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If Labour wishes to make pledges that do not cost anything, why not an all-out attack on private insurance?
The narrative goes something like this.
Personal health budgets are the stepping stone to private health insurance. You’re given a fixed amount of money, which, as time goes on, is not nearly enough to pay for your health and social care needs. But not to worry, you can top up the budget, like you top up your pay-as-you-go phone account. And if you don’t want to spend your budget in the NHS, you can transfer to private insurance firms like a voucher.
The typical media question, in fact used by Robert Peston last week on Newsnight on Andy Burnham last week, is: “Do you have any fundamental objection to healthcare, as long as its cost-effective and of high quality, being provided by the public sector?”
An answer to this normally involves an answer which revolves around transfer of resources from the public sector to the private sector, or a bit of a fudge saying there’s no ideological objection to private providers, so long as there’s a NHS “preferred provider”.
Labour is obsessed about one thing: the deficit. From this, Labour is prepared to swallow all unpopularity, such as not spending money on pay increases in the public sector, or spending money on benefits (even if the benefits are totally legitimate).
When Ed Miliband was asked later in the week about the “funding gap” on LBC, Ed Miliband gave an answer in the style of ‘some of my best friends are midwives’, and then gave the customary fudge-answer on how he would like the NHS to make better use of the money it’s got.
Except, this won’t wash. There are currently more papers in the business management press along the lines of ‘why belt tightening still won’t make you fit in your trousers’ than Ed Miliband’s been to friends’ bar mitzvahs.
And yet the more blunt way of saying we will preserve the NHS is to go out for an all out attack on the City or private insurance. Labour supporters have to ask why he won’t do this. Is it because Ed Miliband does not wish to be seen to be anti-aspiration? To give you some context, Labour is planning to give hedge fund boss, Michael Farmer, a top honour.
Labour, in saying it does not wish to promote private insurance, does not spend any money. It might though nark off previous Secretaries for State for Health in the Labour Party who work for private healthcare funds.
People pay into the National Health Service, knowing that it is there for them. There is a genuine sense of solidarity and pooling of risk, and equity: free at the point of need. It’s a moot point whether the service is as comprehensive as it could or should be.
But Simon Stevens in bigging up personalised medicine has nailed his colours to the mast without saying so.
Many have alluded to, as indeed the previous CEO of NHS England – Sir David Nicholson has, the fact that knowing the precise risk of a condition with a strong genetic contribution, such as in rare causes of dementia, would mean that that person and their family would end up paying much higher premiums than in the National Health Service.
Ultimately it seems voters want to go for the least costly option – which is why Ed Balls and Ed Miliband would rather wire themselves up to the National Grid than to discuss with Andy Burnham how social care is going to be funded comfortably.
So if Labour tells voters in an all out private insurance system some people will be paying through the roof, and the NHS will go to pot, this will play very nicely to those people who are dead against private insurance in the country’s healthcare.
It will play nicely: if Labour actually mean it.
The NHS needs an innovative ‘blockbuster’ now. That is to be brought back under the State.
The term “innovation” must be one of the most misused terms in the media. It simply means a different way of doing things, such as a product or a service, whose popularity and effectiveness ultimately govern its success.
And yet the term has been strikingly bastardised to be used in conjunction with a whole plethora of memes such as “ageing”, “technology” and “unsustainable”. The right wing has been consistently ‘on message’ in this script.
Ed Miliband in Manchester gave last night what was a perfectly plausible speech on the NHS last night. Excerpts of it have indeed been posted on our blog. And there was the usual ‘red meat’, to be accompanied at some later date by how realistic the costings are.
But the legitimate concern of voters, whether hardworking or not, is he who pays the piper calls the tune. It may not be the frontline staff with whom Ed Miliband had photo opportunities earlier this week.
Fifty shades of government, apart from green, have been obsessed with inflicting ‘transformative’ changes, perhaps ‘charismatic’ visions, without ever consulting the wider population. Examples include the private finance initiative, or ratcheting up the NHS into a competitive market.
But Nigel Farage, whether or not he is ‘establishment’, has struck a chord with some voters. I don’t mean with his allegedly racist twangs, but I mean his ‘trust the voter’ skit. He bangs on about the referendum which he knows will never see the light of day.
Labour’s argument for why the NHS needs private companies working for it remains unconvincing with many voters. That’s why the National Health Action Party or the Green Party are watched so keenly by many.
The argument is possibly not as complicated as that justifying our membership of the European Union, but it is one which is best left to the voters to justify.
Labour in pursuing its ‘35% strategy’, where it can squeeze into office on the back of disaffected Liberal Democrat voters, is by definition risk averse. But with taking low risks the return can be very low. Labour’s lack of “blockbuster” is potentially alarming.
And many of the arguments can be discussed under the assumption that GPs work for the NHS. The BMA’s “#YourGPcares” campaign is calling for long-term, sustainable investment in general practice now to attract, retain and expand the number of GP, expand the number of practice staff, and improve premises that GP services are provided from.
The pitch for state ownership is pretty basic. Ed Miliband MP, Leader of the Labour Party, yesterday Labour’s new GP guarantee as part of the next government’s plan to improve services for patients, ease the pressure on hospitals, and restore the right values to the heart of the NHS.
Speaking in Manchester, he underlined his determination to put the health service at the centre of Labour’s campaign over the next year, beginning with these local and European elections.
