It was the Labour Party that started introducing ‘market reforms’ into the NHS, based on the assumption that market-based competition is better than services based on planning, collaboration and peer review by health professionals. Those reforms, back in 2000, were ‘informed’ by a study commissioned from McKinsey at great expense. When Oxford branch member John Lister went back to examine that study, it turned out to be 156 powerpoint slides which, he says, consist of “one assertion after another”. Assertions like: Reducing GPs consultation times by 30% could save £200 million across the NHS. “Nothing about what the consequences would be if doctors reduced their consultation times by 30%, or what the doctors actually think about it, or what the impact would be on patients.”
“If my students handed me a study like that,” said John, a lecturer in health journalism at Coventry University, “I would hand it back for lack of evidence.”
John was speaking at the launch of his new book Health Policy Reform: Global Health versus Private Profit, on Thursday 6th June – a unique and thoroughly researched publication that takes a close look at the evidence (or lack of it) behind health policies being pushed increasingly in the UK, and more disastrously around much of the developing world. More importantly, it revisits some of these policies, introduced with much fanfare and little scrutiny, and examines how they have worked in practice. The only conclusion, he says, is that they haven’t.
And how could they? As John points out, the people who need healthcare services most are invariably the ones who can least afford to pay: the very old, the very young, and the poor. Among those more able to pay, insurance companies do their utmost to make sure that they have get-out clauses that let them wriggle out of paying for the expensive stuff and illnesses their customers are most at risk of developing
“Look at the US: middle-income people bankrupted by healthcare costs. In Peru, 40 per cent of wealthy people can’t access healthcare – never mind the poor.”
It is the UK, under the present government, however, that is now taking a lead in pushing through every variety of market reform on the basis of very little more than ideology – and the virtual absence of any critical appraisal. The very morning of John’s book launch, David Nicholson, the head of NHS England, who will shortly be vacating his post after 10 years presiding over many of these ideologically led policy reforms, commented in an interview that we now need to “question” the idea of the purchaser–provider split. “Why didn’t [he] say that in the last 10 years? Why not when the reforms were going through? Why didn’t [he] say anything about the Health and Social Care Bill until after the Lords had signed it through? Why start critiquing the system now, to get some credibility when all of us were opposed all the way through?”
Researchers and journalists need to take some of the blame, said John. Researchers because they follow the lavish funding offered by the WHO and IMF for people who come up with findings that fit in with their beliefs, and journalists who assume that the orthodoxy being pushed by the big global bodies and research organisations must be right, and fail to ask the awkward questions and demand the evidence.
John’s book, in contrast, is all about the evidence; it fills a huge gap in the health policy debate and has been welcomed by many leading researchers.
What the experts say:
“Essential reading for all students and practitioners of health and social care who want to understand the context within which they are now being condemned to work, and start changing it.” Julian Tudor Hart, author of The Political Economy of Health Care: a clinical perspective
“A really important book which is as ambitious as all-encompassing, and as undoctrinaire as to qualify as a sort of Doyal Political Economy of Health for the 21st century.” John S Yudkin MC FRCP, Emeritus Professor of Medicine and former Director International Health and Medical Education Centre University College London
“A must-read for anyone passionate about universal health care to understand its greatest obstacle and where we must focus our fight” Anna Marriott, health Policy Advisor, Oxfam
“At a critical time for public health care and health systems across the world, John Lister’s book gives us valuable insights into the forces that are arrayed against universal health care and how capitalism is consuming our basic rights and entitlements. It’s time to organise and get them back.” Allyson Pollock, Professor of Public Health Research and Policy at Queen Mary, University of London
Health Policy Reform: Global Health versus Private Profit is published by Libri
More information can also be found at http://www.healthemergency.org.uk