The inequalities of British healthcare

4 Nov 2013

Delighted to now be writing as the new Backbench Health Minister, I’d like to start by focusing on an issue that has been running through almost all problems the NHS has been facing over the past decade. This issue can be described as great inequality in the distribution and provision of healthcare. Geographically, socially and economically, the standards of care being received vary substantially between different counties and social groups. Universality seems quite far away when in some cases there are decades in disparity between life expectancies, and I think that serious questions are going to need to be asked about how we’re going to safeguard our NHS in a world that is seemingly corporate and profit-driven.


But before we talk about tackling health inequalities, I think it’s important that we understand what the underlying causes of this disparity are. Allyson Pollock, professor of public health research, understood this problem as the manifestation of the commercialisation of our healthcare – more specifically, the introduction of the internal market. Huge reforms in the way hospitals operate took place under the Thatcher government, forcing all NHS hospitals to buy and sell services and provisions via an internal market. This has meant that the state no longer plays a role in deciding how resources are distributed across the service; instead such decisions are made on the basis of financial accounts and demands. Because of this, universality and equality is no longer a guarantee – as such a condition relies heavily upon the invisible hand of the market. 

Hospitals that were unable to cope with managing themselves financially within the internal market have mostly closed down, transferring demand to other hospitals and lengthening waiting times. Slowly but surely huge inequalities have become apparent in the standard of healthcare being delivered across different hospitals and regions in the UK. Richer, middle class patients have now turned to the growing private sector as the NHS whimpers in an endless cycle financial reshuffling – creating a whole new two-tier system in the service.


With the internal market, NHS hospitals are able to provision out services for the private sector in order to generate more revenue (a newly found obligation for our many hospitals).  This has meant that services previously used solely for NHS patients are now being used to treat private sector patients, effectively putting private patients ahead of NHS ones in waiting queues. Priority, in my opinion, has shifted towards paying patients at the expense of the general public. Quite obviously this is a huge source of inequality within our healthcare and is likely set to continue in coming years.

What can we do about inequality? I’d argue that nothing short of radical reform within our NHS will solve the problem at hand. We’re going to need a Health Secretary who will uphold the constitutional values of the NHS and the principals it was created under in 1946. This starts with getting rid of the internal market and the disparities it creates. Failure to act will mean the UK will slowly transition to an American style system, where thousands of patients die each year due to not affording health insurance. I’m glad to see Andy Burnham taking a People before Profits stance, and his pledge to end fast-track privatisation lights hope for the thousands fighting NHS restructuring. However, I still have concerns about the inequalities which will thrive in the years running up to the General Election. The question now is how British people can fight to safeguard their health service.

Backbench Minister for Health

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