But so subtly that even ministers don’t seem to know what’s going on
By George Monbiot. Published in the Guardian 21st December 2000
There’s not much to be said for the privatisation of the railways, but at least it was honest. The Conservatives told us what they were doing, so we fought them, and when we lost, we kicked them out of office. Governments and their lobbyists will never make that mistake again. Privatisations, from now on, will be so subtle, so complex, that even the ministers implementing them may not be fully aware of what they’re doing. This is the means by which the greatest prize of all is now being delivered to the private sector.
This Christmas, like every Christmas, will be marked by a massive rise in hospital admissions. And, in accordance with venerable tradition, the NHS won’t be able to cope. But the “concordat” published by the government six weeks ago will ensure that patients will now have somewhere to go: they will be settled in private beds, for which the NHS will pay the full commercial rate.
Viewed in isolation, this is a sensible decision: it will be costly, but will mean that fewer patients will be left to die in hospital corridors. Viewed in conjunction with the developments of the past three years, this signals the beginning of the end of public health provision in the United Kingdom. The NHS is being privatised.
The first step towards privatisation was a change in the way the budgets were allocated. Health services used to receive a single payment to cover all their needs. Now every patient commands a separate account. The NHS is drowning in paperwork, but the new system means that its services are now interchangeable with those of the private sector.
This arrangement, as the professor of health policy Allyson Pollock has pointed out, also enables health trusts to start charging patients for certain services. This is precisely what the government proposed in the NHS Plan it published in July. From October next year, patients in “intermediate care” will be charged for services other than nursing. The fees will encourage trusts to subcontract their services to the private sector, and pocket the difference. By such gentle means, the last government brought the public provision of most long term care to an end. Public services can be closed down one by one, until the NHS is dismantled before voters even become aware that it is threatened.
Still greater dangers are presented by the private finance initiative. This, the government insists, is a means of bringing private money into the public sector. In truth it is draining public money into the private sector. Across Britain, hospital improvement schemes are being rejected not because they are too expensive, but because they are too cheap.
Private companies don’t want to renovate existing buildings, as the potential profits are too small. But the government has made it clear to the health authorities that if the improvements they seek are not privately funded, they won’t be funded at all. So, instead of being renovated, perfectly sound hospitals in city centres are being torn down, and new ones built at great expense on inaccessible greenfield sites. The companies boost their profits still further by selling the city centre land.
To pay for these white elephants, the NHS must butcher its services. Government consultants have calculated that every £200 million spent on the private finance initiative leads to the loss of 1000 doctors and nurses. The government has promised an extra 7000 beds, but the NHS will have to lose far more than this to pay the contractors’ extortionate fees, which it is are legally obliged to prioritise. The initiative, according to a member of the government’s Private Finance Panel, is “the Heineken of privatisation – taking the private sector to the parts of the government machine not reached by previous privatisations”.
All this is documented in my book Captive State, which was published ten weeks ago. No minister has yet sought to contradict my findings. But while the government has consistently failed to engage with opponents of privatisation, all over the country workers and local people are beginning to form alliances of the kind which characterise Britain’s new opposition politics. In Dudley in the West Midlands, for example, hospital workers, with massive public backing, have sustained one of the longest strikes in the history of the NHS.
People are slowly coming to see that this government is implementing plans the Conservatives would scarcely have dared to suggest. We will defend the NHS only by fighting the party which built it.