The End of the NHS?

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For over three decades the public services in Britain have vastly changed from the post war consensus. This documentary will analyse how these services have changed and to what degree creeping privatisation has played an important role. The NHS and has undergone huge changes. Did the era of Blair live up to the hope of so many? Or did he sell off more parts of the NHS than Thatcher? This documentary will investigate the true inner workings and bureaucracy of the NHS and it will highlight to the public that this great British institution is increasingly in danger of becoming extinct.

Narration: Nothing has caused greater damage to Britain than the Second World War. Many towns and cities were devastated by the German bombing campaign. However, once the fighting had finished, it wasn't just the bricks and mortar that was rebuilt - this was a time for a new Britain. Society was reshaped, and a large part of this change was the founding of the National Health Service. The new national health service starts; providing hospitals and especial services; medicines drugs and appliances; care of the teeth and eyes; maternity services, ask your doctor now if you are look after under the new scheme. Lucy Reynolds is an academic specialising in health policy. She explains the simple idea that became a cornerstone of British society.

SOUNDBITE (English) Dr Lucy Reynolds, of School of Medicine: “Anybody who paid any tax, tax of any kind would be contributing to the system and people would be able to use the system when they needed it. When they were ill. To do it that way is the cheapest way to arrange things. And overall it was a very well-organised way of doing things, which is why it got copied by a lot of countries.”

Narration: Six decades after the formation of the NHS, many British citizens cannot imagine life without it.

VOX POP (English) Unknown man: “For me it is a fantastic free service. It keeps everyone fit and well and pretty integral to our culture I think actually.”

VOX POP (English) Unknown man: “It might be for the fact that, yes it is dear and ...If at any time you are like out of the job, low in funds, then it doesn’t mean you would die because you can’t afford health.”

VOX POP (English) Unknown woman: “I think it is good thing to have. Certainly I have been in this situation before were I needed medical treatment and I wouldn’t be able to afford it without the NHS. So, yah it is hugely important and I think it is good thing to have.”

VOX POP (English): “Well, life would be harder without it. Let’s put it that way.”

SOUNDBITE (English) Dr Louise Irvine, of National Health Action Party: “There is an annual survey done; official survey done of attitudes to the NHS and to many other aspects of society and the popularity of the NHS at all time high in 2010. There is also international academic evidence that the NHS was one of the most cost effective and clinically effective health services in the world.”

Narration: The NHS has huge political importance in the UK and every political party goes into every election shouting loudly about their own policy and plans for the NHS. Small reforms are constantly carried out on it, but the current coalition Government has made some of the biggest changes ever seen. These changes could be the first step towards the privatisation of the NHS, and have stirred up anger amongst many health professionals. Dr Dipankar Nandi is Consultant Neurosurgeon in Imperial College healthcare NHS Trust. He believes these changes may take time to implement.

SOUNDBITE (English) Professor Dipankar Nandi, Consultant Neurosurgeon at Imperial College: “Nobody likes change. It’s human nature. So, in that sense I think no matter when and no matter in what fashion you introduce especially in a huge organisation like the NHS, which means so much to so many people; almost everyone in Britain. And, which also occupy such large proportion of public expenditure. So, any major change on anything like this is never going to be universally accepted. I think it will be wrong to expect that to happen“

Narration: Natalie Bennett is the leader of the UK's Green Party and strongly opposes the present health reforms. Her blueprint for the NHS in the future, is to look to its past.

SOUNDBITE (English) Natalie Bennett, Leader of Green Party: “I think we need to go back to sort of ten years or so back and look at what we had, which was a publically owned and publically run NHS, which is what the Green Party very much believes in and support and would like to go back to. And that publically owned and publically run NHS it was based on providing services free at the point of need; based on need. That gave us one of the most cost effective and best health services in the world. That was where we were and the kind of problems we are seeing now, which have being used to attack the NHS other result of many of the changes that they have already being made.”

TIME CODE: 05:00_10:00

SOUNDBITE (English) Professor Dipankar Nandi, Consultant Neurosurgeon at Imperial College: “But the one thing this is done, as I said before is that, which has made people sit back and think of what really is the national health services there for? How are we going to have to pay for it? Because that is very very important. The ideal of providing absolute latest and the best healthcare to everyone is a very good one; but someone has to pay for it. And I think it is very important everybody in all places in Britain should think about it.”

Narration: The main change that the coalition has made to the NHS is who gets to spend the money. They want decisions about what supplies and services to fund to be made locally in each area, and for the people who make those decisions to be doctors themselves rather than managers. On the face of it, it sounds like a good idea.

SOUNDBITE (English) Professor Dipankar Nandi, Consultant Neurosurgeon at Imperial College: “It is practical it is much easier for user group, the patient group and the community to hold their local GPs and the local health authorities to account because now they don’t have the excuse of saying: well we are doing what is coming from central dictate because now they have a budget, they are in control of that budget and they have responsibility to deliver appropriate care and in that sense member of public has a greater to say in many ways.”

