This article originally appeared on VICE UK
I am a junior doctor in the north of England and the way the National Health Service (NHS) is changing around me is pretty terrifying.
The driving force for all the recent NHS reforms is a $157 billion health economy that private companies have coveted for many years. The government is cutting state-controlled healthcare and filling the deficit by allowing of tax money to pay for outsourced, privately controlled health care, operating under market forces.
George Osborne might have promised billions of extra funding for the NHS last week—$3.14 billion, to be exact—but, less than 48 hours after the pledge, it emerged that $1.2 billion of that would be from recycled health department cash. Our glorious, socialist ship is sailing stormy waters.
But instead of giving a blow-by-blow, first-person account of what I imagine might happen in the near future, I thought it would be more interesting to look at a hypothetical family and predict what their journey through the NHS might be like in the coming years. Because numbers and sweeping statements in the media are one thing, but the ramifications are going to be felt by the individual. By people like you and your family.
Meet the Aberswyth family.
Mrs. Aberswyth is a 67-year-old, soon to be retired, lifelong tax-paying teacher and she's going deaf. She needs various investigations and referral to a specialist . "From now to diagnosis, it could be another six months," her doctor informs her. Instead, she draws a chunk of money from her savings, and, one month later, with her paid-for diagnosis, she re-enters the state-funded NHS for the more expensive matter of treatment.
This "opt-in, opt-out" system is nothing new. However, the prevalence of privately-owned of health care services will increase, and, with it, the numbers of people choosing to pay for a quicker diagnosis.
Unfortunately, Mrs. Aberswyth has a rare condition. The internet has led her to knowledge of a novel, expensive nerve-stimulation operation some 300 miles from her home. Although rare conditions often only have one or two specialist centers throughout the country, doctors could refer their patients irrespective of cost.
However, in our dystopian, future NHS, all GP surgeries have now come under directorship of new Clinical Commissioning Groups. CCGs can be formed by anyone—from a group of GP surgeries to large private health firms. The new NHS constitution absolves CCGs of providing a comprehensive, reasonable health service. As such, CCGs can choose the healthcare they provide and, as they have to be financially viable (due to market forces) this choice will be increasingly profit— not patient—centered.
The result? Mrs. Aberswyth faces a powerless and apologetic GP. "I'm sorry, Mrs. Aberswyth, but this treatment is not covered by us. There is, however, a private-funded specialist audiology center hundreds of miles away in London that another CCG may be willing to refer you to, free of charge," he might say. This is not the oft-bleated mantra of "patient choice" that the media used to sell us these reforms. This is GPs being controlled by privately-owned CCGs, choosing patients.
It gets worse, too. Not only are CCGs allowed to chose the health service they are willing to pay for, they can go one step further, too. Her local CCG will kindly offer Mrs. Aberswyth her treatment, but for a fee. They are allowed to charge patients for any health service at all. Luckily, Mrs. Aberswyth has private health insurance. Coincidentally, the same health firm that owns her insurance also owns her local CCG, as well the specialist audiology center. This firm has managed to take her tax money as well as her own money paying for health insurance.
Alarming conflict of interests ensue: A privately-run CCG may decide, for example, that its patients need a new cardiac center. Unsurprisingly, the best company to provide this service is the same private company. Again, this isn't a wild, unrealistic prediction. These large, all-encompassing health firms already exist in the USA, and they'll be coming to a GP near you soon.
After an uneventful operation, sipping her Earl Grey tea, Mrs. Abersmwyth enjoys the chaotic, toy-like landscape of the Thames river front through the window of her 15th-story private ward. It used to be that Foundation hospitals could only generate 15 percent of their income from private "ventures"—this has now been raised to 50 percent. Instead of just the top floor housing private patients, this hospital has turned eight of its 16 floors over to a private company.
This isn't just bed space turn-coating private, either—the previously state-employed surgeons performing the operations will also spend a greater proportion of their working hours for private companies. This will result in Mrs. Aberswyth's neighbor (Mrs. Bernard, shall we say), who has the same rare condition, having to wait even longer for the same operation. She doesn't have health insurance and needed to scour the country for a CCG that was willing to pay for her treatment.
Mrs. Aberswyth was also secretly glad that a proper consultant was performing her operation, and not a trainee surgeon, as may have been the case had she gone through the a state-run hospital.
Soon, all trainee doctors and medical students will find it increasingly difficult to hone their skills under the guise of experienced consultants, because financially viable organizations need worker bees, not teachers. Unless, of course, the private companies employ consultants in a teaching—as well as a productive—capacity, which they will, because the demand will exist, as well as the opportunity to charge universities for access to their hospitals and consultants.
NHS workers striking last week
This extra cost on the universities will filter down to increased tuition fees. But it's OK, because there will be a friendly, all-encompassing health firm that will provide medical students with a "doctor-centered" professional loan, with less interest to pay back if you agree to work within their company once you're qualified. Again, this isn't stuff of some fictitious, dystopian nightmare. It already exists in the US.
David Aberswyth, Mrs. Aberswyth's son, is down and out in London. Despite her best efforts, she has lost her son to the all-consuming cycle of drugs, depression, and ill health. Compared to an elective cataract operation, though, for example, any measurable, positive outcome for people with problems like David's requires a huge amount of coordinated man hours across a variety of services. Here, the private ethos has excelled, and David happens to have a GP under the directorship of a CCG that has devoted smart business planning to provide excellent mental health services. They've invested in making people happy, as it reduces their attendance—and therefore cost—on GPs. The end justifies the means.
Unfortunately, David's CCG has neglected drug addiction, and the government has no remit to enforce provision of this service—as they could have done with PCTs.
But what if David is not registered with any GP surgery? The landmass of the UK was previously divvied up into geographical areas, and PCTs were responsible for everyone within each area. PCTs no longer exist, though, and CCGs are not defined by geographical areas. No. They are fluid organizations responsible only to the patients on their books.
So who looks after David?
The "safety net" for those without a GP is now the local council. Already stretched by recent cuts, they will be asked to provide all health services not deemed necessary (read: financially viable) by CCGs. CCGs will jettison expensive, inefficient services for mental health, drug addiction and long-term health conditions. David will join a long queue, waiting interminably for a beleaguered local council to provide a slither of a service.
Judith, Mrs. Aberswyths elderly mother, died recently after a recent hip operation. Privately-owned centers will perform hundreds of these operations a year, as well as direct many geriatric care homes. Unfortunately, though, the future trouble is likely to be worse on two counts. Firstly, government regulatory bodies will inundated with hundreds of private companies rushing to apply for recognized "Health Provider" status (a new government expenditure). Secondly, compared to the much smaller number of "in-house" government-run PCTs that once existed, it will be increasingly difficult to oversee and regulate all these out-sourced companies.
Disasters like we saw in Staffordshire will become a thing of normality. The next generation will not see it as an anomalous disaster. In the same way that cars of different qualities are built by different companies, health care companies competing in a market place will also provide different levels of quality. Inequality will become the norm—the difference, of course, is that cars are a personally-paid luxury. Health care is a tax-paid necessity.
Since World War II, many public infrastructures have been sold off to private companies. The NHS was the brightest jewel in our socialist crown, but the capitalist magpies have, it seems, finally got it.