Since the Thatcher reforms of the late eighties, the NHS in the UK has been following policies of competition and commercialisation in the belief that they will drive quality up and costs down.
While the three Celtic nations have now turned their backs on the market, not just for ideological reasons but because there is little evidence that it was bringing benefits, England has pressed on with a succession of market-based developments - including the private finance initiative, independent sector treatment centres, payment by results, polyclinics and GP-led health centres.
There is little evidence that these policies have been beneficial and much that indicates their detrimental effects. Proponents of the commercialisation agenda argue that the present financial crisis is a reason for pressing on even further with these policies, claiming that we need new incentives to drive quality and efficiency in these difficult times. They fail to realise that what really drives doctors is the knowledge that they are doing the best for their patients and working co-operatively with their colleagues to design and deliver the most beneficial healthcare services.
One hopes that Mid Staffordshire NHS Foundation Trust and Maidstone and Tunbridge Wells NHS Trust - both of which failed patients and were criticised by NHS watchdog the Healthcare Commission - are isolated cases. But there is a danger that, if we continue to put the achievement of financial targets before the delivery of high-quality clinical care, such tragedies will continue to occur.
The BMA’s stance is not some sort of old-fashioned, 70s-style, ideological trade-union battle, raging against the forces of capitalism. It is an evidence-based analysis that argues that the present policies in England are moving the NHS away from its founding principles and, more importantly, not encouraging the collaborative approach we are going to need if we are to preserve and build on these principles through the difficult years ahead.
The NHS belongs to all of us, but we mustn’t just take it for granted; we need to look after it. By working together, we can do more than just preserve it, we can make it better.
A longer version of this article appeared in BMA News on 23 May
Tags: Privatisation
