The UK National Health Service (NHS) was established in 1948 as a universal service free at the point of delivery and available on the basis of need. This system replaced a fragmented, highly inequitable provision based on a system of charity, municipalities, and private services. This resulted in considerable divergence between health care policy and ystems in UK vis-à-vis USA. However, since 1970s with the increasing expansion and influence of markets, there have been various and repeated attempts at marketization of UK healthcare and an increasing divide between healthcare regulation and deregulation advocates and proponents in both UK and USA.
However, a fundamental difference between UK and USA health care systems has been that the UK health care system places specific responsibility on the government to ensure the availability of universal health services. Therefore, the various marketization and market orientated changes in the UK NHS and healthcare policy have been effected within the statutory framework of a fundamental government responsibility to provide a comprehensive health care service that is free to the users of services at the point of delivery and that covers the entire population of the country. This is explicitly enshrined in the health minster’s duty to provide a ‘comprehensive health service to secure the improvement in the physical and mental health of the people and the prevention, diagnosis and treatment of illness’ (NHS Act 1946: clause1; House of Commons, 1946).
The recent changes in health and social care policy and legislation in USA and UK, have once again taken seemingly opposite orientations.
Whereas, The Health and Social Care Bill (2011) in UK, results in devolution of central powers to local Health and Wellbeing Boards (HWB) and replaces the NHS system with a commercial market in which potential patients and suppliers compete for NHS funds from commercial commissioning consortiums, the USA Healthcare reform places greater responsibility for provision of healthcare services on the central government.
The Health and Social Care Act (2011) abolishes the current public administrative bodies known as Primary Care Trusts (PCT) that are government funded to meet the healthcare needs of their geographic population, and replaces them with consortiums of general practitioners (family doctors) who will have the responsibility of purchasing (commissioning) on behalf of their membership (users of services).
In this context some UK local authorities, such as Bath and North East Somerset council social services and the local NHS primary care trust (PCT), have created a new social enterprise (Sirona) who is charged with provisioning of adult social care and health care for the area. This includes responsibility from care homes and adult social services to community hospitals and health visitors. There are also examples of previous employees of local authorities and NHS forming social enterprises and serving as the service provider for their previous employers.
These changes are not limited to health care or adult social services, and encompass the entire system of health and social care services. For instance a couple of weeks ago, Virgin Care was announced as the preferred bidder for a £130 Million contract to run core NHS and social care services for children and young people in Devon, and from March 2013 will take over integrated children services in south west, this includes the delivery of frontline services. The same company has won a £500 Million contact with NHS Surrey to run community health services.
Therefore, in our debate on 24 July 2012 we would like to examine some of the following questions:
- Is there a difference between private and public provision of services?
- Public health and social care is paid for by all of us and therefore, is not free. Why not allow private enterprise to take the lead and to provide more efficient and cost effective services?
- What are some of the implications of The Health and Social Care Bill (2011) in UK?
- What are some of the implications of Obama’s Health care reform?
- Do these changes lead to globalisation of health care where international service providers replace the national and local providers (e.g. NHS in UK)?
- Is it necessary that social care service providers should have an understanding of the local context and community where they operate?
- What is the role of GP consortiums? What are the opportunities and challenges they face?
- Is it not more effective to have GPs manage the provision health care? And will this not bring health care provision closer to the final user of services?
- How can we ensure continuity and quality of services and care in this context?
- Are there any services that should remain as statutory and run by the government? or can everything be run by the private sector and under specific government mandate and legislation?
- What are the effects of privatising services such as child protection (child welfare) services?
- Can private enterprise be bestowed with statutory powers? What are the implications of this?
We will aim to discuss and explore these and other relevant questions in our debate on Tuesday 24 July 2012.
Join us @SWSCmedia for a debate on Public versus Private Health and Social Care… Challenges, Opportunities, and Realities… Tuesday (24 July 2012) at 8:00 PM BST (UK) / 3:00 PM EDT (US Eastern) @SWSCmedia.