Bad NHS Reforms (in 1993)

Fleecing the NHS

 by Carol Payne

The government appears to be going for the worst possible option as it proposes further changes in the National Health Service. It continues to insist on the principle of the health service being free to all at the point of delivery.

But itis also proposing that the private sector should build and manage hospitals for the NHS. This would mean that funding of treatments would come from taxes via the NHS.

There is a fundamental difference between the NHS and private health care. It is in the interest of the NHS to treat patients only when it is absolutely necessary. This is why the British NHS is the most economical! y efficient in the world. It is also why the British people have not developed the hypochondriac culture that pervades America – or not yet, anyway.

It is in the interest of private health care to encourage its use by as many people-customers – as possible. Whether they need the care or not This creates a huge and unnecessary increase in spending on health. It also creates a society obsessed by health problems – but not at all a healthier society.

Where patients have to pay private companies, there isat least the consolation that at least it is their own money that they are spending, and the market (i.e. the limitations of their wallets) will to an extent limit excesses.

Private medicine in Britain has already reached the limit that the market will bear. It has for some time been in crisis. It has a surplus of beds, buildings, and other fixed assets. Its radio ads for customers more and more take on a note of desperation.

If the government is prepared to pay – via the NHS – for private treatment, the floodgates will open. And we can be sure that a move in this direction will coincide with the cutting off of funding for state hospitals.

America does not have an NHS. But the government funds the treatment of a very large section of the population in private institutions. This is crippling the American economy. Hillary Clinton is attempting to stop this by establishing some kind of NHS. Of necessity she tries to by-pass the vested interests of the bloated private health industry. They, in their tum, are orchestrating an unprecedented, nationwide, campaign of hate against her. I wish her well. But I am not optimistic.

The government’s proposals, there-fore, make no economic sense. Public spending would soar. It is tempting to think that the proposed changes are for ideological reasons. I doubt that ideology plays the major part in government decisions anymore.

People like Virginia Bottomley don’t believe in anything. She is personally ambitious. Formally she is a caring per-son; in the sense that she is a trained social worker. Social workers care about humanity. That is their job. But their training, and probably their personal inclinations, make them care not at all about humans, about actual people.

The current case of a two-year-old child facing death because Mrs. Bottomley insists on closing a specialist bone marrow unit is to the point It is possible that the courts will force the government to back down over this case. But otherwise Mrs. Bottomley seems determined. to “tough it out” and let the child die. It is not about making an NHS decision but about proving her “toughnss” – about putting down her marker should that other caring person, Mr. Major, step down. There is little or no ideology there.

What is there, as already mentioned, is the sorry state of the private health industry in this country. While some residue of ideology may remain in some cabinet members and so make them help facilitate privatisation, the main impetus will come from the greed and corruption wing.

It must be sheer heaven for the private health industry to have unlimited scope for development, and the whole deal paid for by the taxpayer. Friends in government and in Parliament will certainly not be forgotten. And I’m sure a nice little earner will be waiting for Mrs. Bottomley should she not manage to make it to No. 10.


This article appeared in May 1993, in Issue 35 of Labour and Trade Union Review, now Labour Affairs.  You can find more from the era at and