The aims of the NHS
figure. This section will look at two key aspects: Private Finance Initiatives (PFI) and The Health and Social Care Act 2012.
PFI Although, the ‘internal market’ structure 35 was created under the Conservative government, the millennium and Labour’s victory in 1997 brought significant change to the running of the NHS. PFIs involve using private sector money, instead of public sector funds. This effectively causes loans to be taken out with (excessive) interest rates. The key issue is that the NHS is required to repay the loan, with high interest, over a set number of years. The companies 36 operating the PFIs made huge pre-tax profits of £831m from the NHS between 2010 and 2015. Money is being used to pay off huge debts for a long period of time and wasted in interest repayments, which could be used to address the funding gap. Health and Social Care Act 2012 This act saw some of the greatest changes that the NHS has seen ever before. At the foundation of the NHS, 37 it was made clear that the Secretary of State for Health would be responsible for promoting ‘ the establishment of a health service’ . However, this new reform turned itself away from one of the key principles of the NHS and created various other bodies, in which private companies were able to compete; this, effectively, aimed to reduce the amount of government intervention and responsibility. 38 These two acts have increased the amount of private intervention in the NHS, while simultaneously reducing the government’s role. If the PFI exposed the threat of privati zation in the NHS, then the Health and Social Care Act 2012completed the gradual efforts to divest governmental responsibility. The privatiz ation efforts were foreseen to ‘reduce waiting times’. 39 Indeed, one would believe the diversion of patients to services outside the NHS would reduce the burden on the NHS, but, self- evidently, this has been an abject failure, highlighted by the section titled ‘Funding’. The fundamental issue concerning patients is the primary desire of private companies to make profit and the possibility of comprising patient care and health for greater profit, indicated by primary research. Increasingly, the threat to the NHS in a trade deal with America has been exposed. There is a threat that clinical services and drugs could be provided by American companies, which may contradict NICE guidelines, potentially jeopardizing its role. As an example, one 40 mg pill costs approximately $7.78 in the U.S; the price drops to $2.21 in the U.K. 40 In an already under-funded NHS, paying US prices would create an even larger problem, making the NHS unsustainable. One can only wait to see what happens, but, if anything, the previous actions of successive governments in terms of privatization should make us, certainly, worry about the future of our NHS.
National Institute for Health and Care Excellence (NICE) The government set up NICE to give national guidance on quality of care and advice on ways of improvement. 41 Primary research highlights that NICE plays an integral role for nearly all healthcare
35 Welch, 2018. 36 Welch, 2018. 37 Parliament, 1946 NHS Act, 1946. 38 Welch, 2018. 39 Health Secretary, 2000, p. 82. 40 Miller, 2018. 41 National Institute of Health and Care Excellence, 2020.
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