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Why doesn’t Noel Edmonds buy the NHS?
In theory, it’s perfectly possible for one person to buy the entire NHS if rich enough.
I suppose HM The Queen could buy the NHS in theory.
Noel Edmonds suddenly popped up in a most unusual interview with Jeremy Paxman last night. He was talking about his ideas to buy the BBC.
In a way, the BBC, despite its fiascos such as the Jimmy Savile Scandal, is a ‘national treasure’. Likewise, the National Health Service is considered to be outstanding, by some, despite noteworthy scandals such as what was happening at Mid Staffs a few years ago.
Edmonds’ language that the BBC is ‘sleepwalking to destruction‘ is reminiscent of Isabel Oakeshott’s complaints about the NHS being ‘unsustainable’ last week.
In a tirade against the NHS, Oakeshott launched an eyewatering gobbledegook compilation of corporate memes on last week’s Question Time, which was as intellectually coherent as a typical response on the Jeremy Kyle show.
Edmonds refuses point blank to say who his ‘like-minded’ allies might be, reminiscent of the corporate veil so readily utilised by private companies utilised in areas of public interest.
The refusal of Jeremy Hunt in legislating for parity in transparency requirements through freedom of information legislation, in comparison to the alacrity with which the Coalition government has legislated on parity of providers in a health ‘market’, has gone from the ridiculous to the sublime.
It also threatens patient safety.
Curiously, as one of Edmonds’ justifications for taking over the BBC, Edmonds cited it would protect some channels from being shelved, and it could likewise get rid of BBC dead-wood.
Nobody in the private sector has ever justified taking over services in the NHS on the grounds that they would be cut in the NHS. That’s because the private sector are interested, whether they concede to it or not, in cherry picking – high volume low cost products and services.
In this conceptualisation, ‘Mr Blobby’ is the TV equivalent of a hernia operation.
One can only wonder how comprehensive Edmonds’ TV output would be: whether it might be more profitable to make lots of Top Gears than ‘Book of the Week’.
And it’s likely that Edmonds’ team will lead on strategic exports, to help with profits. The NHS has yet to identify what its principal export is likely to be.
But Douglas Alexander MP, on the same Question Time, is right.
For whatever reason, successive Conservative governments have emphasised how unaffordable the NHS is. As somebody in the Question Time studio audience rightly pointed out, is it the case that the NHS is unaffordable or unfunded properly?
The NHS is funded out of general taxation currently, and to all intents and purposes many argue that the TV licence is a form of indirect taxation. But they are clearly different funding strategies.
Edmonds admitted, “Oh God No! I hope the BBC’s Charter isn’t renewed.”
Likewise, many have asked for the sacred cow for the NHS to be sacrified.
But – “The NHS will last as long as there are folk left with the faith to fight for it”
The car crash interview of a Trustee of the King’s Fund about potential payments for the NHS
The political parties have two strands of consensus which at first blush may seem somewhat irreconcilable: a NHS which is universal, and free-at-the-point-of-need, and £15-20 ‘efficiency savings’ within the next few years.
Taxes could rise to increase the size of the public expenditure pot. thereby generating additional funds to flow into public funding for healthcare. There does not seem to be any political appetite for this approach at the moment. While technically possible (tax levels are far higher in Nordic countries than in the UK), this is unlikely to provide an answer in the short term.
The NHS is heading for a “breakdown” if people expect it carry on providing all services for free under increasing demand, the former head of Marie Curie Cancer Care has warned.
Sir Thomas Hughes-Hallett urged us to ‘take more responsibility’, encouraging us to think about what we ‘really need for free'; he gave his view of how to keep the NHS on the road, saying it should – like a a garage – charge “for extras”.
He said people “need a sat-nav” to point them what is “most convenient”, towards chemists or community support centres and “steer them away from the NHS when they don’t need it”.
He further added that people should treat their bodies like a car, with a regular MOT, and that “we need to take more responsibility for our own health”.
