I’m 42 – and I’m a lifelong Labour voter.
And I’ve also never known a leadership election like this.
At his victory speech at the Labour election-night party, Royal Festival Hall, London, 2 May 1997, Tony Blair uttered the now famous words, “A new dawn has broken, has it not?”
However, the way in which this particular #LabourLeadership election was run was dreadful.
As Dr Éoin Clarke had tweeted,
Weighing up all available evidence I’ve spent months gathering, about 250,000 who wanted to vote for Labour Leader were unable to do so pic.twitter.com/Wo59L3wXzs
— Éoin (@LabourEoin) September 23, 2016
I’ve known Liam Young, who supports Jeremy Corbyn, for a long time. His recent piece in the Independent details in full gory detail how, despite his best efforts otherwise, he ended up not voting. I can vouch for Liam’s commitment, having known him for years.
“I have been a member of the Labour for the last six years, and involved with the party for as long as I can remember. I remember heading to party conference in 2010 at the tender age of 15, and my grandparents often fondly remind me of the times they used to take me out canvassing in my pushchair – my grandfather was the leader of the local city council and mayor at one point. I had countless unrelated “aunties” who I grew up with, assimilated into my extended family by virtue of the Labour work they did with my relatives.
So this month, I was surprised when I didn’t receive my ballot in the normal timeframe for this leadership contest.”
The comments to this article make for desperate reading. Most authors, especially ones for The Guardian newspaper, never read the submitted comments, but I strongly suggest Liam has a look.
Here is a typical comment.
The whole Owen Smith campaign was a fiasco.
In fact, what happened from the time at which Hilary Benn threw his early morning temper tantrum was a full blown disaster.
Believe it or not, I had not intended to blog much about this #LabourLeadership election, though I’ve doing some sort of Labour political blog for about 7 years now.
Looking back on it now, the entire anti-Corbyn campaign imploded from the very beginning. The ‘challenger’ was implausible, the policies half-baked, the campaign sodden with gaffes, and, put simply, an insult to the wider Labour Party membership “electorate”.
I charted some of this mess in various blogposts including “Saving Owen Smith“, “The inevitability of death, taxes and Jeremy Corbyn’s re-election as leader of Labour“, and “Owen Smith MP must surely have been aware that the NHS is being rapidly privatised?“.
Some of my time had been taken up the desperate moves of the NEC to thwart people voting in the law courts, and that was before the #LabourPurge2 had gathered full momentum (pardon the pun).
The mainstream media were reluctant to cover the bare essence of the illiberality of the legal manoeuvring, astounding given the overwhelming ‘liberal’ press.
Such blogposts included “The Court of Appeal judgment was profoundly illiberal, and the issues need scrutiny notwithstanding“, “Nobody is above the law not even in the Labour NEC“, and “Tom Watson MP says he doesn’t believe in conspiracy theories, and nor do I“.
Ed Miliband MP, like other failed leadership contenders Liz Kendall MP, Lord Neil Kinnock and Gordon Brown (2010), stuck the boot in, possibly even adding to Jeremy Corbyn’s credibility, viz. “The overall incompetence of Ed Miliband’s opposition should still raise alarm bells“.
But there was no doubt at all, that if Owen Smith MP was the answer, the question was not even worth thinking about.
The Owen Smith MP candidate was the talk of the town – for all of the wrong reasons.
It never gained any credibility.
For example, I wrote on “Why has Owen Smith MP lost all momentum in his leadership campaign?“, “Owen Jones’ interview reveals Owen Smith MP is dangerous for the nation’s health“, “The Parliamentary Labour Party cannot cope with the decline and yet further decline of New Labour“, “Owen Smith’s campaign blowing up on lift-off is not a good look“, “Owen Smith is ‘reconstituted Labour’, but still a disastrous recipe“, and “Owen Smith MP is swimming in the deep end with armbands. We can’t go like this.”.
And it seems now that Angela Eagle MP’s leadership was merely now a ‘bad dream’.
This is where it all started: e.g. ““Saving Labour” or “Crushing Corbyn” – that is the question?“, “Why the level of vitriol against Jeremy Corbyn?“, “Angela Eagle’s “Contrived Leadership” was overbranded and under authentic“, “The emphasis of Hilary Benn on “winning” ironically explains a lot Labour’s failure“, “For me, Angela Eagle is part of the problem for Labour’s electability, not the solution“, and “If Labour can’t unite behind a democratically elected leader, it doesn’t deserve to be in government“.
I feel hugely excited about this morning. I have had enough of trolls suddenly popping up on Twitter, and lying to me – I don’t have to waste hours trying to work out why they are shilling on behalf of a certain lobby any more.
I don’t have to think about reasons why Corbyn would be a ‘disaster for Britain’, or why Jeremy Corbyn ‘does not believe in winning’, or how Labour ‘has become the party of permanent protest’, or how Labour is now full of far left Trotskyist individuals allegedly, and so on.
For me, it feels as if a noose has been finally removed from my neck. There’s about 10 or so Labour MPs I think their local constituencies should examine as to their suitability for parliamentary election. I don’t think any candidate should be renominated under duress if (s) he disagrees strongly with party policy. Democratic re-selection is very healthy for the party. As in all good teamwork, it’s a question of give and take. I don’t see a case for the parliamentary Labour Party having bullied their way into this all-consuming leadership election, detracting attention from the split and division within the Conservative Party, to call any shots. Most scandalous of all, the entire NHS is collapsing, grammar schools are on the way back, the foreign policy with Libya for example has been utterly discredited, and Owen Smith MP is obsessed about talking about he (not the House of Commons or Lords) ‘won the PIP debate’.
Too many people in the Labour parliamentary party love themselves, especially the ones who are now acting like spoilt brats having been to one of the big 4 accountancy firms.
I don’t mean him…
Or Andy – who has been utterly brilliant throughout.
The other bunch of loudmouth talentless Labour MPs, the “deplorables”, rather need to step up to the plate, contribute policy – or else get out of the party.
They should stop fanning their own egos in TV studios with vitriolic bile against Corbyn.
They need to do some actual work in making Labour look like a serious political party. The membership are overwhelming sick of their narcissistic putrid selfish self-centred behaviour, rotten to the core.
Some journalists, especially at the Guardian, should stop preening their feathers, and stop spewing incessant negative junk in their low circulation papers.
Basically – anyone who is not up to the job of helping Jeremy Corbyn has overstayed his or her welcome -…
and should get out now.
And what have we learnt from all of this?
We now know that this man
doesn’t want Seumas Milne’s job now, nor in the future, here or in any other parallel universe.
As was in the statement to the press on arriving at Hillsborough Castle for the Northern Ireland talks, 7 April 1998, Tony Blair said, “A day like today is not a day for, sort of, soundbites, really – we can leave those at home – but I feel the hand of history upon our shoulders, I really do.”
Wherever Labour goes from this point onwards, today is a very special day.
Whoever is ultimately responsible for the definite purge which is going on within Labour, it is clear that the purge has backfired on a number of levels. As Paul Mason identified, Bristol has now lost control of the council due to centrally-driven suspensions. Secondly, many longstanding campaigners for Labour who have given decades of their time have been ‘purged’ and lost the democratic right to vote. Thirdly, it has been a PR disaster of enormous proportions, of a centrally driven Labour NEC appearing to be incredibly vindictive against their own members, many of whom are not financially well off. Fourthly, its actual basis was very dubious, when it is known that the number of extremist ‘entryists’ are in fact very small, whereas the usual people (e.g. Old Holborn) have claimed it’s the best £3 they ever spent.
Whichever way you look at it, Labour is a joke. And it is telling of the state of Labour as it is that this is held as default as an abusive comment, rather than freedom of expression. When a mature Asian Labour voter told Owen Smith MP that he as a MP was wrong, Smith called it out as abuse. Channel 4 presented last night a documentary based on undercover filming, a textbook hatchet job on Labour, featuring a family relative of Alastair Campbell providing legal opinions. And the number of migogynist, antisemite and bullying events shown was nil.
BBC1’s Panorama fared better. Jon Pienaar did what he could to present an establishment view of ‘we’re stuck with Jeremy Corbyn with a landslide – but now what?’ Cumulatively, BBC1 and Channel 4 added to a long list including the Guardian notably of totally distorted mainstream media. The Guardian’s reporting does not even make the grade of toilet paper when printed out, though Suzanne Moore did a brilliant balanced piece on Momentum Kids only yesterday. BBC’s Panorama uncomfortably yo-yoed between Lisa Nandy MP and Peter Kyle MP, before referring to Owen Smith MP for an opinion.
By any reckoning, Owen Smith MP’s campaign was an unmitigated wholesome disaster. In a leadership bid which was in part supposed to have been precipitated by sexism and misogyny, Smith is reputed to have made a laddy joke about his 28″ inside leg measurement. The descriptions of his long term debt financing of infrastructure were so far fetched that ‘no economist disagreed with him’ (an achievement in itself) and, more’s the point, nobody in the mainstream media including the Financial Times, Mail or Times bothered to opine about it.
