David Cameron Conservative Party Conference 2013

Thankfully the “Big Society”, as such, seems to be dead, having been replaced successfully by the “Pig Society”, with the NHS set to turn into a lucrative promised land of ‘wealth creation’ of asset stripping. Many onlookers, who haven’t been following the trials and tribulations of the NHS narrative in recent months, will not have been familiar with the well worn Jeremy Hunt narrative of the NHS presented yesterday. Jeremy Hunt, it seems, is caught in a time warp where he must present Mid Staffs of the past at all times as a ‘death camp’ where present-day inpatients can only be ill at their peril. However, on this last day of this consultation, this toxifies the story in a way parallel to way traders can misuse market-sensitive information to distort the market. At the beginning of last month, for example, the Nursing and Midwifery Council announced that it would establish an ‘unequivocal professional duty’ for registered nurses and midwifes to raise concerns about patient safety, publicly endorsed by former Mid Staffordshire Foundation Trust whistleblower Helene Donnelly.

The stale nasty narrative was all too familiar, with ‘Brian Jarman as the eminent expert’ being wheeled out as a familiar pantomime dame in the pantomime of boos and hisses on the NHS. The “pot of gold” at the end of the rainbow for Jeremy Hunt is not just that ‘the Conservative Party is THE party of the NHS’, which Hunt latterly seems to have become so obsessed about that he is prepared to call ‘hardworking’ NHS staff “coasters”. And yet voters largely are sick of Hunt using the NHS as a political football in this way, and not convinced about his exhausting protestations that the NHS is not being ‘privatised’. For the NHS not to satisfy a conventional definition of privatisation used by all economists, the Conservative Party has uniquely have had to adopt a definition of ‘privatised services’ as services where you’re not charged for anything. For everybody else, privatisation is transfer of state services to the private sector, ideologically in fact ‘benefits for the wealthy’ as you’re in effect providing subsidies for private shareholders from the money from ‘hardworking’ tax payers. It’s the well known trick of ‘money for nothing’ so often complained about by Osborne. It’s what Iain Duncan-Smith called yesterday a ‘hand-out not a hand-up’.

For all the fist pumps about patient safety, it is a plain fact that the £2.4 bn reorganisation of the NHS was primarily about installing an insolvency regime for the NHS, and for providing the machinery for outsourcing as many contracts as possible to the private sector. Cameron’s NHS is nothing to do with ‘stronger communities’ either. For all the heat about ‘listening to patients’, the light has been an enduring legacy of not listening patients even having given them a voice. Once denounced as ‘conspiracy theories’, the situation regarding where the procurement contracts have gone to are now a hard-nosed practicality. The ultimate problem is that ‘the free market’ is not an economic construct. There are very few ‘free markets’ in the world apart from, say, Somalia, as it happens that there has to be regulation to avoid monopolies and oligopolies (markets with few players) abusing the market to hog all the customers, and deliver unconscionable profits for their shareholders. It is either the case that the NHS has not been privatised, or suddenly Serco, Care UK, Circle and Virgin Health have become nationalised.

Without regulation, it is impossible for the market to work properly for the benefit of customers. For the NHS, this is necessary when ‘providers’ offer ‘services’ to ‘users’, and so a third prerequisite of the Health and Social Act in addition to the second one of outsourcing services was to provide the regulatory machine to oversee it. The ‘equality of opportunity’ is an ideological dogma where everyone can profit, where Cameron hopes ‘profit is not a dirty word’. However, in oligopolistic markets, such as utilities, bills get out of control as there is no real competition or choice for effectively the same product, so that the market acts as a “cash cow” for directors and shareholders involved in them. Cameron simply doesn’t ‘get it’ about why or how competition isn’t working in the NHS, so it is critical that the Health and Social Care Act (2012), including its competition thrust, is repealed in the first Queen’s Speech of a Labour 2015 government. It is simply an ideological dogma, but actually a remarkably dangerous one. For allowing a ‘free market’, with ‘light touch regulation’, the few players, like all other privatised industries such as telecoms or energy, can hog all the contracts, make all the money, so profit does indeed become a ‘dirty word’. To run a state-run comprehensive NHS is a worthy ideological goal of itself, in contrast. Parliament can wish to legislate for the NHS to be the ‘preferred provider’ to ensure this, and that is indeed one of the first legislative intentions of a Labour 2015 government. If you don’t run a truly comprehensive NHS, where there is a glut of providers cherrypicking the ten billion hernia operations for low cost and high volume, you won’t be able to treat properly your patient with the rare disease, lending a lie to the notion of Cameron’s Britain where ‘nobody is written off’. By awarding virtually all the contracts to the private sector, and some noteworthy ‘big contracts’, it does seem that the NHS provider is not quite in a “land of opportunity” given its relative lack of experience in making skilled commercial pitches.

