London witnessed on 30 June 2018, thousands of people including health workers, their trade unions and staff associations, come out on the roads. The demonstration was to show people’s opposition to the wrecking of the British National Health Service (NHS). Many of those who took part have been fighting to save their local health services and hospitals and safeguard the future of NHS. The NHS was established in 1948 on the principle that good healthcare should be available to all, irrespective of their ability to pay.
A massive restructuring of the NHS was imposed by the Health and Social Care Act (HSC Act) of 2012. This course has been continuing without public or parliamentary consent and in the face of consistent public opposition.
Until a few decades ago, the National Health Service in Britain consisted of a large number of general practitioners (GPs) and local government-run community health facilities for maternity and child welfare, as well as for immunisation and health education. GPs were not paid a salary but were paid by the government according to the number of people registered with each local GP. There was no competition between GPs and collaboration between GPs was common place. Primary health facilities were available throughout the country and people had easy access to them. There are also district hospitals and larger hospitals with more specialised facilities and treatment.
For the last several decades, NHS is being wrecked under high sounding schemes and slogans like "efficiency", "accountability", "sustainability", "integration" and so on that hide the real intent. And the real intent is to destroy the existing system so as to opens up the sector for private companies and hospitals to make profit from healthcare.
Services at the GP level have been opened up for competition. One can go to any GP and a GP will get paid according to the number of people coming for consultation. This way GP will hesitate to assist other GPs patients. New payment systems will incentivise rationing of services and denial of care. In order to reduce the funding of NHS, the government of UK is fragmenting local District Hospital acute services and the local General Practitioner (GP) services which existed across England. Now, the "providers" compete with each other for patients and services.
Around the country, amalgamation and closure of hospitals have been going on for the last two decades. Hospitals have closed wards and cut beds for "efficiency" and either reduced staff or created a situation of relative employment cuts. Facilities have been moved from existing big hospitals for the creation of "super-hospitals". Valuable assets owned by the NHS have been sold off for a pittance. In this context, "sustainability" simply means reducing services to match insufficient funding. These are obviously not in the public interest.
Under present arrangements, health authorities are no longer responsible for the health care of the population, nationally, regionally and locally. The UK government has been acting in the direction of transforming the health and social care services into a corporate-led system.
This is the "long-term plan" to switch funding into a community service that is intended to be predominately dominated by the private sector companies. Increasing contracts are being given to private companies to manage GP and community services, hospital admissions and private online GP services that will de-register more and more patients and funding from the local GP system. This will restrict further access to local GPs.
These developments are influenced by the thinking that the costs of national health systems like the NHS can be reduced by introducing new models of care, reducing hospital capacity and expecting individuals to provide more "self-care". The UK government’s agenda does not include universal guarantee to free health care. The budget for health care is seen as a burden.
As health workers and the people as a whole across the UK celebrate 70th anniversary of the NHS, as they fight in every part of the country to safeguard the future of the NHS, they are discussing how to build this fight for a new NHS. Such an NHS must at the very least not exist as a pay-the-rich enterprise, but must meet the claims of all for health care as a right. Ultimately, to fight for the right to guaranteed health care, it must be recognised that the decision-making power of the working people is required over society and its economy.