29 June 2020
By Dr Bob Gill
Working as a General Practitioner in South-East England for over two decades, I have experienced the effects of the stealth ideological assault on the NHS. De-funding, outsourcing and marketisation has squandered billions, made my job harder and for my patients more frustrating with delays, fragmentation and in some cases preventable harm. The local Queen Mary's Hospital in Sidcup, had been downgraded with the closure of its A&E department, maternity unit, acute medical and surgical services. It rapidly became clear to me that bed capacity could not meet necessary demand and many patients were not getting timely and safe care. In 2012, on the back of these cuts, came the announcement of plans to downgrade another hospital just a few miles away in Lewisham, spurring me to join the campaign to defend this new target against a dangerous assault. How on earth did it make any sense to further reduce medical services with the population growing and need increasing?
In the years leading up to making The Great NHS Heist, it became clear that fundamental information was being kept out of the public domain. The parliamentary system was broken. We had endured four decades of neoliberal policies supported, enacted but not explained by all three main political parties. Waiting for politicians to come to the rescue was wishful thinking. Mainstream media simply perpetuated public ignorance about what was really going on.
Successive reforms went ahead without meaningful scrutiny, camouflaged in marketing spin and buzz words with consistent regurgitation and the spectacle parliamentary pantomime on our screens. Observing the narrow and shallow debate around health policy after learning much about the reality soon shattered any illusions of having an open democracy with a functional fourth estate. Having produced Sell Off in 2014 fellow campaigners persuaded me to produce another film to paint an updated picture of the future for the NHS and the trajectory to replicating the American corporate dominated nightmare.
Our goal was to explain how far the NHS had been mutated from its original public service function and reveal the destination to be the US-style for-profit healthcare. A system designed to deliver grotesque profits by avoiding sick patients, denial of care, financial and bureaucratic barriers to access and outright fraud.
With filmmaker Drew McFadyen and support from a core group of health campaigners, we embarked on producing this crowdfunded film. There have been many challenges not least to weave together analysis of the history, legislation, tactics and implications of the privatisation plan but we were determined to make a robust factual and engaging documentary. Experts from the UK and USA combined with NHS staff and patients provided powerful testimony to reveal the crime of the century.
The Thatcher privatisation plan relied on stealth, secrecy and cross-party support. A market bureaucracy facilitated outsourcing and transfer of power away from clinicians to a bloated managerial tier designed to impose change without question or concern for the consequences. The NHS was slowly prepared for asset stripping. To its staff, patients and the public, the NHS represents a respected institution delivering healthcare to the sick irrespective of income, based on medical need. Unknown to most, it had been moulded into a corporate structure with a business ethos under cover of the completely false ‘efficiency’ rubric, patiently over the preceding forty years.
The NHS hospital network was broken up into independent Foundation Trust with separate management boards that control how the hospital is run. The internal market system broke up the collaborative spirit between GPs and hospital consultants. NHS land liberated for property developers using Private Finance Initiative (PFI) debt burden and financially engineering Trusts into the red. Mass patient data sets made available to Big Tech companies through public-private partnerships and outsourced data systems. Tax-funded budgets parcelled up into Clinical Commissioning Groups creating private insurance-style funding pools. The transition of control of these budgets to insurance companies now presided over by Simon Stevens as Chief Executive of NHS England since 2014, formerly president of global expansion for UnitedHealth, America's largest private health insurance conglomerate.
As we approach the end game it remains for Primary Care funding to be directed into new organisational structures called Primary Care Networks replicating the American Health Maintenance Organizations in which insurers and healthcare providers work together to maximise their profits. Clinical staff no longer autonomous healthcare professionals but tightly controlled, guidelines-following corporate employees kept in check using financial incentives, performance management and institutional climate of fear.
Patients will find it harder to access the care they need having to negotiate a minefield of administrative and bureaucratic hurdles. The comprehensive range of NHS services salami sliced down to a remnant of poor standard emergency care in fewer locations. For non-urgent care the choices will be to go without treatment, pay out of pocket or buy top-up insurance. A two-tier system that will be lower quality, more expensive, bureaucratic, with perverse incentives that damage professionalism, patients, tax-payers and the privately insured who risk claims being denied or capped, as we see clearly in America.
People should be in no doubt that a tax-funded, publicly delivered system like the NHS is of fundamental importance to rich and poor alike. The coronavirus pandemic so catastrophically managed by our government that remains ideologically determined to continue its deadly objective of a fully Americanised health system.
The NHS must be re-nationalised and excluded from a US-UK trade deal which would lock-in privatisation. A critical mass of determined and organised people must resist what is being done to our NHS. The Great NHS Heist is a call to action in the fight against the neoliberal assault on our vital public service. Bold and effective tactics have to be deployed to raise awareness and have an impact on high profile companies like Virgin and Boots that are profiteering from the demise of the NHS. Education and support of NHS staff in effective resistance to imposed destructive changes, non-violent direct action, social media campaigning and political pressure all need to be mobilised to pull us back from the brink.
Bob Gill is an NHS doctor and producer of The Great NHS Heist documentary.