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Burnham goes from strength to strength as ‘striker’, but who’s the David Moyes?
There’s no doubt Andy Burnham MP drives the Conservatives potty.
Despite the Conservatives’ best attempts to annihilate Burnham MP, Burnham keeps on scoring goals.
Meanwhile Jeremy Hunt continues to score blanks, apart from where profits from ‘Hot Courses’ are concerned.
But Burnham is more concerned about the day job, and that is running the NHS to a level of some degree of competence.
Hunt meanwhile continues to run his NHS into the ground, paying for costly advice on the managerial implementation of compassion, when he could be paying nurses to do the professional job they’re trained to do.
So Burnham can certainly hold his head up high as chief striker or scorer for Labour United.
As the Conservatives spit out the oranges from their half-time pep talk, as the oranges were in fact horsemeat due to the abolished Food Safety Agency, it’s time to recapitulate.
Clive Peedell kindly tweeted the other day points on which he would like Labour to play ball.
@legalaware @andyburnhammp 1. Fill £30bn funding gap by abolishing PFI & cracking down on tax avoidance 2. Get NHS exempted from TTIP
— Clive Peedell (@cpeedell) April 22, 2014
Before the 2010 election, Liberal Democrat leader Nick Clegg indeed condemned PFI as “a bit of dodgy accounting – a way in which the government can pretend they’re not borrowing when they are, and we’ll all be picking up the tab in 30 years”. It’s well known that PFI is a relic of the John Major government from 1995 (predating New Labour in fact). In opposition, Osborne pledged that the Conservatives would stop using PFI and denounced Labour for relying so much on a source of finance that he said was “totally discredited”. “We need to find new ways to leverage private-sector investment. Labour’s PFI model is flawed and must be replaced,” Osborne muttered in November 2009. Indeed Margaret Hodge, chair of the powerful Commons public accounts committee, said the coalition had failed to come up with the promised alternative since coming to power. The facts speak for themselves.
And Burnham is handicapped by not being the actual Secretary of State for Health at this crucial time for the NHS.
He nonetheless did go to Strasbourg last month to try to explain the case:
(This is a video recording I took of Andy’s talk at the Southwark Labour meeting recently.)
Labour will need to abolish PFI contracts or renegotiate them or both. But Ed Balls will need to be on the wing to help Burnham shoot. And it’s hoped the football manager is not asleep on the job. Labour has indeed proposed a five point plan to tackle ‘tax avoidance’. Labour supports a form of country-by-country reporting. It would extend the Disclosure of Tax Avoidance Schemes regime, which Labour introduced, to global transactions. It would open, further, open up tax havens, with requirements to pass on information about money which is hidden behind front companies or trusts. Crucially, Labour also wants to see fundamental reform of the corporate tax system. But Peedell’s work is not done.
@legalaware @andyburnhammp 3. Abolish purchaser provider split 4. Improve NHS accountability with transparency & openness — Clive Peedell (@cpeedell) April 22, 2014
The abolition of the purchaser-provider split remains one of the totemic political decisions to be made, as is not a ‘deal maker’ for many grassroots voters.
In fact, the whole issue of whether the general public is interested by public health or competition remains uncertain.
Nonetheless, a pioneering integrated healthcare scheme in New Zealand has improved the care of patients while reducing demand on hospital services.
On the contracting side, the report said that the abolition of the purchaser-provider split in the health system was important as it gave boards the autonomy to decide how to fund their hospitals.
The project was launched in 2007 in response to rising hospital admissions and waiting times and to a population that was ageing more rapidly than in other parts of New Zealand and other developed countries.
Similar to the drive towards whole person care in this jurisdiction, is aim was to create a “one system, one budget” approach to health and social care, together with various aspects as centrepieces: sustained investment in training, support for staff to innovate, and new forms of contracting, including abolition of the split between healthcare service purchasers and providers.
The outgoing NHS England chief executive Sir David Nicholson last year told HSJ his organisation was looking at “whether the straightforward commissioner-provider split is the right thing for all communities”.
Hospitals wish to focus on delivering better services to patients and often get frustrated by the amount of time they have to spend negotiating contracts with commissioners with the legal shutgun pointing in the direction of their necks.
And there’s no doubt there’s a steady stream of whistleblower tragedies, with Raj Mattu the latest in the long line of casualties.
People still struggle to think of a NHS whistleblower who has had a good outcome.
The Nursing Times ‘Speak Out Safely’ has only so far succeeded in signing up 30% of NHS Trusts.
Most people accept that the whole system is rotten, not least in how clinical regulators appear to pass the buck or even worse target whistleblowers.
Many do not think the Public Interest Disclosure Act, enacted by New Labour is 1998, is fit for purpose either.
So Clive Peedell is right, but Andy Burnham may have trouble in shooting goals on target with nobody on wing or a manager more concerned about ‘One Nation’.
Moyes, sacked by United on Tuesday after the 2-0 defeat at former club Everton on Sunday confirmed their failure to secure Champions League qualification, oversaw just 51 games in charge of the team after succeeding Sir Alex Ferguson last summer.
Moyes, like Ed Miliband, though had his army of people who thought he was doing a good job.
But Burnham like many, although focused on sorting out the undeniable problems of the NHS, is avoiding relegation for his team too.
I certainly don’t want to ask who the Ryan Giggs is. That certainly would be tempting fate.
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.
‘Whole person care’ needs a bit of tinkering and strong leadership
In a now very famous article, “The genius of a tinkerer: the secret of innovation is combining odds and ends”, Steve Johnson describes how innovation must be allowed to succeed in face of regulatory barriers.
“The premise that innovation prospers when ideas can serendipitously connect and recombine with other ideas may seem logical enough, but the strange fact is that a great deal of the past two centuries of legal and folk wisdom about innovation has pursued the exact opposite argument, building walls between ideas”
“Ironically, those walls have been erected with the explicit aim of encouraging innovation. They go by many names: intellectual property, trade secrets, proprietary technology, top-secret R&D labs. But they share a founding assumption: that in the long run, innovation will increase if you put restrictions on the spread of new ideas, because those restrictions will allow the creators to collect large financial rewards from their inventions. And those rewards will then attract other innovators to follow in their path.”
Bundling of goods can offend competition law, so that’s why legislators in a number of jurisdictions are nervous about ‘integrated care’.
In the past, Microsoft has accused of abusing Windows’ dominant status in the desktop operating system market to give Internet Explorer a major advantage in the browser wars.
Microsoft argued bundling Internet Explorer with Windows was just innovation, and it was no longer meaningful to think of Internet Explorer and Windows as separate things, but European authorities disagreed.
There’s no doubt that ultimately ‘whole person care’ will be some form of “person centred care”, where the healthcare needs (as per medical and psychiatric domains currently) are met.
But it is this idea of treating every person as an individual, with a focus on his or her needs in relation to the rest of the community which is the most challenging aspect of whole person care.
Joining up medical and social care with an ‘unified care record’ has never been attempted nationally, but it makes intuitive sense that care information from one institution should be made available to another.
Far too many investigations are needlessly repeated on successive admissions of the same patient, which is exhausting for the person involved. It would make far more sense to have a bank of results of investigations for persons, say who are frail, who are at risk of repeated admissions to acute hospitals in this country.