But it feels as if Ed Miliband is making a meal lacking the key ingredients.
Andy Burnham MP’s ‘NHS preferred provider’ is conspicuous by its absence in the speech.
Only once Ed Miliband has slain this dragon, he can be given to talk about how primary care is best delivered. Labour is aware of its history of “polyclinics” first proposed by Professor the Lord Darzi of Denham in his review of healthcare in London for NHS London “Healthcare for London: A Framework for Action”.
The Labour Government at the time argued that this was a way of providing more services in the community closer to home and at more convenient times (including antenatal and postnatal care, healthy living information, community mental health services, community care, and social care and specialist advice).
Ed Miliband seems to care about ‘privatisation of the NHS’, in that he cared to mention ‘ending’ it.
But this is again at odds with what Simon Stevens has been thinking about.
A “Free School” is a type of Academy, a State-funded school, which is free to attend, but which is not controlled by a Local Authority.
Like other types of academy, Free Schools are governed by non-profit charitable trusts that sign funding agreements with the Secretary of State.
Supporters of Free Schools, such as the Conservative Party, including that they will “create more local competition and drive-up standards” They also feel they will allow parents to have more choice in the type of education their child receives, much like parents who send their children to independent schools do.
But Ed Miliband also talking about ‘ending competition’ which is somewhat against the mood music Simon Stevens was singing in his appearance against the Commons Select Committee.
It’s innovative bringing something back into state control, but could make good ‘business sense’, akin to insourcing a service which had been previously outsourced.
The main arguments for state control and ownership of the NHS are that such a drive would encourage co-operation, collaboration, equity; services could be properly planned not fragmented; and services would not be run for shareholder dividends.
It’s undoubtedly true that there could be operational changes to be made, such that patients could plan their GP appointments without having to ring up as an emergency at 8.30am the same day.
NHS GPs overall say that they are working flat out, and, short of having greater resources, no political gimmick will help them. Instead of lame slogans such as “Hardworking Britain Better Off”, and making do with “35%”, Labour could do something really innovative – and return to a socialist approach.
‘Saving the NHS for the public good’, on the other hand, is not a vacuous gimmick. It’s what many people in Labour also believe, possibly. More importantly, it’s the title of a current party election brodcast by the Green Party. It might be the case that Ed Miliband is left wing than the Labour Party membership. This has been mooted here. If so, “bring it on!”
The Right needs to make up its mind: is society, or the individual, more important?
Socialism has never been clearer.
We not consider the State to be a ‘swear word’. We are proud of our values of solidarity, social justice, equality, equity, co-operation, reciprocity, and so it goes on.
The Right, meanwhile, needs to make up its mind: is “societal benefit” more important, or the individual?
The rhetoric under Margaret Thatcher and beyond, including Tony Blair, was individual choice and control could ‘empower’ individuals. This was more important than the paternalistic state making decisions on your behalf, and indeed Ed Miliband was keen to read from the same script at the Hugo Young lecture 2014 the other week.
Yet, the phrase “societal good” has been used by an increasingly desperate Right, wishing to justify money making opportunities in caredata, or cost saving measures such as NICE medication approvals or hospital reconfigurations, So where has this individual power gone?
Whilst fiercely disputed now, Thatcher’s idea that ‘there is no such thing as society’ potentially produces a sharp dividing line between the rights of the individual and the value of society.
“There is no such thing as society. There are individual men and women, and there are families. And no government can do anything except through people, and people must look after themselves first. It is our duty to look after ourselves and then to look after our neighbour.
was an individualist in the sense that individuals are ultimately accountable for their actions and must behave like it. But I always refused to accept that there was some kind of conflict between this kind of individualism and social responsibility. I was reinforced in this view by the writings of conservative thinkers in the United States on the growth of an `underclass’ and the development of a dependency culture. If irresponsible behaviour does not involve penalty of some kind, irresponsibility will for a large number of people become the norm. More important still, the attitudes may be passed on to their children, setting them off in the wrong direction.”
(M. Thatcher, Woman’s Own, October 31, 1987)
Whilst the Left has been demonised for promoting a lethargic large State, monolithic and unresponsive, there’s been a growing hostility to large monolithic private sector companies carrying out the State’s functions.
It is alleged that some of these companies are not doing a particularly good job, either.
It has recently been alleged that the French firm, ATOS, judged 158,300 benefit claimants were capable of holding down a job – only for the Department of Work and Pensions to reverse the decision. At the end of last year, private security giants G4S and Serco have been stripped of all responsibilities for electronically tagging criminals in the wake of allegations that the firms overcharged taxpayers
So why should the Right be so keen suddenly on arguments based on ‘societal benefit’?
It possibly is a cultural thing.
The idea that “large is inefficient” was never borne out by the doctrine of ‘economies of scale’, which is used to justify the streamlining of operational processes across jurisdictions for multinational companies.
This was a naked inconsistency with the excitement in corporate circles with “Big Data”, that big is best.
Many medical researchers are rightly excited at the prospect of all this data. Analysis of NHS patient records first revealed the dangers of thalidomide and helped track the impact of the smoking ban. This new era of socialised big NHS data could be very powerful indeed. Whilst there were clearly issues with informed consent at an individual level, the argument for pooling of data for public health reasons were always compelling.
