The Health and Social Care Reform Bill and its effects on the Tameside area
In the Edwardian times, a regular feature of Tameside’s markets was a tooth puller. People would queue to have their bad tooth or teeth removed in public, and their cries would be drowned out by musicians.
On the 5th July 1948, such scenes would be confined to history, with the launch of the National Health Service. As a thank you for surviving a tumultuous few decades, Britons would receive free healthcare at the point of delivery, funded by National Insurance contributions. As a consequence of Aneurin Bevan’s plan, they would be freed from finding money to pay the doctor, or ambulance fees. This also led to greater awareness in health promotion, life expectancy rising and improved health overall.
The NHS had its roots in a plan launched by Tredegar Miners’ Welfare and motivated by business’ need for healthier employees. From the modest beginnings in his constituency came Aneurin Bevan’s bill. 63 years on, it has become part of our family and the nation’s psyche, even after numerous reorganisations, internal markets, pay beds and prescription charges. It is also among the most cost effective providers of socialised healthcare in the Western World.
Fast forward to 2010: a mandate-free coalition government is sworn in as the General Election resulted in a hung parliament. Instead of a minority coalition government of progressive left-of-centre parties, the Liberal Democrats agree to go into coalition with the Conservatives. With demonic zeal, the Conservatives choose a health minister with links to more private healthcare companies than anyone cares to mention. From the off, our NHS was put on death row.
By the end of this month, (unless their Liberal Democrat partners suddenly develop a backbone), our mandate-deficient coalition government could signal the end of the NHS as we know it (in England). If the Conservatives and the Liberal Democrats get their way on the 13th March, these worries about finding doctor’s bills could return to haunt us.
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Empire State Unum
The elephant in the room is eventual privatisation of our National Health Service, paid for using direct and indirect taxation, and our National Insurance contributions. Instead of Foundation Trusts and Primary Care Trusts (the former pertinent to Tameside General Hospital), control would shift to Care Commissioning Groups. Unlike Foundation Trusts and Primary Care Trusts, CCGs will have no mandate to provide healthcare services to anyone living outside the area of their local Care Commissioning Group.
In the short to medium term, it reintroduces the internal market advocated by Thatcher’s government in the late 1980s. Instead of Regional Health Authorities, Community Health Councils and Primary Care Trusts, CCGs would be held to account by Healthwatch, which would have less control than the CHCs. Healthwatch would be little more than a talking shop for the CCGs and their successors. The bill also paves the way for future privatisation, and a state of chaos none too far removed from bus deregulation and rail privatisation.
All NHS and private provision is regulated by Monitor. Using a transport allegory, Healthwatch would be akin to the Transport Users’ Consultative Committee, with Monitor being the Traffic Commissioners.
Imagine this scenario: Stalybridge Celtic are at home to, for example, Altrincham. Their opponent’s player is stretchered off and replaced by a substitute as would always be the case. Then the ambulance arrives; though his nearest hospital to Bower Fold is Tameside General Hospital, the injured player cannot receive treatment at Darnton Road. Instead, his local CCQ happens to be South Manchester and Trafford, so he receives treatment at Wythenshawe Hospital.
Say we fast-forwarded this scene to 2015, our injured player may be forced to pay for his treatment at a hospital outside his Care Commissioning Group. This would be at great cost physically to Altrincham F.C., who could potentially lose a player (if sufficient funds are unavailable from the patient) and financially to the player. Just to complicate things, he may be forced to pay for his ambulance.
To avoid this, the Robins’ star man would have to purchase private healthcare insurance. Therefore, he could be treated at a hospital free from the fear of CCG policies, so his stay at Tameside General (or any hospital close to where the Robins are playing) would have to be covered by his insurance policy. Potentially, he could ‘buy his way out’ from early retirement, or wait longer to pay less. Ditto this paragraph and the two above for anyone holidaying in the UK.
Over the last year, periodicals, newspapers and television stations have seen a rise in advertisements for private health companies. Most prominently is the First Unum Life Insurance Company. Though you may not realise this, they have been highly influential in the development of the 1996 Social Security Act and subsequent social security and health legislation in the UK since then. Another company, Lifeline Screening, has frequently advertised in national newspapers by means of full page adverts and flyers. Up to now they have been testing the water in readiness for the commercialisation of healthcare in England.
Persons on long term medication could find themselves more sensitive to market rates. Instead of being a patient, they become a long term income stream for medical insurance providers, akin to railway season ticket holders. Potentially, prescription charges could be subject to market forces with a national rate being abolished in favour of the CCG’s.