And this can’t be brought in with the usual haphazard ‘there is no alternative’ and ‘a pause for consultation’ if things go wrong. The introduction of the Health and Social Care Act (2012) and the CareData makes one nervous that lightning will strike a third time.
Labour has had long enough to think about what could go wrong.
Care professions might feel themselves ill-prepared in person-centred care. A range of training needs, from seasoned physicians to seasoned occupational therapists, will have to get themselves oriented towards the notion of a ‘whole person’. This might involve getting to grips with what a person can do as well as what they can’t do.
The BMA will need to be on board, as well as the Royal Colleges. Doctors, nurses, and all allied health professionals will have to double declutch from the view of people as problem lists, and get themselves into a gear about their patients as individuals who happen to be well or ill at the time.
This needs strong leadership, not people proficient at counting beans such that the combined sum total of a PFI loan interest payments and budget for staff doesn’t send a Trust into deficit.
Nor does it mean hitting a 4 hour target, but missing the point as a Trust does many needless admissions as they haven’t in reality fulfilled their basic admissions assessment fully.
For too long, politicians have been stuck in the groove of ‘efficiency savings’, ‘PFI’, ‘four hour waits’, and become totally disinterested in presenting a person-oriented service which looks after people when they are well as well as when they’re ill.
Once ‘whole person care’ finds its feet, with strong leadership and evident peer-support, we can think about how health is dependent on other parts of society working properly, such as housing and transport.
Technology, if this means that a GP could immediately know what a hospital physician has prescribed in real time in an acute admission, could then be worth every penny.
For the last few years, the discussion has centred around alternative ways of paying for healthcare instead of thinking how best to offer professional care to patients and persons.
The fact that this discussion has been led by non-clinicians is patently obvious to any clinician.
Technology also has the ability to predict, say in thirty years, which of the population is most likely to develop Alzheimer’s disease. Do you really want one of your fellow countrymen to have health insurance premiums at sky high because of having been born with this genetic make-up?
A lot of our problems, like the need for compassion, have been as a result of the 6Cs battling head-on with a 7th C – “cuts”. It’s impossible for our workforce to perform well if they haven’t got the correct tools for the job.
Above all, whole person care needs strong leadership, not just management. And if we get it right the NHS will be less focused on what it’s exporting, but more focused on stuff of real importance.
Andy Burnham MP’s speech in Birmingham on the state of the NHS
Thank you all for coming today.
It’s a sign of how much we value the NHS that you have taken time to come along this morning.
In February 2012, the battle over the Government’s proposed reorganisation was reaching its peak.
There were claims and counter-claims about what it would all mean.
Now, two years on, it’s time to assess what has happened in the two years since and the overall state of the NHS today as we head towards a General Election which will determine its future.
My conclusion is this: the NHS has never been in a more dangerous position than it is right now, and the evidence for that is the relentless pressure in A&E.
The last 12 months have been the worst year in at least a decade in A&E with almost a million people waiting more than four hours.
A&E is the barometer of the whole health and care system and it is telling us that this is a system in distress with severe storms ahead.
A reorganisation which knocked the NHS to the floor, depleted its reserves, has been followed by a brutal campaign of running it down.
It looks to many that the NHS is being softened up for privatisation which, all along, was the real purpose of the reorganisation.
Things can’t go on like this. It’s time to raise the alarm about what is happening to the NHS and build a campaign for change.
The tragedy is that the Government can’t say they weren’t warned.
Even at the eleventh hour, doctors, nurses, midwives and health workers from across the NHS were lining up in their thousands and pleading with the Prime Minister to call off his reorganisation.
Why?
Because they could see the danger of throwing everything up in the air in the midst of the biggest financial challenge in the history of the NHS.
But David Cameron would not listen. He ploughed on regardless.
It was a cavalier act of supreme arrogance.
As the dust settles on this biggest-ever reorganisation, the damage it has done is becoming clear.
The NHS in 2014 is demoralised, degraded and confused.
The last two years have been two lost years of drift.
Even now, people are unsure who is responsible for what.
Two years of drift when the NHS needed clarity.
And what was it all for?
The Government hasn’t even achieved its supposed main goal of putting doctors in charge.
CCGs are not the powerhouse we were promised.
Instead, the NHS is even more ‘top-down’ than it was before, with an all-powerful NHS England calling the shots.
Just look at Lewisham.
When local GPs opposed plans to downgrade their hospital, the Secretary of State fought them all the way to the High Court.
So much for letting GPs decide.
Now the Secretary of State wants sweeping powers to close any hospital in the land without local support. Labour will oppose him all the way.
And the specific warnings Labour made ahead of the reorganisation have come to pass.
First, we said it would lead to a loss of focus on finance and a waste of NHS resources.
An outrageous £3 billion and counting has been siphoned out of the front-line to pay for back-office restructuring – £1.4 billion of it on redundancies alone.
Just as we warned, thousands of people have been sacked and rehired – 3,200 to be precise.
One manager given a pay-off of £370,000 – and last week we learn he never actually left the health service.
It is a scandalous waste of money and simply not justifiable when almost one in three NHS trusts in England are predicting an end-of-year deficit.
Cameron promised he would not cut the NHS but that is precisely what is happening across the country as trusts now struggle to balance the books.
2,300 six-figure pay outs for managers; P45s for thousands of nurses – that’s the NHS under Cameron.
What clearer sign could there be of a Government with its NHS priorities all wrong?
Second, Labour warned that the reorganisation would result in a postcode lottery.
Last week, a poll of GPs found that seven out of 10 believe rationing of care has increased since the reorganisation.
NICE has warned that patients are no longer receiving the drugs they are entitled to and has even taken the unusual step of urging them to speak up.
New arbitrary, cost-based restrictions have been introduced on essential treatments such as knee, hip and cataract operations – leaving thousands of older people struggling to cope.
Some are having to pay for treatments that are free elsewhere to people with the same need.
Cameron’s reorganisation has corroded the N in NHS – again, just as we warned.
Third, we warned that rhetoric about putting GPs in charge was a smokescreen and the Act was a Trojan horse for competition and privatisation.
Can anyone now seriously dispute that?
Last year, for the first time ever, the Competition Commission intervened in the NHS to block collaboration between two hospitals looking to improve services.
How did it come to this, when competition lawyers, not GPs, are the real decision-makers?
The NHS Chief Executive has complained that the NHS is now “bogged down in a morass of competition law”.
Since April, CCGs have spent £5 million on external competition lawyers as services are forced out to tender.
And it will come as no surprise that, since April, seven out of 10 NHS contracts have gone to the private sector.
Who gave this Prime Minister permission to put our NHS up for sale, something which Margaret Thatcher never dared?
The truth is that this competition regime is a barrier to the service changes that the NHS needs to make to meet the financial challenge.
It is sheer madness to say to hospitals that they can’t collaborate or work with GPs and social care to improve care for older people because it’s “anti-competitive”.
If we are to relieve the intense pressure on A&E, and rise to the financial challenge, it is precisely this kind of collaboration that the NHS needs.
