A book that was released some years ago examining the impact of market-based reforms of the National Health Service in the UK gives us some timely insights into where Australia is heading.
That’s the warning from Dr Peter Short, a health industry worker with extensive background in clinical work and health professional education, who has provided this review of Allyson Pollock’s book, NHS plc – The privatisation of our health care.
“Australia’s universal health care system is under threat by the ideologies and ideologues of the neo-liberal market economy. The United Kingdom’s National Health Service (NHS), a beacon of universality since 1948, has been taken over by these market forces and it is this process that is the subject of the book NHS plc – The privatisation of our health care, by Allyson Pollock.
Pollock, an experienced public health medical practitioner and Director of the Centre for International Public Policy at the University of Edinburgh, is a controversial figure in health policy in the UK due to her opposition to health policies that fail to demonstrate value for money for the public services. Furthermore, she argues, these policies have led to an increasing role for private-for-profit providers, effectively privatising the NHS.
NHS plc is divided into eight chapters that fall roughly into three parts: the new ideology (Market Prescriptions, The Real Cost of Market Prescriptions and Privatising the NHS: An Overview); the effects (Hospitals, Primary Care and Long-Term Care for Older People) and the future (Overcoming Opposition and The Emerging Health Care Market).
In the first section Pollock argues that changes in health system thinking have increasingly privileged knowledge of business management principles re-conceptualising health care as similar to factory production lines, with the automobile factory a favourite model.
Pollock analyses a number of private finance initiative projects in the UK that, prima facie, appeared like good value for money although the actual cost was rarely revealed remaining ‘commercial-in-confidence’. One hospital was supposed to cost 94 million pounds but had to repay 115 million pounds after costs for fees and finance was added. (p28) Inevitably, cost over-runs mean reduced public services when services are closed or are taken up by private service providers.
The middle section of NHS plc is where the ideological rubber hits the health system road. In these three chapters the effects of the privatisation process are detailed. Patients have been relegated to products whose prime function is to cause no impediments to their discharge. Those who require more care than their clinical pathway allows (for example, people with chronic illnesses, the elderly with complex needs or patients requiring rehabilitation) have become bed blockers and slow down the speed of the hospital assembly-line, blocking entry. A growing waiting list is more evidence of the absolute requirement and necessity to ‘improve’ the hospital.
The third section analyses how opposition was overcome. Like in Australia, the UK government: ignored its chronic underfunding and privatisation program; cast its health system as on its knees because of its staff; used catastrophic demography (the ageing population) as a spur to act quickly; imposed endless auditing; began caring more for the organisation and its performance rather than the population’s health needs; reduced the power of clinicians and closed beds and services.
Little evidence was ever produced for these initiatives and evidence was replaced by slogan and ‘common sense’ arguments’. Ironically, the privatised US health system was held up as a desirable model.
Probably the most distressing aspect is that health care clinicians have become, as Pollock puts it, ‘care deniers’ rather than care givers. Care is denied in the public sector when: staff are asked to justify why certain patients are still in hospital beyond their anticipated date of discharge; patients are discharged earlier; patient care is outsourced to families when patients reach the end of their clinical pathway and public sector services are closed. An audit denial culture has replaced a caring accountable culture.
Pollock’s arguments are clearly and generously supported with an impressive gathering of statistics, health service memorandums, parliamentary papers, newspapers and her team’s own academic research. This is in disturbing contrast to the paucity of critical thinking and uncritical acceptance and promotion of the ideology by politicians.
Consider the response of Gordon Brown when asked the rationale of using more expensive private sector funding for public investment – he repeated that the public sector is bad at management and only the private sector is efficient and can manage services well. (p3) Would anything different be said in Australia by a local premier or health minister?
In Pollock’s book, I have seen the future. And I don’t like what I see.
If one was to simply replace the acronyms UK with New South Wales and localise the names and places it would tell the same story.
Pollock’s description and analysis of the NHS may appear far-fetched until Australians connect the changes in local rhetoric and policies, the service closures, the hand-on-heart expressions of political support, the introduction of factory-like management principles and the hundreds of other small, apparently insignificant, changes.
Most clinical workers are encouraged to develop critical thinking during their preparation for practice, and now is the time for them to use that faculty, resisting systems of thought that, on the one hand, speak of modernisation, renewal and patient centred-ness while, on the other hand, promote care denial, car factory principles of care and the destruction of our universal health system.
For Australian voters and patients, Pollock’s book can explain what is being done to our health system in our name, but not with our consent.”
• NHS plc – The privatisation of our health care. By Allyson Pollock, London: Verso, 2004