Narration: On the other side of this argument is Sue Richards. She is a member of ‘Keep Our NHS Public’, a campaigning group that sees the Government reforms as damaging to the core principles of the NHS.

SOUNDBITE (English) Professor Sue Richards, Co-chair at Keep our NHS Public: “I think the government rhetoric is that they have handed over the power to the GPs through the clinical commissioning groups, which is dominated by local GPs and which make the local decisions about commissioning but actually what is actually also put in place is a market framework that requires those GPs and the clinical commissioning groups to put services out to tender each time an existing contract with an internal NHS supplier comes up, it has to go out to tender and of the umpteen of those that have so far been put out to tender since this Act came in to being, 80% have gone out to private sector. So, it is very much still the thin of the wedge in terms of privatisation, but it tells us very clearly what the direction of the travel is.”

SOUNDBITE (English) Dr Louise Irvine, of National Health Action Party: “It’s still going to be funded by the state, but state is going to be giving more and more of its money to the private companies to provide services for patients. Now at first patients feel very little difference because it still be free. It is still free healthcare but our concerns are that the private companies to make a profit form a service have to start to cut their costs. And the main way of to cut costs is to cut the staff levels. Because the staffing is the major expense. And once starting to cutting staff ratios quality of healthcare goes down and we have seen some examples of that.”

Narration: Richard Taylor is the co-leader of the ‘National Health Action Party’. His medical career spans four decades, and he has a strong understanding of the health service in the UK.

SOUNDBITE (English) Dr Richard Taylor, Co- Leader of National Health Action Party: “Job security will go with privatization and the skill mix will go down because is far cheaper to employ care assistance than registered general nurses. So, the standard of care inevitably could fall.”

Narration: This is Andrew Lansley. The NHS reforms are his brainchild. He did not heed the dissenting voices we have just heard from and pushed his NHS reforms through. As you can see, his unshakeable faith in these reforms has not made him popular.

SOUNDBITE (English) An old lady challenging Andrew Lansley on street: “You could wait for a change! You could wait like people are waiting for a bed now. And when it goes private, when it goes private we don’t have any. You were privatising since 1979 don’t you dare lie to me! No, I'm not letting you go, no I'm not letting you go!”

Crowd shutting in street against Andrew Lansley: “Shame on you! Shame! Shame on you! We don’t go away Lansley! Shame on you! Don’t shake your head!!”

TIME CODE: 10:00_15:00

SOUNDBITE (English) Old Lady in street: “He's gutless, he's a coward and he's got no conscience. They'll only look at the few who didn't vote to gain it not the majority who vote against. Always the few, they only look at the few because they know that the majority are against them. So they never invite the majority, only their little few.”

Narration: The Conservatives promised no major reform of the NHS during the 2010 General Election, but Lansley has been planning these reforms in secret for some time.

SOUNDBITE (English) Professor Sue Richards, Co-chair at Keep our NHS Public: “Actually Andrew Lansley the first secretary of state in this government. First secretary of state for health had been working for many years to introduce exactly what the 2012 held for social care act did bring about. So, although there were elements of marketisation before that was different from going over whole sale to a new market model. “

Narration: The Conservatives are adamant that their reforms are the right thing to do, and that the critics are wrong.

SOUNDBITE (English) David Cameron, British Prime Minister: “I am committed to the changes, I am committed to take them through but we need to do everything we can to explain to people this is about improving and enhancing our NHS not in any way in danger.”

Narration: Is this stubbornness based on principle though? Or is it something darker? The Unite union put together a dossier of MPs who have financial interests in private healthcare companies. Unite say that there is corruption at the heart of the NHS reforms. Many of these companies have made substantial monetary donations to influential. Conservative MPs and Ministers, and these companies will benefit financially from the reforms. Andrew Lansley, William Hague, and even David Cameron have links to such companies. The Conservatives are quick to point out that none of this information was secret, and that all ties to these companies were declared in the proper way. But the question remains, shouldn't MPs sever all ties with private healthcare before passing legislation that is hugely beneficial to those organisations? How can the public possibly trust the motives of their government when money is changing hands in this way? Unite call it 'a betrayal'. The real question is what does this mean for an ordinary member of the public? What effects have these reforms had on the healthcare provided to patients? And what do they mean for people working in the health service?

SOUNDBITE (English) Dr Louise Irvine, of National Health Action Party: “Down in Cornwall there is a private company called 'Circle', which took over out of hours care there and there have been many many complains and criticisms, including the fact they fiddled some of the statistics. People don't have any choice but to use that service because it is the only one providing out of hours care. You have got 'Virgin Healthcare' have taken over providing community services in south east England including parenting care for children and some community nursing and community hospitals. The problem with, that is we don't know what the quality of standards are because we can't ask questions of private companies because the information what we call commercially confidential, so it is really hard to scrutinise them.”