The fact that this Government is simply not trusted when it comes to corporate capture has strongly undermined its case. Also, if the individual must put itself first, why should he allow his data to be given up? Critically, this knowledge doesn’t just have a social good, or multiple individual health ones. It has economic value too.
It might simply be that the Right is keen on this policy through now is precisely because such data will offer significant financial benefits, and that any to wellbeing are simply pleasant side-effects. The concern that this policy is actually about boosting the UK life sciences industry, not patient care. This is science policy – where science lies within the technical jurisdiction of the Department for Business, Innovation and Skills – not just health policy.
Is it not reasonable that an individual should have the right to opt out of having his caredata being absorbed?
“Societal good” has been used by the current Government in a different context too.
The National Institute for Health and Care Excellence (NICE) will consult next month on an update to its methodology for assessing drugs. It had been asked by the Department of Health to make judgments on the “wider societal benefit” of medicines before recommending them for NHS use. But a board meeting this week has decided it would be wrong to make an assessment that effectively would put a monetary value on the contribution to society of the people likely to be taking the drugs.
It is thought that any assessment of “wider societal benefit” would inevitably end up taking age into account, say papers from the meeting. “Wider societal benefit” could therefore be simply an excuse for excluding more costly older patients.
NICE’s chief executive, Sir Andrew Dillon, has said it is valid to take into account the benefit to society of a new drug, but great care had to be taken in the way it was done, so that an 85-year-old was not regarded as less important than a 25-year-old. One group of patients should never be compared with another.
But an older individual must put his access to medications first surely?
A legal challenge brought by the local authority and the Save Lewisham hospital campaign showed conclusively that the secretary of state did not have the power to include Lewisham in a solution to the problems of SLHT.
As Caroline Molloy explains:
“The hospital closure clause gives Trust Special Administrators greater powers including the power to make changes in neighbouring trusts without consultation. It was added to the Care Bill just as the government was being defeated by Lewisham Hospital campaigners, in an attempt to ensure that campaigners could not challenge such closure plans in the future. But the new Bill could be applied anywhere in the country.”
Clinical commissioning groups (CCGs), the groups of state representatives making local health plans about resource allocations, will still need to be consulted in this process, and the consultation has been extended to 40 days. However, disagreements between CCGs may now be overruled by NHS England. So, the most important local decision makers may have no say in key reconfigurations of their hospitals and care services.
An individual within a locality must surely have the right to put his own interests regarding social provision first?
I believe that part of the reason the Right has got into so much trouble with caredata, access to drugs and clause 118 is that it appears in fact to ride roughshod over people’s individual rights, and in all three cases is only considering the potential economic benefit to the budget as a whole. They are not interested in the power of the individual at all.
And the most useful explanation now is actually that with such overwhelming corporate capture engulfing all the main political parties, that there’s no such thing as “Left” and “Right” any more. It might have been once our duty to look after ourselves, but it is clear that conflicts have emerged between individual autonomy and the needs of the corporates.
The “Right” is not actually working for the needs of the individual at all, nor of society.
The most parsimonious reason is that the Right is not as such a Right at at all. It, under the subterfuge of being “centre-left” or “centre right”, is simply acting for the needs of the corporates, explaining clearly why so many are disenfranchised from politics. From this level of performance, the Right has not only failed to safeguard the interests of the Society, it has failed to uphold the rights of the individual. This is an utter disgrace, but entirely to be expected if the Government governs on behalf of the few.
Of course we knew that this would happen under the Conservatives and the Liberal Democrats, but Labour needs to return to democratic socialism urgently.
“All it takes for evil to succeed is for a few good men to do nothing…”
“All it takes for evil to succeed is for a few good men to do nothing…” is the famous saying by Edmund Burke.
Burke despised the abuse of power, so one can only wonder what he would have made of the enactment of the Health and Social Care Act (2012).
It’s often forgotten that the original name of the Liberal Democrats Party is the ‘Social and Liberal Democratic Party’. Nick Clegg worked for Tory Grandee, Leon Brittan, so is bound to have been the recipient of right-wing ideological stardust. David Laws, Nick Clegg and others like them don’t like to describe themselves as “social democrats”, they prefer to describe themselves as Liberals favouring ‘the smaller state’ in the tradition of J.S. Mill. David Laws has described previous Labour governments as having too many collective social democrat experiments, and possibly feels as much hostility towards Labour as is probably felt towards ‘the Orange Bookers’ by Labour members. The irony is, of course, that the “fixed term parliament” to run from May 7th 2010 – May 7th 2015, has only led to everyday being a phoney election (rather than bringing stability). This is in doubt continue for 2014.
The idea of Labour voluntarily wishing to go into a Coalition with the Liberal Democrats in May 2015 should frankly make you wish to throw up down the nearest toilet. Lord Andrew Adonis explains his version of events in the account in “5 days in May”, and from it emerges a clean narrative of how the Liberal Democrats only used their abortive negotiations with Labour to try to improve their bargaining hand with the Conservatives. The brilliant Matthew d’Ancona is consistent with his account too. Nick Clegg clearly wanted to ‘go right’, and not go left. Clegg had reached a judgment, despite policy overlap with Labour, that a Lib-Lab coalition was not going to work. To explain, in his book ‘In It together’ D’Ancona describes a tight social circle running the Tory side of the coalition – “old friends, their wives, ex-girlfriends, all joining each other for holidays and dinner parties and sharing childcare, now all ministers or Downing Street staffers.”
