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Health Editor
The British public must learn to live without "equity, comprehensiveness, and universality of health care", the Lancet medical journal warns in a damning attack on the Government's changes to the health service.
In a stinging editorial, the journal urges Stephen Dorrell, Secretary of State for Health, to "own up, face the music, and take the consequences from an angry electorate whose trust you have betrayed".
It accuses the Government of "privatisation [of the NHS] by the backdoor" which has been flung wide open by ministers.
The Private Finance Initiative (PFI), launched by Norman Lamont when he was Chancellor of the Exchequer in 1992, has triggered the attack. The initiative requires trust hospitals to find private finance for development before NHS funds are made available to them.
In an accompanying article headlined "NHS goes private", Dr Allyson Pollock, of the Department of Public Health Sciences at St George's Hospital, south London, says the PFI has led to profound and potentially disastrous changes in the provision of British health care.
"In the long term, this policy is likely to prove more costly than public sector borrowing (since western governments can always borrow more cheaply than the private sector) and its effects on health-care provision could be disastrous," Dr Pollock writes.
She argues that the initiative effectively hands over large chunks of the National Health Service to the private sector, with the result that profit rather than public health will become the priority; quality of care and terms and conditions for staff are likely to diminish; and public accountability for public funds is abolished.
There are more than 800 PFI projects currently in progress, many of which involve private investors being given NHS hospitals and land sites in exchange for new buildings which they will eventually lease back to the NHS.
This means they are guaranteed contracts for ancillary staff, lighting, laundry and waste services so that they are "exempt from competition and innovation", Dr Pollock says. "This effectively suspends compulsory competitive tendering, a cornerstone of the UK government's privatisation policy."
The Government says the risks for private investors are huge, but Dr Pollock asks, what are the risks in taking over a "pounds 32bn, recession- proof, inflation-proof business, with 0.75 per cent growth annually?"
She concludes that the PFI is a licence to print public money, and that the initiative is simply an extension of the Government's 1980 policy on long-term care, which has seen a massive switch from public sector provision of beds to the private sector.
The end result has been a diversion of pounds 1bn of taxpayers' money from services to shareholders in the private companies now providing 57 per cent of the total market in residential and nursing home care.
"The UK population ... cannot afford the costs of handing health care over to the private sector," Dr Pollock says.
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