Wednesday, 6 May 2015


On 9 June 2011, I attended a medical networking event at the Oxford and Cambridge Club in London. At the end, a man with an American accent stood up and spoke about how backward our NHS was, and about how everything was about to change as we adopted a ‘modern’ US style healthcare system.

Having worked in the US and experienced first-hand the striking contrast between both systems, I stood up and responded. The NHS is an excellent model for cost-effective universal healthcare, promising equal access to high quality healthcare without fear of bankruptcy when patients are at their most vulnerable. The US, despite all its innovation and technology in various cathedrals of excellence, spends far more on healthcare with worse outcomes and denies healthcare to its weakest.

Less than four years later, that vision of a US style healthcare system is being realised in the UK at a faster pace than many of us imagined possible.  The NHS has been reorganised and is now on its knees with flat-line funding since 2010, morale at an all-time low and more threatened ‘efficiency’ cuts. The Health and Social Care Act passed in 2012 set this government’s agenda for disruption of the NHS. It had two main effects.

A. Control of the NHS budget was handed to GP-led Clinical Commissioning Groups (CCGs) that were doomed to fail without adequate support. CCG support services have sprung to their aid, so that many jobs previously done by the NHS for the NHS (eg. the design of future services) will now be carried out by companies like KPMG, McKinsey and US health insurer United Health (1). Note that in 2010, KPMG’s head of global health believed that ‘in the future, the NHS will be a state insurance provider and not a state deliverer of healthcare’ (2).
B. CCGs are also being forced to open up every part of the local health service to private companies. Time-consuming tendering processes in which the NHS is no longer the preferred provider will lead to expensive bidding contests. In the US, administrative costs account for 20% of healthcare costs compared to 7% in the UK (prior to the 2012 Act). Private organisations will cherry-pick profitable services, leaving NHS providers to mop up less profitable work.

In order to save the NHS, the Health and Social Care Act 2012 must be revoked. The NHS must become the preferred provider of healthcare services to protect it from competition. We must resist changes that will make the NHS even more expensive and unaffordable. Electoral promises to pour £8 billion into the NHS mean nothing if the money flows out of the NHS and into private hands. 

Add to this equation the impending TTIP (Transatlantic Trade and Investment Partnership) between the US and EU which would make it impossible to reverse these changes, and the future of the NHS starts to look very bleak. Cameron has described fears that TTIP might damage the NHS as ‘bogus nonsense’ (3).

If like me you regard the NHS as a national treasure to be defended from global corporate interests, and if you agree that all of us (and especially the most vulnerable amongst us) should have access to healthcare free at the point of delivery without fear of bankruptcy, then please consider all of the above when casting your vote tomorrow.

Vinod Achan

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To see my 'Elevator Pitch' on NHS reforms in 2013, see here.