So the summary is this – the NHS has been laid low by the debilitating effects of reorganisation, has been distracted from front-line challenges and is now unable to make the changes it needs to make. It is a service on the wrong path, a fast-track to fragmentation and marketisation.
It lost focus at a crucial moment – and is now struggling to catch up.
The evidence of all this can been seen in the sustained pressure in A&E – the barometer of the NHS.
The price we are all paying for the Prime Minister’s folly is a seemingly permanent A&E crisis.
Hospital A&Es have now missed the Government’s own A&E target in 44 out of the last 52 weeks.
This is unprecedented in living NHS memory – a winter and spring A&E crisis was followed by a summer and autumn crisis. The pressure has never abated.
The reorganisation has contributed very directly to this A&E crisis.
Three years ago, the College of Emergency Medicine were warning about a growing recruitment crisis in A&E but felt like “John the Baptist crying in the wilderness” as Ministers were obsessing on their structural reform.
The very organisations that could have done something about it – strategic health authorities – were being disbanded. Just when forward planning was needed, we saw cuts to training posts.
All this leaves us with an A&E crisis which gets worse and worse.
Of the one million people who went to a hospital A&E this January, 75,000 waited longer than 4 hours to be seen.
Of the 300,000 people admitted to hospital after going to A&E, 17,500 had to wait between 4 and 12 hours on a trolley before they were admitted.
On one day in January, 20 patients were left on trolleys for over 12 hours.
In the last year, ambulances have been stuck in queues outside A&E 16,000 times – leading to longer ambulance response times.
On 92 occasions, A&E departments had to divert ambulances to neighbouring hospitals because they were so busy.
And now the pressure from the A&E crisis is rippling through the system.
In January, over 4,500 planned operations were cancelled – causing huge anxiety for the people affected.
The waiting list for operations was the highest for a November in six years.
The truth is that the Government have failed to get the A&E crisis under control and it is threatening to drag down the rest of the NHS.
They have desperately tried to blame the last Government’s GP contract – it’s never their fault, of course – but the facts shows an exponential increase in A&E attendance since 2010.
In the last three years of the Labour Government, attendances at A&E increased by 16,000.
In the first three years of this Government, attendances increased by 633,000. No wonder we have an A&E crisis.
The question we need to ask is: why, behind the destabilising effect of reorganisation, has there been such an increase?
I see three reasons – all policy decisions taken by David Cameron.
First, David Cameron has made it harder to see your GP.
He scrapped Labour’s guarantee of an appointment within 48 hours.
Now, the story I hear up and down the country is of people phoning the surgery at 9am only to be told there is nothing available for days.
The Patients Association say that it will soon be the norm to wait a week or longer to see your GP.
What will they do? Go to where the lights are on – A&E.
We have called on the Government to reverse their scrapping of the 48-hr target this winter.
The problem is made worse by the scrapping of Labour’s extended opening hours scheme.
Now hundreds fewer GP surgeries stay open in the evening and at weekends – taking us backwards from the seven day NHS we need.
To make matters worse, a quarter of Walk-In Centres have closed and NHS Direct has been dismantled.
A terrible act of vandalism even by this Government’s standards – nurses replaced by call-handlers and computers that say ‘go to A&E’.
The second reason for the sudden increase in people attending A&E is cuts to social care and mental health.
Under this Government, almost £2 billion has been taken out of budgets for adult social care.
Compared to a decade ago, half a million fewer older people are getting support to help them cope.
We have an appalling race to the bottom on standards with 15-minute slots, minimum wage pay, zero hours contracts.
Over-stretched care workers, often not paid for the travel time between 15 minute visits, having to decide between feeding people or helping them wash.
Social care in England is on the verge of collapse – and yet last year Jeremy Hunt handed back a £2.2bn under-spend to the Treasury.
That’s unforgiveable when care is being taken away from vulnerable people.
If Labour were in Government now, we would be using the NHS underspend to tackle the care crisis this year.
Instead, older people are being allowed to drift towards A&E in record numbers – often the worst possible place for them.
A recent Care Quality Commission report found avoidable emergency admissions for pensioners topping half a million for the first time – and rising faster than the increase in the ageing population.
Terrible for older people, putting huge pressure on A&Es and costing around a billion pounds a year.
But other vulnerable people are suffering too.
The Government is cutting mental health more deeply than the rest of the NHS.
Some mental health trusts are now reporting bed occupancy levels of over 100%.
That means more than one patient being allocated to the same bed.
It’s no wonder we’ve heard growing evidence of highly vulnerable people being held in police cells or ending up in A&E because no crisis beds are available.
Under this Government, A&E has become the last resort for vulnerable people
And this brings me to the third reason for the pressure on A&E – the cost-of-living crisis.
As Michael Marmot set out in his seminal public health report, our health isn’t just about our health services, but the kind of society in which we choose to live.
No phenomenon more clearly symbolises the true impact of this Government than the rise of food banks, teachers having to feed hungry children at school or GPs having to ask their patients if they can afford to eat.
And all this while millionaires get a tax cut.
We have seen diseases of malnutrition like scurvy and rickets on the rise – diseases we once thought had gone for good.
Today we are exposing another scandal that goes right to the heart of whose side this Government is on.
People are struggling to keep warm in their homes.
The average energy bill has risen by more than £300 since 2010 – while the support for people in fuel poverty has been cut considerably.
The Government replaced 3 successful Labour schemes- warm front, community energy saving programme and carbon emissions reduction target with their ECO scheme.
And the consequence is that just a fraction of households have received help in the past year, just when the support is most needed.
I don’t see how it can be right that money from all of our energy bills should subsidise people who can afford to improve their properties, over those people in dire fuel poverty.
We’ve seen record levels of hypothermia reported this year.
Since the election there has been a dramatic increase in the number of older people admitted to hospital for cold-related illnesses.
There have been 145,000 more occasions when over-75s had to be treated in hospital for respiratory or circulatory diseases than in 09/10.
This is the human cost of this Government’s cost-of-living crisis and their failure to stand up to the energy companies.
And why Labour’s energy bill freeze cannot come a moment too soon.
In conclusion, this is the fragile state of the NHS and the country after almost four years of Tory-led Coalition.
The country can’t go on like this – the NHS needs a different Government.
Cameron’s Government has delivered it a brutal double whammy.
First they knocked it down the NHS down with a reorganisation no-one wanted. Then they have spent the last year running it down at every opportunity.
They are guilty of the gross mismanagement of the NHS.
But it is not just incompetence. They are running it down for a purpose.
Only yesterday, the head of the independent regulator attacked the NHS and called for more privatisation.
This was an astonishing intervention at a time when politicisation of regulators is so high in the news.
To have the independent regulator making such a political statement means there can no longer be any doubt – more privatisation is the explicit aim of this Government’s NHS policy.
Labour believes this will break up the NHS and bring fragmentation when what the NHS desperately needs is permission to integrate and collaborate.
That is why this Wednesday we will force a debate in the Commons on the A&E crisis and repealing the Government’s competition regime.
This is the choice the country faces – a public, integrated NHS under Labour or a health market under David Cameron.
That’s the ground on which we will fight in 2015 and, for our NHS, it’s crucial that we win.
