mal notably removing the legal definition of a private patient from its Health and Medicines Bill.
But even before it gets to fundamental structural changes it is clear that the government is planning cuts in the real effectiveness of the NHS. It is planning to run the NHS down and make it unPhoto: GRAEME COOKSON These figures have been denounced not just by the health unions and the but by every: health organisațion.
• The British Medical Association (BMA) announced following the white paper that: Politicians of all parties must intervene in the debate on the white paper to ensure that additional funding is provided? Uneconomic But if one side of the Tory coin is running down the NHS the other building up private medicine largely at the taxpayers expense The truth is that private medicine is uneconomic and can only be sustained deliberate government policy: The facts of the last nine years show this.
As soon as it came to office in 1979 the Thatcher government set about trying to increase the weight of private medicine in Britain. The number of those taking out private health insurance schemes jumped by 20 per cent in 1980.
But since then the increase in private health ELas slowed down dramatically. Since 1981 growth has been three per cent a year.
A key reason is soaring costs. For four successive years after 1983 private health insurance premiums rose faster than inflation - with a 15 per cent increase in 1986.
Chronic This is despite the fact that private insurance schemes are, of course, careful to turn down those who have greatest need of health care and concentrate on the profitable. Kidney failure for example is not covered by the British United Provident Association (BUPA) and Private Patients Plan (PPP) - the two groups which together account for ninety per cent of private health insurance. BUPA restricts chronic coverage to 180 days in hospital a year. PPP does not cover psychiatric сате, Callal complications, or drug and alcohol dependency.
Their schemes are also particularly biased against the elderly. spokesperson admitted: The elderly have both heavier use of hospital care and once in hospital tend to stay longer, pushing premiums up..We only have about 300,000 people past retirement age. They are at present subsidised to. some extent by our younger subscribers. But SO, for them expensive. If they got tax relief, many more thousands would continue their cover.
Despite thebe restrictions a Bupacare plan providing coverage for a married health insurance take it out individually. More than a half (1,160,00) are covered by company schemes. The rest (391,000) are in some form of group scheme.
Private The therefore concerhed to bring about a dramatic increase in the proportion of the population using private medicine.
proportion population covered by insurance went above 10 per cent for the first time since the creation of the NHS. Running down the NHS is seen as one way of increasing this figure As The reported:
Conservatives advising government that private health insurance will grow naturally if the squeeze on the NHS is maintained. The other crucial measure is introducing tax relief on private neal lsurance senemies Far from 'aiding the NHS', as on official Tory ideology private medicine is supposed to do, such tax relief would immediately strike a major blow against the public health service. As Malcolm Dean noted in the Guardian: 'Extending tax relief to all, even if it was restricted to the basic rate... would mean an immediate bill of over £150 million for the government without any extra help to the NHS - tax relief at 27 per cent on the estimated f650 million spent last year on health insurance premiums last year. Tax relief would undoubtedly increase the number of people taking out insurance because it would cut the cost by 27 per cent (or 25 percent if the basic rate is reduced). Just how many extra is difficult to predict. It is precisely because it strikes such a direct blow at the NHS that tax relief private health, insurance schemes is a political hot potato.
Battlefield While the government has so far had limited success there is no doubt that it is beginning to shift the balance in health care. For example the number of NHS beds fell by 41,000 between 1979 and 1985 while the number of beds for acute cases in the private sector rose by 3,600.
The government has decided to take the opportunity of the crisis in the NHS to take a step forward in its plans for degutting the health service and setting in place an economically and socially inef ficient and irrational, but privatised, health service. That is why even when it has every economic means to increase spending on the NHS it refuses to do so. Its political goals take priority.
This is why the entire the entire NHS has become a battlefield starting salaries are all higher than the maximum pay of a ward sister/charge soulse Nurses fare in : London weighting allowances, rent allowances and so on, and, unlike the police, do not receive free prescriptions, dental treatment etc.
Any extra pay for 'unsocial hours' is therefore a necessary part of a nurse's pay. But nurses have one of the worst shift payments systems in Britain.
Unsocial hours' payments only begin at 8pm and the payment for week ends was reduced two years ago from 33 per cent to 30 per cent for Saturdays (same rate for early and late shifts) and from 66 per cent to 60 per cent for Sunday working and bank holidays.
Most nurses work shifts - although traditionally there has been a separate night-shift However in many health authorities are now trying to change existing shift systems.
Some authorities have now abandoned a separate night shift and all staff have to BICS ON rotation. At the government's instigation health authorities are also trying to reduce the amount of overlap between the morning and afternoon shifts.
All this has effects on both patients and staff. For staff it has meant that those on late shift work later in order to allow the night shift to begin work later, while those on early shift have to start sooner in order to further reduce the night shift. The biggest losers are those working nights who now have to work an extra night per month for the same pay.
Overlap Patients suffer because the afternoon overlap is often the only time when many jobs can get done - wnen nurses Ila. have some time to sit and talk to patients In psychiatry the afternoon is often the only time when it is possible to take patients off the ward (whether for treatfor specific problems such agrophobia which cannot possibly be dealt with other than off the ward, or for outings, which are a necessary part of life for the elderly mentally ill spending the rest of their days in hospital).
student suffer any reduction in the shift overlap as this is often the only time when qualified nurses are available to teach them. The reducDespite the view amongst nurses for the need for more NHS accommodation little is done to rectify this situation. Moreover there is a need for accom modation for all grades of staff in the NHS, not just nurses. The problem of accommodation will combine with the problem of low pay even more when the poll tax is introduced, further exacerbating the problems of staffing levels.
To make matters worse there has been