A global NHS? What a shameful idea
It is wrong-headed for NHS hospitals to market their skills internationally.
August is the silly season, so when I read this week that NHS hospitals
were to be encouraged to market their skills internationally and even
set up bases abroad, I assumed it was the sort of story that should
be consigned mentally to the annals of cats that can dance and vegetables
that look like the Messiah.
But no, it turned out to be a serious proposal from the Government,
capitalising on the feelgood factor of the Olympics and the high profile
our health service enjoyed in the opening ceremony. And it is not just
the Coalition that thinks it is a good idea. The agency that will promote
the NHS abroad was set up in 2010 by Labour - something that made the
Opposition’s criticism of the initiative ring rather hollow. But
no matter. It is a joke of an idea. The whole scheme is wrong-headed
on many levels.
First, let’s look at the morality of the proposal. For years Britain
has raided other countries for healthcare professionals to make up for
the chronic underinvestment in training and staffing of successive governments
here. We have taken doctors and nurses from developing countries —
where there is a dire need of their services - to fill our gaps in what
is tantamount to reverse colonialism. Indeed, it is worse than the colonialist
era, as we simply plunder their resources and don’t bother hanging
around to make good the mess we create.
Now, to add insult to festering injury, we plan to sell a service back
to some of these countries whose resources we took. Maybe this is how
capitalism in a globalised marketplace works, but I think it’s
grotesque and someone needs to stand up and say so.
But are the proposals even feasible? In reality, the scheme can benefit
only Britain’s world-renowned teaching hospitals - such as The
National Hospital for Neurology and Neurosurgery, the National Orthopaedic
Hospital, Great Ormond Street, The Maudsley Hospital, and so on —
which already have a brand that is marketable around the world. These
hospitals are areas of excellence, offering ultra-specialist services,
so they have patients referred to them from all over the country. Their
survival is not in any doubt, and expanding overseas will simply swell
their already healthy coffers.
But what about the small, struggling district general hospitals? What
about the hospitals trying to meet the health needs of a local community
while being forced to cut services? These are the hospitals that most
of us turn to when we become unwell, and that most need our attention
and focus. Profits from overseas enterprises will not help them because
each hospital is an independent financial entity. The big teaching hospitals
will get a bit richer, while the rest of the NHS will limp along. It’s
not a meaningful solution to any real problem.
Of course, the proposal is little more than the logical extension of
treating hospitals as businesses. But so far this attitude has only
got hospitals into trouble as they struggle to transform themselves
into commercial enterprises, more interested in their profit margins
than in their patients. Can you imagine how bad things will be if they
are expected to transmogrify into multinationals?
It is a recipe for disaster to expect hospitals to behave like fast-food
chains or clothing stores. Hospitals should be focusing every shred
of their attention on improving their services for patients, here, in
this country. Hospitals are not businesses; they are places that are
funded by us, for us, when we become unwell. The proposals miss the
whole point of the NHS and what makes it a system for delivering healthcare
worthy of attention.
Like the grubby men in string vests and gold sovereign rings who sit
outside brothels beckoning gullible tourists, the Government is attempting
to pimp out the NHS to foreigners by promising something that it cannot
deliver. The NHS it is selling is a perverse pastiche of the NHS that
we have in this country, stripped of the essence of what makes it valuable
to us.
It’s not the NHS as a product that is revolutionary and worthy
of export, it’s the NHS as a concept. The main appeal of the NHS
to people around the world is the fact that it is a cheap, effective
and equitable way of delivering healthcare. It is the notion of a system
that is free at the point of delivery, regardless of ability to pay,
that makes it valuable. The great irony of all this is that if we wanted
to export the real ethos of the NHS, as opposed to what might be represented
by some bland, meaningless logo, then we would be going around encouraging
foreign governments to reject market principles and develop a socialised
model of healthcare. And this isn’t going to happen.
The reason why the NHS has not been replicated around the world is that
attempts to introduce socialised medical models are strangled by corporate
interest. Emerging, proto-capitalist economies are rich pickings for
the multinationals that are already lining up to take over running their
health systems. The idea that the NHS might become one of the circling
vultures ready to swoop in before a fair, cheap model of healthcare
delivery can be established makes me feel ashamed.
While the Government intends to use the Olympics to promote Danny Boyle’s
version of an all-singing, all-dancing NHS around the globe, in reality
it is a warped, perverted interpretation of our healthcare system that
is being peddled.
Patients are neglected, while companies count the pennies
If further evidence was needed of the pitfalls of opening up the NHS
to private contractors, then the story of Colin Boulter is a chilling
example. He was suffering from flu-like symptoms and attended the Tollgate
Lodge Health Centre, in Stamford Hill, north-east London, hoping to
use its walk-in service. Unbeknown to him, however, Care UK, the private
company that runs the centre on behalf of the NHS East London and City
Trust, had an agreement not to treat more than two per cent of the practice’s
registered patients each month, when operating the walk-in centre for
unregistered patients.
As the “threshold” for treating patients had been reached
that day, he was turned away without being seen by a doctor. He went
back home, where he became increasingly unwell. Eventually his wife
was so worried that she called an ambulance, and he was taken to Homerton
Hospital. He had meningitis.
Such is the problem of using private contractors. When commissioning
services from outside the NHS, restrictions and caps on the services
offered inevitably have to be put in place to curb costs. The service
becomes about the contract between the NHS and the private company,
rather than the patient who is standing in a health centre with a rapidly
progressing, life-threatening illness.
It is beyond disgraceful. The NHS reform Bill, which comes into force next year, will only increase the role of private companies. Expect to hear of many more stories like this.
Max Pemberton 27 Aug 2012
www.republicansocialists.org.uk
