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The Scottish referendum was, predictably, a disaster for Westminster’s historic view of the NHS
Scotland’s decision on its future, everyone knows, was as much a referendum on the past performance of the Westminster governments to date. In human resources, a guiding principle is that a candidate is likely to behave in future as he or she has down in the past, unless there are exceptional circumstances.
Andy Burnham MP was quoted himself many times as warning against the creeping privatisation of the National Health Service in England. While the ‘No’ campaign consistently explained the Westminster government had protected the NHS budget, it was widely known that the statistical authority has rebuked David Cameron for stating incorrectly that NHS spending has increased in recent years.
The ‘no’ campaign nonetheless did put up a valiant fight, with exceptional campaigners Clare Lally and Johanna Baxter, for example. These campaigners, against some formidable abuse, tried to explain why the leverage of being united with England was especially important for Scotland to withstand future economic pressures resiliently, and why it was in fact intensely patriotic to keep Scotland as part of the United Kingdom.
Whatever Andy Burnham promises as the Shadow Secretary of State for Health, it is a fact that the efficiency savings in the NHS and the private finance initiative loan repayments have put enormous pressure on the operations on the service. Managers, who all too often behave in a divorced way to frontline clinicians, do not appear easily accountable for poor staff shortages impacting on clinical patient safety.
The efficiency savings operate on the assumptions that nobody wants to pay any tax to fund the NHS properly, and that the economy is not growing. Labour, whilst rightly drawing attention to how the ‘cost of living crisis’ is damaging the wellbeing of people, cannot easily claim that people are so unwilling to fund the NHS properly. Nor can they easily dismiss that the GDP of the UK might now be improving.
The resulting democratic deficit which has happened in Scotland is therefore an extreme serious one. Whilst it is the perception that New Labour and the Conservatives, at least, have paid more attention to their friends in the City of London rather than their workforce, there has been a lack of trust between voters and the mainstream parties. Today, UNITE decided it would go on strike. Labour has not yet given a clear indication of what intends to do about the private finance initiative.
In a way, the decision for Scotland was in fact very simple. It was about making a firm decision on separating from England, rather than subjecting Scotland to another eighteen years festering with Devo Max prior to another vote. But of course, we all know it was far from simple. Whatever one’s views about Johanna Lamont or Alex Salmond, the answer of many voters is a response to David Cameron’s original question, “We can’t go on like this.” Gordon Brown’s uttered the famous words yesterday, “And proud that with the powers of the Parliament we can guarantee that the National Health Service will be in public hands, universal, free at the point of need, as long and as ever as the people of Scotland want it.”
But will the general public believe Westminster any more?
It is clear that the Westminster governments totally underestimated the passion and drive of the ‘Yes’ campaign. If Gandhi had been subject to rolling news, one wonders how the Indian independence would have turned out. But the gut feeling of many ‘Yes’ campaigners was a blatant abreaction to lies and misinformation by people who were supposed to be acting in their best interests.
Predictably, Big Business were all mobilised to depict the #iScotApocalypse #ProjectFear scenario. Unfortunately, it had Westminster’s fingerprints all over it. The Westminster delegates, including Danny Alexander, George Osborne and David Cameron, looked utterly unconvincing in raising a populist case. And the media as per usual totally screwed up the reality of the economic contribution to the rest of the UK, which is quite a formidable one albeit not as strong as London and the South East.
When Margaret Thatcher reached Downing Street in 1979, she said, “And I would just like to remember some words of St. Francis of Assisi which I think are really just particularly apt at the moment. ‘Where there is discord, may we bring harmony. Where there is error, may we bring truth. Where there is doubt, may we bring faith. And where there is despair, may we bring hope’ … and to all the British people—howsoever they voted—may I say this. Now that the Election is over, may we get together and strive to serve and strengthen the country of which we’re so proud to be a part.”
England currently is deeply divided, between rich and poor, between employed and unemployed, and, as a result of the ‘welfare reforms’, between able bodied and physically disabled. September 18th was a chance for Scotland to have a ‘clean break’.
The question is, however, will Scotland go Alex Salmond’s way?
The NHS needs an innovative ‘blockbuster’ now. That is to be brought back under the State.
The term “innovation” must be one of the most misused terms in the media. It simply means a different way of doing things, such as a product or a service, whose popularity and effectiveness ultimately govern its success.
And yet the term has been strikingly bastardised to be used in conjunction with a whole plethora of memes such as “ageing”, “technology” and “unsustainable”. The right wing has been consistently ‘on message’ in this script.
