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The solution to the current malaise is not more extreme social democracy
There’s an argument from some that more trenchant tax rises, such as VAT or income tax, and ‘getting more from less’, will be enough to see through an incoming Labour government led by Ed Miliband.
Put quite simply, I don’t think this will be nearly enough. It would the best Labour could come to retoxifying its own brand, reestablishing its credentials as a ‘tax and spend’ government. In fact, for the last two decades, the taxation debate has got much more complicated due to an issue nobody wishes to admit. That is: you’re not actually using taxpayers’ money to go into the salaries or wages of employees of the State, you’re increasingly using this tax to subsidise the shareholder dividends of directors of outsourced public functions (such as beneficiaries of health procurement contracts). Whether you like it or hate it, and let’s face it most people are ambivalent to it, resorting to this would ignore all the groundwork the Miliband team has done on “pre-distribution”. Forgetting this actual word for the moment, making the economy work properly for the less well-off members of society should be an explicable aim of government on the doorstep. Putting the brakes on the shock of energy bills, from fatcat companies, is a reasonable self-defence against an overly aggressive market which has swung too far in much favour of the shareholder and director. Paying people a living wage so that they’re not so dependent on State top-ups to survive is as close as you can get to motherhood and apple pie. Even Boris Johnson supports it.
Of course, Ed Miliband’s natural reaction as a social democrat would be try and survive government as a social democrat. But that doesn’t get round the problem experienced by a predecessor of his, Tony Blair. When Tony Blair had his first meeting with Robin Butler (now Lord Butler of Brockwell), Butler asked, “I’ve read your manifesto, but now what?” Ed Miliband has low hanging fruit to go better than Tony Blair on his first day in office if he can come up with clear plans for office and government.
Let’s get something straight. I don’t agree that the scenario which must be proven otherwise is that Ed Miliband will come into Downing Street only enabled by Liberal Democrat voters. There are plenty of former Liberal Democrat voters who feel deeply disgusted by Nick Clegg not acting as the ‘brake’ to this government, but as the ‘accelerator pedal’. They have seen Clegg’s new model army vote for tuition fees, privatisation of the NHS, and welfare reforms, as if there is no tomorrow. And for many of his MPs, there will be no tomorrow. Clegg’s operating model of supplying votes for whichever party happens to be his employer is clearly unsustainable, as within two periods of office, his flexible corpus of MPs would end up repealing legislation that they helped to introduce to the statute books.
In answer to the question, “What do we do now?”, Ed Miliband does not need to reply with a critique of capitalism. Miliband will have to produce a timeline for actions which he has long promised, such as implementation of a national living wage, controlling seemingly inexorable increases in energy bills, as well as other ‘goodies’ such as repealing of the Health and Social Care Act (2012).
Andy Burnham MP, Shadow Secretary of State for Health, has already explained some of the ‘and then what’. Burnham has insisted that he will make existing structures ‘do different things’. But while getting rid of compulsory competitive tendering, Burnham needs to put ‘meat on the bones’ on how he intends to make the NHS work without it being a quasimarket. Burnham’s challenges are not trivial. Burnham seemingly wishes to maintain a system of commissioning, while intending to abolish the purchaser-provider split. Burnham also seemingly wishes to support local A&E departments in not being shut down, but has as not yet stated clearly what he thinks will work better than the current amendment of the Care Bill going through parliament for NHS reconfigurations. Furthermore, Burnham in advancing ‘whole person care’, in sticking to his stated unified budgets, may have to resist seeing the merging of the non-means tested NHS being merged with the means-tested social care. This might easily lead to ‘mission creep’ with merging with welfare budgets. And this brings up a whole new issue in ‘integrated care’ which Burnham has long denied has been on the agenda: “top up payments” or “copayments”. Reducing health inequalities by tackling inequalities social determinants of health should of course be well within the grasp of a socialist-facing NHS delivered by Labour. With patient safety also, correctly, a top priority for the National Health Service, especially for how frail individuals received medical care in hospitals, Burnham has in fact five timelines to develop fast as top priorities: addressing the social determinants of health inequalities (even perhaps poor housing), commissioning anomalies, reconfiguration tensions, whole person care implementation, and patient safety.