For all the criticisms of Corbyn and team, and there are many, the orchestrated hourly appearances of MPs in TV studios was vile. Episodes such as the staff of Seema Malhotra MP not leaving her office in a timely effect spun in such a way as to discredit a longstanding member of John McDonnell MP’s staff, were vile too. Alastair Campbell siding with Anna Soubry in her attack on John McDonnell, despite Campbell appearing to not make up his mind on which policies he actually disagreed with, was pretty ubiquitously reacted to on Twitter as vile; with many of the Twitterari commenting on how a Labour grandee got away with using the ‘twat’ so often on Twitter, when ordinary party members, maybe who had campaigned for the Green Party but who had now re-joined the Labour Party, had been ‘suspended’ according to the NEC’s ‘make it up as you go along’ rules for retweeting Caroline Lucas a few years ago, perhaps on taking back the railways into state control (now a Labour Party policy aspiration).
Ed Miliband MP himself in his resignation speech had asked for ‘people to disagree without disagreeable’ – and yet this is precisely what he and Neil Kinnock then did par excellence. They laid into the currently democratically leader of the Labour Party, Jeremy Corbyn MP, as if he had no mandate at all, completely ignoring the fact that they themselves had between them had lost more general elections than most of us have hot dinners.
Secondly, their remarkable achievement was completely to ignore the implications of the Brexit vote. There are some very basic level interpretations of how Brexit came about, including being ‘lied to’ (although lies are not a novel idea in election campaigns, if one remembers Nick Clegg’s ‘I’m sorry’ for example), the impact of immigration on local services, the notion of ‘taking back control’, and so forth. I voted as a Labour voter of 26 years for #Remain, being a ‘reluctant remainer’.
For me, a willingness to be part of the European Union goes way beyond the single market, but goes towards a feeling of genuine solidarity with our European neighbours in fighting on public policy issues, such as public health, data protection, employment rights, etc. But there are aspects of being in the EU which I do find difficult – such as the impact it has on state aid of public sector industries in stress, the way in which Greece had been forced down a path of austerity to the detriment of its citizens, the possibility of the EU-US free trade treaty which would have given a carte blanche to multinational takeover of parts of the NHS, the undercutting of wages happening during free movement of labour, and so on. So for me, it can’t be 10/10 for being in the EU. And Article 50 will probably have to be invoked sooner rather than later, if only because our European neighbours won’t want us to delay on this. It was not Jeremy Corbyn’s direct wish to have a referendum; he did not even stand on a manifesto pledge to have one.
Neil Coyle MP at the weekend was asked how he might win given the summer of discontent of Labour. Bear in mind, I went down one morning, with no expenses paid, to support his bid to become a MP in Bermondsey and Southwark. I was disgusted to hear that people like me who support Jeremy Corbyn are merely part of a ‘fan club’. He then had the gall to say he would be re-elected because of the ‘strong Labour brand’, given the monumental efforts he had made to rubbish the Labour brand, such as our leadership and teamwork, all summer. Good riddance.
I had never heard of Peter Kyle MP until he started TV studios slagging off Jeremy Corbyn MP – in other words, he had made absolutely no impact on me on the national stage in terms of policy.
Not everyone who disagrees with Jeremy Corbyn is though ‘disagreeable’. I differ with Karl Turner MP’s views on some things, but I feel he is fundamentally a very bright and pleasant man (having also briefly met him). I’ve met Tom Watson MP – I don’t think calling Momentum a ‘rabble’ as he allegedly did is crime of the century, and he probably was distressed at this summer’s events too. But I think strong arm tactics for the Labour PLP to ‘get their way’ are a mistake, Tom.
In a completely different category though are Margaret Hodge MP and Margaret Beckett MP who did not offer a coherent narrative on where Jeremy’s policies were ‘wrong’, why millions voted ‘Brexit’ and launched into highly personal attacks on Corbyn.
I don’t think people who disagree with Labour’s policies or dislike the leader intensely should be forced to be members of parliament for Labour. It should never be forgotten that the party is totally dependent on the grassroots activists who go round delivering leaflets, manning phone banks, door knocking, and so on. Momentum has never asked for deselections. I think, however, it would be very healthy for a democracy for our Labour CLPs to look at reselections. MPs who are unable to oppose tax evasion and aggressive tax avoidance, PFI, the lack of social housing, or the market failure of rail should not be ‘forced’ to MPs under duress, particularly this is in asynchrony with our membership’s views.
And John McDonnell MP is right, though he didn’t phrase it this way. Too many of our Labour MPs love themselves. There are a few who’ve done brilliant work such as Andy Burnham MP on Oregreave, or Debbie Abrahams MP on disability welfare, or Grahame Morris MP on local communities; and there is patently room for improvement in the operations of the top team.
We are where we are. Some of the 170 MPs who have previously had ‘no confidence’ in Jeremy Corbyn will want to campaign on behalf of saving their own seats, despite the mess they caused this summer. It is not far right to oppose that the NHS is now being destroyed at accelerated pace. It is not far right to oppose the savage cuts in social care. The only way forward I feel is for there to be a ‘hybrid’ shadow cabinet, with members put forward by both the Party and membership.
Members of the Labour PLP over criticise the ‘delegate’ argument of the membership I feel. I think what is rotten to the core is the rotten spectacle of Labour MPs behaving like independents not representing their party’s membership. It is not true that all of the Labour Party membership, for example, supports Trident as a weapon of mass destruction.
Jeremy Corbyn is likely to be re-elected this week as the leader of the Labour Party.
As Corbyn says, “Things have to change – and they will.”
So why did Chris Hopson do his outburst at the weekend?
This is the one where we warned about the parlour state of the NHS finances.
I personally don’t understand the obsession of NHS managers and politicians with the notions of “productivity” and “efficiency”, because I come from an area in medicine where adding “value” is more important. I think of productivity as a hang up of an widget counting ethos, so beloved of management accountants, in synchrony with a widget factory ethos of management of Frederick Taylor.
McKinsey originally suggested these ‘efficiency savings’ whereby the NHS could aim to contain its budgets, but we all know this is double speak for cuts.
Stephen Dorrell MP, former head of the influential Commons select committee, warned that it had never been done before, so we were in unchartered territory. The Labour Party, as it was then, were fully signed up to this draconian programme of austerity.
Especially when NHS Trusts are trying to balance the budgets, or cook the books, to account of the massive spend on agency staff and PFI corporate wongaesque loans, the idea of ‘efficiency’ has become toxic and frankly ludicrous.
Nonetheless, Chris Hopson CEO of NHS Providers continued with the myth this weekend:
“But NHS trust bosses are now ringing that bell – we face a stark choice of investing the resources required to keep up with demand or watching the NHS slowly deteriorate. Trusts will, of course, do all they can to deliver efficiency savings and productivity improvements. But they are now saying it is impossible to provide the right quality of service and meet performance targets on the funding available.”
These performance targets are only as good as the wisdom in their selection. I ‘get’ the fact that these targets do not include doctors’ morale or nurses’ wellbeing, but even on the more conventional targets such as delayed transfers of care, delayed discharges, or waiting times, Jeremy Hunt is missing by a country mile. And of course the whole ethos of simultaneously many people working their butt off under incredible pressure, while some CEOs are sitting pretty with inflated salaries despite catastrophic failure, is an enduring one of Hunt’s NHS culture. (And of course the relentless lack of statutory whistleblowing protection for junior doctors in training – see the Dr Chris Day case).
As the junior doctors’ dispute shows, it is also untenable to ask NHS staff to close the gap by simply working harder and harder.
All this reminded me of this tweet I had once made:
— Dr Shibley Rahman (@dr_shibley) August 20, 2016
This is a reference to the Baumol “cost disease”.
In some sectors of the economy, however, such productivity gains are much harder to come by—if not impossible. Performing a Mozart quartet takes just as long in 2012 as it did in the late 18th century. Mr Baumol calls industries in which productivity growth is low or even non-existent “stagnant”.
In some sectors of the economy, however, such productivity gains are much harder to come by—if not impossible. Performing a Mozart quartet takes just as long in 2012 as it did in the late 18th century. Mr Baumol calls industries in which productivity growth is low or even non-existent “stagnant”.
The most parsimous explanation for the outburst of Hopson is the up and coming autumn spending review to be done by the new Brexit Chancellor.
So what does give? A range of options are now open to political and NHS leaders. Additional funding is the most obvious, with the new government’s first autumn statement on 23 November providing an immediate opportunity.
Something has to give. This is particularly so since NHS funding increases are about to drop from 3.8% this year to 1.4% next year and 0.3% in 2018-19. As total NHS demand and cost rises inexorably, by at least 4% a year, this will mean even larger gaps after seven years of the deepest and longest financial squeeze in NHS history.
