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It was back in September 2013 that we penned a post for Cost of Living entitled “We need to talk about Jeremy”. Way back then we were blissfully unaware of the possibilities of Brexit or Trump. Our major concern was the back-door privatisation of the NHS. Here we are, four years and 310 days later, with a new secretary of state (SoS) for Health and Social Care, whose appointment is inextricably linked to political machinations around the calamitous march towards Brexit.  In any Pre-Brexit era the selection of a new Health Secretary would deserve some scrutiny, but now the appointment has barely warranted a mention.  The danger that any form of Brexit poses to the NHS is well documented and compounded by the desire of the present government to strike a Post-Brexit trade deal with Trump’s America.  Such a deal will certainly accelerate privatisation and could well spell the end of the NHS. Indeed, concerns about backdoor privatisation appear to have been moved front of house with the new SoS, who has a voting record which appears to clearly support the ongoing privatisation of the NHS.

Doctors Protesting Trump at Blenheim Palace

In the intervening period between 2013 and now, there can be little doubt that the NHS has been transformed, and not in a good way. The list of horror stories is too long and abject to summarise. Having said that, the junior doctors strike and the development of the so-called Hunt Effect, where patients died because they were too scared to go to hospital at the weekend merits particular mention. But as to the question of privatisation, this is an incredibly difficult question to answer. Such is the convoluted way in which the NHS is organised (both pre or post 2012 Health and Social Care Act).

Full Fact, (self-described as the UK’s Independent Factchecking Charity), states that the amount spent on private providers commissioned to provider NHS care has increased from 2.8% in 2006 to 6.1% in 2013/14.

Another more recent Full Fact post responded to an allegation from David Davis (back to Brexit again) who had claimed that “the proportion of the NHS budget spent on private providers rose much more quickly under the last Labour government than it had under the Conservative and Coalition governments.”

Again, it is hard to disaggregate this data from wider changes, but a Health Foundation report asserts that community care is the area in the NHS where there has been most transfer of provision from NHS to non-NHS providers “In recent years, spending on community care delivered by non-NHS providers has increased substantially – and faster than in any other any area of NHS care. However, surprisingly little is known about who is providing these services, or the size and scope of the contracts.” In their survey, the Health Foundation found that of the community care contracts in their sample, private providers held 5% of the total annual value, but 39% of the total number of contracts issued – suggesting lots of smaller community services contracts being offered out to non-NHS providers.

Reporting similar levels of complexity, the Kings Fund report an increase in private sector spending in the NHS from 7.3% in 2014/15 to 7.7% in 2016/17. Echoing the Health Foundation report, it seems that most privatisation has occurred in community services and also mental health services. Indeed, they refer to attempts in 2016 to push £1.2 billion of cancer and end-of-life services out to tender. This plan was eventually abandoned in July 2017 after a series of NHS England starts and stops. This failure is interesting in relation to the apparent tendering successes of private providers in community care services. This suggests that many of these privatisation processes are happening on the fringes and the margins, out of sight, but fundamentally impacting upon the provision of universal healthcare.

While the question of determining the extent of privatisation creep is complex, what is easier to ascertain is the overall funding situation of the NHS.  Full Fact, along with others, has warned that the NHS faces a £20 billion funding gap by 2020.  This in the context of the Governments own study that shows any version of Brexit will have an effect on the economy that ranges from bad (a 2% drop in GDP) to catastrophic (8% drop in GDP).  Moreover, currently, growth in spending on the NHS is below that during the Thatcher years.  It is difficult to see how any government will be able to plug this funding gap from the public purse with a failing economy and many other demands on spending.

It is in this context that we reframe our insistence that “we need to talk about Matt Hancock”. Hancock has a very close association with Institute of Economic Affairs (IEA), a conservative think tank that promotes free-market economics, the privatisation of the NHS and an ultra hard ‘no deal’ Brexit.  It is currently under investigation by the Charity Commission to determine if it has breached charity regulations on political independence. It is a matter of public record that Neil Record, chairman of the IEA, has donated £32,000 to Matt Hancock’s office. According to Adam Curtis, the IEA was set up with the express intent of masquerading as a “scholarly institute”, while behind that it would function as an ideologically motivated PR organisation, promoting the unregulated free market ideology of Hayek.

On marking the recent 70th birthday of the NHS, the IEA produced a pamphlet on structural reform of the NHS that called for an expansion of the “quasi-market reforms of the 2000s … to improve patient choice, strengthen the self-governance of providers and enshrine the principle that money follows the patient.” This clear commitment to processes of privatisation suggests that our new SoS for Health and Social Care may be making bolder moves to privatise our universal healthcare system.

It appears that the NHS is facing a perfect storm of chronic underfunding, creeping privatisation, Brexit and a Trump trade deal capitulation.  We warned two years ago, on these pages, about the existential dangers that the twin spectres of Brexit and Trump posed to health, healthcare and much else beyond these.  The worrying thing is that little has changed since then and, if anything, our present situation is even worse than we suggested.  Of course, the very real perils of Brexit (and also Trump) could implode under its contradictions and the terminal ineptitudes of those who advocate it.  In the meantime, it is still the task of those who wish to continue having a universal healthcare system to carry on unmasking the so-called ‘reform’ of the NHS which inexorably leads us towards a dystopian future.