Boris Johnson kicked off the Tories’ general election campaign this week with the bold claim that they were “the party of the NHS.” This follows many months of messaging aimed at wrapping the Conservative Party in the flag of public healthcare. But what is their real record as custodians of the National Health Service?
At Conservative Party conference this year, party chair James Cleverly claimed that the Tories had founded the NHS. This was met with widespread derision — the Tories had, in fact, voted against the creation of the NHS 22 times. And throughout their term in office, since the NHS was established in 1948, the Tories have sought to undermine the social vision which brought it into being.
At the inception of the NHS, its creator Aneurin Bevan said, “we will never have all we need. Expectation will always exceed capacity. This service must always be changing, growing and improving, it must always appear inadequate.” Bevan knew that change had to be part of the fabric of the NHS. However, successive changes by Tory governments have undermined the core values of the NHS as a universal, publicly owned health service, which is free at the point of use.
The Privatisation Agenda
The most prominent of these changes was the Health Service Act 1980, when the Thatcher government tried to incentivise the use of private healthcare services. Such was the NHS’s popularity, that the effort largely failed — and demand for public healthcare continued to rise. But the Conservatives weren’t finished. Their answer to the rise in demand for NHS services was to starve public healthcare of funding, and instead turn to the market to fill in the gaps left behind by government cutbacks.
Consequently, they introduced the National Health Service and Community Act of 1990, creating the first split between commissioners and providers of healthcare services within the NHS. This commissioner-provider split was devised to create an ‘internal market’ within the NHS, with the argument being that this competition would drive up quality and reduce costs. Instead, the internal market became a milestone of NHS privatisation and fragmentation.
Instead of focusing on care, hospitals were forced to direct their attention to competing with one another to provide healthcare services and, as a result, NHS administration costs doubled. The NHS remained the preferred provider for healthcare services but support services like cleaning, catering, and security were increasingly privatised.
When the Tories returned to government with the Liberal Democrats in 2010, they continued this drive to ‘modernise’ the NHS with market reforms. That government’s Health and Social Care Act 2012 was arguably the greatest reorganisation of the NHS in history. Under this new legislative framework, the Secretary of State for Health’s overall responsibility for the NHS was abolished. Clinical commissioning groups and NHS England became responsible for commissioning healthcare services not from the NHS but from ‘any qualified provider’ with a compulsory tendering and procurement process, and local authorities became responsible for public health and prevention services.
The need for the NHS to be reformed and improved over the years can’t be denied. Undoubtedly, public healthcare faces huge pressures due both to an ageing population and greater technological capacities, which allow more conditions to be prevented, palliated and treated. These, however, are both signs of the success of the NHS. Instead, successive Tory governments have framed them as its failures — and used that to justify undermining its public service ethos with drives towards privatisation.
A Weaker NHS
A large part of the NHS budget today is used to administer the compulsory tendering process and stave off legal challenges from profit-seeking companies. This is money that once went to patient care. The Conservatives claimed that the removal of ‘preferred provider’ status from the NHS should mean the company providing the best quality, most cost-effective service would win the contract, creating greater efficiency and driving up standards. In reality, corporations like Serco and VirginCare hire professional teams to write legally robust bids. Therefore, lucrative profit-making contracts are invariably awarded to private companies.
Privatisation has thus more than doubled since 2010. Virgin alone has been awarded almost £2 billion worth of NHS contracts in the past five years. Private provision is widespread, ranging from 33 to 97 percent in services areas such as mental health, psychiatric care, and healthcare services for people living in secure settings. Commercial sensitivity protections afforded to private corporations as well as cuts to NHS England’s budget have resulted in little oversight to the quality of care delivered to the most vulnerable people in our communities.
Driven by the profit motive, corporate interests consistently cherry-pick services, transferring profitable services out of public hands into the private sector, leaving the NHS with the unprofitable services without the buffer of the lucrative parts of the system.