We know that demand has always outstripped ‘supply’ since the NHS’ conception, but the solution of tackling this demand by greater supplier competition in markets through the Health and Social Care Act (2012) was deeply flawed. It itself produced an opportunity cost of billions. There seems to be a lot of money for war but not for building hospitals, so it was entirely predictable that a lot of money got siphoned off into corporate restructuring management consultants and to paying off dismissal claims (and confidentiality agreements) for managers of PCTs, rather than frontline care. Nurses receiving yet another pay freeze “would not complain”.
That Doctors feel that they cannot cope with delivering safe care under the new contract should be a reason for their regulator to be concerned. As it is, anyway, the BMA recommended the ‘new contract’ which it had negotiated, and was left with the situation that a large number of junior doctors did not like the contract (for example for safety issues or gender pay gap issues, inter alia), and the attitude of whether to go on strike was “complicated”.
The media have generally portrayed junior doctors to be some mob of crypto-anarchists or Trotskyite agitators, and have regularly misrepresented the dispute as one simply of pay. The manifesto pledge from the Conservative Party was not actually to impose a contract on junior doctors or other staff, but to implement a 7 day NHS; but we know that in the absence of funding for a 7 day NHS with ancillary staff, and with corresponding funding in the rest of the system, it is impossible to deliver a 7 day NHS. The junior doctor contract correctly was seen as a way of putting 5 bags of sugar into 7 containers.
But the Hopson ultimatum is dire. Taken at face value, it appears to mandate the Chancellor into maintaining NHS spending. Every time a Conservative minister ‘defends’ NHS spending, it is always said that the level of spending is what Simon Stevens, CEO of NHS England asked for.
Stevens remains inconveniently quiet on this. NHS spending is “ring-fenced” and social care is not, but the whole notion of ‘ring fencing’ has become dubious given the increased costs of everything and increased demand of the NHS. And the ‘elderly’ (horrible term) are not simply to blame for this bill, as many children and young people are benefitting from costly interventions.
SO while the NHS continues to trot out infograms and ‘calls to action’ like no tomorrow, sneaking in under the RADAR is that dreaded term ‘sustainability’.
NHS trust leaders rightly argue that this piecemeal approach is unsustainable. It is not tenable to ask local leaders to deliver the impossible, make unpopular local decisions as quietly as possible and then carry the can when the decisions become public.”
And we’ve been here many times before. For example, The King’s Fund report, Deficits in the NHS 2016, published on the 11th July 2016 argued that due to increased level in demand of services the NHS is fast becoming ‘unsustainable’.
Unsustainable means chronic underfunding of the NHS.
Hopson produces a menu of other options
If, however, there are is to be no extra funding, the NHS must make some quick, clear choices on what gives, however unpalatable these choices may be. The logical areas to examine would be more draconian rationing of access to care; formally relaxing performance targets; shutting services; extending and increasing charges; cutting the number of priorities the NHS is trying to deliver; or more explicitly controlling the size of the NHS workforce. These are all approaches adopted by other public services such as prisons, local government and the police when faced with similar funding challenges over the past decade – though they would clearly provoke public unease and ministerial anxiety if applied to the NHS.
And the “logical areas to examine” would be a fast track to having a 2-tier health service. Get some astroturfers and the House of Lords Sustainability Committee, perhaps along with a cross-party parliamentary commission to boot, with a dash of the Socialist Health Association, to sign up to the meme ‘we can’t afford the NHS’, and then the machinery came come into action to produce a bargain basement NHS covering the very basics. The second tier consists of the private insurance market, where the profitable bit called ‘prevention’ is emphasised (see the rationale for the HMO Act 1973 in the US and President Nixon.)
The major problem with the “free at the point of use” meme, even used by Owen Smith and other Conservatives, is that it takes no account of the comprehensive nature of the NHS. If the railway network only comprised routes which were profitable, there’d be no train service to some remote part of Scotland; the equivalent is not bothering with people with ‘expensive’ rare diseases. When you get rid of the need for comprehensiveness or universality, you can ration to your heart’s content – starting off with cataract operations, but then building up to ‘NO’ for bariatric surgery.
Then you can twist the “taking responsibility for your own health” meme into a direct accusation of blame. In other words, “we don’t want to pay for treatments for these fat people as they ate too much” or “we don’t want to cure this lung cancer as they smoked too much.” This can all be dressed up under the gloss of ‘choice’ and ‘control’, and the ‘tough decisions’ CCGs have to make.
Hopson warns about the NHS finances, and Hunt ‘responds’ by maintaining NHS spend – all pretty twee and orchestrated, and everyone’s happy.
Well – they’re not. The nurses are taking out loans to be educated, the doctors are stuck with a contract they don’t want, certain failed NHS CEOs appear unsackable, social care is on its knees, and Hunt appears to have a job for life.
I have spent much more time living with chronic long term conditions as a patient than I have spent as a Doctor on the UK medical register. I owe my life to the NHS, having been resuscitated from a cardiac and respiratory arrest on the same day and having been kept alive for a subsequent month in a coma both in a busy London teaching hospital.
My response to the notion of regular five day strikes is therefore mainly emotional, rather than cognitive, for which I apologise. As a member of the Royal College of Physicians of London, I’d like to thank NHS consultants who’ll be doing their best in exceptionally difficult times. They’ll have to do blood tests, write TTO discharge notes, do all the correct management for their complex inpatients as ever. That won’t be easy for them.
The NHS is not only in dire straits, but social care is. They act in one big system – therefore having social care in managed decline means that social care practitioners are hard pressed to enhance the wellbeing of users, but it also means that NHS patients cannot be discharged in a timely manner. Doctors are not the only ones who are demoralised. I have had personal conversations who are literally living in fear that something will go wrong on their watch. They view their shifts as a matter of survival. They know if something goes wrong the Nursing and Midwifery Council will not have any sympathy for the argument that nurses don’t even have time to go on a tea break, let alone implement the 6Cs to A* level.
Just as justice delayed is justice denied, and we know about the mental pain of grieving families from NHS scandals, treatment delayed can feel like treatment denied. I’ve never personally never bought this argument that ‘no harm is done’. Take for example, somebody writhing with colicky pain due to a ureteric stone (a stone in the tube from kidney from bladder)). Waiting and waiting for an appointment for a procedure to remove the stone, over months and months, is undeniably mental agony. But it is also physical agony – and what about those reams of reams of QUANGO guidelines about acute and chronic kidney injury?
Whatever the political posturing of the chief protagonists, such as the BMA, the GMC, the NMC, the RCN, the AMRCos, Hugh Pym or Roy Lilley, it’s clear that the cliché that there are no ‘winners’ is partly true. True up to the point that Jeremy Hunt can consider it a win that he can start the job he started, of imposing a contract against the will of some of the medical profession. A strike is now happening against some of the will of the junior doctors. We are all going for #Brexit, despite some of the will of many of us who wanted us to remain in the European Union. We’re all paying through the taxpayer route for the private finance initiative bequeathed to us from both New Labour and Conservative governments, akin to a corporate Wonga direct debit.
When you think about the NHS Outcomes, you realise that all the policies are immediately rendered null and void, and this should alarm most of us. We all have our own personal opinions about how we arrived at this mess. But for all the razzmatazz about NHS vanguards, new models of care, ‘rocking the boat’, we have the dire position that we cannot meet any of the NHS outcomes (for example on patient experience, avoidable admissions.) We don’t know how many people will die prematurely from the strikes, but we don’t know how much damage has been inflicted so far from paying off the PFI debt and paying for certain CEOs for a long period of time at the expense of running timely services either.
I have a particular personal pain, in that despite my moaning and groaning I think it’s a huge privilege and honour to be in a position to be a medical Doctor. I ‘get’ this thing about how one would be happier in New Zealand, but I feel I really have been through hell and back to get my professional registration. I was also given no support for my own substantial mental health problems from the NHS which prefers regulation to performance management. And yet, despite this, or perhaps even because of this, I feel a profound sadness of where we all are. And of course Jeremy Hunt can sleep well at night, one assumes?
This isn’t about me – nor about Jeremy Corbyn…
nor my followers, including
I happen to agree with Jeremy Corbyn’s policies. I was pretty appalled about the way the 172 Labour MPs disrespected democracy by trying to bully Corbyn into resigning outside of the rule book, and various antidemocratic moves were then subsequently tried – like keeping Corbyn off the ballot paper, then trying to stop 230,000 members from voting.
But we have to talk about my follower Sadiq.
I’ve been in the same room while Sadiq was giving a talk – and seen his manner and behaviour with people. He is very polite, and certainly not an ‘élitist’. I suppose he will wish to ‘side with’ the current Labour MPs who believe that Jeremy Corbyn will not win the 2020 election – but they can no more predict this than I can. I am though fairly confident that Jeremy Corbyn MP will win the current Labour leadership contest – and it is pretty unlikely that Sadiq’s comment will alter this outcome.
