So you want to sell off the NHS? The 67-year old behemoth has radically improved people’s quality of life for nearly a century, so it won’t be easy. Here’s a handy step-by-step guide to privatising the health service.
1. Know your enemy
In 2010, a King’s Fund poll put NHS satisfaction at above 70% – the highest ever recorded approval rating. The UK is 31st in the World Bank ranking of 216 countries for child mortality; in 2013 there were 4.6 deaths per 1000 children under five. In 2005, there were six, while in 2010 the figure was 5.2. France is 25th, Germany is 21st, while the US is ranked 45th with 6.9 deaths per 1000 children. Luxembourg comes out top with two deaths per 1000, while Angola is ranked 193 with 167.4 deaths per 1000. The UK came first out of the 11 countries in eight of the 11 measures of care used by authors of a 2014 Commonwealth Fund study. “The United Kingdom ranks first overall, scoring highest on quality, access and efficiency,” the fund’s researchers concluded in their report (pdf). Their findings amount to a huge endorsement of the health service, especially as it spends the second-lowest amount on healthcare among the 11 countries reviewed. Only New Zealand spent less. According to World Bank data from 2013, the UK spends US3,598 a head, less than half the US9,146 that the US spends. To sum up, you’re faced with a well-liked, efficient, life saving machine. You won’t be able to try a head-on approach; public opinion will need to be swayed first.
2. Misinformation
The great thing about the NHS is most voters at any given election will not have had much experience of its services. Many people only see one aspect of the service, for them the NHS is for shoulder physiotherapy, antibiotics for a chest infection, and maybe the odd stitched wound at A&E. This is to your advantage. Start early by pervading a message of improvement and efficiency. Steer every news piece towards this same message, regardless of context. Be consistent and quickly this will become the norm. You will need some national newspapers on side to reinforce the message. Before you know it the NHS will be percieved as failing.
3. Divide and conquer
It doesn’t matter what you campaigned for – once you’re elected you only have to apologise occasionally and you can do whatever you want. Push through some major reorganisation as early as you can – use words like “transform”, “power” and “into the hands”. These will keep everyone in the service on the back foot trying to respond. Make sure any change is complex; this has two advantages.
It makes it difficult for opposition campaigners to create headline zingers against you and this is your opportunity to embed the legal framework to build your platform. If you have to bridge an election with this still hanging over you just apologise for it. Say it was a big mistake. Then once you’re re-elected you don’t have to do anything about it.
4. Wash your hands early
When no one is looking, make sure the government no longer has a legal duty to provide a NHS.
5. Open market
Everyone knows they get a better deal when one supermarket opens next to another one. Use that knowledge to your advantage. Use words like “competition” and “drive up performance” – the more you can paint the NHS like a car the better – people like to sell their cars. Meanwhile once the law has changed, open up the NHS to private contracts bit by bit. If anyone kicks up a fuss, you can say, “Come on! It’s only 4%! It’s only 8%!” etc. When the numbers start to get bigger, use the relative percentages: “It’s only increased by 15%!”. Useful phrases here are, “can we please focus on the bigger picture?”.
6. Undermine NHS staff
NHS staff will see what’s happening, and people will listen to them if you don’t do something about it. Politicians are the least trusted individuals in the country, while doctors are the most; start early on with subtle denigration of the perception of all NHS staff. Take any news report about A&E or midwives or doctors or nurses and make sure someone high profile gets on a box and sticks it to them. Appoint a health secretary who will regularly inflame the situation – this will create distraction from the sell off. Frequently offer empty re-organisations that both fail to address and belittle any problems.
7. Make cuts
Cut it, and cut it hard. People use A&E and the GP the most – keep these areas stripped of cash and drive up demand. Eventually, locum agency costs to cover staff gaps will cripple failing departments, and smaller GP closures will domino into bigger ones. Don’t be seen to be thrifty. Use words like “efficiency savings” and “reform”, and above all “austerity”. But do cut services away. The more gaps you can create the easier it will be for private companies to fill them. Put pressure on the front services by cutting departments like A&E and maternity, and sell off the back end like microbiology and biochemistry, because no one really understands this stuff anyway. Make sure you use this opportunity to crush the spirit of the staff – cut their pay in as boring a way as possible, eg by pay freezes and under inflation changes. Doctors and nurses will leave, temporary agency staff will come, the service will worsen and the people will suffer.
8. It’s showtime!
If you’ve followed the above steps then this will be a doddle. You’ve got a demoralised and depleted workforce, an unhappy electorate and you aren’t even spending very much on it all. You’ll need to do some handwringing, some lamenting, some explaining away. You will find these phrases useful; “It’s an ageing generation”, “21st century demand is too much”, and “the burden to the taxpayer”. Hopefully by this time you will have got private companies into at least 20% of services.
9. Sit back and relax
All your hard work no doubt has been a lot of stress. And those long hours of drinking and smoking and missing the gym have really taken their toll. You deserve some time off. Don’t worry about the newspaper backlash – it’ll come eventually, and there won’t be a hint of apology as the same papers that supported you will hypocritically tear you down. And don’t worry about that chest pain you’ve been having. You’re insured right? Oh you lost your job? But what about the end game – the cushy seat on the board of the health companies? Oh, you’re politically toxic now and all those backroom offers disappeared? And you didn’t save anything?
Oh.
Goodbye.
This is an edited version of a blog post that first appeared on juniordoctorblog.
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