The vision to lead the NHS
If you look at this person’s billboard, you’ll find a very short passage from Aneurin Bevan from 1942.
Aneurin Bevan had his critics too. Bevan would often comment that the Labour Party was not inherently socialist: citing that one in five members of Labour at the time were truly socialist.
Still, Bevan and Attlee carried on regardless. Here’s a comment from Bevan from 1946.
Bevan left school at 13. He didn’t go to Charterhouse and Oxford.
The vision of the creation of the NHS is indeed one of the things which truly shocks critics of socialism. And for decades various Governments have been trying to undermine the National Health Service.
You can in fact tie yourself in knots over definitions of socialism, but certainly equality of opportunity for treatment and care (equitable access), solidarity, cooperation and collaboration might be strands. The idea of efficiently planning resources for the greater public good of the country might also be in the mix.
Lloyd George himself said it would be indecent for a democratic dictatorship to emerge from the National Government which had been put on a “war footing”.
Cameron and Clegg put us on a war footing, despite not having won the 2010 general election. But the war footing was to use the five years to extract as much money out of the public service and outsource it to the same bunch of people, as per outsourcing and privatisation of NHS, probation services, Olympics or workfare. These people are in the private sector.
Diverting resources from the public sector to the private sector is privatisation.
The result of this war footing for the NHS was an Act of parliament which did not have a single clause on patient safety, apart from the abolition of the National Patient Safety Agency; so it is rather ironic and foolhardy perhaps that Jeremy Hunt would wish to campaign on this issue.
The 493 page Act of parliament has been used to spin a number of lies, such as GPs being in the ‘driving seat’. CCGs, or clinical commissioning groups, are simply insurance schemes which apportion risk to local populations, and work out how much money should be alloted to them for their future care or treatment (and how it should be spent.)
They are conceptually the same as the “health maintenance organizations” (sic), borrowed from the United States.
The absurdity of it is that the NHS was borne out of the failure of private insurance approaches before the War, so why should we wish to return to an inequitable fragmented country which the Attlee government had tried so hard to repair?
That war footing for the NHS was a convenient way to shoehorn in that famous section 75 and its Regulations which provided the jet engine for a market – competition. This market needed to be ‘regulated’ (in as much as the cost of living crisis has demonstrated the failure to regulate an oligopoly of companies which can legally collude in setting prices). And there needed to be a régime for fast managed decline of NHS trusts.
Private markets are fragmented, and always introduce “transaction costs” leading to waste and inefficiency. Directors of private limited companies have a primary duty to make a profit for their shareholders, and that’s the case even if you’re using the “NHS” as a logo or kitemark.
And you can take treatments out of scope. This is rationing. It happened under the previous Government, is happening under the current Government, and will happen under the next.
And it cost £3bn – money which could have been better spent elsewhere, such as on the frontline.
The myths keep on coming and coming and coming.
Who’s going to pay for the NHS going seven days a week? Are NHS Consultants simply going to accept a unilateral variation of contract with no mutual agreement? It might be a case of ‘see you in court’.
The next Labour government needs to set out a vision which can inspire the general public, and equally importantly inspire the staff of the NHS.
The staff of the NHS do not want to be told that ‘a culture of evil has become normal’ by the Secretary of State for Health. They want some dignity and respect too.
They don’t want a technocrat who can implement textbook ‘transformative’ leadership, such that they can turn their NHS Trust into the healthcare version of a motor car production plant.
They wish their views to be respected, and where they can speak out safely where something goes wrong.
Nobody’s ever dared to discuss with the public the effects of PFI on local economies, or the billions of efficiency savings, but, if indeed ‘transparency is the best disinfectant’, we need all major political parties to speak openly about this issue.
It might be that “clinical leaders” need to grow some balls where possible to neutralise some who are overly aggressive NHS management seeking to balance budgets and hit targets at all costs.
I’m sorry if this sounds like a rant more fitting for a left-wing version of Katie Hopkins (perish the thought).
But we need a vision.
That vision is the SHA.
Benn, Bevan and Burnham: continuity of care?
One of the lasting legacies of the introduction of the Andrew Lansley Health and Social Care Act (2012) is that it was a massive betrayal of trust. It explicitly did not appear in the Conservative manifesto. It was clearly a Lansley ‘vanity project’ which cost billions to implement.
While the purpose of this Act was promoted in a number of different marketing ways, the Act, nearing five hundred pages, is in fact incredibly simple.
It sets up a market based on competitive tenders. It sets up a beefed up economic regulator. It sets up the climate for ‘liquidation camps’ that only Frederich Hayek could have been truly proud of.
That was basically not a vision that most people had for the NHS in these demanding times.
With not a single clause on patient safety, save for abolition of the National Patient Safety Agency, it was clearly not drafted to prevent another Mid Staffs.
With this level of mistrust, there are people who think integrated care is a shoehorn for a private insurance system.
And yet paradoxically the latest NHS reforms seems to have taken a lot of wind out of the sails of a move towards an insurance-based system as proposed by Reform a few years ago. Whilst Kaiser Permanente seems to still quite chummy with certain think tanks, it’s clear the voters in majority want a properly funded national health service funded out of taxation.
Against this backdrop, care of older people is possibly not what anyone would want it to be currently.
Labour has indeed a long legacy in the NHS history, but is clearly now looking to the future. It is argued that ‘whole person care’ can complete Bevan’s vision, uniting the NHS with social care. This would mean one service looking after the whole person – physical, mental and social. Indeed Andy Burnham at this year’s Party conference recalled the “spirit of 45″. This vision would be symbolic for beginning to bring to a close the marketisation and privatisation of the health service.
Labour have pledged to repeal the Health and Social Care Act 2012, which is fragmenting the service.
And yet a decade ago the Health and Social Care (Community Health and Standards) Act 2003 Commencement (No. 1) Order 2003 was the most controversial piece of legislation to come out of the then government’s 10 year strategy for the NHS in England. This piece of legislation, which abolished government control of NHS trusts by turning them into competing independent corporations called foundation trusts, was a major policy reversal. The concern then was it could lead to considerable local variation in services and endangers one of the NHS’s founding principles–to provide equal care for equal need.
Beep, beep – this vehicle is reversing.
Labour has set up an independent commission under Sir John Oldham to examine how health and social care can be integrated. Ed Miliband feels that this is is the biggest challenge in the history of the NHS. This in part addresses the gap between NHS and care demand which is expected in coming years, and current funding.
There is absolutely no doubt that integration is being damaged by the government’s “free market ideology”, a point freely conceded by the corporate competition lawyers.
The great attraction of the Whole-Person approach, with the NHS taking responsibility for coordination, is that it can be in a position to raise the standards and horizons of social care, lifting it out of today’s cut-price, minimum wage business.
It is clear from Tony Benn’s brief interview with Emma Crosby that Benn has concerns. Benn in his latest diaries, “Autumn blaze of sunshine”, talks of various medical issues which have caused him to come into contact with the caring professions. Benn most obviously feels that valuing care workers has not been a priority of English society by any stretch of the imagination. Benn most obviously wants this to be addressed in some form in a future Labour government.
