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You can find the current article at its original source at http://www.theguardian.com/healthcare-network/2015/aug/04/how-to-sell-off-the-nhs-in-nine-easy-steps
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| How to sell off the NHS – in nine easy steps | How to sell off the NHS – in nine easy steps |
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| 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. | 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 enemyIn 2010, a King’s Fund poll put NHS satisfaction at above 70% – the highest ever recorded approval rating. United Kingdom is joint fourth in the world for child mortality outcomes, joint fourth in the world for life expectancy (male), and joint eighth in the world for maternity mortality. However, it currently spends only 9.1% GDP on healthcare or US$3,598 per person, which is free at the point of service. The US spends twice as much (17.1% of GDP or US$9,146) and scores sixth in child mortality, sixth in the world for life expectancy and 24th for maternal mortality. 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. | 1. Know your enemyIn 2010, a King’s Fund poll put NHS satisfaction at above 70% – the highest ever recorded approval rating. United Kingdom is joint fourth in the world for child mortality outcomes, joint fourth in the world for life expectancy (male), and joint eighth in the world for maternity mortality. However, it currently spends only 9.1% GDP on healthcare or US$3,598 per person, which is free at the point of service. The US spends twice as much (17.1% of GDP or US$9,146) and scores sixth in child mortality, sixth in the world for life expectancy and 24th for maternal mortality. 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. MisinformationThe 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. | 2. MisinformationThe 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 conquerIt 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. | 3. Divide and conquerIt 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 earlyWhen no one is looking, make sure the government no longer has a legal duty to provide a NHS. | 4. Wash your hands earlyWhen no one is looking, make sure the government no longer has a legal duty to provide a NHS. |
| 5. Open marketEveryone 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?”. | 5. Open marketEveryone 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?”. |
| Related: Privatisation is ripping the NHS from our hands | |
| 6. Undermine NHS staffNHS 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. | 6. Undermine NHS staffNHS 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 cutsCut 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. | 7. Make cutsCut 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. | 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. |
| Related: Outsourcing in the NHS – your views | |
| 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? | 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. | Oh. |
| Goodbye. | Goodbye. |
| This is an edited version of a blog post that first appeared on juniordoctorblog. | This is an edited version of a blog post that first appeared on juniordoctorblog. |