I’m not a Corbynista.
But the situation is clearly more nuanced than that.
There’ll be some traditional Labour voters who feel disenfranchised by the EU – such as the undercutting of wages by multinational corporates, or local collieries being shut down due to application of EU ‘state aid’ rules.
I think Sadiq is pretty Fabian in outlook, though. I had to remind myself of Tony Blair’s aspirations for the Labour Party from a speech he gave to Progress last July. He believes that the socialist left wing errs when it does not project a positive vision about the future but is reactionary. Indeed the sole aim of the Labour government should not be to ‘fix’ the mistakes, but it happens that there are plenty of mistakes (e.g. tax loopholes, unconscionable profits in privatised utilities, market failure in social housing, rip off PFI deals crippling the NHS). It is of course essential Labour is vaguely attractive to all business, big and small, but I think Tony Blair fundamentally misses the point of how it’s also possible to have a vision about the future from Corbyn’s perspective, for example judicious use of investment in the North of England through an investment bank. Also, Blair’s caricature of socialists always being stuck in 1983 is clearly not true when aggressive tax avoidance and PFI are devices of today.
And the problems with Sadiq’s position politicially of doing ‘austerity lite’ is graphically represented by the closure of thousands of law centres in England on his watch as shadow minister for justice – not once did he pledge the timely return of these law centres, which like CABs were the lifeline of people like me who’d lost disability living allowance for no reason.
We were never a happy family in Labour. When I looked at this picture of me and Charlie Whelan, I thought of the time Nick Cohen was trapped in a pub with Charlie Whelan talking about the limitations of Alistair Darling during the global financial crash. As Nick knows, I defended Brown to the hilt, often irrationally, even when Brown claimed to be ‘saving the world’, during his 10p fiasco, when he was called Mr Bean by Sir Vince Cable, when he turned up late for the signing of a EU treaty, and so on. But Brown’s biggest mistake was probably the underregulation of the City – as the Americans pointed out, nobody forced the Brits to buy their dodgy securitised mortgage products.
In happier times maybe…? But remember how Brown tried desperately hard to get rid of Blair, and ultimately succeeded – then there was the fiasco of the election that never was.
I don’t feel in any way betrayed by Sadiq suddenly decided to endorse Owen Smith MP. I suppose Sadiq as Mayor of London feels also obligated to represent those members who robustly oppose #Brexit, such as corporate lawyers.
Everyone knows Jeremy Corbyn will win in this current leadership contest by a landslide – the question is whether the shadow cabinet is up to the job of writing coherent policy not in a cliquey club, and taking this policy to the doorstep. Owen Smith MP is worse than really dire as a contender.
Kinnock thought he’d win in 1987 and 1992, and look what happened to him. Blair won in 2005, despite a disastrous share of the vote – it is said that even he was so depressed by his own performance he turned the TV off for an hour of the election coverage.
We’ve been here before…
The famous utterance “Those are my principles, and if you don’t like them… well, I have others” attributed to Groucho Marx could have been designed for Owen Smith, MP.
Owen Smith MP during the course of this odd leadership contest, and his short-lived political career, appears to have given out confusing and conflicting messages. Whereas before he believed in the private finance initiative was good for building infrastructure in the NHS, he now appears to agree that this represents poor value for money. In defence of his strange comment of having ISIS around the table, when Corbyn has been lambasted for months for being ‘friendly to terrorists’, Smith complained that he had been cut off rather like a 140 character Twitter message. As @chunkymark describes in one of his recent videos, Jeremy Corbyn somehow manages to juggle a dual alias of being anti-war and being friendly to terrorist sympathisers. Amazing.
Even on subjects where Corbyn and Smith clearly disagree, Smith has changed rapidly from the persona of ‘saviour’ to ‘crowd pleaser’. His language and tone has changed during the course of the live-streamed hustings from ‘I think Jeremy is fundamentally wrong’ to ‘Where Jeremy and I have different positions’.
In the latter years of Tony Benn, Benn somehow was reinvented in the media from ‘public enemy number one’ to ‘national treasure’. There are still trolls on Twitter who insist that he was completely disastrous, but Tony Benn I feel was very right on one thing in particular. That is, Tony Benn used to categorise politicians as either ‘signposts’ or ‘weathervanes’. Signposts indicate the way ahead, resolute and unchanging in the face of criticism or challenge, whereas weathervanes spin on an axis, responding swiftly and unthinkingly to changes in the prevailing wind.
Like it or loathe it, and Corbyn does really appear to be ‘marmite’ politician par excellence, Corbyn has been the signpost. This has meant that he has been forced to disagree with his party’s line on Iraq and PFI, but he has voted consistent with his principles on the national minimum wage, human rights act, or equality legislation. Now, Owen Smith MP and 171 brands of Labour MPs, all identikit, happen to believe that winning is paramount, but to suggest that Jeremy Corbyn MP is disinterested in winning is highly disingenuous.
The final tally from Sophy Ridge ‘Sky’, who had the privilege of shadowing Ed Miliband during his 2015 general election campaign, was signalled thus.
And taken to extremes is it the strong case of the parliamentary Labour Party that anyone who runs the risk of losing should be dismissed at a shot? Remember that there were many ‘moderate’ MPs who refused to serve in @uklabour’s Corbyn cabinet from day 1. It is plausible that on Jeremy Corbyn’s inevitable re-election these MPs will continue to play havoc, sitting on their hands, jeering and briefing against Corbyn and McDonnell til the cows come home in TV studios. They are the ones who complain so vociferously of the ‘weak opposition’ of Corbyn when it is entirely their behaviour which sticks in the throats of many in the Labour membership, especially the ones who voted for Corbyn.
Tom Watson MP, taking a sympathetic view, was not implying that all ‘entryists’ were Trots, but how can it possible that even if they were this is acceptable if you pay the £25 ‘enhanced’ fee not the £3 fee? Surely it cannot be the case that money genuinely counts for more influence in the modern Labour Party, when it was Tony Benn who emphasised that the power of the democratic vote was that it counted for more than money. It would be helpful to emphasise Tony Benn’s credentials as a ‘loser’ at this point, but this is somewhat undermined that Benn himself served on the Labour NEC between 1962 and 1993. And that some of his beliefs – e.g. “why is it that there’s always money for war and not for schools?” or “we must have the best protected homeless against nuclear war in the whole world” – have lasted the test of time, say compared to the case for the private finance initiative or free schools.
There is something deeply flawed about someone arguing that someone else should not compete if he will lose probably. At this point in time, given the recent by-election successes of Labour and the successes in mayoralty elections, it is not a ‘given’ that Corbyn’s Labour will be annihilated in the general election of the first thursday of 2020. ‘Winner’ Owen Smith MP did not get the backing of the vast majority of constituencies. Add to Benjamin Franklin’s list of death and taxes, you get a third inevitability: that of Owen Smith MP losing.
This leadership election has been a complete waste of time. The candidature of Owen Smith MP has been an outrageous insult to the membership of @uklabour who only voted in Corbyn as leader nine months ago. Instead of formulating a coherent response to Brexit after the #EURef, which would’ve been a golden opportunity for @uklabour to reconnect with lost voters, 171 Labour MPs put their own self-interest above the needs of their members, who ‘believe in’ the need for social housing, the need to get rid of unconscionable PFI loan agreements, or the need to crack down on aggressive tax avoidance. Ironically, the biggest threat to these MPs’ existence is not Jeremy Corbyn MP, nor John McDonnell MP, nor deselection, nor even @chunkymark’s videos – but the boundary changes (explaining why Theresa May won’t want a snap election).
Anyway – being positive, I prefer the term ‘re-selection’ to ‘de-selection’. I am essentially a glass half full type of guy.
David Cameron himself slammed “top-down” reorganisations, before introducing a £3bn reorganisation of his own.
The changes which seem to fragment the system and introduce a number of new elements, such as the purchaser-provider split, Foundation Hospitals, were many changes under New Labour. And they did not cohere, and ultimately led to the Health and Social Care Act (2012). That of course is a massive fear of what Owen Smith MP would do to lay the foundation slabs for a future demonic Conservative government, despite his current poetic words.
This issue is beyond party politics, and not even about Owen Smith’s doomed leadership bid.
Not even about my support of any one Labour leadership candidate, or another.
I was unable to get a word in edgeways on a popular radio show about this last night, but I did get a chance to rebut fully a previous caller, by the name of John Redwood MP, Conservative MP for Wokingham. He claimed that there had been “no secret plan” to privatise the NHS, and that the Conservatives had been vocal critics of “Labour’s PFI”.
