This house believes that a market will deliver quality and efficiency in healthcare better than central planning ever could.
The NHS has been increasingly subject to market principles for the last 20years during which time costs have risen faster than in any comparable period in its history without a comparable rise in efficiency.[1] Central planning has given new benefits such as NICE and QoF which have increased quality and reduced health inequalities.[2][3] At the same time, due to their independent contractor status, GPs have always been able to tailor their services to meet the needs of their local community.[4] Quality and efficiency in healthcare though vital themselves, are not enough; we must include public health measures to manage the social determinants of health, which remain as urgent as ever. Unless we choose to abandon 60 years of universal healthcare, we must insist upon the redistribution of healthcare resources because poorer areas have a greater burden and complexity of health needs.[5] [6][7] Markets lead to monopolies of power and resources in global corporations such as United Health who are bidding for UK general practice surgeries.[8][9] Markets are inappropriate for the provision of healthcare, or for that matter any human necessity because they are driven by profits not human needs.[10]
As a result of markets in food more people than ever before are dying prematurely from obesity related diseases while billions of people remain starving. Profits are made from selling luxury foods to the rich, junk food to the poor and withholding food from the very poor.[11] Exercise has become increasingly subject to the market and there is a strong correlation between deprivation and lack of exercise.[12] My poor patients cannot afford to join the gyms my wealthy patients patronise.[13] Exercise on prescription, like the NHS, has been devised to compensate for the failure of markets to provide for the poor.[14]
Housing markets started the present global economic crisis. We are in a situation where rich people have second or third homes (or more), purchased for holidays and investments whilst more people than ever are unable to buy their own homes because the cost is too high. Prices are whatever the market will tolerate, not what is needed to house the population. [15]
Central planning is a feature of markets more than ever and in the recent wake of Cadbury’s take over by Kraft and the US government bail out of the US health insurer AIG (the world’s 18th largest corporation) and our own government rescue of HBOS we now know that international businesses are bigger and more powerful than many states. As far as central planning is concerned, markets are the problem not the solution. Major global corporations are too big to fail; huge banks, power stations and hospitals cannot be allowed to close. If they collapse, the government picks up the pieces. [16]
The World Health Organisation has said that health inequalities in lower and middle income countries are widened by markets and publicly financed healthcare is the preferred policy option. There is every reason to believe that this is the case in the UK[17]
I believe that we have a duty to care for our fellow citizens and that the NHS may be “the greatest expression of social solidarity found anywhere in the world”.[18] We cannot abdicate our responsibility to the market.
Jonathon Tomlinson
Feb 23rd 2010
[1] For details about the privatisation of the NHS see the BMA campaign www.lookafterournhs.org.uk/ Keep Our NHS Public http://www.keepournhspublic.com/index.php and my blog www.abetternhs.wordpress.com See also Julian Tudor Hart: The Political Economy of Healthcare: A Clinical Perspective Policy Press 2006 (the second edition is out very soon) and John Lister: The NHS after 60, for patients or profits? Middlesex University Press 30th April 2008
[2] Using NICE Guidance to cut costs in the downturn http://www.nice.org.uk/aboutnice/whatwedo/niceandthenhs/UsingNICEGuidanceToCutCostsInTheDownturn.jsp Accessed 23.02.2010
[3] Doran et al. Effect of financial incentives on inequalities in the delivery of primary clinical care in England: analysis of clinical activity indicators for the quality and outcomes framework. The lancet Vol 372Issue 9640, Pages 728-736 30 August 2008 doi:10.1016/S0140-6736(08)61123-X
[4] For an excellent analysis of local autonomy and corporate healthcare in the US see David Loxterkamp, The Dream of Home Ownership,, Annals of Family Medicine www.annfammed.org/ his other essays in the Annals of Family Medicine are highly recommended.
[5] House of Commons Health Committee Health Inequalities Third Report of Session 2008-9 http://www.publications.parliament.uk/pa/cm200809/cmselect/cmhealth/286/286.pdf Accessed 23.02.2010
[6] Julian Tudor Hart. Inverse care Law The Lancet Feb 27 1971 www.sochealth.co.uk/history/inversecare.htm
[7] Marmot Review: Strategic Review of Health Inequalities in England post 2010
[8] Raj Patel: The Value of Nothing. Portobello books 2010 www.rajpatel.org/
[9] http://en.wikipedia.org/wiki/UnitedHealth_Group Accessed 23.02.2010
[10] For a really deep and engaging review of the history of medicine, public health and socialised medicine, see all the books by Henry Sigerist, especially Medicine and Human Welfare, Yale University Press 1941.
[11] For a thorough investigation of global food systems see Raj Patel, Stuffed and Staved. Portobello Books 2007
[12] Elizabeth Dowler. Inequalities in diet and physical activity in Europe. Public Health Nutrition: 4(2B), 701-709 (2001) DOI: 10.1079/PHN 2001160
[13] Bodywise training. www.odywisetraining.com
[14] For a history of the NHS see Julian Tudor Hart, The Political Economy of Healthcare It’s worth waiting for the very soon to be published second edition. See also: Webster, C The NHS: A Political History, Oxford OUP 1998
[15] Very simple graphs showing trends and affordability are at www.mortgageguideuk.co.uk/housing/housing-stasistics.html Accessed 21.01.2010
[16] John Lanchester, It’s Finished. London Review of Books Vol. 31 No. 10. 28 May 2009
[17] World Health Organisation Commisson on Social Determinants of Health. Closing the Gap in a Generation. Final Report Chapter 12 http://www.who.int/social_determinants/final_report/csdh_finalreport_2008.pdf
[18] Professor the Lord Darzi of Denham KBE; resignation letter to Gordon Brown. July 13th 2009
A Better NHS 
£281m takeover of Care UK by private equity firm Bridgepoint demonstrates increasing differences of competitiveness, scale and accountability between traditional general practice and private providers.
http://www.pulsetoday.co.uk/story.asp?sectioncode=23&storycode=4125252&c=2