The Health of the Nation The Health of the Nation.indd 1 27/11/2014 10:52 The Health of the Nation.indd 2 27/11/2014 10:52 The Health of the Nation NHS in Peril David Owen Methuen The Health of the Nation.indd 3 27/11/2014 10:52 Published by Methuen & Co Methuen & Co 35 Hospital Fields Road York YO10 4DZ www.methuen.co.uk First published 2014 1 Copyright © David Owen, 2014 David Owen has asserted his rights under the Copyright, Designs and Patents Act, 1988 to be identified as the author of this work. All rights reserved Without limiting the rights under copyright reserved above, no part of this publication may be reproduced, stored in or introduced into a retrieval system, or transmitted, in any form or by any means (electronic, mechanical, photocopying, recording or otherwise) without the prior permission of both the copyright owner and the above publisher of this book Typeset by SX Composing DTP, Rayleigh, Essex Printed by CPI Group (UK) Ltd, Croydon, CR0 4YY ISBN: 978-0-413-77772-0 Ebook ISBN: 978-0-413-77773-7 A CIP catalogue record for this book is available from the British Library The Health of the Nation.indd 4 27/11/2014 10:52 To Tessa, Sylvan, Cai and Elizabeth, in the hope and expectation that the NHS will serve them as well as it has served my generation since 1948 The Health of the Nation.indd 5 27/11/2014 10:52 The Health of the Nation.indd 6 27/11/2014 10:52 Contents Acknowledgements ix Introduction xi Action Sheet xxxi Chapter 1 The Hung Parliament of 2010 1 Chapter 2 Fatally Flawed NHS Legislation 19 Chapter 3 A People’s Commission 56 Chapter 4 NHS Marketisation – EU and US 114 Chapter 5 SOS: Save Our Surgeries 161 Chapter 6 A One-nation NHS 196 Annexes: A: National Health Service (Amended Duties and Powers) Bill [HL] 261 B: National Health Service (Amended Duties and Powers) Bill (‘the Efford Bill’) 268 C: Response to the Efford Bill by Allyson Pollock et al. 287 D: Translated text of German Constitutional Court Ruling, paras 395–7 296 E: Charter 2010: Two Extracts 299 The Health of the Nation.indd 7 27/11/2014 10:52 The Health of the Nation.indd 8 27/11/2014 10:52 Acknowledgements I have been fortunate to be able to draw extensively from two published reports: firstly Nicholas Timmins,Never Again? The Story of the Health and Social Care Act 2012 – A Study in Coalition Government and Policy Making (Institute for Government, 2012), and secondly Olivia O’Sullivan and Elizabeth Woodcraft (eds), Report of the Lewisham People’s Commission, available online at www.savelewishamhospital.com/peoples-commission- report. I have also taken a long quote about the People’s March from Jarrow in the summer of 2014 from the Staggers blog. I have deliberately used on many occasions fairly long quotes from speeches, articles and letters of other people because I wanted to convey a sense that the reinstatement of the NHS is a people’s demand. Many people have helped me, too numerous to mention, since I first began as a medical student in 1956 and as an MP in 1966; to all of them I owe a huge debt. This book, however, could never have been completed without the support of Peter Tummons at my publisher Methuen, Jonathan Wadman, my editor, and Maggie Smart, who has worked with me since 1977. To them I owe a special debt of gratitude. ix The Health of the Nation.indd 9 27/11/2014 10:52 The Health of the Nation.indd 10 27/11/2014 10:52 Introduction The major consequence of the 2012 Health and Social Care Act has been how it views health care in England as a business rather than a service. The key political challenge today for many people in England is how to persuade politicians that they are wrong to believe that health should be viewed in this way, and to explain how we can sensibly reinstate the fundamentals of the NHS that are being dismantled in England, fundamentals that elsewhere in the United Kingdom remain intact and widely supported, as we saw during the Scottish referendum. Along with Scotland, Wales and Northern Ireland have retained an undoubtedly recognisable NHS, albeit in slightly different forms. Only in England does the threat exist that the NHS will be unrecognisable by 2020 if the 2012 legislation is not repealed in substance after the May 2015 general election. But this has profound implications for the UK. The underlying reasons that make the original concept of the NHS worth fighting for are clear, but not often stated, perhaps because they go to the ethical and moral basis of xi The Health of the Nation.indd 11 27/11/2014 10:52 David Owen the way many UK citizens wish to live their lives. There is a natural reserve which makes many people