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If Labour wishes to make pledges that do not cost anything, why not an all-out attack on private insurance?
The narrative goes something like this.
Personal health budgets are the stepping stone to private health insurance. You’re given a fixed amount of money, which, as time goes on, is not nearly enough to pay for your health and social care needs. But not to worry, you can top up the budget, like you top up your pay-as-you-go phone account. And if you don’t want to spend your budget in the NHS, you can transfer to private insurance firms like a voucher.
The typical media question, in fact used by Robert Peston last week on Newsnight on Andy Burnham last week, is: “Do you have any fundamental objection to healthcare, as long as its cost-effective and of high quality, being provided by the public sector?”
An answer to this normally involves an answer which revolves around transfer of resources from the public sector to the private sector, or a bit of a fudge saying there’s no ideological objection to private providers, so long as there’s a NHS “preferred provider”.
Labour is obsessed about one thing: the deficit. From this, Labour is prepared to swallow all unpopularity, such as not spending money on pay increases in the public sector, or spending money on benefits (even if the benefits are totally legitimate).
When Ed Miliband was asked later in the week about the “funding gap” on LBC, Ed Miliband gave an answer in the style of ‘some of my best friends are midwives’, and then gave the customary fudge-answer on how he would like the NHS to make better use of the money it’s got.
Except, this won’t wash. There are currently more papers in the business management press along the lines of ‘why belt tightening still won’t make you fit in your trousers’ than Ed Miliband’s been to friends’ bar mitzvahs.
And yet the more blunt way of saying we will preserve the NHS is to go out for an all out attack on the City or private insurance. Labour supporters have to ask why he won’t do this. Is it because Ed Miliband does not wish to be seen to be anti-aspiration? To give you some context, Labour is planning to give hedge fund boss, Michael Farmer, a top honour.
Labour, in saying it does not wish to promote private insurance, does not spend any money. It might though nark off previous Secretaries for State for Health in the Labour Party who work for private healthcare funds.
People pay into the National Health Service, knowing that it is there for them. There is a genuine sense of solidarity and pooling of risk, and equity: free at the point of need. It’s a moot point whether the service is as comprehensive as it could or should be.
But Simon Stevens in bigging up personalised medicine has nailed his colours to the mast without saying so.
Many have alluded to, as indeed the previous CEO of NHS England – Sir David Nicholson has, the fact that knowing the precise risk of a condition with a strong genetic contribution, such as in rare causes of dementia, would mean that that person and their family would end up paying much higher premiums than in the National Health Service.
Ultimately it seems voters want to go for the least costly option – which is why Ed Balls and Ed Miliband would rather wire themselves up to the National Grid than to discuss with Andy Burnham how social care is going to be funded comfortably.
So if Labour tells voters in an all out private insurance system some people will be paying through the roof, and the NHS will go to pot, this will play very nicely to those people who are dead against private insurance in the country’s healthcare.
It will play nicely: if Labour actually mean it.
Trust has become totemic for the NHS, so a promise to preserve it would pay dividends
The CEO of the English National Health Service, Sir David Nicholson, sent out a stark warning in the Guardian today:
“Public support in this country for our healthcare system is greater than in almost any other country in Europe, and that’s so important for a taxpayer-funded system. My worry is that if it gets worse, before you know it you get to a place where a minority of the people support it and then people who can afford to [do so] will go elsewhere for their healthcare. In those circumstances the question of how sustainable the NHS is becomes a much more difficult one to deal with. That’s my worry.”
Various aspects of what Nicholson has said have in the past made me conclude Nicholson is definitely a Socialist, and not merely a Social Democrat.
At the end of a recent interview with Jeremy Paxman, Nicholson referred to how a private insurance system based on complicated genetic diagnoses would simply not work for the healthcare system, referring to imminent issues such as the growth in prevalence of the dementias.
Some even say that the private healthcare companies do not wish themselves a private insurance system; in that, they currently benefit from having some of the work outsourced to them in a controlled manageable way.
Ed Miliband said two highly significant things yesterday.
