Wed 30 Mar 2011
This is the text of my speech to the retired members and fellows of the Royal College of Obstetricians and Gynaecologists.
Lades and gentlemen, thank you for inviting me here today.
The title of my talk is “why Nurses for Reform do not believe the Government’s health reforms go far enough”.
Nurses For Reform – or NFR – is a small organisation with only 200 nurses in membership.
It was established by me in 2006, and its objective is to promote genuine free market reforms across healthcare.
From the outset, NFR has been designed to be a low cost, lean and mean, cyber organisation and nurses who sign up, do so, free of charge.
Today, representing very much a minority perspective, we nevertheless attract a growing amount of media attention – and our views are starting to be taken seriously by politicians – across the political spectrum.
NRF regularly appears in the national press and media, and we now enjoy an ever-expanding on-line following.
In the last few weeks alone our views have been reported in The Daily Telegraph, The Guardian and I have been extensively interviewed on the BBC.
And it was not that long ago I spent an hour with David Cameron in his office presenting NFR’s policy ideas for substantive healthcare reform.
If you listen to John Prescott, The Daily Mirror and countless other friends on British the left, then NFR is the free market conspiracy in British healthcare!
Now, when the NHS was created back in 1948, not only was it established on the basis of taking into public ownership 3,118 independent hospitals and clinics, but, crucially a leaflet was posted through the door of every home in the country.
It contained – in black and white – the promise that was supposed to be full-blown state healthcare… its “founding principles”.
The leaflet stated, and I quote: “[the NHS]…will provide you with all medical, dental and nursing care. Everyone – rich or poor – can use it.”
The key word here was the word all.
The State was going to provide all medical, dental and nursing care.
Today, sixty three years on, the NHS has never come close to making good this promise.
Indeed, as time passes, UK healthcare is moving ever further away.
There have always been services that the NHS has never provided.
While at first doctors in NHS hospitals were encouraged to treat patients according to need, within a couple of years of the service having been established they found themselves working under the imposition of cash limits which soon turned them into the politicised allocators of scarce resource.
Soon, the supply of health – and social care – in the UK was rationed by massive queuing.
Crowded waiting rooms became common in most general practices and out-patient departments.
By the late 1960s, queuing had even become a significant factor for in-patients and those waiting for operations and treatments deemed a “priority”.
Indeed, certain health services have never been provided by the state, reducing demand still further.
Much psychiatry, the treatment of infertility and substance misuse are cases in point.
In reality, people have never had a right to free and equal treatment.
What they have had is a right to a promise of being treated at some distant point in the future and without much mention of quality when they actually get there.
It must also be noted that only in theory does the NHS treat everyone equally.
For as Professor Julian Le Grand of the London School of Economics and Tony Blair’s health adviser made clear a few years ago – relative to need – professional and managerial groups have tended to receive more than 40 per cent more NHS spending per illness episode than those in semi- and unskilled jobs.
Now, in the early years of the NHS, the government made very little investment in its newly acquired health estate.
In fact, during the first decade of the NHS, not a single new hospital was built.
None were even approved until 1956.
And then there was the Great Hospital Plan of 1962!
Even by the mid-1990s most of it had still not even been commenced.
As the health commentator Professor Allyson Pollock pointed out in the middle of the 1990s:
“The plan…remains unfulfilled, with only a third of the projected 224 schemes completed, and a third not yet started.”
In reality, the government never really did get around to investing on the capital side of the NHS, which is why Prime Ministers such as John Major and Tony Blair turned to private sector capital and expertise under their private finance and public private partnership initiatives.
It is with this background that Blair signed the Concordat with Britain’s private hospitals in 2000 – enabling NHS funded patients to get independent sector care and treatment for the first time.
This is why in 2001, a Labour government wanted a new generation of Independent Sector Treatment Centres.
It is why in 2003, the government tried to push through Independent Foundation Hospitals and wanted them to be able to raise private investment on the open market.
It is why we have the Patient Choice Agenda.
And it is why we now have the Health and Social Care Bill going through Parliament.
Make no mistake.
The NHS is being redefined and recast.
