How Thatcher CREATED the split between the NHS, social care and community mental health services

It is summer so we have inflated the NHS Detective Think Paddling Pool. In it, NHS Detectives are looking at how Thatcher CREATED the split between the NHS, social care and mental health services.

This history might suggest some ways of reversing this split and repairing the damage it caused, that are better than the government’s and NHS quangos’ current fix. For instance, repairing the damage created by Thatcher (and the New Labour government too) could mean:

• Returning responsibility for the long term care of the elderly to the NHS and increasing NHS funding accordingly
• Abolishing the market in care homes
• Returning responsibility for the long term care of the mentally ill to the NHS and increasing NHS funding accordingly
• Restoring the caring arts to professionalised nursing and ending the split in nurses’ roles between “personal care” and “health care”

In contrast, the government and its NHS quangos’s “solution” is to dismantle the NATIONAL Health Service into 44 local Integrated Care Systems and Providers. They want to conclude the process by 1 April 2021, when all 44 Sustainability and Transformation Partnerships have to become Integrated Care Systems.

Integrated Care Systems are copies of USA-style Accountable Care Organisations – cost-cutting health care organisations that make up the USA’s Medicare/Medicaid system. This provides limited publicly-funded healthcare for people who are too poor or ill to get private health insurance. It is designed to reduce “demand” for healthcare.

Integrated Care Systems are NOT going to solve the problems of long term care of the frail elderly and people with mental health problems.

Thatcher shifted NHS responsibilities for long term care of the elderly to local authorities

In her first term Thatcher shifted NHS responsibilities for the long term care of the elderly on to local authorities.

(This could be seen as a progressive change in that all too often the elderly had been simply ‘warehoused’ in hospitals. By shifting the responsibility for long term care of the elderly to the social services departments of the local authorities it became possible to provide an integrated service that could support many more old people in their own homes.)

Means-tested “hotel charges” for local authority care of the frail elderly

But it didn’t quite work out like that. Shifting responsibility for the long term care of the elderly out of the NHS had a downside.

It allowed for the subsequent introduction of means-tested ‘hotel charges’ for those who were deemed to have sufficient assets to pay.

This violated the NHS principle that people receiving health care should not pay ‘hotel charges’ for their stay in hospital or other institution. But because long term care of the frail elderly was no longer classed as NHS care, this principle was simply abandoned.

Paved way for privatisation of old people’s homes

This meant that the growing numbers of older people who had become homeowners during their working lives found that they were required to sell their homes if they needed to enter old people’s care homes. It also eventually paved the way for the privatisation of old people’s homes.

In case people are tempted to lay the blame for this solely at Thatcher’s door, the New Labour government – which Thatcher hailed as her greatest legacy – nailed the door shut on this erosion of collective responsibility.

New Labour government rejected Royal Commission view that long term care should be a collective responsibility

In 1997 the New Labour government set up a Royal Commission to examine the funding of long term care. The 1999 Report reaffirmed the 1948 consensus that long term care should be a collective responsibility, but the Labour government rejected its findings.

Allyson Pollock writes,

“By 2000, the Treasury and the Department of Health were wedded to market solutions and the long term care industry had become too powerful to challenge.”

Allyson Pollock, NHS PLC – The Privatisation of Our Health Care, Verso (2005)

Thatcher transferred NHS responsibility for long term care of mentally ill to local authorities

In 1988 the Thatcher government further reduced the scope of NHS care with the transfer of responsibility for the long term care of the mentally ill to local authorities.

This allowed for the closure and sell off of the large mental hospitals, along with their often spacious grounds, as mental patients were transferred to ‘care in the community’.

Thatcher required local authorities to privatise long term care of the elderly

At the same time, local authorities were obliged to contract out the long term care of the elderly to privately run nursing homes. This opened up a whole new market for private nursing care.

In NHS PLC, Allyson Pollock writes:

“The state has now largely turned long-term care over to private enterprise, and over the past two decades has created a for-profit industry worth some £6.9bn/year. In 2003, 90 per cent of nursing home beds and 63 per cent of residential care beds for elderly, chronically ill and physically disabled people in the UK were operated on a for-profit basis. The almost 400,000 older people in those homes are now a source of income and profit for an increasingly corporatised sector…

The NHS has almost entirely withdrawn from the provision of long-term care. The result is that many thousands of older people who had once been promised free care in their final years are now paying for it. ”

Split between reprofessionalised NHS nurses and casualised care workforce employed by private companies

Around the same time, nurses’ pay was re-graded as part of a move to transform nursing into a ‘modern profession’. This facilitated what was to become a growing split within hospital workers between reprofessionalised nurses and an increasingly casualised and temporary work force employed by private contractors.

Apart from Allyson Pollock’s NHS plc, this info comes from a really good 2012 article called “Driving the NHS to Market”

NHS Detectives investigate the crimes of NHS privatisation and cuts. Don’t be a silent witness! Defend #NHS4All!