Some parts of the bill are already being enacted prior to possible Royal Assent! The last year has seen stories of privatised ambulance services, credit ratings for hospitals, the increase in private work to 49% of hospital wards, privatised wheelchairs for children and closures. So far, some ambulance services have outsourced part of their operations to private contractors. Preferred bidders have included Arriva Passenger Services, which could pave the way for further contract gains by the big bus owning groups!
Credit ratings for hospitals would also reduce the national nature of our health service even more. This may have a negative affect on hospitals in less prosperous areas, and inhibit the patient’s ability to afford his or her treatment. More affluent areas may benefit from more affordable treatment than a neighbouring hospital in a deprived area. Future privatisation may see insurance companies cherry pick hospitals in affluent/more profitable areas, again in a move akin to local bus operations. Hospitals in less affluent areas could attract higher insurance premiums, akin to sub-prime lending or bad credit loans and mortgages.
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Closer to Home
Tamesiders will have a lot to lose should the 2011 Health and Social Care Reform Bill gain Royal Assent. Even with the NHS, mortality rates have been above the UK average owing to deprivation in the borough and its surrounding areas. Economically, the borough has historically had the lowest wages in Greater Manchester. Unemployment rates in the area accounts for 10% of economically active citizens. Given these demographics, there is every chance that health insurance providers will discriminate on postcodes, severely restricting their treatment options. Therefore, socialised healthcare free at the point of delivery for Tamesiders is of great importance.
A marketised environment would also see patients and visitors travelling further afield to their hospital or clinic. If Lansley’s bill receives Royal Assent, say farewell to travelling less than an hour to your local hospital, as regional boundaries and psychogeography is ignored in favour of profit. Market forces will govern your choice of hospital, clinic or doctor, which could be bad news for your nearest one.
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The End of National Insurance = RIP Welfare State?
In the last budget, George Osborne proposed a consultation over a possible abolition of National Insurance, possibly merging that with Income Tax. Though not without its faults, our National Insurance system offers the most comprehensive coverage and access to healthcare and benefits nationwide. Introducing a fully fledged marketised system will inhibit this.
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East of the M60 Comment: Bill Should Have Been Strangled At Birth
There are two stories going around about our cherished NHS: one involves higher patient satisfaction, and the other concerns the coalition’s disembowelling. Neither of which have graced the column inches they deserve in the mainstream media.
The former – in spite of Labour’s Foundation Hospitals and some leanings towards a market led system (i.e., You Choose, Patientline and Costa Coffee outlets coexisting with the League of Friends café) – has seen record satisfaction with the National Health Service. Though waiting lists have gone up dramatically since May 2010, they are still a lot lower than they were five years ago.
Lord Lawson of Blaby (Nigel if you prefer) regarded the NHS as the closest thing to a national religion. It is intertwined within our nationhood. It has enabled and fostered great interest in healthy living. We may moan about it like a prying mother-in-law and miss her when she’s gone, but it is part of the furniture.
Lansley has claimed that amid previous reorganisations, there has always been a NHS. It has survived the internal market system, abolished by Frank Dobson MP. This I feel is a reorganisation too far, one which would disembowel, not only the NHS, but also the post-World War II social contract with government and citizen. Doctors – in spite of the coalition’s propaganda – will have less control than under Thatcher’s internal market. The Clinical Commissioning Groups and forerunners will hold the pursestrings.
Lansley’s bill will also have a great negative effect on productivity due to lost days in work. Mortality rates in deprived areas will worsen. People will become more risk averse and less likely to indulge in recreational pursuits – for fear of a massive insurance bill thanks to an ill-judged foul in the 12 yard box from an opposing player. Pollution rates will increase as patients and visitors are compelled to travel greater distances to their nearest doctor, clinic or hospital. The burden of a US style healthcare system would also take a significant hit on footfall in our already bare shopping centres. Families will think twice about having a child or two, owing to the extra financial cost of being treated in maternity wards.
We’ve already heard enough about the tooth pullers in Edwardian times and choice of background music (and we wouldn’t like to see their kind return to Ashton or Hyde open markets). The bill should have been strangled at birth. Its effects will wreak havoc among the living and the unborn. Apart from privatising our NHS, it could pave the way for opportunist cowboy outfits taking over in future years.
Southern Cross’ demise and the chaos of bus deregulation and rail privatisation is nothing on this. Competition and free market economics has no place in care home and transport undertakings. Ditto the above in relation to our health.
- Health and Social Care Bill 2011: a legal basis for charging and providing fewer health services to people in England: Professor Allyson Pollock, David Price, Peter Roderick (British Medical Journal);
- Dr Kailash Chand: a selection of articles by Doctor Kailash Chand OBE, Chairman of the Tameside and Glossop NHS Foundation Trust (The Guardian).
S.V., 09 March 2012