The global financial crash should have given some impetus to the Marxist critique of capitalism, but it didn’t. Tony Benn said famously that, when he asked to think of an example of ‘market forces’, he would think of a homeless person sleeping in a cardboard box underneath Waterloo Bridge. Benn further pointed out that the NHS was borne out of war, where normal rules on spending went out of the window: “have you ever heard of a General saying he can’t bomb Baghdad as he’s overrun as his budget?” However, it was not the global financial crash which caused there to be far too many people who feel disenfranchised from politics. Capitalism always drives towards inequality. It also drives towards economic and political power being rested at the top. The reason why people are well off tell you it’s important to do more with less is that they have a fundamental poverty of aspiration about this country. They don’t particularly care as the most well off are getting even more well off. This is an economic recovery for the few. The economy is not going to grow on the back of a record people with zilch employment rights under “zero hours contracts”. The economy is not going to grow either on the back of a property-boom based in London, even if a sufficiently large number vote Conservative as a result of a bounce in their property prices.
What there is a risk of, however, is socialism being popular, and this of course goes beyond the follower number of a few certain individuals on Twitter. Across a number of decades, particularly in Sweden and Cuba, we’ve been able to learn good lessons about what has happened in the worlds of communism and social democracy, as a counterpoint to capitalism. Tony Benn, when asked to give an example of ‘market forces’, would always cite the person sleeping rough under Waterloo Bridge. The Labour Party, most recently, in large part to Tony Blair being ideologically being ‘of no fixed abode’, has run away from socialism, meaning narratives such as Jackie Ashley’s recent piece are consciously limp and anaemic, a self-fulfilling prophecy of utmost disappointment. There is no sense of equality, cooperation or solidarity, and these ought to be traits which are found to be at the heart of Labour’s policy. If Ed Miliband hasn’t thought of how the answer to ‘Now what?’ fulfils those aims, it’s time he had started thinking about. With this, he can not only build a political party, but build a mass movement. With people choosing to become members of unions, and there is no better time with such a naked onslaught on employment rights, the Labour movement could become highly relevant, not just to very poor working men. Labour has to move with the times too; it needs to move away from reactionary ‘identity politics’, and seek to include people it hasn’t traditionally engaged in a narrative with. This might include the large army of citizens who happen to be disabled or elderly. There is no doubt that a socialist society needs the economy to succeed; if it is really true that the UK sets to be in a dominant position in Europe by 2030, surely the media should be helping the UK perform a positive rôle as a leader. The economy involves real people, their wages, their energy bills, their employment rights, so while it is all very easy to be po-faced about “the cost of living”, or have foodbanks in your line of blindsight, Labour needs to be a fighting force for many more people who otherwise don’t feel ‘part of it’. It should be the case that a vote should buy you influence in shaping society, in as much as the way to buy influence, say in the NHS, is to become a Director of a private health multinational company. This fight against how capitalism has failed can indeed become the alternative to commercial and trade globalisation; a peaceful transition into this type of society is one which the more advanced economies like ours is more than capable of.
Where Labour has thus far been quite successful in trying to make its policies look acceptable to the wider public is courting the opposition. Many would say they have taken this too far. Labour might wish to ‘look tough on welfare’, but Labour can easily advocate employed work being paid for fairly, while being fiercely proud of a social security system which looks after the living and mobility needs of people who are disabled. A radical look at ‘working tax credits’ is possibly long overdue, but Labour will need to get out of its obsession for triangulation to do that. If Labour merely offers a ‘lighter blue’ version of the Conservatives, members of the public will be unimpressed, and boot Labour out asap. Whilst Wilson and Blair both won a number of periods of government, the jury is out especially with what Blair achieved in reality aside from the national minimum wage (which was only achieved with the help of the unions). Many people feel that privatisation was a continuous narrative under Labour as it had been for the Conservatives, and many Labour voters feel intrinsically disgusted at the thought of Tony Blair being Margaret Thatcher’s greatest achievement. People instead of being liberalised by markets have now become enslaved by them. Across a number of sectors, there are only a handful of competitors who are able to rig the prices lawfully between them. The consumer always loses out, and the shareholders with minimal risk receive record profits year-on-year. Of course, rejection of privatisation does not necessarily mean nationalisation, in the same way that decriminalisation of illegal drugs does not necessarily mean legalisation. But it cannot be ignored that some degree of State ownership is a hugely popular idea, such as for the NHS, Royal Mail and banks. Where Ed Miliband might be constructively compared to Fidel Castro (in the days when things were going well for Castro) is that Miliband can set out a vision for a sufficient long period of time for people to become attracted to it (not disenfranchised by it). Thatcher, for all her numerous faults, was very clear about what she intended to achieve. As Tony Benn put it, she was not a “weather vane” but a “weather cock which is set in a direction… it just happened that I totally disagreed with the direction which she set.”