One was that he would take NHS policy out of the claws of EU competition law.
That is going to be essential if Labour is to have a manageable approach to ‘whole peson care’ or integration.
“We recommend that the benefits are considered of a single regulator covering issues of both care and economics, whilst recognising that is not feasible at present. We believe that the Office for Fair Trading’s role in reviewing competition decisions should be withdrawn.”
With an eye-watering contract having been put out to tender only this week, it is going to be essential that the Government tightens up the law in this area, as integration might offend EU competition law.
The second thing which Miliband said, about electoral priorities in 2015, was equally interesting.
Miliband said he wanted the 2015 election to be about ‘the cost of living crisis’ and the NHS, and not whether he would hold a referendum on EU membership.
Whether or not the media will allow this to happen is another matter, but there has been considerable concern over NHS issues during the course of the parliament.
Firstly, Andrew Lansley against all the odds enacted his vanity project, now known as the Health and Social Care Act (2012); only this week, Jeremy Hunt managed to bring in his ‘fast track to hospital closure’ mechanism in the Care Bill.
As long as contracts continue to go out to the private sector, Miliband will be unable to pledge no further privatisation of the NHS. Labour can pledge to repeal the Health and Social Care Act and Clause 119, but this is different.
If the Labour government wishes to pursue ten-year contracts using the ‘prime contractor’ model, it is likely that many of these contracts will subcontract to the private sector.
The NHS ‘preferred provider’ plan, which Andy Burnham has been advocated, may indeed have limited scope if the TTIP (EU-US free trade mechanisms) are negotiated in the favour of the multinational corporations.
The bungle over #caredata has further demonstrated the need for politicians to be transparent with the public.
Angela Eagle may wish to talk up the progress she is making in overcoming the ‘democratic deficit’, the millions of lost votes and so forth, but essentially Ed Miliband’s Labour will rightly come under some scrutiny in the election leading up to May 7th 2015 regarding the NHS.
David Nicholson is a true socialist. He has spoken his mind about the public’s affection for the NHS. Hunt never talks about the Lansley legislation.
If Labour is unable to pledge much on this, it might at least pledge a term of government where the NHS is free at the point of need and paid for entirely through general taxation.
Compromise agreements, redundancy and efficiency – the ingredients of a ‘perfect storm’ in the NHS?
The NHS spent £15 million in three years on gagging whistleblowers, according to the Daily Mail. In just three years there were 598 ‘special severance payments’, almost all of which carried draconian confidentiality clauses aimed at silencing whistleblowers. They cost the taxpayer £14.7million, the equivalent of almost 750 nurses’ salaries.
Whistleblowers have found them at the end of such agreements, and why the NHS culture is not one of transparency and trust is a damning observation. Compromise agreements have also been used in ‘genuine’ situations of redundancy. Redundancy arises when an employer either:
- Closes the place of work; or
- Reduces the number of employees which are employed by it.
The employer is under an obligation to pay a redundancy award to any employee who is dismissed by reason of redundancy if that employee has two years’ service or more. From an employee’s perspective, it is quite common that when employment ends, you and your employer agree to enter into a “Compromise Agreement”. The purpose of the compromise agreement is to regulate matters arising from the termination. A compromise agreement is a legal document that records the agreement between an employee and employer whereby the employee agrees to ‘compromise’, or not to bring, a claim against the employer in relation to any contractual or statutory claims they may have in relation to their employment or the manner of its termination. This type of agreement is typically in return for the payment of a sum of money from the employer to the employee. It may also contain details of additional ancillary agreements between the parties on topics such as: ongoing confidentiality/ restrictions, agreed form references etc.
Compromise Agreements can be very effective and, in essence, amount to a ‘clean break’ that, hopefully, benefit both parties and enable everyone to move on. They are enshrined in law through s.203 Employment Rights Act (1996). A dismissal by reason of redundancy can amount to an unfair dismissal. There are other statutory reasons for unfair dismissal which are allowed, which are cited earlier in the Employment Rights Act.
