Some privatization of pathology and clinical laboratory testing is under discussion

If there is one thing that the healthcare systems of the United States and the United Kingdom share in common, it is the respective budget crises engulfing the national governments of both countries. Each nation is struggling to come up with the funds necessary to pay for the ever-rising cost of healthcare.

In both nations, pathologists and clinical laboratory managers are dealing with the consequences of various initiatives to reform or re-organize the delivery of medical laboratory tests. In the United States, clinical laboratories will see a multi-year reduction in Medicare Part B funding as mandated in the Accountable Care Act of 2010 (ACA). In the United Kingdom, hospital laboratories are being asked to regionalize and consolidate. In some regions, privatization of pathology testing services is under consideration.

Pathologists and Clinical Lab Professionals Are Watching Developments

Thus, it is instructive for pathologists and clinical laboratory managers on both sides of the Atlantic to track the progress of the substantial cost-cutting initiatives that are unfolding in the United Kingdom. Early this year, in an attempt to cut healthcare costs, members of the English government introduced “Health and Social Care Bill 2010-11,” into Parliament on January 19, 2011.

The Bill contained several controversial ideas intended to strengthen Britain’s struggling National Health Services (England) (NHS). Probably the most debated elements of this proposed legislation include increased privatization of different sectors of healthcare and expanded use of competition to spur existing hospitals, general practice clinics, pathology laboratories and other NHS providers to become more efficient and improve patient service.

Shortly after the introduction of this legislation, public concerns over the potential altering of the NHS’s mission prompted Britain’s Prime Minister, David Cameron, to put the Bill on “hold” while a 45-member group called The NHS Future Forum evaluated the Bill and made recommendations.

British Prime Minister David Cameron. (Image sourced from 247onlinenews.com.)

In an article in the Guardian, Professor Stephen Field , former Chairman of the Royal College of General Practitioners (RCGP) and head of the NHS Future Forum, expressed grave concerns that the government’s plan to introduce competition among hospitals and patients would severely undermine the NHS.

“If you had a free market, that would destroy essential services in very big hospitals but also might destroy the services that need to be provided in small hospitals,” said Field.

“The risk in going forward [with the bill] as it is,” he continued, “is [of] destabilizing the NHS at a local level. It would lead to some hospitals not being able to continue as they are. If you were to say ‘we’re going to go out to competition for vascular surgery services,’ University Hospital Birmingham wouldn’t be able to run their own trauma centre, for example, because you wouldn’t have the staff and the skills onsite to do things, and the volume of procedures needed to ensure clinical standards remain high.”

Under pressure from opposing parties in government—and from Britain’s healthcare workers in general—after a two month “listening exercise” Prime Minister David Cameron announced a list of revisions to the Health and Social Care Bill that amount to a near reversal of his party’s previous stance on the subject.

Once Cameron announced his plans to “renege” on his previous plans to support privatization within the NHS, pro-privatization supporters publicly denounced the revised policy as a “disaster.”

“The government’s health reforms are the biggest car crash in NHS history,” said former Labour Health Secretary Alan Milburn in an article published in The Daily Telegraph. “The temptation to elevate short-term politics above long-term policy proved too much for both David Cameron and Nick Clegg.

“Many in both camps inside the Coalition consider the u-turn a triumph,” Milburn continued. “But it has the makings of a policy disaster for the NHS and, maybe in time, a political disaster for the Government. It leaves both health policy and British politics in a very different place.”

Canada’s Review of Privatization as an Option in Healthcare

The United Kingdom (UK) is struggling to save its socialized government-funded National Health Service (NHS) by considering some very non-socialist ideas—namely, privatization—just as did Canada in 2008, under the guidance of that country’s “Father of Quebec Medicare,” Claude Castonguay, the creator of Canada’s national health system.

At the Canadian government’s request, Castonguay led a “task force” charged with finding ways to save the national health system from collapse due to rising costs and increasing demand for services. Castonguay’s final recommendations included imposing a fee on patients to discourage usage, and also allowing physicians to market their services outside of the public system to reduce the burden. This call for privatization was soundly rejected by Canada’s then Health Minister, Philippe Couillard http://en.wikipedia.org/wiki/Philippe_Couillard.

Those who followed these events in Canada will see parallels to the UK’s current woes. Britain’s universal single-payer healthcare system also cannot pay for itself, and the British government is being forced to make tough decisions that are not at all popular with Brits.

What’s ironic is that, decades ago, Castonguay based his Quebec universal healthcare system design on the UK’s system of healthcare.

In an interview shortly after his task force proposals were rejected, Castonguay said, “The Canadian system, or the Quebec system, was patterned initially after the National Health Service, the British system, but [the British] have moved quite a distance in the last few years.

“What comes out of all these studies is there is no ideal system,” he continued. “Each system has to evolve in accordance with its own situation. But there are some ideas that you find that seem to be working well in all systems.”

Moving forward, it is expected that the privatization debate in the United Kingdom will continue and probably become more rancorous. Because it is easier to move pathology specimens from place to place than it is to move patients, it will not be surprising if pathology and clinical laboratory testing services are considered prime prospects for future experiments in privatization in the United Kingdom.

Related Information:

Health and Social Care Bill 2010-11

Government Response to the NHS Future Forum Report (PDF)

Kill or Cure: The government hopes to squeeze hospital costs without closures

This NHS debacle sets us back a generation (Alan Milburn, The Daily Telegraph)

David Cameron defends NHS reform rethink as ‘sign of strength’

David Cameron defends NHS reform plans: ‘doing nothing will end in tears’

Cameron outlines changes to NHS reforms after criticism

David Cameron Accepts Changes To NHS Reforms Recommended By NHS Future Forum

David Cameron sets out NHS reform changes

David Cameron’s NHS reforms are now a ‘car crash,’ says Alan Milburn

NHS reforms: David Cameron unveils key changes NHS reforms: David Cameron unveils key changes

NHS is safe behind my red lines, says Cameron as he tries to keep health reforms afloat

Castonguay prescribes radical changes

Couillard flip-flops on pro-private report