Today, NHS Direct announced that it is to withdraw from the nine remaining contracts (out of the eleven it had originally tendered for) relating to the provision of the NHS 111 service. It withdrew from the other two earlier in the year. NHS Direct says that it cannot make money from the 111 contracts, that they are not ‘financially viable’. The government’s apparent response to that is that 111 is working very well but that, sadly, NHS Direct just ‘got its sums wrong’.
There are a number of words and concepts in the above paragraph that the majority of readers should find alarming in the context of patient-accessed emergency health care. ‘Tendering’ and ‘financial viability’, to name but two, should have you up in arms. They relate to the fact that this service, part of the NHS, has been privatised, sold off to the lowest bidder, many of whom are there to make a profit.
If ‘NHS Direct’ sounds familiar, you’d be correct. It was the name for the national service of out of hours telephone advice that the 111 service is designed to replace. I use the term ‘designed’ in the loosest possible sense, of course, as it would appear that ‘design’ wasn’t a concept fully envisioned by those who ‘masterminded’ the change. I use the term ‘masterminded’ ironically, of course, because … well, you see where I’m going with this I’m sure.
Previously, if you wanted health advice over the ‘phone for something that did not require the use of 999 then NHS Direct was the place to go. It was a national service i.e. one country, one NHS, one NHS Direct. However, this government decided it needed changing because it wasn’t working well enough. It may well, indeed, have needed some changes, but the Tories applied the only principles they really know to the problem – if something needs to work better, try to make it smaller (it it’s a public service), open it to competitive tendering, drive down costs, aim for minimum satisfactory quality and maximum profit, because, as we all know, profitability means efficiency! Superior quality usually means greater cost and, hence, less profit.
So, one organisation operating one contract with the aim of providing a patient-led service becomes 46 contracts, to be competed for by tendering, where the lowest price offered has an advantage and where, if you want to make a quick buck at taxpayers’ expense, go right ahead!
The telephone lines are not, generally, staffed by qualified medical practitioners. If you think you are ringing a specialist medic of some sort when contacting 111 you are sadly mistaken. There is no guarantee, even, that there will be medically trained personnel available or even on the payroll of the organisation responsible for the particular service you are contacting. In order to be able to tender for contracts and offer a price that might enable them to be successful, NHS Direct made thousands of nurses and qualified staff redundant. When you call, you get someone who is in front of a computer screen. The 111 website says the staff members are ‘fully trained’; what it doesn’t say is what, exactly, they are fully trained in! You can be sure it isn’t any form of health care profession, mostly.
The National Health Service; the clue is in the name. It should be national, it should be a service not a profit-driven enterprise and it should promote health, not line the pockets of the already rich making more money on the back of misery, pain and desperation.
The problem, however, is not with the idea of a 111 type service. After all, that’s what NHS Direct was, albeit with a less useful telephone number. The problem is one of ideology.
The Tories believe that private companies, driven by profit, are more efficient. Indeed, in an unfettered business world where there are no safeguards for health, no protections for employees and unions are weakened to the point of impotence, they are right. In such circumstances the profit motive drives down wages, drives down material costs and drives up selling prices, all for the purpose of maximising entrepreneurial profit at the expense of others. This is a vision likely to prove too orgasmic a fantasy for your average Tory, but make no mistake, this is the ultimate objective. This is why, over the years, unions arose to defend the rights of workers, to prevent exploitation in the name of profit. It is also why this government is waging a war on employment rights, making it easier to sack people, and, in its latest attack on the average worker, making it costly to seek redress for unfair dismissal through the Employment Tribunal.
Our NHS is not about profit and privatisation but health and well-being, putting patients’ interests at the forefront. In the current climate the emphasis is on cutting – cutting the deficit, cutting the need for the government to borrow. To achieve this, the government is intent on cutting public spending, cutting down ‘big government’, cutting out ‘waste’ etc. As a consequence, it is cutting down employment rights, cutting benefits for the poorest in the community, cutting down access to justice. However, it is not cutting one thing – profiteering at the expense of the ordinary person, the taxpayer, by the rich and already wealthy, the bankers bonuses.
The Tory Party agenda is to privatise as much of the Health Service as possible. It has begun it already and will continue to do it for as long as it can get away with it; for as long as the British population lets it do so. What will you do?