SOUNDBITE (English) Natalie Bennett, Leader of Green Party: “I think, when I talk to the NHS staff and what it feels like, they feel like, they are kind of sitting on top of a rumbling volcano. Lots of things are changing; lots of things are expected to change in the near future. They are living with considerable uncertainly. They don't know if their job would be there next year.”

SOUNDBITE (English) Dr Richard Taylor, Co- Leader of National Health Action Party: “The vast majority of doctors and nurses are completely committed to providing the best service they possibly can for their patients and the more reorganisations and edicts come through it worse it gets as far as I am concerned.”

Narration: People working in healthcare often speak of it being a difficult job involving long hours that pays a pretty ordinary wage. David is an ambulance paramedic and agreed to speak out on the condition that his identity is concealed. He paints a grim picture of what performance targets and austerity cuts have done to the ambulance service.

SOUNDBITE (English) David, Paramedic: “Myself personally, I believe that certain people in certain areas are now more at risk. We are still behind the target driven culture in the ambulance service of arriving on scene at the category A. We've got 75 percent of those. The higher percentages of those actually occur in cities. So the ambulance I believe again, ambulance services concentrate all their resources there. Frontline services I believe in the cities are pretty well sustain still but I believe personally again that people are at risk in the countryside. So, if you are ill, have suffer of a heart attack or stroke you need to be picked up quickly and transfer to the hospital, I think you are at higher risk now you were five years ago. I think some ambulance services are moving towards what they call it 'front loaded model', which is replacing ambulances with cars! And primarily have done this and we can stop the clock. So we get a car there and then stop the clock. And then it will take I have heard of incidences recently, where cars have been waiting on the scene for an hour, and somebody had a heart attack. Because it was not enough ambulances to pick those people up and it is important with heart attack patients to get them into a hospital and they can have an operation called PCI, and they longer wait on the scene they more worry they gonna become and the more damages done to their heart.”

Narration: Privatisation is an issue for the ambulance service as well. Privately operated ambulances have become more and more common, but the conditions that the staffwork under are completely unacceptable.

SOUNDBITE (English) David , Paramedic:“With the people I spoken to, they don't have an annual leave, they don't get paid any sickness, they have to fund their own uniforms. Travelling time to and from work, sometimes it could be an hour and half or two hours for them. Stories about from six months ago even of a private company is working in east of England and they have to sleep in tents because their overnight substances were not enough to cover a hotel. So these people are now sleeping in tents and also are answering emergency calls. And I wouldn't want that, not for number of staff, not for the patient your going to the next day. If you want somebody turning up for your family member, you want them in tip top shape.”

TIME CODE: 15:00_20:00

Narration: Private staff are not the only ones facing difficult working conditions. Public service ambulance staff are being held to much tougher standards too.

SOUNDBITE (English) David , Paramedic:“Even staff now on ambulances are working ten, eleven hours without a break. I have got a whole eight hour shift without a break and they just think it is acceptable now. Eight hours without a break.”

Narration: The NHS does not often see whistleblowers come forward as there is a great fear of the consequences that one might face for stepping out of line. David fears revealing his identity because of how it could affect him professionally. Richard Taylor wants to see this attitude change. He is the co-leader of the National Health Action Party - a political party founded in 2012 in direct opposition to the Government's NHS reforms.

SOUNDBITE (English) Dr Richard Taylor, Co- Leader of National Health Action Party: “Any reforms we made of the health service would be to make sure that the voice of patients and the voice of staff is heard and doesn't put them into jeopardy into fear of any of the awful sort of punishments that we hear about people getting when they have blown the whistle in the current set up.”

SOUNDBITE (English) David, Paramedic: “When you do come out with these stories you need people to back you up. And in work, other experiences in the past when you speak up and you think you have got people behind you but they soon run for cover. But I think if we don't speak up surely if we don't stop appearing in front of the cameras and our identities its all revealed and I think it would be too late for the patients. And patients will suffer.”

Narration: The main justification given for privatizing services is always the same. Privatisation means many companies compete with each other to provide the best services. Each company strives to be better than all of the others so it can attract more customers and make more money. In short, competition drives up standards and means better service for the public. But does this really work for healthcare?

SOUNDBITE (English) Professor Dipankar Nandi, Consultant Neurosurgeon at Imperial College: “Whenever there is competition, quality does improve. But one has to understand that health is not industrial like the others. So, where the end result may generate profit but make people's life better. It is likely more difficult to gage the outcome that leads you. So, I think yes it is good that you drive efficiency but it has to be very careful about how you set the benchmarks what is better.”