reluctant to talk about these values in a political setting. But at the next election we must drop that reserve and fight not just an ideological battle but a struggle for the heart. Politics is not solely about power; it is also about people and how to make power serve the people. In 1952 the founder of the NHS wrote these words, which sum up the timeless moral case for the reinstatement of a recognisable NHS in England: ‘Society becomes more wholesome, more serene and spiritually healthier if it knows that its citizens have at the back of their consciousness the knowledge that not only themselves but also their fellows have access when ill, to the best that medical skill can provide.’1 ‘Wholesome’ is a wonderful word and so is ‘serene’. To live without the fear of being unable to afford medical care is a blessing, but one which has only been with us since 1948 in the UK. The market does not have to penetrate every nook and cranny of our day-to-day life. In the nineteenth century the philosopher Thomas Carlyle warned of the marketisation that was starting to feed through into all parts of society: We have profoundly forgotten everywhere that cash- payment is not the sole relation of human beings; we think nothing of doubting, that it absolves and liquidates all engagements of man. ‘My starving workers?’ answers the rich mill-owner. ‘Did I not hire them fairly in the market? 1 Aneurin Bevan, In Place of Fear (Heinemann, 1952). xii The Health of the Nation.indd 12 27/11/2014 10:52 The Health of the Nation Did I not pay them, to the last sixpence, the sum covenanted for? What have I to do with them more? 2 The social history of the NHS makes clear that it would be ‘an error to regard the NHS as a spontaneous creation’. The cumbersome National Health Insurance (NHI) administration established in 1911 supplied minimum financial relief during sickness and a ‘panel doctor’ service for the low paid on the basis of weekly deductions of income for the so-called health stamp.3 But many were not covered by this insurance. There was nothing for those excluded other than the charity of the doctor or a hospital. The Dawson report of 1920 pointed the way but many slum dwellers had totally inadequate healthcare, if any, and lived in conditions of Dickensian squalor. The Second World War brought the Emergency Medical Service, the Beveridge report and the 1944 White Paper outlining the provisions of the projected NHS: a resolve emerged in wartime within the British people that when peace came there would be a different and better system of healthcare for everyone. In 2014, the political writer David Marquand wrote about the profound dangers to the NHS of what amounts ‘to a transition from a managed market to an unmanaged one’.4 What is more complicated about this market and more important ‘has to do with the mentality and rhetoric of the marketisers and with the social vision they encapsulate’. At the heart of all marketisation and commercialisation of the NHS lies the ‘totemic term 2 Thomas Carlyle, Past and Present (Chapman & Hall, 1843). 3 Charles Webster, The National Health Service: A Political History (Oxford University Press, 1998). 4 David Marquand, Mammon’s Kingdom: An Essay on Britain, Now (Allen Lane, 2014). xiii The Health of the Nation.indd 13 27/11/2014 10:52 David Owen “choice”: free choice by unconnected individuals, satisfying individual wants through market competition’. Healthcare, whether public or private, in a very real sense is infinite: money can be – and in many countries is – poured into healthcare by those who can afford it. Money for the NHS is a public choice, but it is all relative to what we choose to spend on education, housing, welfare, defence, all legitimate demands. Healthcare, if publicly provided, inevitably has to be constrained. That rationing process within the NHS is flexible, professional and democratically accountable. It is decided by Parliament through the Chancellor of the Exchequer, the Secretary of State for Health and Cabinet. By democratic choice it is not done by a market or by insurance premiums. Voters could have chosen a different system – they exist in many parts of the world – but no major political party has ever felt brave or foolish enough to put that choice to them. It was not, as this book will show, a choice put to the electorate in 2010 by either the Conservatives or Liberal Democrats. The unknowing nature of choice when applied to health- care dramatically demonstrates the problem that many politicians and journalists have when they come to make quick appreciations, half-decisions and slick prescriptions for the NHS.