This week Philip Hunt, an ex-Minister of State for Health under the last Labour government, went on the record to express his concerns about the sale of Plasma Resources UK (PRUK) to the private equity company Bain Capital. The now Lord Hunt stated his concerns were primarily around issues of ‘security of supply’. This concern seems to imply that Bain Capital may not be as well placed as the Department of Health (DoH) or the NHS to oversee the ongoing operation of PRUK. Can these concerns be construed as an objection to the corruption of the principles of altruism that have been held to characterise UK blood donation through the privatisation of blood supply? If so, it begs a further question of why the issue of blood raises concerns about privatisation where the sell-off of community services, adult social care etc. has not. If one is opposed to the privatisation of blood, surely, surely one must also be opposed to the privatisation of other (and all) aspects of the NHS? Why has there been no such public outcry about processes of commodification and privatisation in other areas of the public sector that have endured a similar fate? The p-word is anathema in discourse around the NHS for mainstream media (and politicians), but it seems to be much more acceptable to question the wisdom of privatisation in the blood debate. What is it about blood and blood products that push an ex-senior government figure – Hunt served as Parliamentary Under-Secretary of state in the DoH and as Minister of State for Health under two different Labour Prime Ministers– to raise concerns about marketisation in this way?
The idea of security of supply speaks directly to one of the key aspects of Titmuss’ arguments about voluntary versus for-profit blood markets – which in turn speak to issues around the marketisation of healthcare in general. Titmuss proposed that practices of blood donation were not suited to, indeed were antithetical to, market principles. He argued a far more effective means of organising the distribution of blood was the principle of voluntary donation. This highly influential book was re-published in 1997 (with additional contributions co-edited by Ann Oakley and John Ashton).
In this book Titmuss used the moral, ethical and procedural issues raised by the buying and selling of blood products as a means of undermining the market orthodoxy. Central to his argument was the assertion that the market in blood products was immoral and unethical, as it replaced altruistic concern (where blood donation is construed as a life saving gift) with selfish self-interest, (where blood donation is construed as the pursuit of rational financial gain). One of the additional contributions from the 1997 edition is an afterword by Julian Le Grande, (before his appointment as ‘choice tsar’ to Tony Blair’s NHS). Le Grand (as one would expect) rather blithely dismisses Titmuss’ argument, but concedes there are two key components from Titmuss that still speak strongly against the idea of a market in blood products; these are the contamination argument and the corruption argument. Both of these are well rehearsed.
Contamination relates to the idea that once a product (i.e. blood) has a financial value, suppliers tend to think only of their own financial gain and as such may cover over any potential contamination in the product they are supplying. Market value overcomes any and all other concerns. This relates to issues around ‘security of supply’. As Hunt asserts, the purchase of PRUK offers new opportunities for the sale and re-sale of blood products, raising concerns about how the provenance of blood supplies might be guaranteed (i.e. about possibilities for contamination). For example, if a blood donor stands to gain financially through the sale of their blood to a corporation that buys and sells blood to healthcare providers, is the donor more or less likely to admit to the presence of hepatitis or HIV in their blood.
The second point, corruption, relates to the assertion that all of this nascent (and not so nascent) competition and commodification will result in the corruption of principles of altruism. Again to return to Hunt, he raises concerns in terms of the provenance of the ownership of PRUK itself. Hunt states
“…(t)he distance between the National Health Service and its requirements for these blood products and the company becomes ever distant. Ownership is confused and there are no guarantees for the future…”.
The implication seems to be that whilst the NHS needs these blood products to save lives, Bain Capital needs these blood products to generate profit and to increase the re-sale value of PRUK. There is clearly for Hunt a real danger that altruism will be corrupted by competition.
But these are not merely abstract principles of economic theory. These processes of contamination and corruption are evidenced in the 1990’s in the so called Arkansas Prison Plasma Scandal, where prisoners were paid $7-$10 per blood donation in a blood product centre run out of the prison. Contaminated blood collected from the Arkansas prison population was allegedly used in the international production of Factor 8, a blood-clotting agent, which led to the contamination of a number of people outside of the USA. Contamination is clearly a very real danger when the distribution of blood products is profit-led.
It is clear that concerns over contamination and corruption, as first voiced by Titmuss, still run through contemporary debates about blood donation. Hunts’ key objections draw centrally from these themes. Events like Bain Capitals’ purchase of PRUK demonstrate a moral and ethical dilemma of conceiving of blood as an altruistic gift versus conceiving of blood as a tradable commodity. The question it raises for me is why is this concern a live issue for blood, but not for healthcare or social care? Why has there been no media discussion about corruption and contamination of principles of altruism in the NHS?