When the British bourgeoisie created the NHS as a bribe to the British working class to abandon any thoughts of travelling down the road to revolution, it necessarily took the Soviet healthcare system as a rough model.
It did not, however, want to keep the private accumulation of profit out of the new system altogether so it made sure that doctors and dentists could still work privately for the better off and, crucially, it kept the manufacture of medicines and medical equipment in private hands, making the treatment dispensed by the new ‘people’s’ NHS largely dependent on the private sector.
This meant that although the treatment was free at the point of use, the public money that was poured into the health service went not just for buildings and staff wages but, to a significant extent, it ended up in the coffers of large companies, which grew big and fat like bloated tics or leeches living off the body of the service.
Over time, these companies have merged and consolidated while keeping their fabulous profits out of the glare of public scrutiny as much as possible. There have been a few odd scandals over the years as the safety of patients (always given second place to profits) was sometimes overlooked altogether by these all-powerful drug dealers, but they have mostly worked away at relieving the NHS of as much money as they could – quietly, unnoticed and unceasingly.
Some mild restrictions have been imposed over the charges that the drug giants charge the NHS, but, on the rare occasions when the NHS has refused to buy a drug because of extortionate pricing, the drug barons have run campaigns through the daily news sources claiming that the NHS is putting patients’ lives at risk by not buying their drugs, with the effect that shortly afterwards the NHS has usually rolled over and added the disputed costly drug to its list of drugs ‘licensed to be used’.
On a much smaller scale, but still very costly for regional health authorities, individual hospitals and GP surgeries, is the question of ‘specials’. A ‘special’ is an unlicensed medicine prepared to order for patients who are unable to use mainstream drugs or who have conditions for which no authorised drug exists. Very often, the ‘special’ is a simple combination of readily available medicines or different formulations of existing medicines made specifically for patients who might be allergic to some ingredient(s), or who may be, for whatever reason, unable to swallow tablets.
There was a time when a pharmacist, either working in a hospital or in a high street chemist, would mix these medicines up very cheaply. Very often, the ingredients are just a combination of two or three substances that a pharmacy would commonly hold in stock. Nowadays, however, this in-house making of specials has become rare, ostensibly owing to stricter regulation, increased time pressures and management fear of legal action over mistakes. So, conveniently, the concoction of ‘specials’ is now passed onto the drug giants.
One such company that is quite happy to make specials is the well-known high street chemist Boots, more specifically its parent company, Walgreens Boots Alliance, which also owns Unichem and, until July 2017, also a concern called BCM Specials, which they have now sold to the French company, Fareva.
There are a small number of specials that actually have a fixed price, but everything else is open to rabid profiteering. When specials are needed, the prescription is taken to either the hospital pharmacy or a local chemist, from where it is outsourced to the giants, who are able to charge the chemist whatever they like. The chemist then bills the NHS for that amount plus a £20.00 handling fee.
Before July 2017, the NHS made a payment to one Boots pharmacy of £1,579 for a single 500ml tub of a specially made moisturising cream made up of liquid paraffin and emulsifying ointment for patients with skin problems. The Boots pharmacy had outsourced the making of this ‘special’ to BCM Specials. The very same quantity of the very same mixture is prescribed and made up regularly for chemists to sell to the NHS around the country for prices that vary, but can be as little as £1.73.
In October 2016, a Boots pharmacy charged the NHS £45.47 for preservative-free eye drops for a patient in Surrey. The making of this special had been outsourced to the wholesaler Unichem. The very same eye drops are also on record as having cost the NHS £1.00 in another instance.
Strangely enough, given Rupert Murdoch’s many utterances in the past in support of totally unhindered capitalism, it has been journalists from Murdoch’s Times newspapers who have been digging through the NHS records regarding special prescriptions, and they tell us that specials are prescribed 300,000 times a year at a cost of £50m. (NHS forced to pay £1,500 for £2 pot of moisturiser by Paul Morgan-Bentley and Billy Kenber, 2 February 2018)
Because of the differing prices – sometimes by the same company to the same NHS unit – it is hard for the companies preparing the specials to justify the astronomically high prices often charged, but they do try.
A spokeswoman for Walgreens Boots Alliance claimed: “Specials are unique items ordered at short notice. They are made by highly trained technicians in dedicated laboratories in the UK that source ingredients, produce and quality-check often on the same day, and as a single item. This process incurs high overheads, reflected in the final cost, which is set in line with the sector to reflect the bespoke nature of the products.”
If that is so, we must ask: why are there such discrepancies in the pricing? Payment figures for more than a million prescriptions for specials reveal huge disparities in the price the health service is paying for the drugs from a variety of manufacturers.
The Times journalists give us some other examples over just the past four years of the lucrative scam being played on the NHS, gleaned from the NHS’s monthly drug tariffs:
• A steroid cream, Beclometasone dipropionate in white soft paraffin 0.0025%, for severe skin problems, cost the NHS £1,322.52 for 400g. This was ordered by an unknown pharmacy from an unknown supplier. The lowest price paid by NHS was 95p for 200g.
• 100 chewable tablets of tocopheryl acetate, for vitamin E deficiency, which cost the NHS £2,206 and which was ordered by Boots from an unknown supplier. The lowest price paid by the NHS was £47.91
• A 100ml mixture of 75% coconut oil and emulsifying ointment, which cost the NHS £657.60 and which was ordered by Praren from PH Freeman in Leeds, while on three occasions, Sandwell and West Birmingham CCG paid £360 for single 100ml tubs of coconut oil emulsifying ointments. The lowest price paid by the NHS was £1.04.
Dr Paul Williams, a GP and Labour MP, commenting on the figures said: “It’s disgraceful that private companies are exploiting this to take precious resources away from our NHS,” adding for good measure: “The government must act now to close this loophole and make sure that every pound of public money spent on the NHS is spent responsibly.”
Another Labour MP who felt driven to air her feelings of disgust at the revelations was Louise Haigh, who tweeted with gusto about the “obscene overcharging of our cash-strapped NHS”, and counselled that it is “time for more effective regulation on pharma companies ripping off the taxpayer”.
Perhaps these and other Labour dignitaries also howled at the same rip-off practices being carried out during the 15-year spell when the Labour party was last in office. If so, they will have to excuse our collective bad memory because we really have no recollection of any of them saying anything on the issue during the Blair/Brown years.
In 2015, the health service was promised an extra £10bn a year for the next five years. Last year, another £8bn was pledged in the Conservative manifesto, and yet another top-up worth £6.3bn for day-to-day and capital spending was earmarked in the November budget.
The total budget for 2018/19 is £126bn, but while much of that money is going to a very large layer of management whose main care is to get as much NHS cash as they can stuffed into their own pockets, and vast amounts are just thrown into the bottomless pit of PFI rents and assorted charges, the drug giants sit atop the NHS sucking as much profit as they can from the financial veins of the organisation, and all the most lucrative procedures and contracts are given in armfuls to the private ‘healthcare’ parasites circling our NHS.
In these circumstances, the money provided by the government ‘for the NHS’ could be doubled and frontline staff and patients would still see little or no improvement!
The NHS does not exist in a bubble. The sickness that is destroying it pervades the whole of our society. If we wish to save and improve our NHS, we will have to square up to the question of who should run our society, in whose interests, and the absolute need for genuine social ownership of all the means of production and the very land that holds so many treasures and brings forth the fruits of agriculture.
It is going to take a revolution to truly save the NHS.