There were no negotiations between the Liberal Democrats and Labour on the ‘economic plan’. Vince Cable was not even on the LibDems’ negotiating team. Nick Clegg signed up to ‘faster and deeper’ cuts, and the full ‘Go large’ offer of welfare reforms. Clegg’s promise that he would negotiate first with the party which achieved the most seats had no constitutional precedent. This move was clearly to legitimitise an opening to the Conservatives, and to his own party.
The writing was always on the wall for the NHS too. Nick Clegg’s wife was formerly a partner in charge of competition law work for the large corporate firm DLA Piper. This global legal partnership has been heavily involved in European competition law is DLA Piper, who provide lobbying, public affairs and trade policy services, as well as advice on how to get access to public service delivery contracts. One partner of the firm who is part of the Liberal Democrat Peer who ended up being highly influential was Lord Tim Clement-Jones, in seeing new the competition regulations reach the statute books this year.
“Neoliberalism” is an updated version of the classical liberal economic thought that was dominant in the US and UK prior to the Great Depression of the 1930s. From roughly the mid 1930s to the mid 1970s a new “interventionist” approach replaced classical liberalism. It became the accepted belief that capitalism requires significant state regulation in order to be viable. And we are seeing Labour returning to the idea that unregulated markets do not act to the benefit of the consumer, in his attack on ‘energy prices’. The “cost of living crisis”, whilst not directly about the NHS, is entirely about the dialogue between the State and the markets, which has become so essential for the UK Labour Party to negotiate.
In the 1970s the Old Religion of classical liberalism made a rapid comeback, first in academic economics and then in the realm of public policy. Neoliberalism is both a body of economic theory and a policy stance. Neoliberal theory claims that a largely unregulated capitalist system (a “free market economy”) not only embodies the ideal of free individual choice but also achieves optimum economic performance with respect to efficiency, economic growth, technical progress, and distributional justice. This idea has lingered on in the neoliberal policies of all three major parties, in “personal health budgets” which should be more accurately described as “individualised” budgets. With the combination of health and social care budgets likely to form a thrust of Labour’s “whole person care” policy, the neoliberal concept of choice is potentially very much alive and well, but it will be for Burnham and colleagues to swing the pendulum back towards the inherent socialist (and left populist) notion of putting a ‘national care service’ on an equal footing with health. In this narrative, which Labour had thus far been reluctant to question before Burnham noticeably started making strong ‘anti-market noises’, the State is assigned a very limited economic role: defining property rights, enforcing contracts, and regulating the money supply. State intervention to correct market failures is viewed with suspicion, on the ground that such intervention is likely to create more problems than it solves. If Ed Miliband’s concept of the relationship between the State and markets is anything to go by, and this itself represents a marked departure from Tony Blair’s viewpoint, Andy Burnham is likely to be able to make inroads into this socialist agenda.
The definition of socialism is in fact well known to all members of the Labour Party, by virtue of their membership card. It is worth noting that recent policy decisions have been promoting neoliberalism, and the net effect has been that the Socialist Health Association has been asleep at the wheel. Competition is a massive shoo-horn into neoliberalism. Nearly exactly one year ago, I described how section 75 of the Health and Social Care Act (2012) would be exactly the sort of legislative mechanism which would impose competition like never before on the NHS. As Lynton Crosby himself says, “You should lock in the base, and then go for the swing?” In my view, the base is competition, the swing is the free movement of capital.
My article on the Socialist Health Association website is here, long before Polly Toynbee and David Nicholson were reporting as thinking that competition was a problem. Once capitalism had become well established in the US after the Civil War, it entered period of cutthroat competition and wild accumulation known as the Robber Baron era. In this period a coherent anti-interventionist liberal position emerged and became politically dominant. Despite the enormous inequalities, the severe business cycle, and the outrageous and often unlawful behavior of the Goulds and Rockefellers, the idea that government should not intervene in the economy held sway through the end of the 19th century.
What explains this political difference between large and small business? The mood music appears to be that Labour is intending to refine its pledge of ‘being the party of business’. Ed Miliband in his conference speech of 2013 made quite a big play of ‘standing up to bullies’ rather than ‘the weak’. It would therefore make no intuitive sense for Miliband to become very pro-corporations and ignoring SMEs. And this makes complete sense when you understand the relationship of the symbiotic relationship between the State and big corporations. When large corporations achieve significant market power and become freed from fear concerning their immediate survival, they tend to develop a long time horizon and pay attention to the requirements for assuring growing profits over time. They come to see the state as a potential ally. Having high and stable monopoly profits, they tend to view the cost of government programs as something they can afford, given their potential benefits. By contrast, the typical small business faces a daily battle for survival, which prevents attention to long-run considerations and which places a premium on avoiding the short-run costs of taxation and state regulation. This explains the radically different positions that big business and small business held regarding the proper state role in the economy for the first two-thirds of the twentieth century. It is no particular surprise that some of the G8 dementia summit agenda has had textbook ‘corporate capture’, in going down the road of personalised genomics medicine rather than care.
To some extent, this “horse has bolted”, and it is to his credit that Andy Burnham MP has vigorously said the marketisation of the NHS went far too far. For example, in his first ever Healthwatch Conference speech,
“I think we let the market in too far. The time has come to say that and to draw a line and make a break with it. If you let this market in too far, I believe, in the end, you will destroy the whole, what is so fantastic about the NHS, that ethos that Danny Boyle captured so memorably at the opening ceremony of the Olympic Games.”