The “private finance initiative” was started in 1992 under John Major, and continued with much more force under Tony Blair from 1997 onwards. It was exasperating that this is still barely talked about by followers of New Labour as it was continued by the Coalition under George Osborne in 2010-5.
This ‘off budget accounting’ of PFI under New Labour was brought in at a time to address the poor physical infrastructure of the NHS. The risk was transferred to the public sector, while all the reward went to the finance sector. You can even trade in PFI units in the City.
The effect of this substantial privatisation technique? Firstly, due to the ‘corporate wonga’ nature of the loan repayments for these PFI hospitals money for safe staffing is driven to the bone. It is therefore effectively investing in shiny buildings and the City and disinvesting in people and skills in the NHS.
And back to John Redwood.
And, if there had been no “secret plan”, why was it then that John Redwood and Oliver Letwin in 1988 published a document for the Centre for Policy Studies called, “Britain’s biggest enterprise – ideas for radical reform of the NHS”.
On reflection, I actually agree with John Redwood MP.
This plan was far from secret.
And the conclusion could not be more blatant.
The Conservatives persist with the lie that privatisation is ‘not happening’ and yet boast of how things would be much more ‘efficient’ if the NHS were privatised.
The depth of this deception to the general public is completely laid bare by private companies providing NHS services hiding behind the NHS logo not their own corporate logo.
And you can still buy this from Amazon – authored by now Conservative Peer, Lord David Willetts, from 1993, the ‘golden era’ of John Major PFI.
A Guardian article yet again yesterday outed the lie there had not been any privatisation.
The ‘public face’ of the Conservatives is that they are ashamed of privatisation, whilst propelling it at full force. For Owen Smith MP or any others to argue that they were unaware that they were letting the NHS progress on this privatisation road is either deeply negligent or massively fraudulent, as the facts speak otherwise.
The Conservatives rely on the fact that there’s no ‘big bang’ flotation of the NHS, like the ‘Tell Sid’ campaign of privatising British Telecom in the 1980s.
Of course, the notion of the ‘privatisation of the NHS’ is deeply unpopular. People who are “experts”, like Christine Lagarde, Mark Carney and George Osborne, warning about economic armageddon delivered a #Brexit vote, were utterly rejected in the #EUref, reflecting perhaps the contempt that the City is held by some voters.
This contempt is not superficial – it is an endophenotype of how investment bankers crashed the economy, and yet nurses on their pay freeze or low paid teachers or the disabled are somehow meant ‘to pay for it’.
And then the next trick is to avoid defining what privatisation is. All privatisation is is transferring assets from the public sector to the private sector.
This is completely in keeping with other mutterings elsewhere from the Conservative Party – as described in “Opening the oyster: the NHS reforms in England” by Dr Lucy Reynolds and Prof Martin McKee (Clinical Medicine, Journal of the Royal College of Physicians) April 2012.
“According to a glossy brochure summarising the conference held last October, Britnell told his audience: “GPs will have to aggregate purchasing power and there will be a big opportunity for those companies that can facilitate this process … In future, the NHS will be a state insurance provider, not a state deliverer.” He added: “The NHS will be shown no mercy and the best time to take advantage of this will be in the next couple of years.””
And remember Oliver Letwin MP, John Redwood’s co-author of the pamphlet above?
“Oliver Letwin has reportedly told a private meeting that the “NHS will not exist” within five years of a Conservative election victory. The Shadow Chancellor said that the health service would instead be a “funding stream handing out money to pay people where they want to go for their healthcare”, according to a member of the audience. The remarks, which have been furiously denied by Mr Letwin, were last night seized on by Labour pecks evidence of the Tories’ true intentions towards the NHS. It is not disputed that Mr Letwin met a gathering of construction industry representatives in his constituency of Dorset West on 14 May. During the meeting he urged the group of around six local businessmen to work together to win contracts for a new PFI hospital to be built in Dorchester. Mr Letwin then astonished his audience, however, by saying that within five years of a Conservative election victory “the NHS will not exist anymore”, according to one of those who were present.”
It is simply up to the Conservatives and New Labour to defend this blatant policy, rather than lying to the public about it.
I’ve mentioned one technique which has delivered poor value for the taxpayer (the poor value for money to subsidise shareholder profit is an onrunning Conservative and New Labour theme; it is no accident that the privatisation of the NHS was conceptualised by Andrew Lansley like the privatisation of the utilities).
But there are many other techniques – and they’ve all been attempted/completed.
For example, the privatisation of auxiliary services – e.g. chemists, cleaners, lab staff.
Or, the selling off of NHS property (including buildings and land).
Or, the rampant outsourcing of NHS services/contracts to private sector (Health and Social Care Act 2012, section 75).
The components of the NHS privatisation jigsaw have been put in place by Tony Blair’s re-introduction of the internal market, and the introduction of the purchaser-provider split. (Tony Blair had originally won a mandate to get rid of the internal market, which had been advanced in statutory instruments such as the NHS and Community Care Act, but actually in the end ended up amplifying it. It is argued that Frank Dobson tried to stem the advance of the private market, but his work was thwarted in this respect by Alan Milburn)
And we know from New Labour’s watch, that the rush for Foundation Trust status, including financial competitive autonomy, means that some clinical services went down the pan. New Labour don’t like talking about Mid Staffs much for good reason.
There is no evidence that the private sector in producing clinical services is any more efficient.
In fact, there’s substantial evidence that there’s massive reduplication of unnecessary work, as that can cause repeated billing.
And it was a farcical situation when under a previous Government a merger could not take place which would have been for the benefit for providing better quality clinical services, as it breached competition law.
And the mere act of funnelling everything through private contracts, consequent to 2012 (and laid in place from the New Labour NHS Act 2007 and Public Contracts Regulations 2006), has seen a massive amount of extra paid work for corporate lawyers in litigation and other dispute work.
What is even more incredible is that a ‘serious’ Labour leadership candidate could have been unaware of this.
If the Right of the Labour Party want to throw their toys out of the pram, and split, and not support democracy or the vast majority of the membership of the Labour Party, they’re welcome to leave.
But – parliament is ultimately about sending delegates who represent the public’s feelings, not representatives of a big slick corporate marketing machine.
And look what happened to the SDP in the 1980s.
It is necessary to refer to the Adam Smith document by Pirie and Butler (entitled “The health of the nations – solutions to the problem of finance in the health care sector”) which charted all of this – in 1988.
Phase I 1988 – 1997 Thatcher/Major Abolition of District Health Authorities
“Perhaps a better candidate for abolition or reform, however, would be the tier ofDistrict Health Authorities”
“There must be more of an internal market within the NHS — that those units and districts with excess capacity or with some particular expertise should be more able to market their services to others who need them.”
“With a direct charging mechanism, with hospitals as cost centres, and with the use of management budgeting techniques by which each service provided by a hospital can be properly costed, such an I internal market could be vibrant.”
“Private hospitals, undertaking 400,000 operations per year, have a number of special strengths: they are particularly experienced at hip replacements, for example, because many older people who have saved to make their retirement comfortable happily spend the money on going private rather than waiting for two years or more in the public sector. Buying in such operations from the private sector — with NHS patients going to private hospitals for their treatment, but continuing to receive it free of charge — could be a cost effective way of clearing the waiting lists.”
PFI It is of course remarkable that in an article called “Private equity pioneer”, the impact of Michael Queen is laid bare. The timing of this is particularly noteworthy, predating the Blair government commencing 1997.
“CEO of 3i Michael Queen on his accountancy roots and how private equity can help develop world infrastructure. As chief executive of 3i, a FTSE 100 company and one of the world’s leading international private equity groups, Michael Queen is one of the most influential business people in Britain. In his 23 years with the firm, Queen has notched up many successes. Working his way through a variety of roles including finance director, he led the firm’s growth capital business and founded its infrastructure investment arm. In the mid-1990s, he found time to pioneer the NHS private finance initiative (PFI) which kick-started hospital building in the UK for the first time in decades. Recently, as CEO, he’s turned a £2bn debt in 2009 into £350m currently, built some £2bn in cash reserves and led a restructure of the group’s private equity business. And he’s just won the ICAEW’s Outstanding Achievement in Corporate Finance Award for his major contribution to UK business, entrepreneurship and the economy. But none of these are the moments that have defined his career. That was getting a position as an accountancy trainee with Coopers & Lybrand.”
As Andrew Sparrow outlined in an article last year in the Guardian,
“George Osborne, the chancellor, is pressing ahead with private finance initiative (PFI) projects on a multibillion-pound scale despite having dismissed the infrastructure funding mechanism as “discredited” when he was in opposition, research has revealed. A report on Channel 4 News shows 61 PFI projects, worth a total of £6.9bn, have been taken forward since the general election. This is despite claims that private sector borrowing costs currently make PFI particularly poor value for money.”