I think Ed Miliband will surprise people, exactly as he has done so far, in winning the general election on May 8th 2015. I also feel that he will surprise people by having answers to the “And then what?” bit too.
Which Tony will win on the NHS? ‘Social democracy’, please meet ‘democratic socialism’.
At the heart of the ‘perfect storm’ about the NHS is a mediocrity of some managers, lack of ability from some NHS ” leaders “, and some inexperienced or unknowledgeable junior politicians and the civil service, who are crippling the best efforts of the frontline clinicians. Not helping is the split personality of the UK Labour Party which has seen an unbearable tension between socialism and neoliberalism. A good short-cut to understanding this difference in opinions is to examine how Tony Benn and Tony Blair have considered the NHS.
Benn hates the idea that ‘the left’ destroyed the Labour Party, and this chicken is yet to return to roost. Baroness Thatcher’s biggest achievement might have been New Labour, but it might be sensible now to conceptualise ‘New Labour’ as a political experiment. It can be to all extent and purposes it can be considered now to be a separate party to Labour proper. As we enter Conference season, it would be helpful if Ed Miliband could begin to form a vision of what he wants the NHS to be like. Without this vision, Miliband will be floundering, firefighting, and be lost in an ideological abyss. Benn is genuinely intrigued ‘why the Labour Party ignores people’, and thinks that capitalism prefers to see their policies ‘advocated from the left’. That is why Sean Worth may be so keen to write blogposts for the Socialist Health Association. This could be conceptually similar to Rupert Murdoch liking New Labour. “People don’t believe what they’re told, and people don’t listen to them”, complains Benn, and this is especially true in how NHS managers and politicians have approached the running of the nHS.
Tony Benn has not substantially changed his views on socialism for a number of decades, and while Ed Miliband is a card-carrying ‘social democrat’, Tony Benn’s view of ‘democrat socialism’ made famous in 1978, now published as “Why America needs democratic socialism”, does now perhaps merit further scrutiny. Benn’s argument that many in the general public advocate a form of “the left”, further left than Labour, is not ill thought out either. Privatisation, which has brought excessive profits for a few, has not turned out to be a democratising process at all due to the dynamics of neoliberal oligopolies. Privatisation is not popular. Benn has never seen socialism as a destination on a railway line, but sees socialism as an “ongoing struggle”. Benn, conversely, thinks the Thatcherite “revolution” was to ‘wind up the welfare state’, in much the same way as Reagan wished to unwind ‘The New Deal’, and undermined by the failure of monetarism. He cites that he senses that ‘people realise that they don’t have any power’, and is strongly critical of the unelected nature of corporatism, meaning that the power invested in the undemocrat Central Bank, World Trade Organisation, IMF and multinational corporates has effectively led to a ‘one party state’. One can imagine what Benn thinks of the creeping corporatisation of the NHS. Benn argues instead that people feel that they are not being represented any more, and nothing could be further from the truth than the inability of Labour and the Conservatives to discuss the McKinsey Efficiency savings or the private finance initiative strategy.
The media “rejected socialism”, according to Benn, so did Mandelson, Blair and Kinnock. However, Benn weirdly enough has not given up the faith. As for private ownership, Benn argues that we are using taxpayers’ money to subsidise the railways which would otherwise run at a loss.
Benn thinks that clinicians and nurses should be involved in the management of the NHS, which is somewhat reminiscent of the ‘co-determination‘ strategy in Germany of corporate management. Ed Miliband is in fact known to be very keen on this model of corporate governance, as it is consistent with his view of ‘responsible capitalism’. Benn opines at 26 mins in:
“Absolutely. They’ve got all these management consultants. I don’t wish to insult management consultants. There’s a lovely story I heard years ago. It’s about a boat race between a Japanese crew and NHS. Both sides practice long and hard. The Japanese won by a mile. So the NHS faced with this problem set up a working party. The working party report that the Japanese crew had 8 people rowing and 1 steering, and the NHS crew had 8 people steering and 1 rowing. So they brought in management consultants who confirmed the diagnosis. They suggested that the NHS crew should be completely restructured with 3 Assistant Steering Managers, 3 Deputy Steering Managers, a Director of Steering Services, and a rower incentivised to row. They had another race. They lost by 2 miles. They laid off the rower for poor performance. They sold off the boat. There are too many management consultants and not enough managers in the hospital. When I went to Havana years ago, they took me to their hospital, I didn’t wish to see the equipment. I asked how the hospital is run. We discuss everything. The first meeting is one chaired by the management, the second meeting is one chaired by the Unions, and the third meeting is. So I really am not in favour of this top down view at all, and I feel industrial democracy has an appeal and people feel that they’re kicked about…”
At about 11 mins in of this second film, there is a clear contrast in tone with Tony Blair interviewed by Will Hutton in the film “The Last Days of Tony Blair”:
“Tony Blair:“Actually in the NHS it is the reforms around putting the patient at the centre of the system, choice, competition, incentives for the system to treat better, and more … those are the structural changes.”
