[A-List] UK corporate state: unhealthy accumulation

["Michael Keaney" <michael.keaney@xxxxxx>]

Selling off by stealth is here to stay

Co-payment is a menace already threatening our public services

Allyson Pollock
Wednesday February 11, 2004
The Guardian

If you take the recent discussion about co-payments at face value, you would
be forgiven for thinking that they don't in fact exist. Peter Mandelson and
Tony Blair have recently presented them as an idea that is yet to become a
reality. But co-payments - the American term for what used to be called user
charges - are already the everyday experience of the old and frail, the
chronically sick and disabled, or most people who need dental or optical
care.

There are countless stories of the hardship people are enduring as a result
of the charges which are being levied upon them. Aneurin Bevan promised
people freedom from fear. Now that fear has returned. People, especially
older people and those with disabilities, have to endure not only the
hardship of their disability but also the crippling effect of co-payments.
My email box is inundated with tragic stories of individual hardship,
distress and injustice.

It is now government policy that it doesn't matter who provides the service
as long as it is publicly funded. The result is that there is no area of the
public sector, whether it be rail, postal services, healthcare, education or
pensions, that has not been - or is being - broken up, commodified and
privatised.

Take long-term care as a prime example. In England and Wales this is no
longer a right or a collective responsibility. Over the past 20 years the
NHS has almost totally withdrawn from the provision of long-term care. It
has closed beds and services, with the result that thousands of older people
are paying for their healthcare needs where once they had been promised free
care "from the cradle to the grave".

The primary responsibility for the care of frail or sick older people and
those with disabilities is largely left to 5.7 million carers, of whom
800,000 provide unpaid care for 50 hours or more a week.

The state only intervenes as a last resort. But rather than offer direct
assistance, it has turned the delivery of long-term care over to private
enterprise at an annual cost of more than £11.1bn. This has become an
increasingly corporatised sector. In 2000, 91% of nursing home beds and 75%
of residential care beds in England were operated on a for-profit basis.
Meanwhile, cuts in central funding have seen local authorities drastically
reduce the number of people receiving vital social services such as home
help and meals on wheels, turning over what remains to the private sector.

The truth is that Labour has not only continued the policies it inherited
from the Tories, but is extending them. Its latest painful policy
prescription combines time limits on NHS care with £100 fines for local
authorities that fail to discharge patients within two days.

But there is a contradiction in government policy. In its NHS plan 2000,
Labour stated that "charges are inequitable and risk worsening access to
healthcare by the poor". So how is this contradiction at the heart of
government explained? The uncoupling of funding from service delivery by
direct privatisation of services has been at the centre of its policy. But
the government has been quick to point out that this is not the same as
privatisation because the funding comes from the public purse.

But that is only part of the story. Under the public private partnerships
and private finance initiative contracts that the government negotiates, it
is guaranteeing the private sector a steady stream of income for 30 years.
It is also true that this income is paid for from tax revenues. This is a
dream scenario for the private sector, with the government acting as tax
collector.

But the high costs of these contracts have seen a reduction in services, as
well as public bodies facing financial ruin. The government can't bail them
all out - at least not from tax revenues. The solution is to offload its
political responsibilities by privatising not just delivery but funding.
Privatisation also involves the government giving the private sector the
right to vary and reduce public services, subject to the regulator's
authorisation. But the regulator's role, as we have seen with the railways
and postal services, is not necessarily to act in the public interest.
Rather, it is to operationalise the market, at least cost to the government
and minimal inconvenience to the regulatee.

It is not hard to foresee a time when foundation hospitals, faced with
revenue shortfalls, will appeal to the NHS regulator to reduce the package
of services, regardless of local people's needs. This is precisely what the
rail regulators agreed to last year. Service users beware. Despite the
rhetoric, the public must be under no illusions that co-payment is a
creeping menace that threatens the very heart of our public services.

· Professor Allyson Pollock is head of health policy at University College
London