There has been much said about valuing social workers, but the profession of social care work have been equally vocal about voicing their hard-felt concerns. It is possible that social care careers could be more valued and young people able to progress as part of an integrated Whole-Person workforce. This is yet to be seen.
So an NHS providing all care – physical, mental and social – could be held to account by powerful “patient rights”.
The approach, unlike the Health and Social Care Act (with the exception of the surgeons), has been welcomed by professionals in the Royal Colleges. For example, the Royal College of Psychiatrists has argued that ‘a parity approach’ should enable NHS and local authority health and social care services to provide a holistic, ‘whole person’ response to each individual, whatever their needs. They have also argued that this should ensure that all publicly funded services, including those provided by private organisations, give people’s mental health equal status to their physical health needs.
Central to this approach is the fact that there is a strong relationship between mental health and physical health, and that this influence works in both directions. Poor mental health is associated with a greater risk of physical health problems, and poor physical health is associated with a greater risk of mental health problems. Mental health affects physical health and vice versa.
And it’s clear that ‘whole person care’ is not some weird science fiction. A number of local authorities have already signed up to become “whole person care innovation councils” in a programme led by Labour’s shadow health secretary Andy Burnham. The councils are already taking the first steps towards turning into reality Mr Burnham’s vision of a single health and social care service. Under these Labour plans more care will be provided directly in people’s homes, there will be a greater focus on prevention and better co-ordination between different branches of the system.
In the 21st Century, the challenge is to organise services around the needs of patients, rather than patients around the needs of services. That means teams of doctors, nurses, social workers and therapists all working together. This ideally means care being arranged by a single person who you know – ending the frustration of families being passed around between different organisations and having to repeat the same information over and over again.
This seems to be the sort of thing which Tony Benn would like too.
But it is a marked shift in gear. It means a greater focus on preventing people getting ill and more care being provided directly in people’s homes so they avoid unnecessary hospital visits. Keeping frail individuals out of hospital will clearly be one of the ‘next big things’ in English health policy, whoever is in government after May 7th 2015.
It will be quite a culture shock to move the NHS from an organisation being pump-primed for global multi-national expansion. But the NHS has been through worse changes. This one might actually be useful.
Even the figures suggest Labour is more trusted on issues to do with the economy
It’s taken me a few days to think about the data which John Rentoul reported on a few days ago in the Independent. Aside from the headline figure that the Labour lead is only of the order of a few % points, the poll results make interesting reading even for those people like me who are normally totally uninterested in such rough population statistics.
As a disabled citizen, I am always quite touchy about the rhetoric of being ‘tough’ in the benefits system. This is because it took me approximately two years for my own disability living allowance to be restored, and this was only after I appeared in person at a benefits tribunal here in London. And yet the lead which the Conservatives have on benefits is massive: “Be tough on people abusing the benefits system: Conservative lead 39 points”. Here, I think usefully Labour can distinguish between people who deserve disability benefits for their living and mobility, whom they should be proud to champion, and people who are clearly free-loading the system. To try to get to the bottom of this, I tried to ask a 64-year-old friend of mine from Dagenham whether this notion of ‘benefits abuse’ is a real one. She explained ‘too right’, citing even that the council estates in Barking and Dagenham appeared to be stuffed full of immigrants who had somehow leapfrogged the social housing waiting list. I cannot of course say whether she’s right, but this is her perception. She went on to say that there were blatantly people around where she lived, who were making use of schools and hospitals, “to which they were not entitled.” The truth and legal arguments surrounding this feeling are of course longstanding issues, but the margin of the Conservatives’ lead on this is not to be sniffed at.
The finding that, “Keep the economy growing: Conservative lead 14 points”, is not of course particularly surprising. This is also a fairly robust finding. I suspect most people are still unaware of the enormity of the challenge which the last Government find itself confronting, such that Gordon Brown describes having to consult a few Nobel prize winners in economics at the last minute about his plans for bank recapitalisation (in his memoirs “Beyond the Crash”). How the £860 billion contributed to our famous deficit has been played out ad nauseam on Twitter, but such a discussion does not appear to have dented in the minutest sense the mainstream media. When Conservatives are faced with the question what they would have ‘done differently’, most do not even offer any answer, though true libertarians argue that they probably would have done nothing learning from the ‘Iceland experience’. But certainly one of the greatest successes of the political landscape has been converge all issues to do with the economy on the question, “Who do you trust on the economy?” The facts do actually speak for themselves, even though somewhat unclear. We may dispute we have had a double or triple recession since May 2010, but there is absolutely no doubt that the economy under this Coalition since May 2010 has done extremely badly (when the economy was indeed recovering in May 2010). That the economy may be dethawing a bit when the latest GDP ONS are released on Friday may not be a bad thing for Labour either. If voters are ‘grateful’ for an economy in recovery, and ‘trust’ Labour sufficiently, they may ‘hand over the keys’ to the Ed Miliband.
But would you like to give the keys back to the people who “crashed the car”? We, on the left, know that Ed Miliband, Ed Balls and Gordon Brown, did not single-handledly (or indeed triple-handedly), “crash the car”. Only, at the beginning of this week, JP Morgan was handed an eye-watering fine by its regulator over securitised mortgages. Nonetheless, this IS the public perception, and there are no signs of it shifting yet, given the sheer volume and brilliance of the lies from professional Coalition MPs. When you turn to issues to do with economy, which face, “real people”, the poll results produce an altogether different narrative. Whilst the media and Westminster villages enjoy GDP figures and “the scale of the deficit”, most hardworking people in the UK don’t go to work thinking about the deficit. Car drivers may think about the cost of filling up a tank of petrol in their car, or worry about the monumental scale of their energy bills.
This is why in a sense it’s payback time which Labour intends to take full advantage of. The Conservatives are clearly hoping for ‘analysis through paralysis’, where voters will be bored to death over what is exactly causing such high bills, including ‘green taxes’. The fundamental problem is, arguably, reducing the competitive market from 14 to 6, in part, but the public appetite for blaming Labour for this appears to be surprisingly weak. The public appear to have gone somewhat into “I don’t care who caused it, but please do sort it out” mode. Therefore, the poll finding, “Keep gas and electricity prices down: Labour lead 20 points” is striking. The market is not anywhere near perfect competition. It is an ‘oligopoly’ as it has too few competitors, which means that they can arrange prices at a level suitable for themselves. This is called ‘collusive pricing’, and it’s notoriously hard to regulate. That’s why the ‘price switching’ approach is so banal. As soon as you switch from one energy provider, you can land with another energy provider who is teetering on the brink of putting up energy prices themselves. They can do that. The latest intervention by Sir John Major provides that Ed Miliband has identified the right problem but arrived at the wrong solution. The irony is that Major himself has probably himself arrived at the right problem, but many disagree with the idea that a ‘windfall tax’ will ultimately benefit the consumer because of the risk of taxes and levies being indirectly handed down to the end-user. Nonetheless, it will make for an interesting Prime Minister’s Questions at lunchtime today.
