Most people will be familiar with the name of physicist Stephen Hawking, former Lucasian Professor of Mathematics at the University of Cambridge, and currently its Director of Research in the Department of Applied Mathematics and Theoretical Physics. He is well known for his work on the emission of radiation from black holes (known as the Hawking Radiation) and for his celebrated book, A Brief History of Time. In 1963 he contracted motor neurone disease and, at the time of diagnosis, was only given two years to live. He defied all expectations and has gone on to enjoy an illustrious career as one of the most acclaimed theoretical physicists of modern times – despite being confined to a wheelchair, and dependent on a computer and voice synthesizer to enable him to communicate with colleagues and students. For much of his career, he has required substantive medical care. In an interview with the New York Times in 2011, responding to rather negative perceptions in the United States with regard to the National Health Service (NHS) he stated, “I am British, I live in Cambridge, England, and the National Health Service has taken great care of me for over 40 years. I have received excellent medical attention in Britain, and I felt it was important to set the record straight. I believe in universal health care. And I am not afraid to say so”.
So it is of great interest to hear of Hawking’s concerns with regard to the present state of the NHS. In a recent speech to the Royal Society of Medicine, he has accused successive governments of undermining the NHS through measures such as inadequate funding, the abolition of the student nursing bursary fund, and generally steering the organisation on a path of privatisation. The government denies such allegations, and insists it is fully committed to a world-class NHS free at the point of use, now and in the future. So, who is correct? Is the NHS safe from privatisation, or is there an agenda to realise this goal through stealth, with a program of creeping privatisation measures, and public underfunding?
Before we look at the evidence, it would be useful to consider whether it is necessary to privatise the NHS. In terms of cost, the NHS is one of the most cost-effective health systems in the world. Indeed, a recent Commonwealth Fund survey reported that, in a comparison of 11 western nations, the UK ranked as number one in overall health care performance. The United States was ranked the worst. What’s more, the total health spend for the United Kingdom amounted to 9.9% of GDP (2014) compared to 16.6% for the United States (where there is no universal health care coverage). Clearly, it would seem the UK health system is far more cost-effective than the privatised system in the USA. So, why privatise?
An argument extolled by the advocates of privatisation in recent years is that the NHS is becoming unaffordable in its current form, due to increased life-expectancy and an ageing population. But is this concern well-founded? – this notion has been rejected by a Royal Commission report. The Sutherland Report (1999) on Long Term Care stated that even though ‘the population aged 80 or over is growing rapidly and appears likely to continue to do so, the UK was not on the verge of a “demographic time bomb” as far as long-term care is concerned and as a result of this, the costs of care will be affordable.’ This study has been supported by others.
So what is the evidence that privatisation is occurring?
First, consider NHS underfunding. Since its inception in 1948, the NHS has enjoyed a mean increase in annual spend of 3.7% per annum (The Health Foundation) – a rate higher than the mean UK GDP growth rate over the same period. This would reflect the social democratic consensus between all major political parties that existed during most of this period. However, since 2010, the NHS has received mean annual increases of just around 1% – a massive underfunding compared to historical levels. Annual growth over the next 5 years has been set at 0.9% (NHS Support Federation) at a time when the economy is estimated to grow at a rate of 15.2% (providing an annualised GDP growth rate of around 2.9%). Gradual under-funding would make sense if the strategy was to replace publicly funded care with privately funded care.
Second, we consider the advancing agenda of outsourcing services. Outsourcing started around 30 years ago when ancillary services such as cleaning were put out to private tender. Since then, outsourcing has moved into clinical services. Contracts monitored by the NHS Support Federation show that private firms won £3.54bn of £9.628bn worth of NHS work in England during 2014 – amounting to a share of 36.7%. A freedom of information request by Labour revealed that, a year later, private firms won 40% of the contracts that CCGs put out to tender, worth a total of £2.3bn – only slightly fewer than the 41% awarded to NHS bodies.
Increasingly, the NHS has been made to rely on Private Funding Initiative (PFI) schemes to fund capital projects such as the building of new hospitals. They are hugely expensive to finance, and account for another reason why so many NHS trusts are in deficit. Massive structural reorganisation also hints at a privatisation agenda with the introduction of Sustainability and Transformation Partnerships (STPs) and Clinical Commissioning Groups (CCGs). Empowered by the Health and Social Care Act of 2012 (HSC), their remit is to provide health care with a more rigorous approach to service procurement in the private market. CCGs are not obligated to provide a universal free health service and the fact that their customers do not have to be tied to a specific geographical area lead many to suspect that they are paving the way for an insurance-based system. Finally, HSC removes the obligation of the Secretary of State for Health to provide for universal free health care. Thus, the link between the NHS and parliamentary democratic accountability has been removed. Taking all of the above into consideration, one does not have to be a rocket scientist to recognise the direction of travel for the NHS.
The National Health Service is an institution that all British people can be proud of; it represents the best in human civilised values. It would be a tragedy for our nation to lose it. Let’s work for its preservation, and support the NHS Reinstatement Bill. May God bless Stephen Hawking, and God bless the NHS!