Hughes-Hallett, a trustee of the King’s Fund, and Executive Chair of the Institute of Global Health Innovation at Imperial College, London, predicted: “We need to make tough choices for now about what we really need for free”.
Unfortunately, Sir Thomas was a guest on Wednesday’s Daily Politics today, and his defence of his own argument was worse than pitiful as you can see here (at 1 hr 29 minutes).
car crash
Andrew Neil started the discussion by enquiring off Hughes-Hallett where he “would draw the line”, mooting gastric banding, acupuncture, and varicose veins.
For fertility treatment, he said: “there is no yes or no answer.”
Neil then replied that some difficult questions would have to be answered.
Alan Duncan MP said: “It’s free-at-the-point of need and that’s not going to change…. but for the mainstream medical needs, that’s not going to change.”
Vernon Coaker MP said: “This is the thin-end-of-the-wedge. The whole point of the NHS is that’s free-at-the-point-of-use, and if you start charging, you’re going to end up with a two tier service, and the poor will be disadvantaged.”
Hughes-Hallett claimed: “Many people are willing to pay.”
The NHS could start to draw in funds from other sources, such as co-payments and supplementary insurance. Again, these could potentially start to challenge existing views on equity, because they inevitably introduce an element of some kind of payment to access services. Exemptions and subsidies can mitigate this to some extent, but the more they are used, the more they offset the expenditure benefits of alternative sources of funding in the first place.
In a recent view, the departing CEO of NHS England said that the introduction of co-payments, imminently, was “unlikely”.
A question still remains over how to deal with services that fall outside the defined core package. If they are significant in the eyes of patients, markets will develop to cover those services, funded either through fee for service or insurance-based mechanisms.
On the one hand, the development of such a market might be regarded as undermining equity (some in society will be able to pay to access health services that are not freely available to all). Others will interpret it as a natural market response that is neither desirable nor sensible to prevent — what matters is ensuring that the core package of services that is available to all is adequate.
It cannot be denied, however, that a growing number of people feel that the marketisation of the NHS has gone far too far.
In fact, many want the market abolished altogether now.
Smell the Starbucks coffee: a toxic mix of marketing, politics and tax
In a page on the Starbucks website, Kris Engskov, Managing Director of Starbucks UK, Starbucks offered a full explanation. Engskov provided that, “I want to personally assure you that Starbucks pays and will continue to pay our share of taxes in the UK to the letter of the law. We always have and always will.” Meanwhile executives told analysts that the UK business was “successful”, “profitable” and they were “very pleased with the performance”. The company has made UK sales of £1.2bn in the past three years but declared no profit despite having described the British business as “profitable” to investors and analysts.
PayUpandGetOut, on the same webpage, offered a problem with this argument, “Yes, we know you’re paying “to the letter of the law”, but you are using the law to allow you to pay less tax than really you are expected to. It’s such a shame that you have worked so hard to improve your ethical credentials, and while this does not detract from your apprenticeships, links with local businesses and creation of more jobs, nor your support for farmers, it certainly makes me question your ethics, and thus will make me question buying from you in the future.” Some critics believe that corporate social activities are undertaken by companies such as British American Tobacco, BP, and McDonalds to distract the public from ethical questions posed by their core operations. They argue that some corporations start CSR programs for the commercial benefit they enjoy through raising their reputation with the public or with government. They suggest that corporations which exist solely to maximise profits are unable to advance the interests of society as a whole. Kappa99 offered another widely-held view that it is perfectly possible for somebody to act legally but totally immorally. Kappa99 writes, “Its legal to have sex with a horse in many US States. Its legal in the UK to kill a Scot in Nottingham with a crossbow.” There are numerous absurdities in how English law has evolved, to some extent through a process of ‘trial and error’.