Andy Burnham, as Shadow Secretary of State for Health, has pledged to repeal the Health and Social Care Act (2012), which will go some way to discredit the extremely poor arguments for competition which have emerged from prominent healthcare analysts in recent years. There is no doubt, for example, that the merger involving Royal Bournemouth and Christchurch hospitals NHS foundation trust and Poole Hospital NHS foundation trust was a particularly low point. All the people whom I have spoken to in private think that Andy Burnham MP and all members of the Shadow Health Team really firmly believe what they’re saying, in standing up for the NHS. This should in theory be low hanging fruit for Labour as Labour is consistently many % points ahead of the Conservatives on the NHS. It should also be in theory low hanging fruit for the Socialist Health Association.
Having failed so triumphantly in having warned about the threat posed by this pro-competition legislative instrument, the Socialist Health Association is at risk of being asleep at the wheel yet again over a second and equally crucial matter. Some analysts argue that globalisation has produced a world of such economic interdependence that individual nation-states no longer have the power to regulate capital. Free movement of capital is described as being “at the heart of the Single Market and is one of its ‘four freedoms'”. According to the European Commission,
“It enables integrated, open, competitive and efficient European financial markets and services – which bring many advantages to us all.”
Tony Benn has described graphically how he considers “free movement of capital” to be a threat to basic democracy in socialism. Benn argues that this particular free movement is simply “imperialism” under a new form: only the agents of imperialism are companies rather than countries. To this extent, the media excitement as to whether you should provide NHS treatment for migrants brings something to mind: “smoke and mirrors”.
And what about the EU-US Free Trade Treaty? This is the second big issue nobody wants to talk about, as it is the “swing” part of neoliberalising “our NHS”. The aim of the Agreement, according to the Commission, is to remove ‘unnecessary obstacles to trade and investment, including existing NTBs, through effective and efficient mechanisms, by reaching an ambitious level of regulatory compatibility for goods and services, including through mutual recognition, harmonisation and through enhanced cooperation between regulators’. (Art 24) It is mooted that the EU-US treaty would set in stone all liberalisation and privatisation measures already achieved at the time the treaty is signed and bring all future regulations within the restrictive provisions of the agreement. This treaty, if passed, would represent an enormous challenge to public-owned health services across Europe. There was very little awareness in Europe, even among those wanting to defend public services, to the implications of the EU-Canada agreement. Debbie Abrahams has become a lone voice virtually in discussing this in parliament. It would now be very desirable that campaigns in Britain pay serious attention to the US-EU negotiations and link up with campaigns in other EU states, and the Socialist Health Association as a national entity affiliated to the Labour Party should have a clear view on this. It would be even more helpful for its members if this settled view were consistent with a definition of socialism ‘as we know it’.
Whatever one’s precise definitions of privatisation and nationalisation, in the context of the NHS, it is clear that the public have some views about national identity and state ownership of assets. This is borne out by the electoral successes which are widely predicted for UKIP int the European Elections next year. So far, we’ve had the debate, but with no thanks to the BBC, of how the NHS is being outsourced and privatised without anyone’s knowledge. It is essential that the Socialist Health Association is fit for purpose in influencing Labour policy in 2014, in having a view on whether it wants to see primary care as well as services in NHS hospitals being run by private domestic and multi-national companies for maximisation shareholder dividend. This of course would be a tragedy in a year in the run-up to the General Election on May 7th 2015, though this is as much about a battle for the soul of the Labour Party as it is about winning an election.
In 1945 Herbert Morrison was given responsibility for drafting the Labour Party manifesto that included the blueprints for the nationalisation and welfare programmes:
“The Labour Party is a socialist party and proud of it. Its ultimate purpose at home is the establishment of the Socialist Commonwealth of Great Britain – free, democratic, efficient, progressive, public-spirited, its material resources organized in the service of the British people.”
But also – all it takes for evil to succeed is for a few good men to do nothing.
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.
“The twittering machine” – Michael White, the NHS and Paul Klee
Just before I got in a black cab to go to my slot for a viewing of Paul Klee’s amazing paintings at the Tate Modern, I was finishing a Twitter conversation which included Michael White (@MichaelWhite) from the Guardian.
I posted an article on ‘mega dairies‘ on my Facebook. Various approaches to reconfigurations of the NHS had been on my mind. The rôle of the district general hospital had come under scrutiny. Some people think that it might be better to produce “super hospitals”, but my experience from my friends is that they would rather go to a local hospital if they had an acute medical emergency such as acute severe asthma.
This analogy with milk production has no limits for me. I am particularly sick of the ‘we cannot afford the NHS’ argument, although I am very familiar with the ‘funding gap’ arguments from the usual suspects. I think of the ‘more from less’ argument in my analogy as making existing cows produce milk harder. As for the supply of milk? I can buy a carton of milk either from my local corner shop, or I can drive to a huge out-of-town supermarket a few miles away. It’s the same carton of milk.
The moronic economic arguments keep on coming, totally blasting out-of-the-water what the patient or person actually wants. The mantra of ‘no decision about me without me’ has become totally ludicrous when you think that the Lewisham campaign had to take the Secretary of State for Health to court, not only in the High Court but also in the Court of Appeal. If Jeremy Hunt feels the need to appeal the decision at the Court of Appeal in the Supreme Court, I’ll be tempted to emigrate.