Will Hutton: Those are the things you were criticising the Conservatives for in 1995, 1996, 1997, the markets, incentives, and the “wrecking ethos”, and here you are talking about ”
Tony Blair: Again it’s a fair point. Although it’s true there were elements in the 1990s which we brought back, on the other hand – it’s done in a more fundamental way. It’s done in a far more equitable way.”
Blair thinks of ‘communities’ as the dividing line between him and Thatcherism – as expressing solidarity and standing by the weak, more important than the “rights” of individuals. This ‘confirmed Christian’ ‘Good Samaritan’ ethos has somehow got lost in translation in Blair’s legacy, and will be savaged by the Health and Social Care Act (2012) which has acccelerated a fragmented NHS which is not comprehensive. These ‘community values’ are not to be seen in A&E departments being sporadically shut nationally. Miliband is likely to be supposed to be interested in this sense of justice in his view of social democracy, but this is indeed a common interface with democratic socialism. The problem is that these attempts at triangulation, bridging ‘left and right’ before, have been publicly strained, for example in Tony Giddens’ ‘Third Way’ which Giddens himself moots might have been a failure.
Blair thinks his approach is more “equitable”, but this can be fiercely debated. Blair talks of his love for his independent schooling system, and wishes that the best elements of this should be brought into the state system. The problem of these “academies” is that this is a repudiation of a ‘comprehensive’ system. While Blair is criticise a uniformity in low standards, reducing barriers to entry for private health providers driven by the bottom line, even that means compromising patient safety for profit, could make the final stage of NHS outsourcing and privatisation explode. Many members of the General Public do in fact the NHS to be properly funded, and do wish for a comprehensive system free-at-the-point-of-use. For all of Blair’s talk about asking the communities what they want, nobody has yet asked the general public whether they want to outsource services to India to make the bill cheaper. They are however wary of political decisions being made behind their back. In an article in the Health Services Journal, many will read with interest Patricia Hewitt’s view that, “Former health secretary Patricia Hewitt said trusts were either trying to access the fast growing sub-continental market ? estimated to be worth £110bn by 2017 ? or to harness Indian expertise”, but they will also be mindful of Hewitt’s own professional interest in opening up new private (perhaps emerging) markets in healthcare (see for example this article).
For this political issue, triangulation between ‘democratic socialism’ and ‘social democracy’ is not necessary. The neoliberal market is a boon for increasing profits in a crowded market for some. All the evidence suggests that this market will drive up health and social inequalities, and indeed increase the cost of running the NHS massively through waste and inefficiency. The final denouement of course comes from the destination of the transition we are now embarked upon; this unelected move will take us up to an estimated 31% of the budget going on admin. and wastage (as beautifully articulated by the Himmelstein and Woolhandler papers). Tony Blair may believe that ‘it doesn’t matter who supplies services in the NHS’, but for nurses about to be made redundant it does matter. Outsourcing these services to India will bring resentment, as well the exploding budget spent on management consultants; it is estimated that the NHS reorganisation, whilst creating massive turmoil, has cost billions so far. Nobody has ever bothered to criticise the impact of the inefficiency savings in delivering unsafe and uncompassionate care, and not thought to link it to the general state of the economy which has been a disgrace under the present Coalition of Conservatives and Neoliberal Democrats.
Miliband should repeal the Health and Social Care Act (2012), which does not even contain a single clause on patient safety. Miliband should also scale back massively the extent to which the NHS services are outsourced to the private sector, marketed fraudulently under the NHS label. He should most of all restore a properly funded comprehensive NHS free-at-the-point-of-use with a safe level of minimum clinical staffing. He needs to restore the Secretary of State’s duty for the NHS in this regard.
If we are so desperate about £20bn McKinsey efficiency savings, why are we spending £80bn on #HS2?
