It was, of course, Batman who back in the eighties first let the Tory notion that the health service should be not a service but an industry out of the bag. This quaint right-wing notion is still very much alive and well today. Lambo’s Health and Social Care Bill, with its recently highlighted provision that NHS trusts can now devote up to (just one percentage point shy of) half of all their activities to privately funded work, is part of the cold steel of this reckless policy. Those who doubt the extent of Tory industrial intent need look no further than Cambo himself. Only last November, he told us – during a speech that was meant to be about exports and growth – that he wanted to ‘drive the NHS to be a fantastic business’. No doubt that will include some token assurances about the importance of customer service, but there, plain for all to see, the emphasis is on business.
And then, out of the blue, the French breast implant story burst upon us. This a story with more ironical twists in it than a trotter’s tail, and enough inbuilt innuendo to fuel a full-on Carry On film. Carry On Busting, perhaps, featuring Sid James as the maverick French silicon oil salesman, Kenneth Williams as the overweening surgeon, Hattie as the hapless patient who got the implant from Hell that she never even needed, and – naturally – the wonderful Babs, as the babe for whom the bust tolled.
Enough silliness, for there are more than a few serious sides to this story. Others have covered the messy and unfortunate nature of the official announcements on the extent of the risks, and the delicate matter of who should pick up the tab for remedial surgery. But for Dr No, perhaps the simple message from this story is that it reminds us what happens when we allow commercial interests free reign in medicine. Sure, the NHS is more than capable of injecting toxic, even lethal, material into patients, but generally when it does, it does so accidentally, with nary a commercial thought in mind; more often than not because the hazard has been ahead of the science.
But when commerce reigns, the temptation to maximise profits is ever present. Today, England’s relatively small private healthcare sector is ever-mindful of the fragility of its image, and necessarily – at least most of the time – keeps an eye on the quality. But once trusts start operating Lambo’s forty-nine percent rule, private healthcare will become big business, indeed big business on an industrial scale, and with big business will come the temptation to maximise profit, to shave margins, and to cut corners, on an industrial scale. The very same dark forces led to hundreds of thousands of women having their breasts perked up with what is believed to be – a little irony here – mattress grade silicon will be cast wide across English healthcare. Even worse, the very same ‘commercial interests’ will insist that ‘commercial sensitivity’ precludes disclosure detailed disclosure of their methods and materials, making effective regulation of dodgy practice near impossible to police. The mind can only boggle at where it might end.
The fact that the root of this sorry tale of blown busts lies in France – a country often held up as a paragon of modern, effective and safe, if expensive, healthcare, not to mention a nation that values elegance and beauty, should serve as a warning to us all. Those right-wingers who bang on about how we in England should catch up with our French colleagues’ healthcare ways might also wish to take heed, less the bust soon toll too for them.