Much of what is happening to the NHS is because the current government wants to massively reduce the size of the public sector (see http://www.guardian.co.uk/news/datablog/2012/oct/16/government-spending-countries-gdp#data) and open up public services to private companies.
Despite denials, it is increasingly clear that the government ‘reforms’ are leading to the privatisation of the NHS (see http://nhsforsale.info/). NHS services are already increasingly run by multinational companies and investment firms (see http://www.express.co.uk/posts/view/355999/Who-now-owns-the-NHS-and-can-they-cure-it-), with the NHS becoming a kind of collective ‘brand name’ for a host of NHS and private health care providers.
For example, contracts monitored by the NHS Support Federation show that private firms won £3.54bn of £9.628bn worth of NHS work in England during 2014. And a freedom of information request by Labour revealed that private firms won 40% of the contracts that CCGs put out to tender, worth a total of £2.3bn – only slightly fewer than the 41% awarded to NHS bodies (http://www.theguardian.com/society/2015/apr/25/far-more-nhs-contracts-going-to-private-firms-than-ministers-admit-privatisation).
Private companies are free to decide which NHS services they compete for, so they inevitably chose to work in areas where they can make the most profit – for example where there is high turnover. This leaves the NHS to cope with the most complicated, costly and unprofitable services such as A&E, care of the elderly and the chronically ill.
Until the HSC Act, there has been no profit motive driving the NHS. However, the first duty of a private healthcare business is to make profits for its shareholders – and this profit has to come out of the NHS money allocated for patient care.
In some cases, the creeping privatisation of services is leading to clinical problems. For example, researchers at Imperial College, London found that private sector and other non-NHS providers of GP services performed worse than traditional GP practices on 15 out of 17 indicators, such as patient satisfaction, control of diabetes or high blood pressure, and keeping patients out of hospital. (http://www.independent.co.uk/life-style/health-and-families/health-news/private-sector-providers-of-gp-services-being-outperformed-by-traditional-practices-10199610.html).
Private health care companies are protected by rules on ‘commercial confidentiality’. This lack of transparency makes it difficult for those who are monitoring services to find out if the public is getting the best deal when private companies are involved, or to check safety records.
As a result of the HSC Act, the NHS budget is managed by a whole range of new organisations that have to give private companies the opportunity to compete for contracts. Making organisations and services compete against each other is fragmenting the NHS instead of building collaboration and good communication across services. It is also thought to lead to a “race to the bottom” in service quality.
Finally, the added costs of running the NHS as a market (arising, for example, from contracting, billing and legal costs) are contributing to the financial problems of the NHS. (see also our page on marketisation.
An informative video, made in 2011, on the anticipated effects of the HSC Act: https://www.youtube.com/watch?v=YiLhJrZOkAU