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





Copyright © Republican Socialists 2017

Designed by Patrick Sweeney 2017