The Green Party holds that the profit motive should have no place in our health care – in any form of care

Natalie Bennett is a Green Party member of the House of Lords. She was leader of the Green Party of England and Wales from 2012-16.

The House of Lords last night debated the regulation of Physicians and Anaesthetist Associates in the context of a health system under enormous pressure. The shock of Covid-19 is certainly one part of that story, the deep discontent behind major strikes among doctors (continuing) and nurses, another, but the issues are long term and structural, and yet astonishingly little discussed.

That’s unsurprising in some respects. With restructure after restructure of the NHS, starting with the marketisation of the 1991 purchaser/provider split, introduced by the Tories and reinforced by Blair’s Labour, which led to a massive increase in management costs, changes have made its operation steadily more opaque and incomprehensible. 

The 2012 Health and Social Care Act, which took away the responsibility of the Secretary of State to provide health care, a fundamental blow to democratic oversight, instituted 207 Clinical Commissioning Groups. Then there was the 2022 Act, which redrew the structures again, restirring the alphabet soup with now 42 Integrated Care Systems (ICSs) that are responsible for allocating funds to trusts and commissioning services in their area.

These were yet one more aspect of the US healthcare system being imported into the UK, modelled on the Accountable Care Systems there. It is astonishing how much US models have been copied in our NHS in recent years, and how many senior managers imported from or having experience there, given the dreadful outcomes and enormous cost of its approach.

Yet it is hard to find a news story that even mentions the ICSs that are now so central to our NHS. Credit to Sky News for this rare exception, a detailed examination from December of their financial state, which is, in short, parlous.

Perhaps because it is a continuing story of disaster, there’s few stories now also about the impact of privatisation, despite the level continuing to rise. In 2022 nearly 10 per cent of treatments for NHS patients, more than 2 million people, were provided by private companies, up from 3 per cent in 2011. Yet there’s evidence that in areas where privatisation is at the highest levels the outcomes are dire – in the form of more people dying from treatable causes.

In mental health care – in the face of terribly tragedies, and much higher levels of privatisation, with public provision gutted – there’s been more attention. Now 55 per cent of under-18 inpatient mental health care is delivered by for-profit providers.

Meanwhile, we are all continuing to pay for the disaster of Labour Party-promoted Private Finance Initiative (PFI) schemes. That sees some hospitals paying a sixth of their total budget on payments, frequently to offshore hedge funds, and from a £13 billion original investment a final bill that will reach £80 billion, the equivalent of £1,200 for each person in the UK.

The Green Party holds that the profit motive should have no place in our health care – in any form of care – but the current largest opposition party, Labour, appears to be a fan of even further steps of privatisation.

There’s also long term underfunding, with austerity in the face of a growing and ageing population having disastrous impacts. Provision for investment on infrastructure and technology collapsed; the RAAC crisis was just one visible tip of a very large iceberg of decline.

And that austerity saw a collapse in real terms of the pay of nurses and doctors, which has seen a huge exodus overseas and to other jobs, meaning huge understaffing, which puts massive pressure on remaining staff.

Make no mistake. The state of the system is not the fault of medical staff. It is not the fault of managers. It is a long-term political failure, the application of ideology over evidence, the interests of private companies over public good.

This is the context in which the House of Lords considered my “fatal motion” on the regulation of PAs and AAs, and the “regret” motions of crossbencher and medical professor Baroness Finlay of Llandarf, a professor of palliative medicine and former president of the royal Society of Medicine, (who cannot be accused of having any political axe to grind) and the Lib Dem’s Baroness Brinton. Labour was lined up with the government.

The rules were brought in by means of an Order, a “statutory instrument” (SI) in our terminology, which was barely debated in the Commons, and which the Lords can only accept or reject (and it is extremely rare for it to do the latter). There would not have even been a debate in the main chamber had we three not put down our motions; there’s been nothing from Labour, which supported the Order.

It inevitably passed, despite the fact, as Lord Patel, medical crossbencher, said, it was “inappropriate” to be doing this through an SI.

I was asked on Twitter if this was the end. At one level, of course, it is, but at another this is only the start. As my speech made clear, we need “regulation by consent”, and I would urge everyone concerned to keep challenging the government and the medical hierarchy and regulators, to ensure the risks – to patients, to Pas and AAs themselves, to disadvantaged communities – are explored, understood, and as far as possible mitigated.

Finally, I want to be absolutely clear. I am not seeking to attack the existing PAs and AAs who’ve studied, taken on personal debt, and are doing their best. We need clear “scope of practice” rules that protect them, that are within the limits of their two years of postgraduate medical education, that does not see them pushed to act as though they are qualified doctors. And we need to explain to patients who they are and what they can, and cannot, do.

Comments are closed.