“All it takes for evil to succeed is for a few good men to do nothing…” is the famous saying by Edmund Burke.
Burke despised the abuse of power, so one can only wonder what he would have made of the enactment of the Health and Social Care Act (2012).
It’s often forgotten that the original name of the Liberal Democrats Party is the ‘Social and Liberal Democratic Party’. Nick Clegg worked for Tory Grandee, Leon Brittan, so is bound to have been the recipient of right-wing ideological stardust. David Laws, Nick Clegg and others like them don’t like to describe themselves as “social democrats”, they prefer to describe themselves as Liberals favouring ‘the smaller state’ in the tradition of J.S. Mill. David Laws has described previous Labour governments as having too many collective social democrat experiments, and possibly feels as much hostility towards Labour as is probably felt towards ‘the Orange Bookers’ by Labour members.
The idea of Labour voluntarily wishing to go into a Coalition with the Liberal Democrats in May 2015 should frankly make you wish to throw up down the nearest toilet. Lord Andrew Adonis explains his version of events in the account in “5 days in May”, and from it emerges a clean narrative of how the Liberal Democrats only used their abortive negotiations with Labour to try to improve their bargaining hand with the Conservatives. The brilliant Matthew d’Ancona is consistent with his account too. Nick Clegg clearly wanted to ‘go right’, and not go left. Clegg had reached a judgment, despite policy overlap with Labour, that a Lib-Lab coalition was not going to work. To explain, in his book ‘In It together’ D’Ancona describes a tight social circle running the Tory side of the coalition – “old friends, their wives, ex-girlfriends, all joining each other for holidays and dinner parties and sharing childcare, now all ministers or Downing Street staffers.”
There were no negotiations between the Liberal Democrats and Labour on the ‘economic plan’. Vince Cable was not even on the LibDems’ negotiating team. Nick Clegg signed up to ‘faster and deeper’ cuts, and the full ‘Go large’ offer of welfare reforms. Clegg’s promise that he would negotiate first with the party which achieved the most seats had no constitutional precedent. This move was clearly to legitimitise an opening to the Conservatives, and to his own party.
The writing was always on the wall for the NHS too. Nick Clegg’s wife was formerly a partner in charge of competition law work for the large corporate firm DLA Piper. This global legal partnership has been heavily involved in European competition law is DLA Piper, who provide lobbying, public affairs and trade policy services, as well as advice on how to get access to public service delivery contracts. One partner of the firm who is part of the Liberal Democrat Peer who ended up being highly influential was Lord Tim Clement-Jones, in seeing new the competition regulations reach the statute books this year.
“Neoliberalism” is an updated version of the classical liberal economic thought that was dominant in the US and UK prior to the Great Depression of the 1930s. From roughly the mid 1930s to the mid 1970s a new “interventionist” approach replaced classical liberalism. It became the accepted belief that capitalism requires significant state regulation in order to be viable. And we are seeing Labour returning to the idea that unregulated markets do not act to the benefit of the consumer, in his attack on ‘energy prices’. The “cost of living crisis”, whilst not directly about the NHS, is entirely about the dialogue between the State and the markets, which has become so essential for the UK Labour Party to negotiate.
In the 1970s the Old Religion of classical liberalism made a rapid comeback, first in academic economics and then in the realm of public policy. Neoliberalism is both a body of economic theory and a policy stance. Neoliberal theory claims that a largely unregulated capitalist system (a “free market economy”) not only embodies the ideal of free individual choice but also achieves optimum economic performance with respect to efficiency, economic growth, technical progress, and distributional justice. This idea has lingered on in the neoliberal policies of all three major parties, in “personal health budgets” which should be more accurately described as “individualised” budgets. With the combination of health and social care budgets likely to form a thrust of Labour’s “whole person care” policy, the neoliberal concept of choice is potentially very much alive and well, but it will be for Burnham and colleagues to swing the pendulum back towards the inherent socialist (and left populist) notion of putting a ‘national care service’ on an equal footing with health. In this narrative, which Labour had thus far been reluctant to question before Burnham noticeably started making strong ‘anti-market noises’, the State is assigned a very limited economic role: defining property rights, enforcing contracts, and regulating the money supply. State intervention to correct market failures is viewed with suspicion, on the ground that such intervention is likely to create more problems than it solves. If Ed Miliband’s concept of the relationship between the State and markets is anything to go by, and this itself represents a marked departure from Tony Blair’s viewpoint, Andy Burnham is likely to be able to make inroads into this socialist agenda.
The definition of socialism is in fact well known to all members of the Labour Party, by virtue of their membership card. It is worth noting that recent policy decisions have been promoting neoliberalism, and the net effect has been that the Socialist Health Association has been asleep at the wheel. Competition is a massive shoo-horn into neoliberalism. Nearly exactly one year ago, I described how section 75 of the Health and Social Care Act (2012) would be exactly the sort of legislative mechanism which would impose competition like never before on the NHS. As Lynton Crosby himself says, “You should lock in the base, and then go for the swing?” In my view, the base is competition, the swing is the free movement of capital.
My article on the Socialist Health Association website is here, long before Polly Toynbee and David Nicholson were reporting as thinking that competition was a problem. Once capitalism had become well established in the US after the Civil War, it entered period of cutthroat competition and wild accumulation known as the Robber Baron era. In this period a coherent anti-interventionist liberal position emerged and became politically dominant. Despite the enormous inequalities, the severe business cycle, and the outrageous and often unlawful behavior of the Goulds and Rockefellers, the idea that government should not intervene in the economy held sway through the end of the 19th century.
