Healthcare cannot be sold like an iPad
It is time to reject the market ideology that has plagued the NHS for more than 30 years and wasted billions
NHS England is embarking on its single biggest outsourcing of services so far by inviting bids for a contract that will be worth between £700m and £1.1bn. The sale of NHS services is fragmenting the health service and having a negative impact on patient experience.
Driven by political ideology, a significant section of the Coalition administration and the medical director of the NHS, Sir Bruce Keogh, believe that the answer to our healthcare problems – indeed, the only answer – is to rely on the free market. Keogh has said that the health service should copy retailers such as the Dixons chain. But the evidence from other parts of the world conclusively demonstrates that healthcare cannot be marketed and run like PC World/Dixons.
Nobody disagrees with Keogh that the NHS has got to be cost-effective, but purchasing care services from private providers with shareholders demanding profits can only lead to increased costs or reduced quality of care – or both. After the fiasco of the NHS Direct’s 111, the government needs to seriously examine its privatisation, commercialisation and marketisation policy for the NHS.
There are two distinctive aspects of healthcare. One is that you don’t know when or whether you’ll need care – but if you do, the care can be prohibitively costly. For big private corporations the real money is in safe, elective procedures, like hip, knee, heart or cataract surgery, not routine visits to the GP/hospital outpatients, or looking after older, chronically ill or mentally ill patients. Only a small minority of people can afford to pay major medical costs out of their own pocket.
Healthcare cannot be sold like an iPad or a TV. It must be largely paid for by some kind of central taxation like the NHS, or an insurance scheme like in the US and other developed countries. This means that someone other than the patient, such as clinical commissioning groups, ends up making decisions about what is affordable. In my view choice and competition is nonsense when it comes to healthcare. And you cannot trust private companies either – they’re not in business to promote your health – they are there to make a profit.
The second thing about healthcare is that it is complicated, and you cannot rely on experience or comparison shopping. That is why doctors follow an ethical code, and why we expect more from them than from bakers or Virgin, Care UK etc.
Healthcare does not work as a marketable commodity.
For the last two decades, the leaders of all major political parties have been wedded to the concept of the marketisation of healthcare. Do they really believe that chosen private healthcare firms will treat all patients fairly, and not just select those based on the criteria of how much profit will be made? The commissioning system makes it easy for private providers to cherry pick tasks to ensure they maximise their income and overall profit from the NHS while minimising their costs. From the perspective of patients and taxpayers this bias is highly undesirable – a recipe for overcharging, over-treatment and corner-cutting on safety.
All these problems can be controlled by tight regulation, but unfortunately we have a government wedded to the lightest of regulation because this “keeps costs down for business”. They ignore the risks to the public of failing to regulate healthcare providers which have an incentive to run unsafe services because the money not spent on ensuring safety contributes directly to their profits. The real interest in choice is not among patients, for whom we could simply complete countrywide choice-of-referral care which existed before market reforms started. Those who are for the kind of choice that these reforms will allow are providers, who will soon be able to decline to treat cases that may be expensive to treat, usually those with complex or multiple conditions. They are the patients who need the NHS most, and yet they will be forced to rely on the ever more cash-strapped CCGs.
There are no evidence-based examples of successful healthcare relying on the principles of the free market. People, like Sir Bruce, who say that the market is the answer to achieving better outcomes for health are flying in the face of both theory and overwhelming evidence.
The NHS faces huge challenges; a continuous evolution is needed, with greater provider responsiveness and accountability. However, a high-quality and efficient NHS will never be achieved using the market forces of creative destruction. It is time to reject the market ideology that has plagued the NHS for more than 30 years and wasted billions of pounds, and move forward with a depoliticised NHS, publicly funded, provided and accountable healthcare system based on co-operation, collaboration and the social contract between doctors and patients.
http://www.theguardian.com/healthcare-network/2013/jul/30/healthcare-sold-like-ipad