In all other babies of Thatcher, the privatised energy or telecoms industries, there has been much foreplay about how ‘we must low barriers to entry’ and yet this does not seem to have altered the reality of all the contracts going to the usual suspects in all sectors, whether it’s health, probation, telecoms and media, or whatever. The actual experience of the ‘free market’ means that the Tories have become the party of big business or corporates, as evidenced by their hardworking delegates in Manchester this week. Ideologically, the Labour Party is not against profit or competition per se, but it appears to be against immoral profits from a rigged market with little or no competition. In that rigged market, it’s incredibly difficult for new entrants to get in somehow into the market. There is no land of opportunity. To that extent, profit is indeed ‘elitist’ for the successful oligopolies of this corporatised world. That is the fundamental difference.

Real economists don’t deny that there can be ‘economies of scale’ from running large organisations. The Conservatives have turned the debate into ‘we don’t want it to be public good, private bad’, but the real issue now is to what extent the NHS can deliver a comprehensive service with so many fragmented bits pulling in incoherent directions. That there is no duty of the State to provide a comprehensive service from the date of the enactment of Cameron’s NHS is highly significant. Instead, the furious ideological self-gratification has gone into running a surplus for the country at large. Last year, the NHS was successful in running a surplus of billions in its budget sheet, and yet successfully managed to avoid re-investing this surplus back into frontline care where the money could have been of considerable benefit to trusts such as “the 14 Keogh Trusts”.

Real economists also need to reclaim the debate. The NHS should not have become, fundamentally, about economics but it has done. It is no longer tenable to say ‘keep politics out of the NHS’. Thousands of nurses cumulatively in parts of the country have been made redundant, with some NHS FT CEOs running unsafe staffing levels. Why should union representation become two ‘dirty words’ in Cameron’s dictionary? The answer is most probably that hard-working hedgies hate hard-working unionised workforces, as it makes share acquisitions very much harder. A unionised workforce should not be ‘public enemy no 1‘ where careworkers have enforceable legal rights, instead of being shoved on zero hour contracts for the benefit of their employer. It’s one thing for a party to advocate ‘tax cuts’ in encouraging enterprise, but it is an altogether different thing if you have a NHS health provider with a registered office in a foreign jurisdiction for the purposes of tax avoidance.

When you peel away of the layers of the Cameron onion on his view of the world, you cannot help but be in floods of tears. David Cameron will attempt to give the ‘sunny uplands’ speech of his life today in Manchester, but the only opportunity in David Cameron’s NHS is the “opportunity cost” of where £2.4 bn could have been better spent. According to Wikipedia, “in microeconomic theory, the opportunity cost of a choice is the value of the best alternative forgone, in a situation in which a choice needs to be made between several mutually exclusive alternatives given limited resources. Assuming the best choice is made, it is the “cost” incurred by not enjoying the benefit that would be had by taking the second best choice available.”

Instead of paying external management consultants on their never-ending gravy-train  of the great ‘national hospital sell off’, the money would have been better spent on more frontline staff. Indeed, it’s been a bonanza for those management consultants in a golden age of ‘wealth creation’ at the NHS’ expense. The reality is for these new private health providers is that for all the bogus terminology of ‘transparency’  the data on their staffing levels remains hidden because of the Freedom of Information Act. You can hardly argue that a nurse being laid off to improve the surplus of a NHS hospital or to improve the profit of a private provider, to improve its shareholder dividend for hard-working shareholders, is living in a ‘land of opportunity’.

But it’s all semi-skilled hype from wordsmiths who don’t understand what it is like to work in some areas of society, who are paid to write crap so that a party with an average nearing 70 (according to Jeremy Paxman last night on Newsnight) can clap. At the heart of it is a man who fails to take responsibility for his failed policy for the NHS, but who will definitely be booted out at the beginning of May 2015.