In the future, the NHS will simply be a funding mechanism but it will not be the owner of the facilities in which people are cared for or treated.
Looking further out, nor will it be the controller or manager of healthcare professionals.
At this point, I could of course talk about the collapse of NHS dentistry, or the way that spectacles were privatised in the 1980s, or the way that to manage NHS waiting lists the service has become ever more reliant on using capacity in the UK’s 220 independent hospitals…
But alas, I don’t have time for that…
What I want to do with the time that remains is tell you what I think the Bill going through Parliament is actually about, and why NFR does not think it goes far enough.
Overall, I am pleased that the government is planning to empower patients by introducing what will in effect be a shadow-voucher system.
For in enabling patients to freely choose their general practitioners and then having the vast majority of the NHS’s funds flow through their hands, the system can move towards a much more open and diverse market in provision and facilities.
In the future, I believe no one in this country should ever have to go into any hospital owned or directed by the state.
Whether for-profit or not-for-profit, mutual, worker co-operative, or charity, all our hospitals, clinics and care homes must be set free from political control and returned to independent forms of ownership.
These organisations should then be free to raise money commercially or as they see fit, and free to reap the rewards of serving patients well.
It is vital that UK hospitals and clinics are freed from the constraining and historic shackles of the Treasury.
When looking at the current Bill in Parliament, I think it is good that in the future, not only will hospitals be allowed to raise investment and capital from private sources, but that the caps on their private pay-bed work will also be removed.
For too long, high quality independent provision has been the preserve of the well-healed and those able to afford exclusivity.
For too long, private hospitals have profiteered with high margins from the manifest failings of nationalised provision.
However, where Nurses for Reform differs from the government is that we also believe national collective pay bargaining arrangements have run their course and should be abandoned.
Alongside privatizing NHS hospitals, NFR wants the government to encourage a more vibrant and open labour market for the benefit of all doctors, nurses and other health workers.
No one working in healthcare should ever have their professionalism and integrity undermined by uniform, one size fits all, politically decreed, pay scales.
Nor should remuneration be imposed and held back at regional level.
To properly value doctors, nurses and other healthcare professionals, remuneration must be set at realistic levels but this will only happen in a more open, dynamic and responsive market.
Similarly, NFR wants the government to end health censorship.
In today’s internet age it is absurd that advertising by doctors and pharmaceutical companies are still largely restricted or subject to outright bans.
Why can’t GPs advertise and compete with each other?
What can’t Foundation Trusts advertise on television or in local newspapers?
Why can’t many medicines operate under the rubric of commercial free speech?
To encourage informed patients and build trusted brands we must dramatically liberalise the laws surrounding health information: we must encourage a lot more advertising.
While there is no such thing as perfect information or perfect knowledge, better-informed people are able to make choices and better decisions.
Trusted brands can also deliver powerful checks against producer-capture and the monopoly abuses of those with professional – monopoly – legislative favour.
And that means you and the GMC and it means me and the Nursing and Midwifery Council.
Finally, I think the government should go much further to liberalise the planning laws surrounding the building of new hospitals and all other health and social care facilities.
We need to make it much easier in this country for social enterprises and entrepreneurs to build new healthcare facilities.
Instead of an ever shrinking healthcare estate we need to respond to the demographic and medical challenges of the future by enabling a rich and diverse tapestry of institutional arrangements more focused on consumers, quality and value for money than the politics of greedy vote motivated politicians and trade union leaders.
NFR is established and we here to stay.
We are small, but we have a distinct voice.
We are free marketeers who put patients and best value above professional and sectional vested interest.
We are not afraid to criticize the state or the NHS.
And we have a clear agenda.
While we think the current Bill before Parliament is at best only an incremental step in the right direction we also think it is a missed opportunity.
From a consumer perspective, it does not go far enough.
What we want is universal independent provision.
We want more healthcare advertising so as to inform and build trust.
We want an end to national collective pay bargaining.
And we want to do away with planning laws that restrict supply and keep prices artificially high.
What I want is better healthcare for all and I want the vote seekers to get out of the way!