The Health of Nations had provided:
“The private sector may also be able to help in terms of raising capital for new facilities. In areas where medical treatments have been contracted out, one of the first actions of the private sector providers is commonly to scrap existing buildings and equipment and start afresh with facilities that are less costly to maintain and more pleasant to work in. Sale and leaseback arrangements might well be a good way of raising capital for the public hospital and simultaneously contracting out certain forms of care, such as long-stay care, which the private and charitable sectors might be better able to provide anyway. Contracts with private consortia to design, build, and operate complete hospital units on behalf of the Service would seem to be a logical extension of present practices. In addition, they could provide aninteresting source of new approaches to medical care.”
Phase III – Cameron/Clegg (2010 – present day) Formation of the NHS National Commissioning Board
“Making the Service less political may help to solve some of these problems. At national level, it might be better to run the NHS through a board which, like other nationalized industries, does not include the direct involvement of government ministers and does not allow their day-to-day involvement in the running of the industry, but is ultimately responsible to them.”
“With the management of the NHS switched over to HMUs instead of Regional and District Health Authorities, national supervision of the HMUs will be necessary. A ministerial body will license each HMU and specify the standards which they are required to attain. It will also have the responsibility of ensuring that the levels of service reach those required. It will publish the criteria and compare the performance of HMUs across the country. If the HMUs make use of sub-contractors for certain aspects of health care, these, too, will be required to attain what are deemed to be the appropriate standards.”
“Perhaps one of the most exciting new ideas, however, is the concept of management by contract, which works well abroad and is just now being tried out within the NHS.” “contracts can be of any duration, though five years is a workable minimum” “In this new version, however, it is the managers who are under contract, rather than the front-end service workers. The skills needed to run each function come not from in-house managers but from outside experts, hired under a contract of finite duration. They must achieve whatever targets are negotiated and agreed at the beginning of the contract, or risk losing their work to a competitor.”
“Contracting out the management of an entire hospital, including the medical services, could lead to greater opposition, but on, the other hand it might be seen as a lifeline to units that are threatened with closure because of demographic changes, smallness or obsolescence.”
Choose and Book (“AQP”) with CCGs funded by PHBs (“vouchers”)
“In more radical versions of the idea, however, patients are given a wider choice about the NHS doctor and hospital they want to treat them, and the average per caput health expenditure represented in the voucher actually follows them when they choose.”
Introduction to CCGs (Clinical Commissioning Groups) funded by PHBs Abroad, in the Netherlands, “unintended consequences” of PHBs have now been described. The “Health of Nations “provides:
“Fundamentally, HMOs offer a complete health care delivery service to groups of individuals in return for a fixed and prepaid annual premium. A group, such as a group of employees contracted into the HMO by a company, pays a premium on joining the scheme, and for that the HMO guarantees to provide each member with all the GP and hospital care that may be needed in each case. The scheme managers will in turn contract with the doctors and hospitals they need in order to provide this whole-care service.”
The CCGs use the PHBs to contract with GPs of CCG member practices & purchase hospital and other secondary care through competitive tendering or through Choose and Book (“AQP”)
“For example, we might break down the NHS delivery system in a particular city or area, transforming it into a series of competing whole-care delivery plans on the HMO model, whose budgets were allocated on a per-patient basis rather than from a DHA grant, and who contracted with their own doctors and bought in the necessary hospital treatment from the private or public sectors.”
The insurance risks for CCGs are highlighted
“However, difficulties remain. There are still no obvious structures presently in existence within the NHS which would provide the nucleus around which new HMO-style systems could be grown. Some group — managers or doctors — have to accept the risk that they can deliver a complete health care service within the per caput budget, and neither group currently working inside the NHS is likely to accept that new challenge with much pleasure. In fact, staff at all levels would be worriedby the prospect of their service being divided into competing units.”
Patient choice will not extend to consultation over exchanging universal tax-funded NHS coverage for an insurance-based healthcare
“Even if a new structural arrangement could be devised, there would be the problem of how to allocate residents to each of the new plans. A free individual decision to stay with the present structure or opt for the new plan might be dangerous in the initial stages at least, because those in most need of treatment might self-select. Thus, it would be a case of compulsorily transferring patients from the existing structure into the new plans, which again might not be a popular proposal. Any move to explore the possibilities of how best to do this, however, would undoubtedly meet loud objections against using NHS patients as guinea-pigs for some new organizational theory.“
Phase IV Cameron/Clegg (2012-5) Abolition of SHA & PCT management superstructure
“The key to reform of the NHS, as in education, lies in reorganization of its management structure. In place of the Regional Health Authorities and the District Health Authorities there should be management bodies which have every incentive to spend resources in ways which are cost effective and attractive to patients. These bodies should be funded from taxation and should have the responsibility of proving a full health care service for patients. They should distribute resources to general practitioners at the primary level, and to hospitals and consultants at the top. They will be, in effect, Health Management units (HMUs).”
CCGs as statutory health insurance? The idea of CCGs as “insurance schemes” has been previously mooted. The ‘pooling of risk’ is explicitly referred to in the Department of Health’s Health and Social Care Bill (2011) impact assessment thus:
“CCG Size: There is no consensus on a minimum size to handle the financial risk.2 5 Inter-GP relations and peer review are strong forces and can counter the effects of higher statistical risk in smaller CCGs for many services. However, while some high risk services are best covered at a more regional level, risks could be shared by CCGs grouping together to form their own risk pools.”
Meanwhile, the “Health of Nations” provided,
“The public sector HMUs, taking responsibility for total health care of NHS patients, are not too far removed in structure from private insurance and management bodies. The funds for premiums are publicly provided, but the same competition and incentives operate, and the same choices are made available.”
PHBs as the basis of calculation of the funding allocated to CCGs
“The HMUs themselves will have to provide total health care on the basis of an average annual allocation per patient. They will have the incentive to make sure they get value for money from the GPs who subscribe to them, and for the hospital and consultancy work they obtain for their patients.”
Performance management of GPs and hospitals by CCGs
“They will have the incentive to make sure they get value for money from the GPs who subscribe to them, and for the hospital and consultancy work they obtain for their patients.”
Situation of GPs once CCGs are authorised
“The HMUs will be licensed non-profit bodies responsible for the total health care ofthe patients registered with their doctors. They will be management bodies, drawingupon the existing skills of health managers.” (p.32) “The HMUs will be required to buy hospital and specialist services for their patients as required” “The payment and monitoring of their GPs will be part of the task of HMUs, and will be performed in ways which ensure value for money. Cost details of GP work will be compared, and action taken where necessary to improve efficiency. HMUs will be vigilant in the selection of specialist and hospital services for their patients. They will be concerned to provide these on the most cost-effective basis they can, because the less they pay for each service, the more services they ‘will be able to offer to patients’ and the more attractive will be the rewards they can offer to personnel. The HMUs will not operate on a simple least-cost basis, but on a most cost-effective basis. Patients and their GPs will have the choice to move to an HMU whose services are more attractive, and will take with them the state’s allocation per patient. It will be very much in the interest of the Health Management Units to lower the cost per patient by timely preventive work and early diagnosis by regular check-ups. The move to HMUs will have a dramatic effect on the costs and the efficiency of hospital treatment. As hospitals go to independent management they will have to cost each service and will need to be aware of precise cost information. They will be very much more flexible in their management and method of operation. Pay scales will be more flexible and will be negotiated on a local basis instead of the rigid system of national scales and procedures. It is doubtful if restrictive practices in operation at present in the NHS will survive the changeover. There will be an incentive towards efficiency and flexibility, as well as to specialization. In some areas it is quite possible that HMUs will send their patients to the private sector for some categories of service and treatment. Where private clinics offer better value than state hospitals, there will be every incentive for them to do so. What certain hospitals do in particularly effective ways they will be able to sell widely, leading to the expansion of what each does well. The result will be for a new partnership of private and public medicine, with the services of each available to NHS patients on the basis of their comparative efficiency. An early result of the switch to HMUs will be the development of specialist low-cost treatments. Existing NHS hospitals and new intermediate facilities will have every incentive to develop methods of treatment which can bring economical results. Again, the example of other advanced countries and the private sector in Britain suggests that new methods will be pioneered which involve shorter hospital stays, more localized services, more preventive medicine, and a generally less costly style of care. The incentive will be there with HMOs seeking to provide health care efficiently. HMUs and hospitals will be able to undertake new capital projects with a combination of central grants and monies raised or saved locally. Funds from the private sector might well be attracted to areas which promise a saving on current expenditures. GPs acting singly or in groups will have the incentive to add facilities, perhaps leased from their HMUs, in order to compete with the cost of more expensive hospital services. Some of the work which now has to be done in hospitals will move out to smaller and lower cost treatment centres, some in the surgeries of doctors.”
“The proportion of remuneration which derives simply from having patients on their books will disappear, leaving payment only by results.”
Patients and their GPs will have the choice to move to an HMU whose services are more attractive, and will take with them the state’s allocation per patient.