TIME CODE: 20:00-25:00

SOUNDBITE (English) Dr Louise Irvine, of National Health Action Party: “We just don't think the healthcare should be a source of profit. That doesn't mean to say there should be no private enterprise at all in the UK, just we think it should be a mixed economy and certain things do not lend themselves to competitive profit orientation and we say healthcare is very much in that domain.”

SOUNDBITE (English) Professor Sue Richards, Co-chair at Keep our NHS Public: “Nobody in their right mind. No visitor from Mars who came and looked at this would say it made any sense. So, only make sense if you got the blinkers on that say markets is the best way of doing things always and everywhere and can't see the other way.”

SOUNDBITE (English) Dr Richard Taylor, Co- Leader of National Health Action Party: “I don't think there is any documentary proof that stands up to examination that says competition improve healthcare. If there is, then I have missed it but I would like to see it because I would doubt it extremely.”

Narration: There is an argument that these reforms jeopardize the NHS at a fundamental level. The public could wind up having to pay in order to avoid truly dreadful healthcare.

Louise Irvine explains.

SOUNDBITE (English) Dr Louise Irvine, of National Health Action Party:“The private companies are not interested in providing full range of services, they are looking to the things they will give them...predictable costs that don't carry risk. So, that used usually, things like cataract operations; hip operations, what we might call 'Cold' cases, elective care. They are not interested in providing emergency care. But by removing those services from our hospitals, our hospitals then suffer financially, because they can't compete with the private companies and the hospitals start to lose some of the basic elective services they were providing. And those elective services, whether ones that income to the hospitals, to offsets the cost of providing emergency care. So, hospitals will lose one of their main funding streams and that will destabilise many local hospitals financially and leads to cause for them to be closed.”

SOUNDBITE (English) Natalie Bennett, Leader of Green Party: “What we are heading towards and this is something, I think people are starting to realise, where there are people don't fully realise it, is that we are heading towards to American healthcare system, which is...uses twice amount of the GDP that we use for our services now and yet it produces far worse healthcare outcomes.”

Narration: America has a fully privatised system, where you need to find and pay for health insurance or risk paying thousands upon thousands of dollars for medical care should you fall ill. It is a system that provides the most exceptional healthcare in the world to the wealthy elite who can afford it. But this structure badly neglects the poor, who can afford only limited insurance or none at all. This system is completely alien to British people for whom healthcare has always been free.

SOUNDBITE (English) Dr Louise Irvine, of National Health Action Party:“At the moment only a few wealthier people have health insurance, and some people through their work but it is tiny minority of British people have health insurance but gradually if you start to see deterioration in the service, longer waiting times, fewer services locally. More and more ordinary people will be pushed into trying to take health insurance and then you lent up with two tier systems. With a very poor not able to afford health insurance and they are for getting sort of very second rate service and everybody else having to pay something towards a healthcare. And we think there are this dynamic has being set up by this privatisation agenda, which will lead to a situation where a lot of healthcare will no longer be free.”

Narration: This would be a dramatic upheaval of the healthcare system and one that would not be welcomed by the British public.

VOX POP (English): “If I get hit by a car now I can go to the hospital and I am covered and I don't lose my house paying for medical coverage whereas in the US if I don't have a paid insurance I am paying out of my pocket full price and it could be thousands and hundreds of thousands, so it is a terrible system.”

VOX POP (English): “My family are in US and I know that they have that all heath insurance and they have to top it up. Without health insurance you can't do anything. I think this is one those things that they trying to implement it in the UK, I don't think how far they go though. I thinks a lot of people will against it, more so.”

VOX POP (English): “More people are going to die, because people won't have the money.”

Narration: Interestingly enough, the United States does have something to do with these changes to the NHS. International trade treaties mean that American companies will be able to extend their reach into the British public services.

SOUNDBITE (English) Dr Lucy Reynolds, of School of Medicine: “Not very many people are aware at the moment it would be appear in this country, there is an upcoming trade treaty with the USA. Between the EU and the USA. So, that would control how we're able to organise our public services. In brief, it a very tight trade treaty, the previous rolls have been tightened up quite considerably and now they are working on the basis of all public services and their budgets have to be through open to private sector participation and exportation. Except where the governments specifically exempt them. And our government is not interested in exempting health services. And they are not interested in talking about that either.”

TIME CODE: 25:00_30:00

SOUNDBITE (English) Natalie Bennett, Leader of Green Party: “These real problems about those all together and I would question whether we should be doing at all. But particularly we have to make sure that we don't have a situation where that negotiation leaves us saying that if we have privatise something we can't then bring it back to public hands and that's where the discussions are at the moment.”

Narration: The desire to privatise the NHS goes back a long way. It is not just David Cameron's regime that has sought to shift healthcare towards privatisation, other governments and other political parties have played their part as well.

