The Telegraph recently published an article: ‘NHS to be franchised around the globe under post-Brexit plans’. Here we re-publish an updated version of the article we wrote on this subject in January 2017 for the National Health Action Party. Whilst it’s good to see these issues raised in the mainstream media The Telegraph makes some seriously incorrect assumptions, although it picks up on all the main points of our original.
The NHS as a public service was once the envy of the world and recognised as one of the greatest humanitarian achievements of the 20th century. The purpose of the NHS was and has been until recently to provide for healthcare for anyone in the UK who needed it.
The NHS here at home is in crisis. Many hospitals have been on black alert during winter periods in recent years as a matter of course (hospitals at full capacity, closed to further admissions), routine operations cancelled including cancer surgery in winter 2017-18. There is a perennial lack of provision of mental health services, a social care system that is collapsing due to privatisation, and general practice in meltdown.
But brand NHS is alive and strong: the NHS is now commercial, it’s a global competitor, earning private income to subsidise the public sector. This has echoes of the pre-1948 concept of healthcare for the poor as charity, and is a method being replicated in all our public services and in our economic discourse. But universal public services are not based on asking for contributions from the rich to pay for the poor, nor on providing paid-for services to the rich to generate a surplus to pay for the poor. That is philanthropy, not universality. The NHS is for all, equity is its foundation stone.
Within the NHS there are rich hospitals and poor hospitals which have a corresponding ability to maximise private income from various sources (see our blog Privatisation from the ground up) . The NHS is being moved away from the idea that its funding is a primary public responsibility to one where ‘private income streams’ subsidise shortfalls in its budget. This is part of a series of measures accelerating the transition of the NHS from a universal and comprehensive service to a limited service for those who cannot afford to pay for a full range of treatments.
The NHS – a global brand
Healthcare UK may be one of the least well known branches of the NHS. The NHS is now a global competitor which sells its ‘trusted brand’ across the world, in selected markets. To do this Healthcare UK was created following the enactment of the Health and Social Care Act in 2013. Its publicity brochure, annual reports, sales conferences and seminars have been extolling the virtues and success of the famous NHS model of health to the international markets ever since.
The agency is a joint venture of the Department of Health, UK Trade and Investment and NHS England.
Here is a quote from the blog of the CEO of Healthcare UK, the global marketing arm of the NHS, about 2016’s International Expo: “We hope to show not just why an NHS organisation, be it a large acute hospital or a small community care provider, should consider international work, but exactly how they might go about it and learn from others already out there and doing it. One good example of this is the joint session between the Department of Health and NHS Improvement, which will look at how the NHS is already generating commercial income and how the centre can best support others to do the same.”
Campaigners may be familiar with some of the ‘global NHS’ facilities, such as Moorfields Eye Hospitals in Dubai and Abu Dhabi. Moorfields’ website says ‘In 2007, more than 200 years after its foundation in 1804, Moorfields moved beyond the United Kingdom to open its first overseas branch.’
But considering the recent celebrations over the ‘pausing’ of the move to create Subsidiary Companies in the NHS for property, facilities and other support services, it may be that there is less awareness of how ‘SubCos’ are operating – and are part of the global marketing strategy.
Prime among them must surely be Guys and St Thomas’ NHS Foundation Trust (GSTT) which launched its SubCo in May 2013 within a month of the Health & Social Care Act being enacted. In fact the ability to form wholly-owned subsidiaries has existed since the NHS Act (2006) but there is certainly more emphasis on them since 2013. The GSTT SubCo is called Essentia and its branding dominates the hospital transport, building works and facilities of both hospitals in the Trust – and others further afield.
Essentia’s website boasts – ‘We help clients to become more efficient and more effective. Our experts provide consultancy services to guide and support your strategy and estate development’. This is a far cry from the claims that the SubCos are simply tax efficient or have other benefits solely for the advantage of the parent Foundation Trust company.
Essentia’s clients include not only other NHS Foundation Trusts but also the National Centre for Comprehensive Cancer Care, Qatar, Sunshine Coast University Hospital, Australia, New Royal Adelaide Hospital, Australia and the National Children’s Hospital, Dublin.
It is worth noting too that the HSJ said last week (sorry – paywall) that despite NHS Improvement advising a pause whilst new guidance was drawn up, two Foundation Trusts are going ahead with their plans from 1 October.
But this is just a snapshot. HealthCare UK provides a clearer guide to the extent of its work in its annual reports. The picture below is from 2013/14.
The Telegraph’s concluding paragraphs are slightly ‘orphaned’ from the main article, referring to a different source of private income.
“Under the 2013 Health and Social Care Act, passed by the Conservative Lib-Dem Coalition, hospitals are allowed to get 49% of their income from commercial sources.
Whilst major cancer centres like The Royal Marsden Foundation Trust get almost one third of income from private patients, investing profits into frontline NHS services, the total amount from such sources is only around 1 per cent of the health services resources.”
Leaving aside the conflation of ‘resources’ with ‘income’ (the NHS’s most important resources are its staff, equipment and premises) this statement is also misjudged. There is little or no evidence that any excess profit is generated. And our own research (the early results of which were published in The Independent) shows that defining what proportion of income is now from commercial sources is a complex question.
As a result of all this activity we disagree with the framing of The Telegraph’s headline ‘NHS to be franchised around the globe under post-Brexit plans’. The NHS is already being franchised. Pretending that it is a future yet-to-happen event distracts from real events taking place that are happening with increasing frequency.
Real resources – staff and premises – are needed to create these private services. For those caught in the SubCos that is likely to mean worse pay and conditions. For those in the business of providing ‘NHS private’ it may mean better terms of employment – but at a cost to the availability of personnel to keep the NHS itself staffed. The fundamental principles of the NHS are under attack from this process and the private sector is profiting from the ‘brand image’ of goodwill and love for the NHS created over seven decades of contribution and public service.
A global NHS is a contradiction in terms.