I won’t reproduce the entire conversation – but here’s some of it.
You can trace it back to Twitter here.
(Click here to see the thread better.)
And I had an added ‘bonus’ when I turned up at the Tate Modern finally. It dawned on me that, despite the change towards National Socialism that Germany was undergoing for much of Klee’s life, Klee to me looked and sounded like a socialist. I feel socialism is like pornography: you recognise it when you see it. Klee had a close friend called Franz Lotmar, and it turned out that Lotmar introduced Klee to socialism. I was first introduced to socialism by Martin Rathfelder, in contrast. And apparently Oscar Wilde’s “The soul of man under socialism” impressed Klee so much that he gave a detailed summary (and added his thoughts) to another friend called Lily.
The first painting I came to was “The Twittering Machine” (Die Zwitscher-Maschine) – a 1922 watercolour and pen and ink oil transfer on paper. Like other artworks by Klee, it blends biology and machinery, depicting a loosely sketched group of birds on a wire or branch connected to a hand-crank.
The Twittering Machine
Ironically both ‘biology’ (the ageing population) and ‘machinery’ (technology) are being blamed for the demands on the NHS budget in the future, which lead some people to conclude erroneously that the NHS is not sustainable (assuming that you refuse to contemplate methods of funding the NHS properly.) Ed Balls this morning again revisited the narrative of ‘public good, private bad’, advancing as ever Labour’s commitment to “PPPs”, viz public-private partnerships. This of course has been a totemic strand in the NHS policy from both the Conservatives and Labour, examples being the independent sector treatment centres, private finance initiative, and, of course most recently, the Health and Social Care Act (2012). It’s so easy to go with the flow of the associations of the words ‘private’ and ‘public’ that one can loose sight altogether of the actual meanings of the word ‘private’ and ‘public’. For example, thinking about what ‘private’ means, it should be no surprise that private limited companies wish to hide behind the corporate veil in refusing freedom-of-information requests?
In 1941 (the year after Klee died), the celebrated art critic Walter Greenberg called attention to the “privateness” of Klee’s work. It had some reminiscences of a scathing review published in the 1920s in the Dusseldorf Review which likened Klee’s “private work” to “pig Latin” which was ‘unfit for public consumption’. Indeed, walking around the twenty or so rooms of the Klee exhibition, you can really notice the change of style from a ‘completely personal’ style of illustration, more fitting perhaps for the decoration of picture books, to a more public style of display, more fitting perhaps for decoration of whole walls.
One of Klee’s more famous sayings is, “One is always in good company when one has no more money.” Possibly Klee was predicting the political pain of Liam Byrne’s oft-quoted ‘there’s no money left’ note with Labour losing the 2010 general election? However, a narrative in Klee’s art appears to parallel his imputed journey in political philosophy, for example in his attitudes towards ‘collectivism’.
Living with austerity is something which the NHS is trying to do, but it is still very striking how the shift in English health policy is taking place towards value-based outcomes rather than activity per se, mirroring a change in emphasis in US corporate management. Life after the global financial crash in 2o08, not unilaterally caused by Gordon Brown, has also seen a change in emphasis from output as measured by GDP to wellbeing. The concept of a ‘happy peasant’, a peasant who is extremely poor but more contented than an investment banker with a high income, has emerged in recent years in the wellbeing research. Klee’s exhibition at the Museum of Modern Art in New York had as its canvas the Wall Street Crash of October 1929. In the spring of 1930 Klee commented, “What do I prefer? international renown, without a penny; or the well-being of a wealthy local painter?’
Klee once remarked that, instead of taking part in the discussions between competing schools of the Bauhaus, he would sit back and watch both sets of academics fight it out between them. It is tempting for English health policy commentators to sit back and watch the political philosophies of socialism and neoliberalism fight it out for the soul of the NHS.
Unfortunately, this is a fight which there doesn’t seem resolution for in the near future. Even with Andy Burnham’s promise of the ‘NHS preferred provider’, there’s still a market, and there’s still a need for regulation. Possibly Burnham can get rid of the competitive elements with a final thrust towards ‘whole person care’. However, ‘whole person care’ may be a polite way of saying the ‘integrated share model’, and, with prime contractor models lasting at least ten years, Burnham and Miliband’s Labour might find this all remarkably difficult to unwind.
Paul Klee escaped to Switzerland from National Socialism.
Where Labour flees to from section 75 and associated regulations is anyone’s guess. Nonetheless, Burnham and Labour have been emphatic about repealing the Health and Social Care Act (2012).
It’s the necessary start, nonetheless.
“The EY Exhibition: Paul Klee – making visible” runs at the Tate Modern, near Blackfriars, London SE1 between 16 October 2013 and 9 March 2014. For further details, please go here.
Ed Miliband should best avoid the Harold Wilson ‘razzle dazzle’?
This is when Harold Wilson lost the UK general election on June 18th, 1970.
David Dimbleby was doing an ‘inquest’, in Wilson’s own words, as to what happened.
