsible to the secretary of state for health John Reid. The department sets overall health policy in England, is the headquarters for the NHS and is responsible for putting policy into practice. It also sets targets for the NHS and monitors performance through its four directors of health and social care. The NHS is one of the largest employers in Europe. It has more than a million staff working in over a thousand Trusts. Around one million people work for the NHS in England and it costs more than £60 billion a year to run, and the figure is rapidly rising annually.

In 2002, the socialist healthcare system which was ranked highest by the World Health Organisation was France. France combines a system of private and public hospitals. The French system has two obvious advantages over the discredited British system. Firstly, it encourages the growth of privately owned hospitals and consultancies in greater numbers than the British have. Secondly, it encourages a degree of competition and innovation as private hospitals compete with each other and the state ones for "customers". However, a greater difference is the dissimilarity of the British and French tax systems. The French simply spend more money on health than their British counterparts. In fact, they spend over twice as much on health than British government.

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The NHS consists of several organisations, which all relate to each other. Department of Health is one of several organisations which is the Government department. It is responsible for delivering fast, fair, convenient and high quality health and social care services to the people of England. The Department of Health also has four Directors of Health and Social Care who work directly with the NHS and performance manage strategic health authorities. Strategic Health Authorities are another organisation. They are responsible for developing strategies for the local health services and ensuring high-quality performance. They manage the NHS locally and are a key link between the Department of Health and the NHS. They will also ensure that national priorities (such as programmes for improving cancer services) are integrated into local plans. The NHS Direct which opened in March 1998, offers fast and free 24 hour advice about personal health care. NHS Direct nurses aim to provide callers with the advice and reassurance they need to care for themselves at home. NHS Trusts, which are found in most large towns and cities, and usually offer a general range of services to meet most people's needs. Some trusts also act as regional or national centres of expertise for more specialised care, while some are attached to universities and help to train health professionals. Trusts can also provide services in the community - for example through health centres, clinics or in people's homes. Except in the case of emergencies, hospital treatment is arranged through your GP. This is called a referral. Appointments and treatment are free. Together, NHS trusts employ the majority of the NHS workforce including nurses, doctors, dentists, pharmacists, midwives, health visitors and staff from the professions allied to medicine, such as physiotherapists, radiographers, podiatrists, speech and language therapists, counsellors, occupational therapists and psychologists. Their many other staff include receptionists, porters, cleaners, IT specialists, managers, engineers, caterers, and domestic and security staff. NHS walk-in centres offer fast access to health advice and treatment. They are open and available to anyone and provide, 7 day a week service experienced nurses, advice and information. Amongst the other organisations are Optometrists/Opticians, Pharmacists and GPs (Primary care).

Today, the NHS has been described as a fiasco with shortages of skilled workers, low morale, long queues for services, crumbling facilities and corrupt practises. One ‘solution’ to this ‘problem’ may be to privatise or part-privatise the NHS. But there is great objection in the British population, because for many years they have enjoyed a free health care system, but the question they should ask is, at what costs? And, can the British government continue to use taxpayer money on a service that isn’t up to the standards of other EU countries? The demand for better service has been voiced in opinion polls, the media and ministers, so the privatisation of the NHS seems a sound solution. Many people in Britain object, politically, to the privatisation of the NHS because they believe that they will be at loss. Britons need to know exactly what privatisation means, and because it would be such a radical change, they are naturally afraid. It would mean no waiting lists, queuing is a feature of the lack of a price mechanism in state ownership, it disappeared very quickly when BT was privatised. Secondly there would be more efficient management, none of the bureaucracy that has arisen with government cost cutting attempts. Thirdly there would be better incentives, resulting in lower costs and most people being able to pocket much of their tax cuts and not have to spend it too much of it on health insurance. Paying for healthcare ensures a better service for all, as the doctor then wants to please us rather than the government. Most people in Britain are unaware of how much better service is in other parts of the world.

Furthermore in the NHS, Unit costs are high because there is no competition; hospitals are often sited for political reasons - jobs for the constituency and close healthcare. For the same reasons unnecessary hospitals can't be closed. However much Britain loves the NHS, its standard of care particularly in chronic illness is far below that of EU and US.

A free NHS promotes unhealthy lifestyles since the individual doesn’t pay for their health, they expect their health treatments (as a result of unhealthy lifestyles) to be paid for. If Britons had to pay for their health, they may think first about lifestyle choices. Britain has the highest rate of heart diseases in Western Europe.

It is no wonder the claim that the ‘NHS is being privatised by stealth.’ Evidently, the British government of today sees the advantages, but is hesitant, for fear of public upheaval. The Labour government has traditionally been the ‘party for the people’ and represents ideologies of social justice, trade unions, community ties etc. New Labour has tried to incorporate these ideas with Tory policies. For example, supporting the privatisation of some state services, weakening of trade unions etc. Nevertheless, to completely privatise the NHS in today’s day and age would firstly cause public mayhem. Secondly, it may not be totally beneficial to privatise the entire NHS. I believe that the government of today and the precedent governments understand this, and the only way to combat this, is by stealth. Stealth being, ‘creeping privatisation’ where the process is slow. This measured and unhurried process is an advantage, as it allows the public to adapt to the new system of operation, and means the process isn’t rushed. If one scheme didn’t work, the government can learn from that, and take try and rectify the problem in the future.

Tony Blair, insists he does not want to see the NHS privatised. However, he wishes to merely bring in private sector expertise and management skills where this can help the health service do its job. Both Labour and Tories support a mixed economy for healthcare in which the private sector plays a partnership role to the NHS.

The introduction of foundation hospitals would mean, that each hospital trust would become responsible for their own finances, and will be able to borrow extra funds. The government argues that the NHS hospitals would be more accountable to the communities they serve. They claim it is not privatisation, but democratisation. Keeping the NHS a public service but ensuring for the first time in the history of the NHS genuine public ownership and staff involvement. Some would argue this a step forward to privatisation, and utter stealth.

Everyone in Britain will get a “health passport” allowing them to pick and mix private or NHS hospitals under Tory plans. The state will pay the cost of NHS ops and up to 70 per cent of private treatment. Patients would pay the difference out of their own money, or from private “top-up” health insurance. Tories believe the move would free up hospitals to deliver faster treatment for poorer families. Shadow Health Secretary Liam Fox said, “For the first time, the patient will be given the freedom of choice.” Anyone who needs hospital treatment will be able to select where and when to have it. Charges for all procedures will be set out in a price tariff. This “Health Entitlement Licence” is designed to reduce abuse of the NHS by asylum seekers. Immigration officials would investigate anyone unable to produce one.

From examining current New Labour policies, such as foundation hospitals and new Tory policy, it is apparent that they are both driving towards a better system of health care, which they believe involves some form of stealth. But this stealth is beneficial for everyone, because it means the government can assess what works, and what doesn’t. It also means the public has time to become accustomed with an improved health service. Some schemes will prove more popular than others, and not all transformed practices will work, but it does pave the way for a better National Health Service. It means that the service will become accountable to the people, taxes can be spent on priorities such as education.