“It will be important to prevent HMUs from selecting patients by picking the one’s which cost least to treat. HMUs will be required to accept patients who register with their doctors, without any selection permitted other than on the basis of optimum size of the HMU. Even here, where patients are refused because an HMU is at its optimum, waiting lists will have to be established with new patients admitted in order of application as places become available.”
CCGs as a vehicle for increasing uptake of private sector hospital care and other commercial services
“In some areas it is quite possible that HMUs will send their patients to the private sector for some categories of service and treatment. Where private clinics offer better value than state hospitals, there will be every incentive for them to do so. What certain hospitals do in particularly effective ways they will be able to sell widely, leading to the expansion of what each does well. The result will be for a new partnership of private and public medicine, with the services of each available to NHS patients on the basis of their comparative efficiency.”
GP incentive scheme?
“GPs acting singly or in groups will have the incentive to add facilities, perhaps leased from their HMUs, in order to compete with the cost of more expensive hospital services. Some of the work which now has to be done in hospitals will move out to smaller and lower cost treatment centres, some in the surgeries of doctors.”
“The basis of funding will be the annual health allocation for each patient registered Health Maintenance Organizations is largely avoided by keeping patients with their present GP. The resources go to the HMU selected by the doctor, although the ultimate choice lies with the patient, who can change HMO by going to a doctor registered with another one. The resources are thus directed to the HMOs which are most favoured by doctors and patients.”
PHBs calculated with demographic weighting
“The size of the average health allocation will be set each year, and there will be pressures to keep up with an advancing standard of living. A major difference is thatthere will be internal competition, with some HMOs managing to offer a greater range of services than others do on the same per caput budget. There will be the option available to vary the health allocation for each patient according to the local health costs. Geography will play a part, but so will the age pattern of the population. It may be desirable to vary the allocation by category of patient, on the grounds that older patients are more expensive to care for. This is not different in degree from varying the central funding for each age group of child in the education system.”
Personal health budget (partial roll-out now commencing) as allocations calculated for individuals which the individuals can transfer from public to private sector providers (from CCGs to insurance companies selling NHS top-up insurance)
“Under this idea, each individual would receive from the state a health voucher, equivalent in value to the average per caput sum that is presently spent on providing health care. The voucher can be used towards the purchase of private health insurance or exchanged for treatment within the public sector health system. Through this mechanism, the state honours its assumed obligation to ensure that everyone has access to health services. Those who opt into private insurance can use the voucher to pay their premiums, and the insurance companies then collect the cash value of the voucher from the government. This guarantees that everyone can afford at least a basic level of insurance cover, and (perhaps more importantly) it allows each individual a choice between different insurers and insurance packages, no matter how rich or poor they might be. However, people who decide that health care is particularly important to them are free to add to the amount covered by the voucher and thus purchase more expensive forms of insurance, perhaps covering more unlikely risks or providing superior standards of comfort or convenience. The voucher does not force people into private insurance, although it certainly makes the option of going private instantly available to everyone. Those who want to use the state service will continue to receive it, their voucher being their ticket to free treatment just as their national insurance number is at the moment. Under the more modest voucher proposals, that is the end of the story, the NHS continuing much as before — though perhaps losing some customers to the private sector that has suddenly become so much more affordable to all. In more radical versions of the idea, however, patients are given a wider choice about the NHS doctor and hospital they want to treat them, and the average per caput health expenditure represented in the voucher actually follows them when they choose. Thus, the pressure of competition is introduced in the public sector as well, because those doctors and hospitals which are popular with patients will be taking in more vouchers and thus getting a larger share of the government’s health budget. There are strong incentives to improve standards of care and to regard the patient more as a paying customer who must be satisfied.”
CCGs as transitional structures leading to unification of the NHS with the private healthcare industry
“Perhaps the greatest advantage lies in the flexibility of the new system. In place of the rigid demarcation between a public health service which does what it can on a take-it-or-leave-it basis, and a private system for the rich which offers choice and competition, the distinction between the two is blurred. They begin to overlap, each on the territory of the other. “
CCGs as insurance mechanisms
“The public sector HMUs, taking responsibility for total health care of NHS patients, are not too far removed in structure from private insurance and management bodies. The funds for premiums are publicly provided, but the same competition and incentives operate, and the same choices are made available.” “This convergence is one of the most attractive features of the change which HMUs will bring. The HMU principle lays the groundwork and the basis for further changes at a later stage, but it brings its benefits immediately. Most of the groups involved in health care stand to gain from its introduction, the patients most of all. It is from realities such as this that change is made possible.”
Phase V Here are the new resources to be brought into the healthcare system that the 2010 White Paper mentioned: payments to private health insurance companies from private individuals to pay for their healthcare, as in the USA. PHBs have been created in the form of transferable vouchers which can be spent on a pooled basis through CCGs or transferred to supplement a purchased top-up insurance policy. Such top-up policies are already being marketed intensively in England as the insurance industry prepares for the Transition planned by the DH.
“At present in the UK, car drivers are required to have a motor insurance policy that compensates other people in the event that they cause damage or injury in an accident. Similarly, it is argued, we could meet the health needs of everyone without the need for the government itself to provide health services through the NHS, simply by requiring that all individuals have medical insurance cover for a range of services that are deemed to be the acceptable minimum standard of health care. Of course, those who wished to have a superior standard of service could take out a more extensive policy: there would be no Objection to individuals insuring themselves for additional or more costly services, as long as the basic requirements are met.” “A key advantage of the universal private insurance approach is that individuals have much more choice and that the insurers and health care providers face far more competition than the NHS faces at present. Although people are obliged to have a minimum level of medical insurance cover, they can shop around between insurers and decide which provides the best value for their premium money. Because there is competition, they can decide which insurer’s particular package of services is most suited to their individual needs, instead of having to accept the standard service provided by the NHS. In addition, they can spend more on their health care, if they judge it worthwhile, than is presently spent on their behalf by the government, so new resources will be brought into the health care system.” “Under this idea, each individual would receive from the state a health voucher, equivalent in value to the average per caput sum that is presently spent on providing health care. The voucher can be used towards the purchase of private health insurance or exchanged for treatment within the public sector health system.” “The actual provision of health care services in such a system of universal private medical insurance would be undertaken by private sector doctors and hospitals, and the nationalized health sector in the shape of the National Health Service would lose its reason for existence.”
Owen Smith MP is doing a great disservice by pretending to be the ‘controlled opposition’ to the privatisation of the NHS, when there are great NHS campaigners who have vociferous about this for years.
As such it won’t matter – as I bet my life Owen Smith MP won’t win the Labour leadership.
Whatever cognitive and emotional biases were at play, true or apparent, materially significant or otherwise, let’s assume that there was no untoward process in the decision-making of the three Court of Appeal judges last week.
It is quite incredible that they were able to deliver such a detailed judgment within the space of 24 hours, some might say, but this is probably not surprising given the voluminous nature of the background documentation such as Iain McNicol’s witness statement (if he submitted one.)
Whatever is the real story behind the ‘entryist Trots’, there is absolute no proof that the vast majority wanted to vote for Jeremy Corbyn. For all we know, the #SavingLabour campaign has been a roaring success (so much so it is about to be succeeded by ‘Labour tomorrow’). Also, we can of course safely assume that 130,000 people were so disgusted by Jeremy Corbyn MP’s lack of leadership on the #EURef that they wished to sign up to Labour to give rid of him asap. Not.
The alarms about ‘entryist Trots’ are a matter of conjecture and speculation, so much so no realistic legal judgment would go into great lengths about the need to ban new members from voting. But the Court of Appeal delivered a voluminous judgment which made no reference to how the electronic contract on the website might have been concluded.
The judgment gets into an acceptable review of the jurisprudence on the completeness of a contract, on whether some terms are more important than others. This is to deny that there are certain issues which happen outside of the explicit terms of a contract – i.e. the right of the employee to resign for downright offensive behaviour by his employer, an implied term in the employment contract.
But amazingly the jurisprudence employed by the Court of Appeal makes no reference at all to how the wider way in which people are attracted to the website and might conclude their membership.
There is for example this notice, and note the wording.
The wording says ‘you’ll be’ not ‘you might be’ or ‘you could be’.
Let’s assume that joining Labour is exactly like making a contract, at best a spurious assumption, but one which has been supported by reference to cases such as Choudhury and Ors v Treisman. The Court of Appeal judges appear to have somewhat lost sight of why the claimants were there at all – they thought that through membership they could exercise a vote.
If the freeze date were of such crucial importance, it should have been given such prominence as you’d expect for revocation of an offer for a contract (i.e. same size and letter etc.) – but the fundamental principle of contract law will still hold – caveat emptor. But this for a reasonable buyer to do a reasonable due diligence – cf buying a lettuce on the Sainsburys on-line grocery website. I don’t think it’s possible for a reasonable buyer in this context to be able to inspect every nook and cranny of the Labour rule book nor the surrounding national legislation on elections and referendums.