Wilson attributes, partly, his election defeat to so many people ‘staying at home’, because there was a cigarette paper difference in policies between the Conservatives and Labour. The ‘millions of votes’ problem still persists to this day, arguably. For example, Labour and the Conservatives do not substantially differ on the McKinsey ‘efficiency savings’, free schools and ‘high speed 2′. Labour has not said it would reverse the closure of English law centres. Of course, Labour supporters and members will wish to point out that there are clear differences in areas of social justice, for example repealing the bedroom tax. At the time, the economy appeared to be recovering. Currently, the UK economy appears to be recovering, although not many people would like to hazard the epithet ‘green shoots’ for it.
Where Ed Miliband has a relative luxury compared to Harold Wilson is that his party is relatively united. Despite the issues about Labour wishing to reform its relationship with the Unions, it cannot be claimed that members of the Unions are at each other’s throats as in the old days. The Conservatives will be arguing, no doubt, that Labour should not be the beneficiaries of the ‘new-found’ ‘economy strength’ on May 7th 2015. The economy which Labour inherits in 2015 will have the same fault lines, however. There will still be competition problems in the privatised industries such as energy and water. Workers will have even weakened employment rights in areas such as unfair dismissal. Right-wing commentators still advocate that the Conservatives are ahead on the economy, but all the polling evidence suggests that Labour is ahead on issues to do with the economy, such as employment rights and utility bills.
In 1970, the Conservatives highlighted a different ‘cost of living’ crisis. However, the reasons for that particular crisis were rather different then:
The cost of living has rocketed during the last six years. Prices are now rising more than twice as fast as they did during the Conservative years. And prices have been zooming upwards at the very same time as the Government have been taking an ever-increasing slice of people’s earnings in taxation. Soaring prices and increasing taxes are an evil and disastrous combination.
Inflation is not only damaging to the economy; it is a major cause of social injustice, always hitting hardest at the weakest and poorest members of the community.
The main causes of rising prices are Labour’s damaging policies of high taxation and devaluation. Labour’s compulsory wage control was a failure and we will not repeat it.
The Labour Government’s own figures show that, last year, taxation and price increases more than cancelled any increase in incomes. So wages started chasing prices up in a desperate and understandable attempt to improve living standards.
Other countries achieve a low-cost high-wage economy. So can we. Our policies of strengthening competition will help to keep down prices in the shops. Our policies for cutting taxes, for better industrial relations, for greater retraining, for improved efficiency in Government and industry – all these will help to stimulate output. This faster growth will mean that we can combine higher wages with steadier prices to bring a real increase in living standards.
The issue of whether our economy is a ‘low wage’ one has now become a powerful issue given the ‘record number of people in employment’ claim. The number of people who are paid less than a “living wage” has leapt by more than 400,000 in a year to over 5.2 million, and this single finding contributes to the idea that the economic recovery is failing to help millions of working families. A report for the international tax and auditing firm KPMG also shows that nearly three-quarters of 18-to-21-year-olds now earn below this level – a voluntary rate of pay regarded as the minimum to meet the cost of living in the UK. The KPMG findings highlight difficulties for ministers as they try to beat back Labour’s claims of a “cost of living crisis”. The London mayor, Boris Johnson, has announced a new, higher rate for the living wage in the capital, while in a speech tomorrow, Ed Miliband, will flesh out how his party will create economic incentives for companies to adopt the living wage. There is therefore a curious political consensus emerging between Ed Miliband and Boris Johnson, in a way that will midly concern David Cameron at least.
A famous headline from “The Bulletin” of December 23rd 1964 states that, “Prime Minister Harold Wilson has confounded critics in Britain with razzle-dazzle tactics.”
The opening paragraph states that Harold Wilson greatly admired the election-winning tactics of the late President Kennedy. In November, it will be 50 years since John F. Kennedy’s assassination, and David Miliband has written a nice article in the Times to explain what JFK means to him. Whilst there has been some problem with this project accelerating from standstill, Labour seems on-track again to support the Conservatives over ‘high speed 2′. But, even not that long ago in August 2013, it was reported that the Institute of Directors had become the first large business group to call for the planned high-speed rail link between London and the north to be scrapped, saying the £50bn project would be a “grand folly”.
Whilst the circumstances surrounding the Harold Wilson governments are different today, one noteworthy criticism of the Wilson approach is that he seemed to promise simple solutions for complex problems. Ed Miliband is equally at danger of this, in claiming that he will be able to solve the energy prices problem with a price freeze. His team are at great pains to point out that the price freeze is only part of the strategy. The rest of it involves reforming the market and the regulatory framework overseeing the market. One of Ed Miliband’s favourite catchphrases, in as much that he has them, is that he wishes to be the person who ‘underpromises and overdelivers, not overpromises and underdelivers’. This is of course prone to accidental mix-up like his other catchphrase, “We promise to freeze prices not pensioners” (which has already been misquoted by Chris Leslie MP as, “We promise to freeze pensioners not prices”, on BBC’s “Any Questions” recently.)
In the criticism to end all criticisms, it’s been mooted that Harold Wilson was not in fact a socialist at all, but a Liberal. This may seem pretty small fry compared to the idea that Nick Clegg is in fact a Tory. But Ed Miliband may not be a socialist either. I still feel he is essentially a social democrat. Anyway, whatever label you decide to give Ed Miliband is not particularly relevant in a sense. Miliband’s first concern must be to win his election for his party and his own political career. Supporters of Wilson and Blair are keen to point out that they won four and three general elections, respectively. However, it is also true that many feel that their Labour governments were essentially trying to ‘do things better’ rather radically changing things. The criticism has been made of both periods of government that Labour let down the working class vote. The cardinal criticism is that their periods of government were essentially missed opportunities, even if Blair was more of a ‘conviction politician’ than Wilson.