SOUNDBITE (English) Dr Lucy Reynolds, of School of Medicine: “We have over the last thirty years seen a conspicuous reshaping of the healthcare system we had, which was pretty similar up to 1980 from the system we got after the Second World War. So, the system put in place in 1948 and it started to come under sort of systematic philosophical attack if you like. Supporting privatisation narrative from 1980s. And since then we have seen subtle reshapings, which haven't really been explained but each of them has been devoted to opening up the budget for access to commercial parties really and very often the same commercial parties interest in lead the run the US healthcare system.”

SOUNDBITE (English) David, Paramedic: “I think it has been a thirty year plan to privatise the NHS, I think it has been again a slow burner with different parties, even Labour really can't exclude itself.”

SOUNDBITE (English) Dr Louise Irvine, of National Health Action Party:

“Labour signed off many private finance initiative deals to fund new hospitals using private money, which the deals were very high interest rates, which are actually currently crippling many NHS hospitals.”

SOUNDBITE (English) Professor Sue Richards, Co-chair at Keep our NHS Public:The previous government and particularly under Blair did introduce some market mechanisms. They were really trying to shake up the public service providers.”

SOUNDBITE (English) Dr Louise Irvine, of National Health Action Party: “Before the Labour government under Margaret Thatcher, she had actually invited senior American health specialist to be her specialist advisor in healthcare and even then he was advising her you could start to privatise aspect of the NHS. So, it goes back about thirty years but Margaret Thatcher never dare to do it she knew how precious the national health service was and she just thought one thing even she couldn't touch. And even Labour, who did a lot of harmful things; we are still tinkering around the edges. It took this current Conservative Libdem collation government to come into power to really start the process of dismantling the national health service.”

Narration: The NHS is the last major service in public hands. Royal Mail, British Gas, and British Rail are 3 examples of major public services that have been privatised since the 1980s. The railways are a contentious issue in Britain today, prices go up and up in leaps and bounds but the quality of service does not. Cat Hobbs is the founder of campaign group 'We Own It' who lobby for the tide of privatisation to be reversed.

SOUNDBITE (English) Cat Hobbs, Founder of ‘We Own it’: “So, in terms of train privatisation, basically what we have seen is that train tickets have gone up by 22% in real term since the railway was privatised. So, people are paying more for their train tickets but they are not really seeing a better service, so we know that t he average age of trains now is actually older than it was in 1996. We are not seeing that much improvement really and yes we are paying a lot lot more and study show that we are actually expending one point two billion extra every year on our railways because of privatisations so that money could be put back in to improving services; reducing fares; making the network work better for all of us but instead that money is just being siphoned off.”

TIME CODE: 30:00_35:00

Narration: The public are tired of endless rises in ticket prices, and it isn't difficult to find people on the street complaining about the train service, and the cost.

VOX POP (English): “Typical privatised business will saying ok, more people, less carriages, less assets to use less money invested more profit. So, just the major delays and overcrowded. There is not enough coaches on the trains; so, people are up standing among the isles; you can't get pass; trains delay. So, it is just terrible really.”

TIME CODE: 35:00_40:00

VOX POP (English): “It doesn't seem to me that having a private, privatised rail company where they are competing against each other actually does help the public because there is no integration, there is no … northing is joined up.”

VOX POP (English): “I think it was about last few years, almost doubled what I used to pay. But the service got worse. So, I don't mind paying more if it got better, if I can sit! Right! But it just gone up by twice as much almost in last four five years. Just got worse.”

VOX POP (English): “Well, the biggest complain would be that you never know how much the journey is going to cost you. And you don't know how to get the fairest price. I used to travel to London regularly and get my tickets for under a fiver because I could go on the website and booked them in advance. If you can't book in advance you can pay £35, £40 for the same journey, which just seems really unfair.”

Narration: In 2009 National Express East Coast hit financial trouble and had to give up its rail routes. The Government was left with little choice but to re-nationalise these routes. This arrangement lasted for over 4 years and turned out to be surprisingly profitable. The nationalised company took less money from the Government than the private rail companies, and still made a substantial profit.

SOUNDBITE (English) Cat Hobbs, Founder of ‘We Own it’: “The government is led by ideology on this. So, we know for example at the East Cost Railway is working really well in public hands. It returns one billion pounds to the treasury and that money can be used to improve train services or public services in general but the government is re-privatising East Coast Rail even know people don't want that; even know the service is working well in public ownership. It is re-privatising the line because of the ideology. There isn't really a market in railways. So, if I want to travel on the train from Oxford to London there is only one train line I can take, there is only one route and I don't get any choice about that. So, this idea of the market in rail, it doesn't actually correspondent to reality and what train passengers actually, the choices they actually have”

Narration: The effects of privatisations like this are not abstract concepts, they should not be viewed only as profit and loss on a financial ledger. They can have drastic effects on ordinary people.

