The End of the National Health Service
The End of the National Health Service
Along with many if not most of my generation, I feel as if the NHS has been in my bones and my bloodstream. Like others, I have been alarmed by how little attention the reforms have paid to social inequalities and their effects on health, and also by the emphasis that private providers are placing on profit at the expense of jobs—not to mention the risks of the same inefficiencies and injustices that characterise the money-driven health system in the US. At the same time, I do not believe the reforms have been driven entirely by venality or self-interest. Although these factors have played their part, the changes have mainly been driven by a set of beliefs I do not happen to share, but which I recognise has its own compelling logic: that large scale private enterprise creates wealth and a better quality of life for a great many people, and it is worth tolerating the tremendous disparity in incomes and health between the powerful and super-rich on the one hand and the severely deprived on the other because of this.
Like most commentators, I do not think the trajectory towards privatisation of the English health service has reached its conclusion, or anything like it. I am fairly sure we will see payments introduced for some consultations and services, while a variety of other services will no longer be commissioned at all. In addition, I expect to hear about hybrid models of payment including the possibility of upgrading from free provision to better clinical services funded through additional fees or insurance.
However I am equally sure this will not be the end of the story. Every political and economic system contains the weaknesses that eventually lead to its own destruction. Those of us who lived through much of our careers expecting the NHS and its values to be unassailable have learned this principle to our cost. Those who proclaim the irreversible triumph of the market will sooner or later be in for an equally unpleasant surprise. The consequences of trying to replace the NHS with a fragmented, profit-based system are already beginning to hit the headlines. In the end, the National Health Commissioning System may turn out to be rather more transitory than the service it has just replaced.
Social Inequalities
Along with many if not most of my generation, I feel as if the NHS has been in my bones and my bloodstream. Like others, I have been alarmed by how little attention the reforms have paid to social inequalities and their effects on health, and also by the emphasis that private providers are placing on profit at the expense of jobs—not to mention the risks of the same inefficiencies and injustices that characterise the money-driven health system in the US. At the same time, I do not believe the reforms have been driven entirely by venality or self-interest. Although these factors have played their part, the changes have mainly been driven by a set of beliefs I do not happen to share, but which I recognise has its own compelling logic: that large scale private enterprise creates wealth and a better quality of life for a great many people, and it is worth tolerating the tremendous disparity in incomes and health between the powerful and super-rich on the one hand and the severely deprived on the other because of this.
Like most commentators, I do not think the trajectory towards privatisation of the English health service has reached its conclusion, or anything like it. I am fairly sure we will see payments introduced for some consultations and services, while a variety of other services will no longer be commissioned at all. In addition, I expect to hear about hybrid models of payment including the possibility of upgrading from free provision to better clinical services funded through additional fees or insurance.
However I am equally sure this will not be the end of the story. Every political and economic system contains the weaknesses that eventually lead to its own destruction. Those of us who lived through much of our careers expecting the NHS and its values to be unassailable have learned this principle to our cost. Those who proclaim the irreversible triumph of the market will sooner or later be in for an equally unpleasant surprise. The consequences of trying to replace the NHS with a fragmented, profit-based system are already beginning to hit the headlines. In the end, the National Health Commissioning System may turn out to be rather more transitory than the service it has just replaced.
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