What explains this political difference between large and small business? The mood music appears to be that Labour is intending to refine its pledge of ‘being the party of business’. Ed Miliband in his conference speech of 2013 made quite a big play of ‘standing up to bullies’ rather than ‘the weak’. It would therefore make no intuitive sense for Miliband to become very pro-corporations and ignoring SMEs. And this makes complete sense when you understand the relationship of the symbiotic relationship between the State and big corporations. When large corporations achieve significant market power and become freed from fear concerning their immediate survival, they tend to develop a long time horizon and pay attention to the requirements for assuring growing profits over time. They come to see the state as a potential ally. Having high and stable monopoly profits, they tend to view the cost of government programs as something they can afford, given their potential benefits. By contrast, the typical small business faces a daily battle for survival, which prevents attention to long-run considerations and which places a premium on avoiding the short-run costs of taxation and state regulation. This explains the radically different positions that big business and small business held regarding the proper state role in the economy for the first two-thirds of the twentieth century. It is no particular surprise that some of the G8 dementia summit agenda has had textbook ‘corporate capture’, in going down the road of personalised genomics medicine rather than care.
To some extent, this “horse has bolted”, and it is to his credit that Andy Burnham MP has vigorously said the marketisation of the NHS went far too far. For example, in his first ever Healthwatch Conference speech,
“I think we let the market in too far. The time has come to say that and to draw a line and make a break with it. If you let this market in too far, I believe, in the end, you will destroy the whole, what is so fantastic about the NHS, that ethos that Danny Boyle captured so memorably at the opening ceremony of the Olympic Games.”
Andy Burnham, as Shadow Secretary of State for Health, has pledged to repeal the Health and Social Care Act (2012), which will go some way to discredit the extremely poor arguments for competition which have emerged from prominent healthcare analysts in recent years. There is no doubt, for example, that the merger involving Royal Bournemouth and Christchurch hospitals NHS foundation trust and Poole Hospital NHS foundation trust was a particularly low point. All the people whom I have spoken to in private think that Andy Burnham MP and all members of the Shadow Health Team really firmly believe what they’re saying, in standing up for the NHS. This should in theory be low hanging fruit for Labour as Labour is consistently many % points ahead of the Conservatives on the NHS. It should also be in theory low hanging fruit for the Socialist Health Association.
Having failed so triumphantly in having warned about the threat posed by this pro-competition legislative instrument, the Socialist Health Association is at risk of being asleep at the wheel yet again over a second and equally crucial matter. Some analysts argue that globalisation has produced a world of such economic interdependence that individual nation-states no longer have the power to regulate capital. Free movement of capital is described as being “at the heart of the Single Market and is one of its ‘four freedoms'”. According to the European Commission,
“It enables integrated, open, competitive and efficient European financial markets and services – which bring many advantages to us all.”
Tony Benn has described graphically how he considers “free movement of capital” to be a threat to basic democracy in socialism. Benn argues that this particular free movement imperialism under a new form: only the agents of imperialism are companies rather than countries. To this extent, the media excitement as to whether you should provide NHS treatment for migrants bring something to mind: “smoke and mirrors”.
And what about the EU-US Free Trade Treaty? This is the second big issue nobody wants to talk about, as it is the “swing” part of neoliberalising “our NHS”. The aim of the Agreement, according to the Commission, is to remove ‘unnecessary obstacles to trade and investment, including existing NTBs, through effective and efficient mechanisms, by reaching an ambitious level of regulatory compatibility for goods and services, including through mutual recognition, harmonisation and through enhanced cooperation between regulators’. (Art 24) It is mooted that the EU-US treaty would set in stone all liberalisation and privatisation measures already achieved at the time the treaty is signed and bring all future regulations within the restrictive provisions of the agreement. This treaty, if passed, would represent an enormous challenge to public-owned health services across Europe. There was very little awareness in Europe, even among those wanting to defend public services, to the implications of the EU-Canada agreement. Debbie Abrahams has become a lone voice virtually in discussing this in parliament. It would now be very desirable that campaigns in Britain pay serious attention to the US-EU negotiations and link up with campaigns in other EU states, and the Socialist Health Association as a national entity affiliated to the Labour Party should have a clear view on this. It would be even more helpful for its members if this settled view were consistent with a definition of socialism ‘as we know it’.
Whatever one’s precise definitions of privatisation and nationalisation, in the context of the NHS, it is clear that the public have some views about national identity and state ownership of assets. This is borne out by the electoral successes which are widely predicted for UKIP int the European Elections next year. So far, we’ve had the debate, but with no thanks to the BBC, of how the NHS is being outsourced and privatised without anyone’s knowledge. It is essential that the Socialist Health Association is fit for purpose in influencing Labour policy in 2014, in having a view on whether it wants to see primary care as well as services in NHS hospitals being run by private domestic and multi-national companies for maximisation shareholder dividend. This of course would be a tragedy in a year in the run-up to the General Election on May 7th 2015, though this is as much about a battle for the soul of the Labour Party as it is about winning an election.
In 1945 Herbert Morrison was given responsibility for drafting the Labour Party manifesto that included the blueprints for the nationalsation and welfare programmes:
“The Labour Party is a socialist party and proud of it. Its ultimate purpose at home is the establishment of the Socialist Commonwealth of Great Britain – free, democratic, efficient, progressive, public-spirited, its material resources organized in the service of the British people.”
But also – all it takes for evil to succeed is for a few good men to do nothing.
My blog on ‘Living well with dementia’ is here.