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What is the NHS going to look like post-reform?

One element missing from current discussions of the Health and Social Care Bill is a straightforward account of what will happen if it becomes law. From a detailed study of the Bill and the academic and policy literature about it, plus many discussions with experts, I have distilled this simple scenario of England a few years after the Bill’s enactment.

If the Health and Social Care Bill is passed and fully implemented, the NHS will no longer be a provider of services, as GPs, hospitals and community health services will all be outside the public sector. The NHS will simply be a publicly funded budget and a brand name for a subcontracting operation for competing private organisations, subject to European competition laws which will allow private companies to predominate over other (eg third sector) providers.

Since competition and collaboration are incompatible and in any case, cooperation between providers will be punishable by law as anti-competitive, coordinated services for people with chronic or complex conditions will break down and disappear except within the restricted framework of tied providers under the so-called “integrated care” model developed by the US health insurance industry.

Because the post-credit-crash health service has a more or less fixed budget it will increasingly be the case that services judged to be ‘of lower clinical priority’ will no longer be provided free and will be charged for (or alternatively people will go private). These increasingly common NHS charges will create a demand (i.e. a market) for health insurance, which will mainly be affordable by the most affluent and which will also drive up costs because of administration fees and private profits.

The trigger for the roll-out of top-up insurance will be the impending introduction of personal health budgets, which represent a first step towards user charges.

Clinical commissioning groups will operate on an individual basis so as to be compatible with the insurance companies, unlike the traditional GP service which is population-based and pools risk across the whole country. Illness will begin to cause bankruptcy as is common in the US. Inequalities will increase enormously. Large amounts of public funds raised through taxation will be redirected as profits for the private companies which will provide NHS services and NHS commissioning support, and direct NHS charges (or health insurance payments to cover these) will become a normal item of household expenditure.

This letter first appeared in The Guardian.

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One Response to “What is the NHS going to look like post-reform?”

  1. Malcolm Morrison says:

    So we have finally arrived at Alice’s (sorry Andrew’s) ‘Wonderland’ – at the Mad Hatter’s (or maybe Sarah Palin’s) Tea Party!

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