Health matters: Inequality in the NHS

Primary care
• In 1971, Dr Tudor Hart wrote in The Lancet that ‘…the availability of good medical care tends to vary inversely with the need of the population served’. This still applies: for instance, there are still twice as many primary care professionals per head of population in Cambridgeshire as there are in Manchester. Residents of Cambridgeshire will on average live six years longer. The Office for National Statistics released life expectancy figures recently showing that a child born in the South East and South West of England in 2005 had a life expectancy of 78.9 years for males and 82.9 years for females. This compares with Scotland, where it is the shortest, 74.8 years for males and 79.7 years for females.

• In Camden, north London, a battle has been won to defend GP services. Camden Primary Care Trust (PCT) recently announced that it is no longer planning to establish a polyclinic at University College London Hospital  (UCLH). It has backed down from its intention to move local GPs and/or new GP services to this polyclinic with a further threat of private tender to run it. This is a valuable lesson in the importance of local campaigning, as doctors, nurses and local people have kept up the pressure against the privatisation of primary health care services in the borough since the PCT’s first announcement. Campaigners opposed privatisation, demanding that money spent on the UCLH polyclinic should be spent on existing GP services in the borough and that consultation with local people about any further changes should be transparent from the start.

Precarious private finance
• The Homerton Hospital in east London is a foundation hospital where ‘more income is more security’, the chief executive announced in a recent briefing to staff. A six-week consultation process ended in mid-November over the future of the acute stroke services. These services are being centralised and the hospital will have to bid against private sector companies to run them. In the current economic climate, such a step is very precarious, because if the successful company cannot sustain its financial commitment, there are no guarantees that the services will continue to exist.

• On 31 October, Bob Ricketts, Department of Health (DoH) Director of System Management, confirmed earlier plans to force PCTs to outsource the community services they currently provide. This process has to be complete across England by April 2010. The plan will create ‘real opportunities’ for the private sector in the National Health Service, he said; the DoH estimates it would create a market worth £10bn a year. It is setting up a panel to ensure that PCTs are properly considering bids from the private sector. Foundation trusts can also bid: on 1 November, Hartlepool and Stockton PCTs transferred over 850 community staff and all their services to the North Tees and Hartlepool Foundation Trust, the first services to be outsourced under the edict.

Top-ups allowed
• On 4 November, Health Minister Alan Johnson announced the lifting of the ban on top-up treatment. People will be allowed to pay privately for expensive drugs without losing their entitlement to free NHS care. Johnson denied that this runs counter to the founding principles of the NHS – health care for all, free at the point of delivery. He muddied the issue by ordering the National Institute for Health and Clinical Excellence (NICE) to speed up decisions on new drugs and be consistent in considering applications. He also raised the ceiling on the annual cost of drugs NICE could approve for NHS patients from £48,000 to £80,000 a year. This would make more drugs available through the NHS so that fewer people would want top-up care. Johnson said he was ‘absolutely comfortable as Labour Secretary of State endorsing the recommendations’ and that there was no question of a two-tier system developing.

This is quite untrue. It is a crucial first step in undermining universal health care and moving the NHS to a point where it will provide only basic services, with anything extra depending on being able to pay. Insurance companies have jumped at the possibilities. The head of health at the Association of British Insurers said: ‘Potentially the market is enormous… All of us potentially might get cancer and may want to have these drugs… Without insurance there are very few people going to be able to afford these drugs and insurance is something that would make them available to just about everybody.’ On 26 November, in an article on the Pre-Budget Report, The Guardian suggested that one of the cuts in public spending a government could consider after 2011 would be to extend the system of top-up payments. The writing is on the wall.

Hannah Caller

FRFI 206 December 2008 / January 2009


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