The poll finding, “Protect people’s jobs: Labour lead 16 points”, also represents another powerful opportunity. The finding that there is a ‘record number of people in employment’ has always had a hollow ring, but Channel 4’s “Dispatches” programme managed to explain lucidly how millions were being duped into jobs with poor employment rights by multinational companies seeking to maximise shareholder dividend. The use of ‘zero use contracts’ has also raised eyebrows, as well as the drastic watering down of rights for employees under the unfair dismissal legal framework of England and Wales. And yet these are fundamentally important issues to do with the economy. Political analysts who do not comprehend this idea, in perseverating over their question “Who do you trust with the economy?”, are likely to be underestimating the problem which Cameron and colleagues face on May 7th 2015.
Whatever the public’s eventual ‘verdict’ on who runs the economy or issues to do with the economy better, the Conservative-led government is clearly running out of time. In a week when they should be fist-pumping the air over the GDP figures, three years down the line, they are bogged down in a debate over ‘the cost of living crisis’. That is, because all of his ‘faults’ in leadership, Ed Miliband has managed to choose which narrative he wishes to discuss. Whatever the precise understanding of voters over complicated issues of economics, this Conservative-led government are proving themselves to be excellent at one particular thing. They appear confidently self-obsessed and ‘out-of-touch’ with ordinary voters. Recent announcements, also relating to the economy, such as the decision to build a new nuclear power plant and the privatisation of the Royal Mail, have merely been interpreted as Cameron and ‘chums’ looking after his corporate mates rather than having the interests of consumers at heart. Whereas the Independent poll did not examine the issues to do with the NHS, it is clear that Jeremy Hunt’s relentless smear campaign has not even produced the slightest dent in Labour’s substantial consistent lead. With an imminent A&E crisis over Winter, actions will speak louder than words anyway.
But for Labour things appear to be ‘on the right track’. Even the figures suggest Labour is more trusted on issues to do with the economy, even if the answer to ‘who do you trust more on the economy?’ does not appear to be at first blush in Labour’s favour. What is, though, interesting is that Labour appears, at last, to have some ‘green shoots’ in a political recovery after one of its worst defeats ever in 2010.
How a fairly standard hate campaign against Labour and Andy Burnham on the NHS went so badly wrong
Andy Burnham in Willow Park Housing Trust
I am not even a hard-core ‘activist’ of Labour, whatever that is. I do nonetheless find it highly amusing how a pretty bog standard hate campaign against Labour and Andy Burnham MP, former Secretary of State for Health and current Shadow Secretary of State for Health, went so badly wrong. Isabel Hardman from the Spectator recently remarked that Andy Burnham MP is driving the Conservatives potty. Nothing would give the Conservatives greater satisfaction than to achieve the Burnham scalp, but the fundamental problem is that the facts keep on getting in the way of this hate campaign. Burnham, unfortunately for them, has considerably more experience than his counterpart, who is currently Jeremy Hunt. Burnham does not fit the mould either of someone who looks as if he wishes to work for a private equity fund when he’s more ‘grown up’. Burnham firmly believes in the founding principles of the NHS, and ideologically he is desperate to unwind the marketisation of the NHS. He wishes to make a break from the past, and “good for him”, many will say. He is in fact one of Labour’s biggest assets in the party as a whole, and has even put his neck on the block to say constructively why Labour might need to up their game to be guaranteed of a good working majority. Labour can win a massive majority on the back of their policy in the NHS, as indeed the 1997 Blair victory, helps to demonstrate. As in all of medicine, it has to make an accurate diagnosis of the problem before putting in a coherent management plan. The argument against the markets, which can drive up shareholder dividend at the expense of patient care and which introduces a level of inefficiency and waste such that an estimated 31% of the budget will now be going on admin. and wastage (as beautifully articulated by the Himmelstein and Woolhandler papers), has been won. The need to encourage collaboration and the dignity of clinical staff cannot be underestimated. The Conservative Party have failed miserably on the NHS, and it is for this fundamental reason why they will ultimately become unstuck on May 8th 2015.
The problem with the Conservative HQ copy, regurgitated in the medical and health policy press uncritically, is that it simply does not make sense. Even worse, it is not borne out by the facts. Take the meme that “money does not grow on trees“. Even the most ardent patient safety campaigners need to acknowledge the need for safe staffing levels, which might include a basic level of nursing staffing numbers. If money does not grow on trees, how is it possible that £860 billion was found miraculously by a Labour government to fix market failure of the first global financial crash. If money does not grow on trees, how come is it that estimates of HS2 are pitched around £40-60 billion realistically? Even the £2.4 billion McKinsey ‘efficiency savings’ were returned to the Treasury, and not ploughed back into frontline care. It all fundamentally hinges on a steady stream of lies about the NHS from the Conservative Party.
Money tree
Andrew Dilnot, chair of the UK Statistics Authority, recently concluded in December 2012 that changes in NHS spending over the two years had been small and health spending was actually lower in 2011-12 than in 2009-10. He nonethlesss said the watchdog’s calculations were based on what he considered “the most authoritative source” of national statistics on the subject from the Treasury. In a letter to Health Secretary Jeremy Hunt, Mr Dilnot said: “On the basis of these figures, we would conclude that expenditure on the NHS in real-terms was lower in 2011-12 than it was in 2009-10.”
Another trick is the misuse of the term ‘sustainability’ is used by people who really have no idea what this means – sustainability clearly not be a lame excuse of stripping frontline staff of the resources they need to do their job. This all pricks the nation’s conscience which is increasingly skeptical of the ‘austerity’ blank cheque excuse to decimate public services in the name of ‘public sector reform’. It simply is a pack of lies, as Labour knows the public fundamentally has no problem with a well-funded by taxpayers state-run service, free-at-the-point of use, offering a comprehensive universal healthcare? The current Coalition vastly underestimate the public’s fundamental mistrust of money being paid on excessive CEO salaries in the NHS, especially on senior members of NHS England who repeatedly offend on the point of lack of accountability of their decisions. They do not accept the business plan that it is necessary to spend thousands or millions on redundancy payments, or compromise settlements to avoid unfair dismissal claims.
Even the question of the nation’s “priorities” generally runs into the buffers immediately. The public resent the idea of carers in a ‘caring profession’ by definition being put on ‘zero hour contracts’, even if the party-line from profit generating multinational corporates is that these allows staff ‘flexibility’. The arguments criticising the NHS have swung from one hyperbole to another, with the NHS having been called a 65 year mistake. And yet, this argument is unable to touch the scandal at Winterbourne in the private sector. On the issue of the nation’s priorities, can one reasonably suggest that one of the very worst things for this current Government to do was to embark on a £3bn reorganisation of the NHS with the sole primary purpose of outsourcing and privatising the NHS? As the lawyers say, “res ipsa loquitur” or the facts peak for themselves. In a 493 page Act, there is not a single clause on patient safety, which seems rather odd given everyone’s correct focus following the disasters at Mid Staffs and Morecambe Bay which Labour has every intention of remedying. The Act clearly thrusts private competitive tendering as the prime method of commissioning, which is being played out as a disaster in the legal/justice system. The Act has clearly massively increased the amount of income that a NHS Trust can make from private sources. It is an Act which fundamentally the public did not vote for, and it is little wonder that Andy Burnham MP and his team have repeatedly promised to repeal the Act. Like High Speed 2, which many do not similarly remember ‘voting for’, the costs are threatening to spiral out of control, which makes it all the more ludicrous that it is the Labour Party should be blamed for misuse of the handling of the public finances. Like High Speed 2, this policy is an outcome of intensive behind-closed-doors lobbying, and the genesis of the Act sits uncomfortably with the widely reported general issue of the Conservative Party and hedge funds.