VOX POP (English): “I had to change my life style. I had to stop working in London and trying to find work more locally because it was ridicules trying to get in out, and the cost of the tickets were just getting ridicules. So, I don't work in London anymore. Means I have to take a different career path really because the travel arrange I have to make and the money I had to spend on it just made it unsustainable. So, my professional live is now changed direction completely.”

Narration: Countless voices have been raised in complaint over the last several decades, but no solution for the problems of the railways is forthcoming.The idea of re-nationalising the rail system has not been seriously backed by any mainstream political force in the UK. So what chance is there that this could be about to change? Could the railways be taken out of private hands and returned to the public sector?

SOUNDBITE (English) Cat Hobbs, Founder of ‘We Own it’: “Well the Labour position is that it wants to legislate to allow public sector bids for rail franchises. That is the start but really Labour needs to be asking for public ownership for the whole network. We know the privatisation is failed, we know the 66% of people want to see the railways in public in ownership. So, Labour actually and all political parties need to take a stand for full public ownership of the railway work, it make sense.”

Narration: Spiralling costs and the false promise of choice have been features of the railway privatisation of the early 90s. These match some of the predictions given by critics of the recent health reforms. Healthcare and trains are obviously very different services, but it would be foolish not to observe all of the lessons offered by history when making such a drastic change as privatising the NHS. The most recent privatisation in the UK has been the selling off of the Royal Mail. It was dogged by accusations that the Government set the price incorrectly, and could have sold shares at a higher price, and made more money for the state.

SOUNDBITE (English) Cat Hobbs, Founder of ‘We Own it’: “Royal Mail when it was privatised was a very profitable business. Working well in public hands, it was making around four hundred million profit a year. And that money obviously could be reinvested. The government decided to privatise Royal Mail because of various reasons maybe wanted to get some cash to some its friends, some of its politician friends also there was this commitment to this idea that private has to be better even though they can see it is not. Now the British public know the private isn't better, they know the privatisation keeps failing us, which is why 67% of the British public did not want to see Royal Mail privatise. What we have seen since has been privatised is stamp prices have indeed got up and the what they call universal service obligation, which is the idea that you get your letters and your parcels delivered six days a week, wherever you live in the country, that is under threat because what happened to Royal Mail.”

Narration: The privatisation of the Royal Mail has provoked a similar, though less intense, reaction as the creeping privatization of the NHS.

SOUNDBITE (English) Cat Hobbs, Founder of ‘We Own it’: “The shareholders are the winners and the rest of us are the losers; unfortunately that is the story again and again with privatisation. It's not done for the benefits of the public, which is why the public is against it and actually even though politicians find it very hard to take any kind of stand about this, most people want to see public services in public hands. We find where private companies run and do lots of things, that's great but let's have a mixed economy. At the moment we are seeing everything being put in to private hands even when it is not to our befits.”

Narration: 'We Own It' have set themselves in opposition to the tide of privatisations and are seeking to bring about change that will allow more of a public say in any future privatization that might go on in the UK.

SOUNDBITE (English) Cat Hobbs, Founder of ‘We Own it’: “Although it is difficult to know what to do when the Royal Mail is sold off for example, whenever there is a contract if we can make sure that the people who use that public services are involved and knowing what is in that contract and being able to access information about private companies' performance and being able to have their say about what happens and that will help. So, we are campaigning for a public service uses bill, we have put all of us at the heart of outsourcing and privatisation and give us a say of what happens to our public services.”

VOX POP (English): “I found it very frustrating that you know, everyday people... we don't understand, we , that's our money, that goes in to these services for our benefit and if things are privatised so all that money just goes out of our pocket in to private pockets making small number of people richer and leaving all of us poorer.”

Narration: This long steady course of privatization can be taken as a sign that both of the major political parties in the UK see privatisation as the way forward for the NHS. But what do the public make of this? How have these changes to the much-loved health service been communicated to them?

SOUNDBITE (English) Dr Lucy Reynolds, of School of Medicine: “Of everything that could be privatised in this country most things were privatised pretty quickly; the last thing to is the NHS. Because everybody understands and people value that and they didn't want to let it go. So, it has been left to last, we are coming right up against the US treaty, which is the deadline for having all of our public services; the idea is that the country, which is going to privatised Washington likes it if the local governments do the dirty work first. So, that's why the NHS is being done now but it has been done right to the end. There has been a lot of time to put in place the same propaganda campaign that was used on our national rail services Britain Rail. For many years the budgets were cut to absolute minimum and a lot of bad publicity was put off by the government about the national rail services to make everybody think they are useless and it will be improvement if they privatise them. And exactly the same thing has been done on the NHS.”

