Health: Examining how commercialisation in the NHS can endanger our health

NHS blood donor service is asking people to make a New Year's resolution to give blood.
NHS blood donor service is asking people to make a New Year's resolution to give blood.

Theresa May recently announced a new inquiry into the historical infection of over 7,500 NHS patients, many of them haemophiliacs, with HIV or Hepatitis C, through blood transfusions using plasma bought from the USA during the late 70s and early 80s.

Despite the wreckage of thousands of individual lives (including many deaths) there has never been any formal admission of responsibility and a significant cover up is suspected. Although the initial decisions were taken under a Labour government, the epidemic to be known as AIDS was not recognised until 1981 and HIV was not identified until 1983.

It’s sickening to see the extent of profiteering over the blood which is our common human bond

The inquiry announcement has created many worries, including a fear it will be used as an opportunity for further attacks on the NHS. In fact the scandal is intimately connected with the commercialisation of healthcare. The extraordinary act of routinely giving our blood to strangers is a profound recognition of our common humanity. In 1970 the renowned sociologist Professor Richard Titmuss’ book: ‘The Gift Relationship – From Human Blood to Social Policy’ surveyed the collection of blood across the world, concluding that a private market in blood increases risks to the recipient and, in the long run, creates greater shortages of blood.

These risks, he found, were concealed by commercial blood banks and the pharmaceutical industry.

Titmuss argued that the way in which society structures its social institutions can encourage or discourage the altruistic in humanity, including the spread of generosity towards strangers among and between social groups and generations. The success of the UK blood transfusion service, he thought, could only have taken place in the context of the values of the NHS, whose creation was ‘the most unsordid act of British social policy in the 20th century.’

These days the combination of altruism, reciprocity and social duty which Titmuss so valued has been largely replaced by a corrosive commercialisation introduced under the name of efficiency. Outsourcing, about which I have written before, is the symbol of much that is wrong. It’s bad enough in the NHS, where, for example, a recent large scale study showed that hospitals with outsourced cleaning had an almost 50 per cent higher rate of MRSA infection than those with in-house cleaners. But the Grenfell Tower tragedy has made absolutely clear how the combination of budget cuts and the ease of evading monitoring and accountability in an outsourced system can lead to disaster.

The original Blood Transfusion Service was established in 1946 on a regional basis. By the late 1970s, demand for plasma could not be met from within the UK because of previous contamination through the ‘mad-cow’ variant of Creuzfeld-Jakob Disease. The government therefore decided to buy all plasma from outside the UK but the purchase did not take into account that its prime source, the USA, included blood from prisoners, drug addicts and others who were paid for their contributions. By 1983 it was realised that the plasma was contaminated with HIV and hepatitis C and that heat treatment was necessary. But action was not taken soon enough and responsibility was denied.

The original regional responsibilities for the organisation and processing of blood donations led to problems with availability and distribution. Since 2005 the National Blood and Transplant Service, a publicly-owned and run NHS Special Authority, has handled all public blood donations. Donor blood is still required in significant quantities especially from minority groups. This system of uncommercial donation (including transport of blood across the country by teams of volunteer motorcyclists) contrasts with the USA where organisations like the Red Cross sell whole blood from unpaid donors to hospitals for $225 to $240 a unit; if the unit is billed to the patient, the price can be $1,000 or more.

Plasma is a different matter. Changes in medicine mean that plasma is now often needed rather than whole blood transfusion. As long as the NHS cannot source plasma from within the UK, because of the risk of CJD, external involvement is required. But given the often tense relationship between the NHS and Big Pharma, it’s sickening to see the extent of profiteering over the blood which is our common human bond.

The NHS depends on the commercial and industrial sector for a huge range of products, but the public needs proper information about the consequences and risks, not just press releases trumpeting optimistic advantages. The government’s insistence on shifting control of the NHS to semi-secret partnerships undermines this. In South Yorkshire we are going headlong into an Accountable Care System which has no statutory basis in order to qualify for additional government money. Information about the ACS and its proceedings is closely guarded yet the partner organisations have the delegated power to take all sorts of decisions with a bare minimum of scrutiny - often after the event and obscured by commercial secrecy. It’s vital the prime movers of the ACS come clean about their plans. Visit www.blood.co.uk for details and www.sheffieldsaveournhs.co.uk to campaign against the commercialisation of the NHS.