Burnham has not sat on the fence over issues of health policy either. Despite the ‘smoke and mirrors’ of untrue fatuous claims of David Cameron, Burnham resolutely has promoted plain packaging of cigarettes, consistent with current global evidence and much to the chagrin of Philip Morris International. Burnham has also supported the evidence-led view of the Faculty of Public Health of the UK Royal Colleges of Physicians over ‘minimum pricing’ of alcohol. Burnham has said ad infinitum and absurdum that, despite the purported advantages, the ‘private finance initiatives’ need to be drafted such that the public do not lose out. Three things to say here, that the policy has been extended by the current Government under George Osborne. Secondly, it is a policy which was born under John Major’s government in the mid 1990s Thirdly, the first ‘sighting’ of this policy, which represents fundamentally a synthesis of a Conservative ‘Butskellite‘ policy, was in a 1993 policy document published by the Social Market Foundation with David Willetts MP, current Conservative minister for Universities, entitled “The Opportunities for Private Funding in the NHS”. Burnham, furthermore, has not his hid under a bushell regarding NHS 111. He has in fact accused the Government of destroying NHS Direct, “a trusted, national service” in an “act of vandalism”. According to him, “It has been broken up into 46 cut-price contracts. Computers have replaced nurses and too often the computer says ‘go to A&E’.”
Writing about the situation in Lewisham, Burnham unsurprisingly has been spitting bullets, remarking that:
“The High Court yesterday delivered a damning verdict on an NHS now being run by accountants rather than in the interests of local communities. This ruling is a humiliating blow to Jeremy Hunt. It is outrageous that he thought he could rob a community of its A&E and maternity services to solve financial problems at a neighbouring trust.Labour warned him that he was acting above the law but he refused to listen, and that arrogance has cost taxpayers dear in legal fees but has also caused people of Lewisham unnecessary worry.”
The general public resent this general sense of arrogance with which Jeremy Hunt and colleagues behave in their management of the NHS. The ‘democratic deficit’, where the public are simply not included in decisions about the NHS, makes a mockery of the ‘no decision about me without me’ mantra so beloved of NHS commissioners currently. Arguably, this is not seen any more clearly than in the sharing of confidential data without the valid consent ethically or legally of NHS patients. This was even reported in right-wing newspapers who have on occasion been strongly in favour of patient rights as follows:
“Mr Burnham said it is “absolutely essential” that patient data is safeguarded, after The Sunday Telegraph revealed David Cameron will use a keynote speech to outline far closer “collaboration” between the health service and life science companies. The Prime Minister will say that the controversial industry has the potential to be a powerhouse of Britain’s 21st century economy, but that it is stifled by excessive regulation at present. Speaking to Sky News, Mr Burnham said that while he did not object in principle to close ties between the NHS and private sector life science companies, he was concerned that “one of the patients’ groups that was on the working group looking at this issue has walked away”.”
I first spoke with Andy Burnham after one of the leadership hustings in 2010 at the Methodist Central Hall. I liked him as a person, and I was really struck by the sheer passion he genuinely had for an integration of health and social care pathways, even long before the political shennanigans of the Dilnot Review which were delayed because of the Health and Social Care Act. This was further embellished in a seminal speech to the King’s Fund in January 2013:
“For 65 years, England has tried to meet one person’s needs not through two but three services: physical, through the mainstream NHS; mental, through a detached system on the fringes of the NHS; and social, through a means-tested and charged-for council service, that varies greatly from one area to the next. One person. Three care services. For most of the 20th century, we just about managed to make it work for most people. When people had chronic or terminal illness at a younger age, they could still cope with daily living even towards the end of life. Families lived closer to each other and, with a bit of council support, could cope. Now, in the century of the ageing society, the gaps between our three services are getting dangerous. The 21st century is asking questions of our 20th century health and care system that, in its current position, will never be able to answer to the public’s satisfaction. As we live longer, people’s needs become a complex blur of the physical, mental and social. It is just not possible to disaggregate them and meet them through our three separate services. But that’s what we’re still trying to do. So, wherever people are in this disjointed system, some or all of one person’s needs will be left unmet.”
I feel that nobody could have worked harder than Andy Burnham for the NHS on a range of issues, such as nursing staffing levels, the lie about the NHS budget being protected, the sharing of confidential patient data, the Lewisham decision under appeal, minimum pricing of alcohol, standard packaging of cigarettes, the repeal of the Health and Social Care Act (2012), and PFI. He has also worked extremely hard in exploiting his ‘first mover advantage’ over health-and-social integrated care and ‘whole person’ care. Labour is consistently trusted by the voters on the NHS ahead of the other parties, and this is not particularly any surprise when you consider that many employees of the NHS receive more balanced information about the actual situation of the NHS from their Unions of which they are a part. There is no doubt that the toxic memes of “competition” and “choice” are here to stay, totally bastardised by health policy wonks who have never set foot on a busy NHS ward in their life. Andy Burnham MP can do no worse than to maintain the reputation of and trust in the medical and nursing professions and the NHS. After years of the Coalition rubbishing the NHS, it is definitely time for a change, and we can’t go on like this.
The writing is back up on the wall: this social democrat neoliberal NHS road to nowhere
The Coalition is the current face of the corporate lobbying over the NHS, but some in Labour have acted as ‘ingluorious basterds‘ too. Ironically, neglect of the NHS was a principal cause of the Conservative government’s downfall back in 1997, and was a major issue that helped New Labour mobilise mass political support for a landslide election victory.
In 2002, Professor Anthony King described the Blair government as the “first ever Labour government to be openly, even ostentatiously pro-business”. Thus, the New Labour leadership had been “converted” from tolerating private enterprise to actively promoting it; a significant political U-turn. Now in 2013, Ed Miliband has recently been in the firing line over a lack of direction or policies, with some Labour members being wheeled out of their holiday villa in Tuscany to emphasise that Miliband will win the election in May 2015. Peter Hain talks in his latest up-beat missive in the Guardian about the New Jerusalem of Labour’s flagship integration policy, which ‘joins up’ health care and psychiatric system, but this is a poor attempt at snakeoil salesmanship from an otherwise very pleasant man. It is indeed emblematic of Labour’s outright denial of the disaster that has been the English health policy over a number of years from senior politicians of all parties. People who do actually want to stand up for a comprehensive, universal, free-at-the-point-of-use, National Health Service are finding themselves struggling to get their message across, while Craig Oliver gets panicky about the media representation of Cameron’s unsightly figure on holiday.