Ed Miliband in Manchester gave last night what was a perfectly plausible speech on the NHS last night. Excerpts of it have indeed been posted on our blog. And there was the usual ‘red meat’, to be accompanied at some later date by how realistic the costings are.
But the legitimate concern of voters, whether hardworking or not, is he who pays the piper calls the tune. It may not be the frontline staff with whom Ed Miliband had photo opportunities earlier this week.
Fifty shades of government, apart from green, have been obsessed with inflicting ‘transformative’ changes, perhaps ‘charismatic’ visions, without ever consulting the wider population. Examples include the private finance initiative, or ratcheting up the NHS into a competitive market.
But Nigel Farage, whether or not he is ‘establishment’, has struck a chord with some voters. I don’t mean with his allegedly racist twangs, but I mean his ‘trust the voter’ skit. He bangs on about the referendum which he knows will never see the light of day.
Labour’s argument for why the NHS needs private companies working for it remains unconvincing with many voters. That’s why the National Health Action Party or the Green Party are watched so keenly by many.
The argument is possibly not as complicated as that justifying our membership of the European Union, but it is one which is best left to the voters to justify.
Labour in pursuing its ‘35% strategy’, where it can squeeze into office on the back of disaffected Liberal Democrat voters, is by definition risk averse. But with taking low risks the return can be very low. Labour’s lack of “blockbuster” is potentially alarming.
And many of the arguments can be discussed under the assumption that GPs work for the NHS. The BMA’s “#YourGPcares” campaign is calling for long-term, sustainable investment in general practice now to attract, retain and expand the number of GP, expand the number of practice staff, and improve premises that GP services are provided from.
The pitch for state ownership is pretty basic. Ed Miliband MP, Leader of the Labour Party, yesterday Labour’s new GP guarantee as part of the next government’s plan to improve services for patients, ease the pressure on hospitals, and restore the right values to the heart of the NHS.
Speaking in Manchester, he underlined his determination to put the health service at the centre of Labour’s campaign over the next year, beginning with these local and European elections.
But it feels as if Ed Miliband is making a meal lacking the key ingredients.
Andy Burnham MP’s ‘NHS preferred provider’ is conspicuous by its absence in the speech.
Only once Ed Miliband has slain this dragon, he can be given to talk about how primary care is best delivered. Labour is aware of its history of “polyclinics” first proposed by Professor the Lord Darzi of Denham in his review of healthcare in London for NHS London “Healthcare for London: A Framework for Action”.
The Labour Government at the time argued that this was a way of providing more services in the community closer to home and at more convenient times (including antenatal and postnatal care, healthy living information, community mental health services, community care, and social care and specialist advice).
Ed Miliband seems to care about ‘privatisation of the NHS’, in that he cared to mention ‘ending’ it.
But this is again at odds with what Simon Stevens has been thinking about.
A “Free School” is a type of Academy, a State-funded school, which is free to attend, but which is not controlled by a Local Authority.
Like other types of academy, Free Schools are governed by non-profit charitable trusts that sign funding agreements with the Secretary of State.
Supporters of Free Schools, such as the Conservative Party, including that they will “create more local competition and drive-up standards” They also feel they will allow parents to have more choice in the type of education their child receives, much like parents who send their children to independent schools do.
But Ed Miliband also talking about ‘ending competition’ which is somewhat against the mood music Simon Stevens was singing in his appearance against the Commons Select Committee.
It’s innovative bringing something back into state control, but could make good ‘business sense’, akin to insourcing a service which had been previously outsourced.
The main arguments for state control and ownership of the NHS are that such a drive would encourage co-operation, collaboration, equity; services could be properly planned not fragmented; and services would not be run for shareholder dividends.
It’s undoubtedly true that there could be operational changes to be made, such that patients could plan their GP appointments without having to ring up as an emergency at 8.30am the same day.
NHS GPs overall say that they are working flat out, and, short of having greater resources, no political gimmick will help them. Instead of lame slogans such as “Hardworking Britain Better Off”, and making do with “35%”, Labour could do something really innovative – and return to a socialist approach.
‘Saving the NHS for the public good’, on the other hand, is not a vacuous gimmick. It’s what many people in Labour also believe, possibly. More importantly, it’s the title of a current party election brodcast by the Green Party. It might be the case that Ed Miliband is left wing than the Labour Party membership. This has been mooted here. If so, “bring it on!”
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.
