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The Friday Surgery

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“You mean to say that’s not actually the NHS?”- Using Mars Bars to explain the NHS kitemark scandal

I did a talk very recently in Shoreham on the NHS. It was my standard ‘this is what’s happening to the NHS and this is what you can do about it’ talk. I journeyed my way through defunding, electoral lies, misinformation, financial interests and privatisation but it was during my kitemark slide that a gentleman in the audience understandably took umbrage.

“The NHS isn’t disappearing” he replied indignantly to my suggestion “that’s a myth”.

So as is often the case when trying to explain why the letters NHS don’t always mean National Health Service these days, I used the example of the walk-in centre outside of Brighton station (pictured). I tried to give a recent potted history of the machinations of hidden NHS privatisation, Milburn’s NHS foundation trusts, John Reid’s independent sector treatment centres, the Health and Social Care Act and the process of transforming the NHS from a comprehensive, equitable provider of healthcare into a tax-funded insurer, paying for care provided by others. The intended reduction of the NHS to a kitemark, a logo.

There was a lull. I could tell the man wasn’t having this. While I was talking he’d googled Brighton Station Health Centre and read out loud (with no little satisfaction)

“We’re a flexible, family-friendly NHS (his emphasis) doctor’s surgery providing the community of Brighton and Hove with treatment and advice for a range of minor illnesses and injuries, long term conditions and sexual health concerns.”

The audience faces told me they were starting to side with my new adversary. But I had a card up my sleeve. I asked him to scroll down to see if he could see anything that mentioned Care UK.

“We’re run by Care UK the UK’s largest independent provider of health and social care. Care UK works in close partnership with local authorities, and NHS commissioners, blah blah…eh? So you mean to say it’s not actually the NHS?”

My brief history of New Labour/coalition privatisation had failed. And it wasn’t because the audience were not intelligent nor because I didn’t understand my subject. It was because the last 15 years of privatisation is subtle, labyrinthine and intentionally opaque. And so as is so often in case in my life, when in doubt I reach for chocolate.

“Okay imagine you want a Twix.” I heard myself say. It appeared my mouth had decided to embark on a confectionary metaphor. I hoped my brain would catch up with it.

“I don’t like Twixes”.

“I like Twixes” an elderly lady helpfully piped up. I stuck with my man though.

“Right. Do you like Mars bars? (a nod) Okay imagine you want a Mars Bar”

So I began my unprepared foray into confectionary based-NHS allegory. It went something like this. Right now Mars Bars are the same everywhere in every shop you go in throughout the UK. When you buy a Mars you know what you’re getting. A generation of us growing up in the 1980s came to understand that one of those lovely chocolate caramel nougat bars per day would help us to “work, rest and play”. The diabetes warning obviously didn’t make the final advert edit.

Let’s say though that Mars executives decided that they didn’t want to produce and distribute their bars anymore. Instead they were going to let companies in different areas bid to win a contract to provide Mars in that area. They could still use the Mars Bar wrappers but it was now just a logo rather than a specific concrete thing. In some areas you would buy the Mars Bar and it would look and taste like a Mars Bar. In some it might look like the Mars Bar but taste different. There might be more chocolate or more caramel because the producer realised they can save more money by changing the balance of ingredients. In some areas you might find that the supplier was only prepared to make a certain number of Mars Bars maybe only one or two per shop. You might need to look around to find one. Some might reduce the size of the Mars Bar but keep the wrapper the same. The incentive would be for them to cut costs and save money in the cut n thrust world of competitive confectionary. Some companies might pull out completely and at short notice when they realised that the contract isn’t as profitable as they’d hoped. And so when you got a Mars Bar and opened it there would be nothing there.
But it would still be Mars. The wrapper wouldn’t change. People would start to complain about the Mars company and not the provider who was producing them in that area. Largely because they wouldn’t know who that was. Chances are people would eventually stop buying Mars. And there, I said, the analogy grinds to a graceless halt. Because I explained, many people can’t change the NHS. They can’t afford it.

“I’m sticking with my Twix” said the Twix lady, perhaps not entirely connecting with the metaphor.

A few days later I received an email. I always give out cards with my contact details at these talks. It was David, who had debated the case for whether or not the NHS was disappearing. He’d obviously been thinking about what I’d said and something didn’t quite ring true.

“Okay this may all be true but what if the new providers do better, provide bigger Mars Bars for the same price or tastier Mars Bars? You never mentioned that.”

So in the interests of balance I emailed him the following two links on Care UK and asked him to judge for himself whether the Mars Bar was likely to get bigger or smaller. One was from the Care UK official site- http://www.careuk.com/ and the second was a Care UK appraisal from the NHS Support Federation site- http://www.nhsforsale.info/private-provders/private-provider-profiles-2/care-uk.html .

I asked him to have a look and decide for himself.

David got back later that day to say that he’d probably prefer Mars to keep making the bars in their wrappers.

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