THE UNITED SOCIALIST PARTY
A Party that always campaigns for a fair and just society for all in Britain
1948
A MESSAGE to THE MEDICAL PROFESSION from
ANEURIN BEVAN.
FROM THE MINISTER OF HEALTH
On July 5 we start, together, the new National Health Service. It has not had an altogether trouble-free gestation!
There have been understandable anxieties, inevitable in so great and novel an undertaking. Nor will there be
overnight any miraculous removal of our more serious shortages of nurses and others and of modern re-planned
buildings and equipment. But the sooner we start, the sooner we can try together to see to these things and to secure
the improvements we all want.
On July 5 there is no reason why the whole of the doctor-patient relationship should not be freed from what most of us
feel should be irrelevant to it, the money factor, the collection of fees or thinking how to pay fees -an aspect of practice
already distasteful to many practitioners. Yet it has been vital, if this is to be the new situation, to see that it did not
carry with it either any discouragement of professional and scientific freedom or any unfair worsening of a doctor's
material livelihood. I sincerely hope and believe we have secured these things. If we have not we can easily put that
right.
The picture I have always visualized is one, not of " panel doctoring " for the less well-off, not of anything charitable or
demeaning, but rather of a nation deciding to make health-care easier and more effective by pooling its resources-
each sharing the cost as he can through regular taxation and otherwise while he is well, and each able to use the
resulting resources if and when he is ill. There is nothing of the social group or class in this; and I know you will be
with me in seeing that there does not unintentionally grow up any kind of differentiation between those who use the
new arrangements and those who, for any reason of their own, do not. Let this be a truly national effort. And I, for my
part, can assure you that I shall want vigilantly to watch that your own intellectual and scientific freedom is never at
risk of impairment by the background administrative framework, which has to be there for organizing purposes, but in
which your own active participation is already secure.
In this comprehensive scheme-quite the most ambitious adventure in the care of national health that any country has
seen-it will inevitably be you, and the other professions with you, on whom everything depends. My job is to give you
all the facilities, resources, apparatus, and help I can, and then to leave you alone as professional men and women to
use your skill and judgment without hindrance. Let us try to develop that partnership from now on.
It remains only to wish you all good luck, relief-as experience of the scheme grows-from your lingering anxieties, and
a sense of real professional opportunity. I wish you them all, most cordially.
ANEURIN BEVAN.
Privatisation will be the ruin of the NHS - how long will it
survive with the slogan “Free at the point of use”.
Contract Tendering across the whole sphere of the NHS will
lead to the profitable parts being outsourced to the private
sectors. This is already happening in the Cardiovascular
Disease Services - Hospital Trusts and will lead to less patient
care of the sick and vunerable within their communities.
By Mark Easton
Home editor, BBC News
Continued universal free access to care is in doubt
The simplicity of the National Health Service idea has survived the complexity of extraordinary
medical progress.
Universal, funded from taxation and free at the point of need - these are phrases which Health
Secretaries have reiterated for six decades, the principles which underpin the NHS.
The British public loves its health service, but can it survive another 60 years?
Can a system of free medical care for all be maintained in the face of new and expensive
treatments, and with a population becoming ever more knowledgeable and more demanding?
Some doctors argue that the traditional NHS is doomed because the state cannot afford to fund
an ever increasing array of drugs and procedures.
The future has to be about a tax-based system that is a core package that is reasonable
and everybody accesses it - but if you want to have some luxury items, you top-up
Professor Karol Sikora
Cancer Partners UK
Physicians like cancer specialist Dr Karol Sikora argue that the result will be a two tier service.
He said: "The future has to be about a tax-based system that is a core package that is
reasonable and everybody accesses it - but if you want to have some luxury items, you top-up."
It is a vision that has sent shudders through government.
Alan Johnson, the Health Secretary for England, attempted to outlaw such top-ups by ruling that
any patient who bought additional care or drugs privately would be denied NHS treatment for
their condition.
The papers were filled with stories of patients who had spent their life-savings on drugs the
health service refused to provide and who were then advised that their NHS treatment was being
withdrawn.
In a statement to Parliament, Mr Johnson said: "A founding principle of the NHS . . . is that
someone is either a private patient or an NHS patient."
It proved a desperate attempt to hold back the tide and last week he dropped the policy in favour
of a formal consultation on the matter.
However, it is an issue that will have to be faced.
Drug company pressure
Drugs companies like Roche UK are knocking on the doors of the advisory bodies which regulate
the availability of drugs on the NHS, calling on them to give their products the green light.