All is not lost. The facts speak for themselves (“res ipsa loquitur“), and Labour cannot escape from its past. Ed Miliband is a ‘social democrat’, but there are plenty in the Labour Party who are senior enough to keep him in check over the NHS. Ed Miliband, despite the loyalists, is on suspended sentence with his conference speech next month in Brighton. Whatever he decides to do about social house building, his inability even to get rid of the Bedroom Tax is a sign that all is not well. Few people currently feel that he is up to the challenge of taking the socialist bull by the horns regarding the NHS policy, not helped by entities such as the Socialist Health Association superbly supine in having no material effect on the real problems that matter to most voters.
And yet all is not lost. Take for example the flagship policy of ‘equal opportunity’, championed by Monitor in lowering barriers-to-entry in a corporate dogfight over who runs the NHS. Tony Blair doesn’t especially mind who runs the NHS, as long as it’s a corporate, as his famous dictum goes. The writing was indeed on the wall as far back as , with the very influential John Denham MP, a former Health Minister, writing in ‘Chartist’ as follows in 2006:
But the Government has adopted a simplistic and ideological formula. All public services have to be based on a diversity of independent providers who compete for business in a market governed by consumer choice. All across Whitehall, any policy option has now to be dressed up as ‘choice’ ‘diversity’ and ‘contestability’. These are the hallmarks of the ‘new model public service’.
We can see this formula behind al the recent major policy rows, and its ideological nature goes some way to explain Labour’s internal opposition. But it’s not the whole reason. Plenty of MPs are willing to look at policy change on its merits, whether or not they have suspicions about its origins. And this is the second point where things go wrong.
However strongly the Government believes in ‘choice, diversity and contestability’ there is little unambiguous evidence in its favour, and plenty of evidence that points to caution. The evidence does not suggest, for example, that choice all leads to inequities but it certainly suggests that it usually does. There are services where a choice of independent autonomous providers may make sense, but the evidence suggests that health, or education, works best when this is cooperation between different parts of the system. The link between your nurse, GP, consultant and therapists is more important than competition between different providers.
John Denham MP still has a massive influence on the Labour Party as is well known, having been instrumental in the selection of Rowenna Davis in Southampton Itchen for the forthcoming General Election on May 8th 2015.
The knives were out with the Labour Grandee, now The Rt Hon The Lord Hattersley, writing in the Guardian on 7 November 2005:
“A couple of weeks ago Tony Blair told a specially invited Downing Street audience that throughout the 80s Labour had been kept out of office because it wanted to “level down”. That allegation is as absurd as it is offensive. But plagiarising Tory abuse is not so serious an offence as adopting Tory policies. Last Friday, he again attempted to make backbench flesh creep with warnings that abandoning his “reform agenda” would lead to defeat. That is not only palpably untrue, it is also not a consideration that keeps him awake at night. His policies are on the right of the political spectrum because that is where his heart is. He has happily admitted it.
Socialism is either the doctrine of public ownership or the gospel of equality. The first Tony Blair (now) rightly rejects. The second he openly wants to replace with a commitment to meritocracy – the survival of the fittest at the expense of the less fortunate and less gifted. That proves his intellectual consistency. No prime minister since the second world war, including Margaret Thatcher, has believed so devoutly in the economic healing powers of the market. Meritocracy is a market in which human beings compete with each other for wealth and esteem. Markets always produce losers as well as winners.
The “choice agenda” requires competition for places in what are called “the best schools” and beds in the most efficient hospitals. Unless there is a surplus of secondary schools with small classes, highly qualified teachers and exemplary results, some parents will be forced to accept what others have rejected. The same rule of winners and losers will apply to hospitals. No genuine Labour leader would allow the self-confident and articulate section of society to elbow the disadvantaged and the dispossessed out of the public service queue.”
The mutant DNA is still to be found in Labour’s current NHS policy, sadly, except these are not lone trace fragments by any stretch of the imagination. We’ve been before though, and Labour has fundamentally been frightened to do the right thing. At the 2005 the Labour Party Conference a resolution was passed that attacked the Government’s move “towards fragmenting the NHS and embedding a marketised system of providing public services with a substantial and growing role for the private sector”. It was left up to Michael Meacher MP to put the writing back up on the wall in an article in March 2007 in Tribune, explaining what Tony Blair should do, if he should win the 2007 General Election:
“Domestically, I would reverse the “new” Labour obsessions of replacing the public service ethos by the market. Equity, equal rights according to need, public accountability, a professional standard of care and integrity are being replaced by targets, cost cutting, PFI top slicing of public expenditure, a service fragmentation by private interests. This is the case of health and education housing, pensions, probation, rail, the Post Office and local government. There are even threats against public service broadcasting. Privatisation of our public services should be stopped and reversed.”
Stuart Hall, Emeritus Professor of Sociology at the Open University, argued that whilst the Labour Government has retained its social democratic commitment to maintaining public services and alleviating poverty, its “dominant logic” was neo-liberal: to spread “the gospel of market fundamentalism”, promote business interests and values and further residualise the welfare system. It now falls to Jon Cruddas in the current policy review to stop the rot in Labour, but his words from his article “How New Labour turned toxic” in the New Statesman on 6 December 2007 ring ever true:
“After years in opposition and with the political and economic dominance of neoliberalism, new Labour essentially raised the white flag and inverted the principle of social democracy. Society was no longer to be master of the market, but its servant. Labour was to offer a more humane version of Thatcherism, in that the state would be actively used to help people survive as individuals in the global economy – but economic interests would always call all the shots. Once the Blair government took power, the essentials of its approach became clear: from the commercialisation of public services to flexible labour markets, on through soaring executive pay and on in turn to party funding, big business and the politics of the market had taken pole position.”
Labour is a leopard which hasn’t changed its spots at all. Hence, apart from Debbie Abrahams virtually, Labour appears to be giving tacit support to a current Government policy which appears to be sympathetic to the World Trade Organisation’s (WTO) General Agreement on Trade in Services (GATS), which aim to opens up service provision like health and education, (which account for approximately 15% of GDP in most European countries) to direct multinational competition and ownership, This, in fact, is despite a statement in 2002 from the UK Government that it would not take on WTO commitments that would compromise public service delivery via the NHS. This represents a major U-turn in healthcare policy and it is therefore important to understand from a historical perspective how and why this happened.
Labour is currently involved in a massive con-trick with the electorate, colluding with the Conservatives and the Neoliberal Democrats, and it won’t be long before real voters spit in their face in response to their claim that, “Labour is the party of the NHS.”
Further reading
Hall S. (2003) New labour’s double shuffle, Soundings.
King A. (2002) ‘Tony Blair’s First Term’ in King A (ed.) (2002) Britain at the Polls.
What exactly does Labour achieve by coming third in the Eastleigh by-election?
This is a totally independent post and does not represent the views of the Socialist Health Association.
If ‘expectation management’ were recognised in awards, the Liberal Democrats would get the Nobel Prize.
Martin Rathfelder, Director of the Socialist Health Association, said recently, “By-elections are funny things”. When Labour loses the Eastleigh by-election, the Labour line, as surely as night follows day, will be that nobody expected Labour to win this Hampshire seat which is safe territory for the Tories and Liberal Democrats. The Conservatives can never be underestimated for making a fight back, as anyone who remembers the 1992 general election will testify. And for whatever the faults of Chris Huhne and David Laws, many voters in that part of the country are very loyal to them and the Liberal Democrats. (more…)