Companies also tend to over-promise then under-deliver. Earlier this year Colosseum Dental handed back a suite of its NHS dentistry contracts leaving the city of Portsmouth without a single NHS dentist — this would have been impossible under the public service ethos that once guided our health service. Private companies also only fulfil the specific terms of their contract, which can lead to people falling through the cracks. In a recent example, NHS staff in HMP New Hall are unable to deliver care to babies living with their mothers because Care UK’s contract has only been awarded for adults.
Moving public health to local government, concurrent with slashed council budgets, has also had a disastrous impact on public health services. Dwindling prevention is putting pressure on the NHS and making us all more vulnerable to public health crises.
Reduced council resources mean less funding available to assist people in crucial public health causes such as the taking up of vaccinations. A recent National Audit Office (NAO) report concluded that the coalition’s reorganisation of the health system, as well as austerity-related factors including lack of availability of GP appointments and nurse shortages, are significant elements in the fall in child vaccination rates in England. As a result, measles outbreaks are rising and the World Health Organisation has revoked the UK’s measles-free status.
Labour’s healthcare policies would go some way to remedy the repercussions of the Health and Social Care Act 2012. As well as announcing that the Act would be repealed, Labour recently committed to increased council spending, abolition of prescription charges, and a state-owned pharmaceutical company.
Repealing the Health and Social Care Act 2012 would allow the NHS to eradicate costly and inefficient compulsory tendering, streamline its contract management structures, and restrain legal processes—all of which will contribute to Labour’s pledge to cut management costs by 50%. Services can once again be owned and run by the NHS, giving hospitals and community organisations the stable resources needed to invest and plan for long-term care. Providers would no longer be able to hide under the guise of commercial sensitivity, giving patients and citizens greater transparency into how care is delivered, and making the Secretary of State more accountable to the electorate.
The introduction of free prescriptions would also be a hugely positive change that would transform many people’s lives. To give a sense of the context: over 57 percent of people living with asthma have had an asthma attack or needed emergency care because they skipped their medication due to prescription affordability. The death of Holly Worboys was not a story about a teenager who skipped her inhaler – it was the heartbreaking tale of someone who couldn’t afford one.
Meanwhile, prescription charge fines continue to blight many people’s lives. Vulnerable people are often wrongly fined for committing NHS fraud when claiming free prescriptions they are entitled to. The NAO report in 2019 showed that 1.7 million erroneous fines were issued to people rightfully claiming free dental treatments and free prescriptions. Not only this, the administration of the fines was outsourced to Capita, a private company which keeps the monies recovered from fines. This creates a dystopian incentive for our health system to hound vulnerable people, often with dementia, learning difficulties, and disabilities. It’s not difficult to see why Aneurin Bevan was so opposed to prescription charges.
But pharmaceutical advancements and an ageing population with complex needs brings with it a steadily rising drugs bill, which buckled even the Attlee government. This is why compulsory licensing and the introduction of a public pharmaceutical company is so important. Under the Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement, governments issue patents to reward innovators, giving them exclusive rights to manufacture and sell drugs for many years. However, pharmaceutical companies abuse this agreement, often applying for patents on medicines that are not new or inventive, applying for several patents on the same drug, and using overly general language regarding the scope of interventions.
These tactics by Big Pharma stave off competition from generic drug manufactures, stifle innovation, keep medicines including vaccines expensive, and reduce access to treatments, causing unnecessary suffering and deaths. Compulsory licensing is a procedure outlined in the TRIPS agreement where the government suspends patents and manufactures generic medicines itself to protect the health of its citizens. Multiple international examples in Germany, Ecuador, Thailand and Malaysia have shown compulsory licensing is one of the most effective ways to reduce the medicines bill. A public pharmaceutical company will generate jobs, incentivise innovation, reduce instances of drug shortages, and create transparency regarding drug production costs, giving public insight into fair drug pricing.
The choice in this election could hardly be more stark. We can continue down the road of privatisation with the Tories — who will, soon enough, bring to an end the public service ethos of the NHS altogether amid market competition, corporate profiteering, increasing costs for patients and declining services. Or we can fight to renew the vision of the NHS as it was created under a Labour government: a free, public and universal system bringing the best healthcare to the greatest number of people, regardless of how much they earn. The fight for the future of the NHS starts now.