At the heart of the ‘perfect storm’ about the NHS is a mediocrity of some managers, lack of ability from some NHS ” leaders “, and some inexperienced or unknowledgeable junior politicians and the civil service, who are crippling the best efforts of the frontline clinicians. Not helping is the split personality of the UK Labour Party which has seen an unbearable tension between socialism and neoliberalism. A good short-cut to understanding this difference in opinions is to examine how Tony Benn and Tony Blair have considered the NHS.
Benn hates the idea that ‘the left’ destroyed the Labour Party, and this chicken is yet to return to roost. Baroness Thatcher’s biggest achievement might have been New Labour, but it might be sensible now to conceptualise ‘New Labour’ as a political experiment. It can be to all extent and purposes it can be considered now to be a separate party to Labour proper. As we enter Conference season, it would be helpful if Ed Miliband could begin to form a vision of what he wants the NHS to be like. Without this vision, Miliband will be floundering, firefighting, and be lost in an ideological abyss. Benn is genuinely intrigued ‘why the Labour Party ignores people’, and thinks that capitalism prefers to see their policies ‘advocated from the left’. That is why Sean Worth may be so keen to write blogposts for the Socialist Health Association. This could be conceptually similar to Rupert Murdoch liking New Labour. “People don’t believe what they’re told, and people don’t listen to them”, complains Benn, and this is especially true in how NHS managers and politicians have approached the running of the nHS.
Tony Benn has not substantially changed his views on socialism for a number of decades, and while Ed Miliband is a card-carrying ‘social democrat’, Tony Benn’s view of ‘democrat socialism’ made famous in 1978, now published as “Why America needs democratic socialism”, does now perhaps merit further scrutiny. Benn’s argument that many in the general public advocate a form of “the left”, further left than Labour, is not ill thought out either. Privatisation, which has brought excessive profits for a few, has not turned out to be a democratising process at all due to the dynamics of neoliberal oligopolies. Privatisation is not popular. Benn has never seen socialism as a destination on a railway line, but sees socialism as an “ongoing struggle”. Benn, conversely, thinks the Thatcherite “revolution” was to ‘wind up the welfare state’, in much the same way as Reagan wished to unwind ‘The New Deal’, and undermined by the failure of monetarism. He cites that he senses that ‘people realise that they don’t have any power’, and is strongly critical of the unelected nature of corporatism, meaning that the power invested in the undemocrat Central Bank, World Trade Organisation, IMF and multinational corporates has effectively led to a ‘one party state’. One can imagine what Benn thinks of the creeping corporatisation of the NHS. Benn argues instead that people feel that they are not being represented any more, and nothing could be further from the truth than the inability of Labour and the Conservatives to discuss the McKinsey Efficiency savings or the private finance initiative strategy.
The media “rejected socialism”, according to Benn, so did Mandelson, Blair and Kinnock. However, Benn weirdly enough has not given up the faith. As for private ownership, Benn argues that we are using taxpayers’ money to subsidise the railways which would otherwise run at a loss.
Benn thinks that clinicians and nurses should be involved in the management of the NHS, which is somewhat reminiscent of the ‘co-determination‘ strategy in Germany of corporate management. Ed Miliband is in fact known to be very keen on this model of corporate governance, as it is consistent with his view of ‘responsible capitalism’. Benn opines at 26 mins in:
“Absolutely. They’ve got all these management consultants. I don’t wish to insult management consultants. There’s a lovely story I heard years ago. It’s about a boat race between a Japanese crew and NHS. Both sides practice long and hard. The Japanese won by a mile. So the NHS faced with this problem set up a working party. The working party report that the Japanese crew had 8 people rowing and 1 steering, and the NHS crew had 8 people steering and 1 rowing. So they brought in management consultants who confirmed the diagnosis. They suggested that the NHS crew should be completely restructured with 3 Assistant Steering Managers, 3 Deputy Steering Managers, a Director of Steering Services, and a rower incentivised to row. They had another race. They lost by 2 miles. They laid off the rower for poor performance. They sold off the boat. There are too many management consultants and not enough managers in the hospital. When I went to Havana years ago, they took me to their hospital, I didn’t wish to see the equipment. I asked how the hospital is run. We discuss everything. The first meeting is one chaired by the management, the second meeting is one chaired by the Unions, and the third meeting is. So I really am not in favour of this top down view at all, and I feel industrial democracy has an appeal and people feel that they’re kicked about…”
At about 11 mins in of this second film, there is a clear contrast in tone with Tony Blair interviewed by Will Hutton in the film “The Last Days of Tony Blair”:
“Tony Blair:“Actually in the NHS it is the reforms around putting the patient at the centre of the system, choice, competition, incentives for the system to treat better, and more … those are the structural changes.”