Kris Engskov, UK managing director of Starbucks, has further added that the company had in the past three years “paid over £160 million in various taxes including National Insurance contribution for our 8,500 UK employees, and business rates”. Starbucks is not alone by any means. Last week it emerged that Facebook UK generated revenues of just £20.4m last year and paid just £238,000 in tax to the Revenue. Experts said the social networking giant was not breaking any rules but paid less tax because its European headquarters is not in the UK but in Ireland. Stephen Moss adds in the Guardian: “My mobile network is Vodafone, which UK Uncut alleges obtained a very favourable tax settlement that left £6bn in back taxes unpaid. The headache all these numbers are giving me will be salved by pills from Boots, another target for UK Uncut after moving its headquarters to Switzerland in 2008. In 2009-10, Boots paid just £14m on profits of £475m, equivalent to 3%.” Prominent tax campaigner Richard Murphy, from Tax Research UK, later in this article argues that, “Where there are alternatives we should look for them,” he says, “but we should also be clear that these actions are symbolic. The real purpose is getting political change.” Murphy says the objective should be to make corporate taxation more transparent and establish a ranking of companies – a sort of good corporate taxpayers’ guide. Margaret Hodge, chairman of the Public Accounts Committee, said HMRC should look at the company’s tax affairs after this Reuters report. MPs may also want to grill Starbucks’ management over the revelations. The PAC is responsible for scrutinising the stewardship of public funds, including tax collection.
However, Starbucks as a multi-national company does appear to take its environmental agenda seriously. Earlier this year, Starbucks announced the availability of EarthSleeve™, a new hot-cup sleeve that integrates proprietary technology that enables a reduction in overall material usage while at the same time increasing the post-consumer content. These adjustments correlate to a savings of nearly 100,000 trees. With nearly three billion* hot cup sleeves produced in the United States in 2011 and Starbucks representing nearly half of the marketplace, this material evolution will have a substantial impact on the packaging industry. In marketing management, there has been increasing interest in “greenwashing”. Starbucks, unlike other firms, does not appear to have been engaging in greenwashing activity, on the basis that it takes its environmental agenda seriously. Magali A. Delmas, a professor of management at the UCLA Institute of the Environment and Sustainability and the Anderson School of Management, in California Management Review (2011) has defined “greenwashing” as “a fixed and focus on firm communication about environmental performance … given the shorter time frame required for a firm to alter communications about its environmental performance than for a firm to change it, our analytical focus on the drivers that lead (some) firms to communicate positively about environmental performance while holding firm performance constant is not only useful for analytical tractability, but is also true to shorter-term strategic decisions of managers in these firms.”
There is no doubt that the social media is a major new influence in allowing consumers to give ‘instant feedback’ to suppliers. Indeed, as consumers, the public, and investors become more interested in environmental issues, environmental activist groups become more powerful and can exert more influence and pressure on companies. In the same way, now members of the public are able to give feedback about how they perceive far taxation might work. There is also no doubt in the past that corporates have been using their green credentials to secure “competitive advantage” in the marketplace, and there has been much interest latterly in how ethical banks could attract customers through a “competitive advantage” of acting ethically. George Osborne has a think-tank of a few lawyers thinking about how make the corporate tax system fairer. Taxation has clearly become an issue, with David Cameron restating in one breath that, “Fairness includes asking those on higher incomes to shoulder more of the burden than those on lower incomes. I’m not saying this is going to be easy, as we’ve seen with child benefit this week. But it’s fair that those with broader shoulders should bear a greater load”, while not pursuing aggressive tax policies in top earners.”
Meanwhile, Natalie Bennett, Green Party leader, in responding to David Cameron’s speech, provided that: “Further cutting the real rate of benefits, when they are already insufficient for a basic decent life is unconscionable. As the Joseph Rowntree Foundation calculated, the minimum weekly income needed in Britain is £193 for a single person, but out of work benefits deliver just £85.” A political party which is able to grasp the nettle of this complex toxic mix of marketing, politics and tax may reap dividends at the ballot box perhaps.