It's really a moral decision, whether as a society we decide we want to stay in all this together
or we want start going our own ways
Niall Dickson
King's Fund
"There will be changes in the overall drugs budget within the NHS," said Julian Cole from Roche.
"Money can be released from elsewhere within the health service to actually fund many of these
drugs.
"They are cost-effective, providing good value for money and so if there is a will to provide that
funding then it will follow."
But if the NHS did agree to fund any drug for which there was demand, how much more would it
cost?
As Medical Director of the private healthcare company Cancer Partners UK, Dr Sikora has
calculated that if the NHS agreed to fund ten cancer drugs currently unavailable it would push
the bill up by almost £0.9 billion.
The government believes it is a lot less, but no-one denies that protecting the principles of the
NHS will mean spending significantly more.
Public will
The independent health think tank The King's Fund, though, argues that recent history
demonstrates that voters will pay more to protect the health service.
Niall Dickson, the chief executive, is confident that a tax funded universal system can be
afforded.
FIND OUT MORE
As the NHS turns 60, BBC News is giving it a health check. Watch out for reports, features and
analysis on TV, radio and the web.
"It's really a moral decision, whether as a society we decide we want to stay in all this together
or we want start going our own ways," Dickson believes.
"There is no sign yet that the British people want to go their own way."
As the great and the good gathered this afternoon at Westminster Abbey to celebrate sixty years
of the NHS, it is clear the service stands at a crossroads.
We face a choice: a health service that limits its ambition to providing good enough care.
Or a genuinely universal system that costs a lot more but is true to its principles.
The path we choose will depend on how much we think that simple original idea is worth.
1998 – 2007
The most recent decade, in which the NHS has been controlled by Labour throughout, has been one of the
most eventful. The country saw a boom in the property and financial markets and later the debacle of
Northern Rock, a pension crisis and a swing in political popularity. The accession of new countries to the
European Community was followed by substantial immigration.
The increasing capacity of curative medicine, the availability of more and more expensive drugs for the
control of cancer and AIDS, and the developments in psychiatry in the community added to costs. The
spectre of the rationing of care was never far from the surface internationally, not just in the UK.
Pharmaceutical bills soared. Imaging and non-invasive surgery continued to improve and genetic medicine
was said to promise a future of personalised treatment.
10 Downing Street became involved in the NHS as never before. Successive Secretaries of State, Frank
Dobson, Alan Milburn, John Reid, Patricia Hewitt and Alan Johnson produced a series of plans, white
papers and organisational changes. The NHS Plan of 2000 was the most significant. The turmoil hardly
bears recounting, with the formation, dissolution and rearrangement of the structure and responsibilities of
NHS authorities and trusts. A new type of body that encouraged public participation as members appeared,
the NHS Foundation Trust. Ultimately there were 10 strategic health authorities controlling some 200
primary care trusts that contracted with both public and private providers, trusts, hospitals, community,
mental illness and ambulance, as well as managing GPs and primary health care.
In parallel, new systems of financial flow, payment by results and a tariff system brought instability to the
finances of the NHS. Health service computing finally began to deliver results, with transmission of data,
reports, radiographs and prescriptions, between hospitals, surgeries and pharmacies.
Labour introduced new systems of regulation. The National Institute for Clinical Excellence assessed the
cost-effectiveness of new drugs and technologies. The Healthcare Commission looked at the quality,
governance and financial management of trusts. Bristol and Shipman were followed by a tightening of
professional regulation. There was a drive for ‘modernisation’, changing skill mix and looking at effective
‘clinical pathways’ to increase capacity and reduce hospital waiting lists.
Early in the decade the NHS showed signs of becoming an electoral liability and after a commitment in 2000
by Tony Blair on Frost on Sunday (the most expensive breakfast in British history) the growth rate of the
NHS increased substantially for five years. A report by Derek Wanless underpinned the recognition that the
NHS was, by the standards of the developed world, grossly under resourced. A major expansion of training
for doctors and nurses, and the establishment of new medical schools followed. However mistakes in the
negotiation of contracts, particularly with GPs and consultants, added to the pressure on funds and led to a
temporary financial crisis.