VOX POP (English): “They clearly want to privatise the health service, which is one thing to do. I am actually quite angry with the way... they are not covering it up but they are not being transparent and are not clear about the situation will be in five, ten, fifteen years time.”

VOX POP (English): “I think the media has a lot of blame to take there because they do make all those shark headlines just to get people reading, and they are actually very misleading. And what you see is the headlines on the newspaper as you walk on pass on your way to work. You are not actually is going to know what is going on, you are just gong to get misinformation.”

VOX POP (English): “We hear a little bit through the news but you don't hear the really extreme bad parts. So, and that maybe... you know confusing because that all we hear is probably the bad stories, which supposed to be good ones.”

Narration: The mainstream media's coverage has come in for some heavy criticism from opponents of the NHS reforms, who feel they are not being heard.

TIME CODE: 40:00_45:00

SOUNDBITE (English) Dr Louise Irvine, of National Health Action Party: “Certainly the BBC, supposed to be independent, seem to be afraid to allow alternative voices to be heard. They give a lot of airtime to proponent of this legislation to privatise our NHS and hardly any to opponents. And it wasn't a balanced debate and that's why the average person in the UK still doesn't know what is happening. They're completely unaware of it. Again I think that is also deliberate because if you do a full frontal assault on the National Health Service in the public gaze; people would never accepted.”

SOUNDBITE (English) David, Paramedic: “Little by little things will be taking away from the NHS and unless you experience it you or your family experience it, I don't think people will know and even the NHS staff. I have to say to them if there is a queue in A&E, if there is patient moaning in A&E about queues, I explain the situation to them and they are truly shocked. And if they say that is why are you here for the operation I will explain why they have to wait here it is not because of the NHS, it is because of the reforms that they put through in 2012.”

SOUNDBITE (English) Professor Dipankar Nandi, Consultant Neurosurgeon at Imperial College: “It is not that this is the end of consultation as I said this is a democracy, people go to the polls every so often and if there is widespread discontent and indeed if this doesn't deliver or leads to a falling standards, then there know the public has the right to speak at the ballot box.”

Narration: If the public do want to register their displeasure at the next general election they will certainly have an opportunity to do so. 'The National Health Action Party' will be fielding numerous candidates at the next election, on a platform of opposing the NHS reforms and bringing the NHS back towards its founding principles.

SOUNDBITE (English) Dr Richard Taylor, Co- Leader of National Health Action Party: “We want to improve the National Health Service, we want to in the longer term abolish the involvement of competition because you can't have competition and a market in healthcare. And the whole point of National Health Service right from the beginning has been not only that is free at the point of use, it is publicly provided and publicly accountable. And you can't have a privatise system that is producing all those things. So, it is to get back to the real original ideals of the NHS and to improve it from the point of view of patients' safety; quality of care and value for money.”

Narration: Health is an issue that motivates the public to vote as well as protest. Richard Taylor successfully won election in 2001 purely due to local anger at the closing of the local hospital's Accident and Emergency department. Public outrage would be harnessed again in 2012 when, out of the blue, an attempt was made to close down Lewisham hospital in South East London. Louise Irvine has worked as a GP in Lewisham for 20 years. She is also a member of the National Health Action Party and the Chair of the Save Lewisham Hospital campaign.

SOUNDBITE (English) Dr Louise Irvine, of National Health Action Party: “Well at first it sounds like that they just want to close the emergency department and the maternity but the emergency department is like the front door to the hospital, is where the hospital admits its emergency cases into the hospital beds. So, if you close the emergency department you close the acute medical and surgical and children's wards and the intensive care unit. So, we know by looking at other examples when a hospital loses its emergency department it is beginning of the end of that hospital it starts to decline, more and more wards close; more and more staff leave; more and more services get cut back until you are left with a sort of shell of a hospital, maybe with a few minor services. I got together with other doctors and health workers in Lewisham but also members of the public, with patients and with all kinds of people from all walks of life in the community and organised a big campaign to oppose this decision to close our hospital.”

Narration: Normally when the Government tries to close down hospitals it is due to poor standards - if a bad hospital cannot raise its standards it is shut down. Lewisham didn't suffer from these problems.

SOUNDBITE (English) Dr Louise Irvine, of National Health Action Party:“Then in the case of Lewisham, it is a good hospital. It performs well with by all different ratings but the government wanted to close it, because they wanted to reduce the total number of hospitals in south east London where we are. But they used a very sneaky way of trying to do that and it would get a bit technical to explain it, but basically there were hospitals in a neighbouring area they were suffering financial difficulties. The government put in special administrator to try to sort out those financial problems of these neighbouring set of hospitals and that special administrator instead decides the way to deal with that to close our hospital in Lewisham to divert patients from Lewisham to these financially troubled hospitals to bring more money to them. And that's the point we challenged legally, we said the special administrator under the law should only make decisions about the hospitals to put he has been appointed. He cannot make decisions about other hospitals and another areas and we looked to the wording of the law and our lawyers were right and we fought it and we won.”

