In the ocean of amendments and opinions swilling round and threatening to drown sensible debate about the Tories’ Health and Social Care Bill, and its likely impact on the national health service, there is nonetheless a constant tide that ebbs and flows: the question of privatisation. Critics of the Bill – including Dr No – claim the Bill will, not so much by a big bang, as by the back door, bring about wholesale privatisation of our once national health service. Those for the Bill have been equally vehement that nothing could be further from the truth. Indeed, the Department of Health in its recent tabloid style ‘Myth Buster’ release – BIFF! SoS won’t wash his hands of the NHS! ZAP! Private patients won’t jump the NHS queue! – dismissed the privatisation claim as CRUMP! ‘ludicrous scaremongering!’. For the better understanding of any thickos who still haven’t got the point, the Department adds: ‘We have made it crystal clear, time and again, that we will never, ever, privatise the NHS’.
So the question inevitably arises: how can views on the question of privatisation be so diametrically opposed? The answer, Dr No believes is remarkably simple. The Tories’, and the Department, no doubt aided by their legal teams, have covertly restricted the meaning of privatisation to one of gross funding, and then, and this is the half-clever bit, made it ‘crystal clear…that we will never’ privatise the NHS. Ah-So! So that is a ‘we’ will never privatise the NHS…
The reality is that the privatisation fork is a fork of many prongs. Even on the simplest analysis there are three prongs. The first is the privatisation of structure – chiefly bricks and mortar – and this is already well underway – with the increasingly discredited – none other than a Tory MP last month described it as rip-off – Private Finance Initiative, which simultaneously shunts capital project liabilities off the government’s balance sheet, while providing, at tax-payers expense, a generous long-term gravy train for private investors.
The second prong is the privatisation of service provision – and again this is already underway, introduced, as indeed PFI was, by the last Labour government, under the ‘any willing cowboy’ scheme. AWC allows private operators to provide NHS services – sometimes even phantom services – and still get paid handsomely. The Bill, if enacted, will – indeed, it is one of the primary intents of the Bill – open NHS service provision up to a Pandora’s box of very willing cowboys, all hot to get their hands on that most lucrative source of funding, government – and so tax-payers, and that means our – money.
So far, the ultimate bill for the first two prongs, structure and service, even when provided by the private sector, ends up paid by the tax-payer, through public NHS funding. Dr No suspects that when the Tories say they will ‘never, ever, privatise the NHS’, what they mean is they will never ever privatise the funding of the NHS, even if there is to be wholesale provision of structure and services by the private sector.
But Dr No remains niggled by the wording: ‘We have made it crystal clear, time and again, that we will never, ever, privatise the NHS’ Maybe ‘we’ – meaning the Tories – won’t – but doesn’t that wording leave scope for others to provide the third (and final) prong of privatisation, the privatisation of funding? In a health service increasing built and provided by the private sector, how long before some bright spark spots the potential to market health insurance not on the past limited scale, but on a scale commensurate with the now greatly expanded private provision of services?