Monday, 14 February 2011

Government's weak justifications for NHS privatisation plans

The government has deployed a couple of justifications for their NHS reforms ('reforms' being such a light phrase for a demolition job) but numerous commentators, including the crusading science journalist Ben Goldacre, have helped demolish these, aided by some of the very researchers that government ministers have (mis)quoted.

Two of the government's key arguments are summarised below - the first of which can be best described as misleading; the second of which is quite frankly duplicitous.


The main argument that government ministers have used most often in recent months is that health care outcomes are better amongst continental health care systems than in the UK. Leaving aside the fact that this ignores the chronic underfunding of the NHS over decades compared to its continental cousins and ignores different attitudes to public health and diet, it is not strictly true.

Paul Burstow, the MP or Care Services, has repeatedly pointed to research showing that the UK has poorer survival rates for heart disease and cancer than France. He cites research by Martin McKee, from the London School of Hygiene and Tropical Medicine, and Ellen Nolte from Rand to support this claim.

In reality, of course, he has quoted this research totally out of context. The very same researchers wrote to the Guardian to say the following:

"Paul Burstow MP... seems to have misunderstood....the findings of our research that he cites... We showed that, in the years between 1997-98 and 2002-03, the UK had high death rates from conditions amenable to healthcare, but these were falling faster than in all but one of 18 other industrialised countries. Crucially, we also showed how deaths amenable to healthcare in the US, with its much more competitive system of healthcare provision, were improving at a much lower rate, despite spending vastly more on healthcare than the UK. This, we would suggest, is the most important message of our research".

The British Medical Journal has produced this graph, below, that shows this striking trend: that improvements in UK outcomes means that, by 2012, Britain should have lower death rates for the disease than France, despite the latter spending considerably more on its health system. For cancer, trends are similar.
BMJ, 27 January 2011


A cynic would suggest that the government's desire for shifting the budget for the NHS down to GP consortia would firstly allow rationing to happen at a local level (thus allowing ministers to avoid being the focus of blame) and would enable them to open the door for the rapid privatisation of the system.

The government, of course, has a different argument: that GP consortia - being run by 'front line professionals' rather than the pen-pushing, faceless, politically-correct and probably Labour-voting bureaucrats that currently have the audacity to exist - will be more efficient and better equipped to understand patient need. Oh, and waiting lists will be lower.

The evidence?

Meic Goodyear, Public Health Intelligence Specialist working at Lewisham PCT, has argues that evidence to support the view that lower waiting times at GP consortia is not there - by studying GP fundholding practices that proliferated under the last Tory government:

"Following the election of the Labour government in 1997, I used survival analysis techniques to compare waiting times for patients from fundholding and non-fundholding GP practices for all waiting-list admissions in the South West Thames region in a year. With the exception of orthopaedic surgery, patients from fundholding practices waited significantly longer; in the case of cancer patients in particular, the average wait was 12.5% longer if their GP was a fundholder".

Ben Goldacre has gone further:

"I have never heard one politician use the word “evidence” so persistently, and so misleadingly, as Andrew Lansley".

He cites the lack of evidence for GP consortia being better at commissioning than Primary Care Trusts, as well as pointing to the dangers (as many other informed commentators have) of Lansley's proposed introduction of price-based competition. It's worth a read, as is his more recent critique of Paul Burstow's claims, which points to the irony of a Tory minister drawing attention to an academic study that demonstrates the rapid improvement of health care outcomes under Labour's period in power.

There is, of course, another reason for these NHS reforms, and it isn't about affordability (the US healthcare system, for example, is increasingly expensive and financially unsustainable). It's about neo-liberal politics: that private is always 'good' and public 'bad'. That, in fact, is that.

No comments:

Post a Comment