TIME CODE: 45:00_52:00

Narration: Despite the disagreements about the current reforms, everyone agrees that the NHS needs to change and modernise. Medical treatments are constantly evolving, becoming better and more expensive every year. In addition, the population is ageing. People are living longer and rely on the NHS during their later years as they become more frail. Critics of NHS reform must have their own answers to these questions if they are to be taken seriously.

SOUNDBITE (English) Dr Lucy Reynolds, of School of Medicine: “In terms of the ageing population, it is true that people are living longer. However there is an assumption that if they previously died at 65 and got ill at 60 that's the ageing population now means die now at 95 and got ill at 60. But tath is not actually the case if you look at the pattern of people's ill heath and their wellness during life span what you see is a larger expansion of the well period of the life. So, in other words people are productive and acting longer.”

SOUNDBITE (English) Natalie Bennett, Leader of Green Party: “We need to think of it as a health service not as a treatment of the sick service, so we need to do a great deal more work in health prevention issues and that means everything from stopping smoking to providing as I was talking about having streets that people feel like they can walk and cycle on. I mean 58% or journeys by car are in Britain by less than tree miles. You put significant proportion of those on to bicycles and you go to continental Europe and you find cities where people make journeys like that by bicycles or foot is a matter of course. If you focus on the prevention the providing basic services to people, before they get to crisis then you save yourself the cost of crisis.”

SOUNDBITE (English) Dr Richard Taylor, Co- Leader of National Health Action Party: “And they are many ways where the health service is not making the best use of funds. I mean one of two examples if we have got all patients with long-term conditions looking after themselves as much as they could rather than going their doctor; one organisation told us that would save six billion a year. If we've got people with minor ailments looking after themselves rather than going to the doctor that was quoted to save three billion a year. So there are a lots of ways of improving value for money so much so that the 20 billions that the NHS is supposed to be saving could probably been clawed backfrom those sorts of changes.“

SOUNDBITE (English) Professor Dipankar Nandi, Consultant Neurosurgeon at Imperial College: “It is very expensive modern healthcare. There are so many technological innovations to so much medications; so much research and that is impossible no matter how wealthy and economy is to provide everything that is available to every citizens free at the point of cost. It is an utopian ideal and I think we should all realise it is not possible.”

Narration: It seems that there is little hope for the NHS. Down the years more and more British services have been privatised. From electricity to gas, from railways to royal mail. The process has been in motion for decades and privatisation seems inevitible for the NHS. But were any of those public services valued as much as the National Health Service? Is it possible that it could be kept public?

SOUNDBITE (English) Dr Louise Irvine, of National Health Action Party:

“When we've fought for our hospital in Lewisham at the very beginning when we first heard the news that the hospital might be closed, there were people who said what's the point, there is no point of fighting, it is a done deal; we are powerless; the government can do what it likes. We showed that if you organise a begin of campaign and you are strong enough you can fight, you can win. And I know that is a local issue but I think you learn lessons from for the bigger picture. If you give in now and say it is too late of course you will be defeated, they just walk over you. If you say no, we will not accept it, you can begin to have a fight back.”

SOUNDBITE (English) Professor Sue Richards, Co-chair at Keep our NHS Public: “Some local clinical commissioning groups are moving very slowly in privatising and giving out contracts to private sectors, they don't want to do it; they are being forced to but they are putting obstacles in the way and playing for time. Not all are doing that sadly some rushing ahead and believe in it. But, so we've got time, we've got everything to play for in saving the NHS and I do think that...change of the government at the next election could put stop to most of these nonsense.”

SOUNDBITE (English) Dr Lucy Reynolds, of School of Medicine: “And the most urgent things is to stop the sales of hospital and land and buildings. So, it won't be over until the hospitals' sites are go on. And that's the thing that is the big target on this.”

SOUNDBITE (English) Professor Dipankar Nandi, Consultant Neurosurgeon at Imperial College: “Even a business contract has a time limit. It maybe two decades or so, but more important thing is the principle of this. If the the direction of changes what is not liked by people, as you say the whole thing is perceived as a move towards privatisation. And that can be halted. If it is not easy to reverse it but as I said the NHS budget is over a hundred billion pounds. So, we are talking of a fraction of this at the current moment following into completive hands. So, if people do not agree with principle of the shift of opening up to more competition and that can be easliy be stopped.”

SOUNDBITE (English) Dr Louise Irvine, of National Health Action Party: “If we can help to encourage local movements and local campaigns around these issues and they can all coalesce into a more broad national campaign and I think we have the basis for a movement that could save our NHS. I have to hope that. I can't believe that it could all just go, it is too precious.”  


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