The money helped the implementation of the NHS Plan, four principles of which were
A patient-focussed service (patient choice, an expanding independent sector and providing extra
capacity)
Competitive providers, giving hospitals and GPs incentives to change (Payment by results, money
following patients, the prospect of "failure")
Active purchasers - giving PCTs purchasing power and practice-based commissioning)
Cost effectiveness and affordability, (tariffs, legal contracts and commissioning)
The NHS became a service provided to all without payment, but the provision was no longer necessarily by
a publicly owned infrastructure. Labour achieved a change that, had it been attempted by the
Conservatives, would have faced immense opposition. Private sector organisations came to build and
operate hospitals under the public/private partnerships, and to run clinical services such as Independent
Treatment Centres and some NHS Walk-in Centres. "Contestability" - the introduction of competition
between providers - became significant. Private practice was now an important part of a new and more
sophisticated market. Labour's traditional desire to look at health care from a community and public health
perspective led to policies on these topics rather than achievements (with the exception of a ban on
smoking in public places). The decade ended as it had begun with reviews, Lord Darzi's reviews of the
services in London and related reviews of the other SHAs. Quality was now being made central to NHS
development, amid fears that the world wide economic downturn would have a substantial effect on the
NHS.
PFI hospitals 'cost NHS more'
Doctors have hit out at the government's policy of using private money to build NHS hospitals.
In an article in the British Medical Journal, Professor Allyson Pollack and colleagues at
University College London dismissed government claims its private finance initiative (PFI)
provides value for money.
The doctors said the NHS pays twice as much for the new hospitals than it would if they had
been built using taxpayers' money.
PFI is helping us deliver the biggest hospital building programme in the history of the NHS
Department of Health spokesman
But many of the study findings were rejected by the Commons health committee in a report
published earlier this week.
Ministers are committed to using PFI to fund at least 42 new hospitals over the next few years.
They maintain the scheme provides value for money and is the best way of meeting the costs of
the hospital building programme.
Professor Pollack, who is based at UCL's Health Policy and Health Services Research Unit,
suggested the formula used by the government to assess the economic value of PFIs was flawed
and had not been properly evaluated.
Analysis
Researchers analysed the costs of three PFI schemes in North Durham, Carlisle and Worcester.
They found that even the apparently basic task of raising the money to pay for the new hospitals
through PFI substantially increased costs.
Our best estimates are that the costs of private finance are higher
Professor Allyson Pollack, UCL
They concluded that a variety of costs incurred by developers - comprising higher interest rates
for public sector borrowing and fees associated with preparing a bid and carrying out
negotiations - accounted for 39% of the total bill.
Similarly, the amount of money NHS trusts had to pay annually towards the capital costs of the
new hospital was more than three times more expensive than if the project had been built using
public money.
The authors also rejected the government's claim that PFI provides better value for money
because it transfers responsibility for risk to the private sector.
They suggested this was simply a way of "disguising the true costs of PFI".
The researchers were denied access to government documents comparing the cost of PFI
schemes to those built with public funds.
But the authors said they believed that costs of PFI are significantly higher.
They said: "Our best estimates are that the costs of private finance are higher and that trusts
pay much more than they would if the new buildings had been publicly funded.
"The value for money analysis seems to be no more than a mechanism that has been created to
make the case for using private finance.
"It raises serious questions about why the government is using an unevaluated method of
procurement for critically important services."
Criticism
In its report the Commons health committee said there was no evidence to suggest that PFI
hospitals cost the NHS more.
It stated: "We recognise that there are potential problems with PFI, but we also can see its
potential benefits.
"At the very least a benefit could be getting more NHS services now, for a cost over the lifetime
of a project, should none of the risks come to fruition."
A Department of Health spokesman backed up the committee's conclusion.
He said: "PFI is helping us deliver the biggest hospital building programme in the history of the
NHS. This is good for patients and good for staff.
"PFI projects only go ahead where it is demonstrated through a full business case that they
deliver best value for money. PFI's ability to do so has been supported by a series of NAO
reports."
Good value
A spokesman for the Office of Government Commerce which overseas procurement and PFI
contracts on behalf of the Treasury said the scheme was good value for money.
He added: "PFI is used where private sector expertise can provide value for money facilities and
services.
"Also it means when time and costs overrun the contractor not the taxpayer picks up the tab."
But Unison, the country's largest health union, called on the government to abandon the
"discredited PFI gamble".
"In the face of this damning proof that the PFI costs us nearly twice as much as it would cost
through public funding, the government should ditch this discredited gamble now," said general
secretary Dave Prentis.
"The evidence is overwhelming and it would be political suicide to ignore it."
Private Finance Initiatives (PFI) and Competive
Tendering of services within the Hospital Trusts
and Primary Care Trusts will eventually lead us
back to a two tier health service.
1st Tier - Private Health care Cash or Private
Health insurance, BUPA etc.
2nd Tier - Charitable or government vouchers
for the poor or less well off.