Justice might for one or four claimants might not matter as such, but if you truly believe in the rule of law, you’ll hold that everyone is equal in front of the law. But it is clearly a matter of natural justice that the Labour NEC can’t take the monies off 130,000 at what at best can be best called dubious circumstances. Likewise, it was clearly not natural justice for some in the NEC to deny the wish for Jeremy Corbyn MP to defend his own position as leader. It is well known that many people on the elections committee of NEC are extremely hostile, sometimes to his face or in written form, to Jeremy Corbyn.
The Court of Appeal judgment was profoundly illiberal. The English law for the time being complies with the European doctrine of proportionality, in that its rules are deemed necessary and proportionate by the legislature. Whatever the views about the setting of the ‘freeze date’, including ‘it’s always been done that way’, the fashion of setting a freeze date retroactively when members of Labour had been so vehemently encouraged to sign up is an extemely dangerous one. As an example, the English law is extremely reluctant to produce retroactive law, but it has been known to happen, for example the War Damages Act. This decision unfortunately does give an impression in that the NEC is indeed above the common law – in that its rule book can make up rules at the drop of the hat for any spurious reason. This autonomy is vehemently not called irrational by the Court of Appeal. Methinks the lady protesteth too much?
But on the face value, 130,000 people have concluded a contract, their monies debited, and now they are denied a chance of a vote in a democratic process – and they want their money back. It is a long running thread in English law that the law looks at the substance not the form, which is why it is baffling why the Court of Appeal seem to have completely lost sight of why the claimants felt so strongly enough to make a claim at all.
The Supreme Court will certainly need to have a careful look at how it could have been the Court of Appeal lost its way so triumphantly, with consideration of the formation of the contract in this digital age (e-commerce, for example) and the human rights involved in a democratic right to vote. LJ Laws has of course famously mooted whether human rights law should involve itself in issues of society and moral issues, but we are where are. The Rt Hon Prof Robin Jacob who famously sat as one of the experts in intellectual property for the Court of Appeal was very good at joining up different strands, unlike the three CoA judges last week I feel. Jacob before becoming a distinguished lawyer studied natural sciences at Cambridge.
Lord Falconer claims it was a ‘good judgment’ and emphasises that it was not the Labour NEC who brought the claim. But he is being utterly disingenuous as it was the Labour NEC’s decision to use members’ money to appeal the High Court judgment, a decision which even Frank Field MP found utterly bizarre on BBC Any Questions this friday.
The liberal English press seem curiously silent on the muzzling of liberal principles.
Take for example Thomas Paine (1795):
“The true and only true basis of representative government is equality of rights. Every man has a right to one vote, and no more in the choice of representatives. The rich have no more right to exclude the poor from the right of voting, or of electing and being elected, than the poor have to exclude the rich; and wherever it is attempted, or proposed, on either side, it is a question of force and not of right. Who is he that would exclude another? That other has a right to exclude him.”
It is a matter of conjecture from Alan Ryan, that JS Mill did not think of contract and property rights as being part of freedom.
The right to vote is fundamental: as stated clearly on the Liberty website,
“The right to free elections is crucial to establishing and maintaining the foundations of an effective and meaningful democracy governed by the rule of law.
By agreeing to Article 3 of the First Protocol, the UK has undertaken to hold free elections at reasonable intervals by secret ballot, under conditions which will ensure the free expression of the opinion of the people in the choice of the legislature.
… Conditions may be set on the right to vote such as minimum age requirements and, in some circumstances, residency. But such restrictions cannot impair the very essence of the right to vote. In particular, disenfranchisement is a very serious matter and it will require a discernible and sufficient link between the sanction of disenfranchising someone and the conduct and circumstances of the person being disenfranchised. A blanket, automatic restriction that applies regardless of individual circumstances will be in breach of the right to vote.”
And the late great Tony Benn repeatedly emphasised how the vote was of much more influence than money.
These five questions seem to me to be particularly pertinent, and worth asking for the Labour #NEC and much of the currently motley crue that is that is the parliamentary Labour Party.
This is not a Photoshop. It’s a photo taken of me and Jeremy Corbyn MP many years ago, at the Islington Law Centre. At the time, I was studying for a Master of Law from the University of Law.
The English law, and certainly the Solicitors Regulation Authority, prevents me from discussing ongoing cases in a way which might be considered contempt of court.
But a few tweets on Twitter, all from people who did not follow me but followed Owen Smith MP, clearly had a disregard for the rule of law. These trolls seemed to believe the law must begin and end at the NEC at all times. This is clearly wrong in that nothing, not even the NEC, is above the English law.
There are some general points concerning the law, not involving this particular dispute, which are worth saying.
There is some attention whether the higher courts such as the High Court or the Court of Appeal can have jurisdiction in ‘internal’ matters due to existence of an ‘ouster clause’ in a contract.
As provided by “Mr Google”
We took it from the High Court case, and others, that joining the Labour Party forms a contract in that you become a member of an association. This was taken as before with reference to previous cases such as Choudry and Ors v Treisman.
Now if you assume that it is a contract there’s a question as to whether everything has to be specified explicitly within the contract. This is where the ‘four corners rule’ (or “parol evidence rule”) of contract law would come in – i.e. you don’t need to go anywhere other than the contract to find all the rules. But we know that there are clearly contracts where all the rules are not specified. Take for example, employment contracts, where it is implied that there is a reciprocal relationship between employer and employee of a duty of trust and confidence (or “fidelity”). Because of this duty, if say your employer does something really unconscionable, you can argue that there’s been a fundamental breach of this duty, and you can take a claim within three months for constructive dismissal.
A similar issue has arisen now with this contract of joining the Labour Party and the question of ‘freeze dates’, and indeed there is a classic case of interest here.
If you take the belief that the NEC must have the flexibility to impose a freeze date of its choosing, it could arbitrarily decide that it would bar all new entrants post 2000 from voting in the current election, only for it to be ratified at conference. This would be clearly ludicrous. One could argue that a quarter of the membership joining after June 24th could have been legitimately barred as they might be ‘entryists’ in response to an imminent leadership election (which nobody knew about at on June 24th); or you could equally argue that such new entrants were enthused about joining the Labour Party in solidarity with a leader who was beginning to crystallise a response to the result of the EU referendum. As English law, in keeping with our current European obligations, believes firmly in the presumption of innocence, it can’t be taken as red that this new membership definitely is ‘entryist’ and wants to throw the election. That is why Tom Watson MP’s letter to Jeremy Corbyn MP, citing Richard Angell’s book review of ‘Militant’ by Michael Crick, is so timely and significant.
Anisimic was a classic case from the House of Lords which gave the courts jurisdiction to examine contracts if there had been an err in the law. Now we know that there is a view that there has been a fundamental breach of contract in taking the money of new members of Labour without giving them voting rights. In this regard, it would have possibly been easier to argue that voting rights, whatever the other ‘dividing lines’ for membership, were pretty inalienable. But the flexibility afforded to the NEC dangerously might set the precedent that the NEC is in effect above the English law, and free to breach its own contract with members.
So in summary the Labour Parliamentary Labour Party have acted in a totally disgusting way. Labour MPs are sitting on their hands, silent in #pmqs, totally unsupportive of the Leader of the Opposition, not even bothering to turn up to key debates, such as John McDonnell’s economics debate. They think that they can bully Corbyn into resigning, whereas Corbyn is under no obligation to resign. They humiliate Corbyn in TV studios, alleging that he is a psychopath who is quite unable of rustling up followership at the drop of the hat, rather than producing policy. They then try to stop Corbyn from defending his own leadership in an election. And then the Labour NEC tries to stop a whole swathe of new members from voting – loses, and then uses monies, perhaps including members’ own monies, to defend the case at vast cost. Then Owen Smith MP puts in a putrid performance in Gateshead, where he says he must return to the back benches rather than joining Corbyn, if he won, in fighting the Conservatives, whenever the election is called.
Smith’s political manner was vulgar, aggressive and offensive towards Corbyn; and the content of his answers ubiquitously intellectually void of any calibre. Owen Smith MP by no stretch of the imagination is leadership material for Labour. As somebody I trust totally called it yesterday, “Owen Smith MP’s politics are in a charisma-free zone.”
But this, as I’ve said before, is desperate stuff from a putrid Labour PLP and the true entryists, ‘influential’ people pulling the strings from afar for example as in the Big 4 accountancy firms. It is tragic that the Labour parliamentary party is so intent on wrecking itself, rather than fighting the Conservatives on key issues. A system of open primaries would however ensure that we have Labour candidates who are fit for purpose, and we know that the vast majority of the constituency Labour Party divisions have voted for Jeremy Corbyn not Owen Smith MP.