Time will tell whether Ed Miliband will emulate the “successes” of Wilson or Blair; or whether he can go better.
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.
A call for a new SHA committee to look at how socialism is implemented across all SHA policy threads
Val Hudson has recently written a brilliant article called “Wither the Socialist Health Association”, which was recently knocked off the front page by a sudden flurry of other blogposts, curiously by the Director, Chair and Vice-Chair of the SHA. However, Val’s post is as relevant today, as it was a few days ago when it was first published.
Recent discussions here and beyond have confirmed an unofficial sentiment amongst some members of the Socialist Health Association that the Association does not appear to be advocating socialist principles for the NHS, currently. This would not be a problem of course if the Association were merely a group hoping to provide useful and relevant input to the Labour Party on health, but it has the word “Socialist” in its title and claims to espouse socialist values:
for example on the homepage
A longstanding member of the SHA even opined recently:
“there is precious little socialism in the day to day workings of SHA. This needs to change.”
In talking about Mid Staffs, Richard Bourne, Chair of the SHA, recently remarked that, “The situation … must be seen as an opportunity, not a response to “failure”. ” But the problem, arguably, comes from a comment made by Martin Rathfelder, Director of the SHA: “If socialism only means nationalisation then we are sunk.” A sensible response therefore is for there to be an accountable Committee within SHA, with card-carrying Socialists participating, which can oversee on behalf of the senior members of the SHA that the implementation of all policy strands is consistent with a reasonable interpretation of ‘socialism’ in relation to the NHS. Any exceptions deviation from this standard could be discussed as exceptions or issues in a coherent, mature and balanced way, within an acceptable band of tolerances. This would also help to restore the trust, reputation and confidence in the leadership of the SHA that the conduct of the SHA is taking place in a way which reflects the views of its socialist members.
There is no escaping from Martin Rathfelder’s view, it will be argued by some, that entire state ownership of the NHS is impossible, given how many contracts of the services ‘in the name of’ the NHS are being awarded to entities in the private sector, including social enterprises in the private sector. However, there has been concern by Colin Leys and others that the ultimate outcome of progression of activities into the private sector is that the NHS is left with the difficult, ‘unprofitable’ cases, with the private sector having ‘cherrypicked’ the more lucrative business (see for example Colin Leys’ article from merely 3 days ago.) The existence of a hybrid ‘mixed economy’ may be consistent with a ‘third way’ definition popularised under Tony Blair and Prof Tony Giddens (as described in Wikipedia today):
Major Third Way social democratic proponent Tony Blair claimed that the socialism he advocated was different than traditional conception of socialism, and referred to it as “social-ism” that involves politics that recognized individuals as socially interdependent, and advocated social justice, social cohesion, equal worth of each citizen, and equal opportunity.[4]
However, this is not a definition of true Socialism, and this ‘mixed economy’ poses substantial problems not only from a professional perspective but also from a macroeconomic one. Prior to the parliamentary debates about the Health and Social Care Bill, Sunder Katwala reported on ‘Next Left’: “”We are all socialists in a funny way when it comes to the NHS”, Tory MP David Ruffley told Newsnight, explaining why Tory MPs are so nervous about Andrew Lansley’s proposed health reforms.” However, the concern with the ‘mixed economy’ is that you end up ‘privatising profits, and socialising losses‘ a saying attributed to Andrew Jackson as long ago as 1834.
Members of this Society have indeed warned relentlessly about the dangers of embracing privatisation in any form, regardless of any abandonment of socialism. Michael Moore could not put any more graphically than this why the US healthcare system is a disaster:
“The case for a free, high-quality national health service in the USA is absolutely clear. The United States spends twice as much on healthcare compared to any other advanced industrialised country yet 47 million Americans are without health insurance. For those fortunate enough to have coverage, they are slowly being crushed beneath exorbitant monthly premiums. For all this Americans have a lower life expectancy and higher infant mortality rates than any other advanced industrialised country.
The US healthcare system is a monumental testament to the lies of pro-capitalist ideologues who preach that private industry is more efficient than publicly-run programmes.”
So, Richard Bourne is right. Treat this as an opportunity for those of us in the Socialist Health Association who wish to discuss how socialism can be implemented across all SHA policy strands. One assumes that most managers in the NHS have some sort of basic training in organisational culture (one hopes, but one cannot be certain): in management speak, this involves ‘breakdown the explicit and implicit barriers’, i.e. making the ethos and language of socialism one which should be pervasive in all the Society does. If it cannot do this, the Socialist Health Association in my mind has certainly failed, and cannot be relied upon by the UK Labour Party to provide reliable advice while called ‘the Socialist Health Association’.
Finally, I remember, shortly after chatting with Shamik Das (@shamikdas) outside ‘Starbucks’ during Manchester for the Labour Party Conference in 2010, I was greeting by a very pleasant lady in her 80s, who handed me this badge:
She was an activist in Labour, and I do not wish there to be a ideological schism between the “Socialist” Health Association and the contemporary views of actual members of Labour (and of the leadership of the UK Labour Party itself, for all I know). There is a lot of grassroots support for the NHS, as this nurse who attended the rally today showed (ht: @marcuschown).
