Heralded by many as one of the best healthcare systems in the world, will new measures for reform of the NHS harm its admirable egalitarian ethos? Elizabeth Beecham examines the impact of proposals by the British Government

The National Health Service (NHS) is interwoven into the social fabric of modern day Britain; it is a system practically unique in the modern world due to its scale and core tenet of being a system which focuses primarily on clinical need and not ability to pay. Established in 1948, it is seen as an institution of the state and high degree of politicisation is apparent whenever change is mooted. The current proposals being advanced by Andrew Lansley MP, Secretary for State for Health are a plain example of public service reforms being introduced amid a bleak climate of economic austerity and debt reduction, and aim to reduce the NHS administrative budget by a third by 2014. The Conservative and Liberal Democrat parties that form the British coalition government may have convincingly beaten Labour in the 2010 election on a ticket of faster debt reduction, and seem resigned to achieving this by greatly reducing state spending on public services. Yet any measure that could impact on the ethos underpinning the NHS will face strong suspicion and resistance from organisations representing health care professionals and the public. Considering that overall the NHS employs 1.7 million people directly, this represents a challenge even for a relatively experienced politician such as Lansley to encourage positive reception by those directly affected to the proposals, and support has thus far been lacking. One of the reforms is to permit foundation trusts to increase the amount of revenue they can earn from private work to a maximum of forty-nine per cent.

The NHS operates as four systems in England, Scotland, Wales and Northern Ireland, with the service in each region functioning under a devolved trust model. The trusts are charged with managing specific areas of health care system in a region such as mental health, or primary care consisting of visits to the doctor or dentist. Foundation trusts, introduced under Labour, have a greater degree of managerial independence then other NHS trusts and set their own caps for the income they can receive from private patients, which generally tend to be low, at around two per cent. What the new flexibility to increase private patient income will mean for the ideology of the NHS and the impact on the quality of care that public patients receive are highly contentious concerns and will provide the main arguments against the introduction of the reforms.

Virtually all sections of the British political establishment propound the NHS’s virtues. Former Labour health minister Frank Dobson claimed that the proposals contained in the Health and Social Care Bill 2010-11 were in essence diverting “people in the NHS from the job of looking after people, they are privatising the NHS, they are fragmenting the NHS and they will cost us a fortune and do little or no good for anybody.”

Even British Prime Minister David Cameron made a point of praising the care that his late son, who was severely disabled, received from NHS staff. He highlighted these experiences as impressing upon him the value of the NHS and to assure voters that the Conservatives weren’t going to undermine or damage the institution. During the divisive public debate on Obama’s health care reforms in America in 2009, Cameron was quick to distance his party from comments made by a Tory MEP criticising the system and reiterated a bold statement made during a Conservative party conference “you can sum up our priorities in three letters: N. H. S … It is one of our greatest national institutions.”

At heart of the dilemma for Conservatives handling NHS reforms is the desperate need to free up public spending to meet their budget reduction target, yet they are wary that measures may be blocked due to a public perception that the Government is commercialising the NHS.

Former Labour Health Minister Frank Dobson claimed that the proposals were in essence, diverting “people in the NHS from the job of looking after people, they are privatising the NHS, they are fragmenting the NHS and they will cost us a fortune and do little or no good for anybody.”

A real risk that could manifest itself if the new rules increasing the percentage of private patients are implemented is an elevated list of private patients receiving a more expeditious approach to their care. This could prove to be as flimsy a reality as a Ryanair priority boarding queue or, as argued by groups such as the Royal College of Nursing, could significantly impact those who rely most completely on the care of the NHS; the poorest in society. Lansley points to an inbuilt protection in the legal mandate of foundation hospitals’ core duty is to care for NHS patients, yet it could be argued that this will have little impact on practical decisions about day-to-day care. With all NHS hospital to be run by foundation trusts by 2014, the significance of allowing increased numbers of private patients could greatly shape the delivery of NHS care in the twenty-first century.

The British public are fiercely protective of the ethos and delivery standards that the NHS lives up to, and one also cannot undermine the ‘public good’ as a tangible source of motivation for NHS staff. Given the profound interactions the NHS has had with the British public in moments of illness, death and vulnerability for over sixty years, NHS reform is a difficult tightrope for any British government to seek to balance upon.