Will Hutton: Those are the things you were criticising the Conservatives for in 1995, 1996, 1997, the markets, incentives, and the “wrecking ethos”, and here you are talking about ”
Tony Blair: Again it’s a fair point. Although it’s true there were elements in the 1990s which we brought back, on the other hand – it’s done in a more fundamental way. It’s done in a far more equitable way.”
Blair thinks of ‘communities’ as the dividing line between him and Thatcherism – as expressing solidarity and standing by the weak, more important than the “rights” of individuals. This ‘confirmed Christian’ ‘Good Samaritan’ ethos has somehow got lost in translation in Blair’s legacy, and will be savaged by the Health and Social Care Act (2012) which has acccelerated a fragmented NHS which is not comprehensive. These ‘community values’ are not to be seen in A&E departments being sporadically shut nationally. Miliband is likely to be supposed to be interested in this sense of justice in his view of social democracy, but this is indeed a common interface with democratic socialism. The problem is that these attempts at triangulation, bridging ‘left and right’ before, have been publicly strained, for example in Tony Giddens’ ‘Third Way’ which Giddens himself moots might have been a failure.
Blair thinks his approach is more “equitable”, but this can be fiercely debated. Blair talks of his love for his independent schooling system, and wishes that the best elements of this should be brought into the state system. The problem of these “academies” is that this is a repudiation of a ‘comprehensive’ system. While Blair is criticise a uniformity in low standards, reducing barriers to entry for private health providers driven by the bottom line, even that means compromising patient safety for profit, could make the final stage of NHS outsourcing and privatisation explode. Many members of the General Public do in fact the NHS to be properly funded, and do wish for a comprehensive system free-at-the-point-of-use. For all of Blair’s talk about asking the communities what they want, nobody has yet asked the general public whether they want to outsource services to India to make the bill cheaper. They are however wary of political decisions being made behind their back. In an article in the Health Services Journal, many will read with interest Patricia Hewitt’s view that, “Former health secretary Patricia Hewitt said trusts were either trying to access the fast growing sub-continental market ? estimated to be worth £110bn by 2017 ? or to harness Indian expertise”, but they will also be mindful of Hewitt’s own professional interest in opening up new private (perhaps emerging) markets in healthcare (see for example this article).
For this political issue, triangulation between ‘democratic socialism’ and ‘social democracy’ is not necessary. The neoliberal market is a boon for increasing profits in a crowded market for some. All the evidence suggests that this market will drive up health and social inequalities, and indeed increase the cost of running the NHS massively through waste and inefficiency. The final denouement of course comes from the destination of the transition we are now embarked upon; this unelected move will take us up to an estimated 31% of the budget going on admin. and wastage (as beautifully articulated by the Himmelstein and Woolhandler papers). Tony Blair may believe that ‘it doesn’t matter who supplies services in the NHS’, but for nurses about to be made redundant it does matter. Outsourcing these services to India will bring resentment, as well the exploding budget spent on management consultants; it is estimated that the NHS reorganisation, whilst creating massive turmoil, has cost billions so far. Nobody has ever bothered to criticise the impact of the inefficiency savings in delivering unsafe and uncompassionate care, and not thought to link it to the general state of the economy which has been a disgrace under the present Coalition of Conservatives and Neoliberal Democrats.
Miliband should repeal the Health and Social Care Act (2012), which does not even contain a single clause on patient safety. Miliband should also scale back massively the extent to which the NHS services are outsourced to the private sector, marketed fraudulently under the NHS label. He should most of all restore a properly funded comprehensive NHS free-at-the-point-of-use with a safe level of minimum clinical staffing. He needs to restore the Secretary of State’s duty for the NHS in this regard.
If we are so desperate about £20bn McKinsey efficiency savings, why are we spending £80bn on #HS2?
