Clegg promised no back-door privatisation of NHS. But new white paper opens the front door
One of the most significant features of the NHS is summed up in the very first clause of the National Health Service Act 1948:
"It shall be the duty of the Minister of Health to promote the establishment in England and Wales of a comprehensive health service designed to secure improvement in the physical and mental health of the people of England and Wales and the prevention, diagnosis and treatment of illness, and for that purpose to provide or secure the effective provision of services in accordance with the following provisions of the Act."
An excellent description is given on the Bad Medicine blog, but the key parts are:
- to promote the establishment in England and Wales of a comprehensive health service
- to provide or secure the effective provision of services
These say that the NHS is a comprehensive (ie, not restricted to specified treatments) and universal (ie available to all) service. They say that it is the duty of the Secretary of State for Health (currently Andrew Lansley) to provide these services.
The first draft of the Health and Social Care Bill removed this duty and changed this clause to:
"the Secretary of State ... must act with a view to securing the provision of services"
This is incredibly weak when compared to the original act. This new clause worried many people and the NHS Future Forum, in its final report, says:
"Nationally, the Secretary of State’s responsibility for promoting a comprehensive health service should be made clearer to the public in order to allay any concerns and remove any confusion. As part of this responsibility, he/she should report to the nation annually."
In response to the accusation of privatising the NHS, the Prime Minister was evasive and deflected the question:
"So let me be clear: as long as I’m Prime Minister there will be, as there are now, private providers and voluntary providers. But let me also be clear, no: we will not be selling off the NHS, we will not be moving towards an insurance scheme, we will not introduce an American-style private system."
This is not the same as saying "no privatisation". The Deputy Prime Minister, however, is more forthcoming:
"That’s why I have been absolutely clear: there will be no privatisation of the NHS."
And in a later speech he says:
"You told us you were worried about privatisation through the back door. So we have made that impossible."
Has the government listened? No, the Bill has now completed the second Committee stage after the Future Forum pause, and now the clause says:
"the Secretary of State must exercise the functions conferred by this Act so as to secure that services are provided in accordance with this Act"
Again, no duty to provide, merely to "secure that services are provided". If the Secretary of State accepts a duty for provision then why change the wording of the first clause of the NHS Act 1948? The reason is that the government does not want the responsibility of providing the NHS. Last week the government published the Open Public Services white paper which says the following (section 5.2):
"In the services amenable to commissioning, the principles of open public services will switch the default from one where the state provides the service itself to one where the state commissions the service from a range of diverse providers."
This specifically says that the government does not want the state to provide the NHS (or any services), and instead, it wants the state to buy services from "a range of diverse providers" (ie private companies). If a service that was provided by a public provider is then provided by a private company then that is privatisation. The OPS is simply announcing the privatisation of the NHS.
Richard Blogger writes about the NHS and social policy at NHS Vault.
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