A dismissal by reason of redundancy can amount to an unfair dismissal. Issues which render such dismissal unfair often include:-
- The selection of a pool of employees from which the redundant candidate is chosen;
- The criteria for such selection; and
- Failure to consult appropriately.
The House of Commons Committee of Public Accounts published a document “Department of Health: progress in making NHS efficiency savings: Thirty-ninth Report of Session 2012–13″ on 13 March 2013. The discussion between Meg Hillier and Mike Farrar talks about redundancy payments, but interestingly this document does not refer to ‘compromise agreements’ once.
“Q29 Meg Hillier: Maybe at chief executive level, but I know for a fact that there are people out there who have taken generous redundancy payments—they may genuinely have thought they were not going to work in the NHS again—but there is such demand for their skills and services that they have been brought back in. There seems to be no real ability to have safeguards. I know they are your members, so maybe it is in your interests for them to get these positions, but this is about all taxpayers’ money, and in the end it affects everyone.
Mike Farrar: We have tried to support the management of people through the system to the best possible place to get the best value for taxpayers; that is what we would want to see. The reforms have abolished authorities and organisations. People have not been able to take redundancy unless they were eligible for redundancy on the basis that their organisation has been abolished. That has allowed management cost savings of a significant level—
Q30 Chair: Well, we do not know, because you might have had a whole load of management costs in terms of redundancy, with people then re-emerging elsewhere. We are very sceptical.
Mike Farrar: I think the reforms of this House are responsible for certain people having been eligible for redundancy. There is a notion that those individuals leapt at the chance to be made redundant in order to deploy their services back, but that has only been created in terms of an opportunity because of reforms passed by the House. Some of these points were made during the passage of the Bill. “
HM Government has never published its “Risk Register” for the Health and Social Care Act (2012), despite the guidance involving the Information Commissioner. Today’s Report published by the National Audit Office on the use of compromise agreements makes for depressing reading:
“There is a lack of transparency, consistency and accountability in the use of compromise agreements in the public sector and little is being done to change this situation, an investigation by the National Audit Office has found.
Public sector workers are sometimes offered a financial payment in return for terminating their employment contract and agreeing to keep the facts surrounding the payment confidential. The contract is often terminated through the use of a compromise agreement and the associated payment is referred to as a special severance payment.
The spending watchdog highlights the lack of central or coordinated controls over the use of compromise agreements. The NAO was not able to gauge accurately the prevalence of such agreements or the associated severance payments. This was down to decentralized decision-making, limited recording and the inclusion of confidentiality clauses which mean that they are not openly discussed. No individual body has shown leadership to address these issues; the Treasury believes that there is no need for central collection of this data.”
It could be there that there is a fundamental faultline in how performance management in the NHS is currently being implemented, in which commercial lawyers are not quite silent bystanders. That is, the NHS has found itself in a situation where it is generating efficiency savings, which do not get ploughed back into frontline care. A reasonable place to start is also the implementation of the Health and Social Care Act (2012), and this complex strategic restructuring has obviously had its opportunity cost, even as described on Wikipedia here:
When you have CEOs and NHS Foundation Trusts being judged by their ‘efficiency savings’ which may involve redundancies (though these parties will argue that many of these staff are mostly employed back), the performance management system is heavily weighted against long-serving staff with experience and skills of working in the NHS who ought to be cherished for ‘adding value’. This is clearly a massive fault with how the NHS rewards ‘success’ in the NHS (and if the CQC’s recent scandal and more are anything to go by does not appear to punish ‘failure’ in the regulatory system, either.) And when you add to that that the experience of NHS whistleblowers, often at the receiving end of compromise agreements with suboptimal legal advice (whereas the NHS has access to the best commercial and corporate lawyers), is that whistleblowers tend to get humiliated and marginalised to such an extent that they never work again, you can see how compromise agreements, while certainly enshrined in law for a legitimate person, along with an alleged lack of teeth of the Public Interest Disclosure Act (1998), has successfully allowed a ‘toxic culture’ to perpetuate very successfully indeed?
