I have agreed to put my head on the block and write about what I think the Socialist Health Association is for and should be doing. This follows some debate and discussion and ‘argument’ on twitter and in the Health Service Journal about the principles of the Association and what we should be promoting.

I joined the SHA because I believed it was a socialist organisation that would promote socialist principles for the NHS. Indeed article 2e of the constitution confirms this; ‘To disseminate the principles of socialism’ there has been some discussion this week on the meaning of ‘socialism’ but the Oxford English dictionary definition says socialism…. ‘Advocates that the means of production distribution and exchange should be owned and regulated by the community as a whole …’ This seem to me to fit objective 2a of the SHA constitution ‘To work for a fully free and comprehensive national health service’

Most of the discussion this week & previously has been around three major issues. Firstly the role of the private sector in the NHS, secondly the role of the Socialist Health Association, and thirdly the role of officers and board members in promoting the private sector. I will give my view on these in relation to the constitution above

The role of the private sector in the NHS

I am grateful to Clare Gerada current chair of the RCGP for summing up what many of us probably feel about this. In Monday’s Daily Politics Show on the BBC she said ‘any money going out of the NHS to a ‘for profit’ organisation is privatisation.’ That does not fit any definition of socialism I can find, especially the one above. We may split hairs and say parts of the NHS are already privatised, but the point is still one of principle and those elements that have been privatised ( like GPs) even since 1948 have still given us a free comprehensive service. But we only have to look at what has happened in dentistry and ophthalmology to see what eventually happens with privatisation, charges are implemented. All the evidence shows that is the trajectory of privatisation. As a socialist association we should be fighting to prevent this. A further argument is that Andy Burnham has said that the NHS would be the preferred provider, and this means in some instances the NHS would not be preferred. I sat in a room twice in one day with AB last week where he said categorically under a Labour government the NHS would always be used first and foremost. The private sector would only be used in addition to the NHS where demand could not be met and waiting lists were rising

The role of the Socialist Health Association

This to me is quite simple. If we are an association that ‘promotes socialist principles’ for a ‘fully free and comprehensive health service’ then that is what we should be doing. We should not be an organisation that opens up to debating privatisation with neo-liberals or others. We should not be entertaining ‘evidence’ that says people do not mind who provides their health service. That is not our role. There are plenty of other organisations that will do that, and indeed members have shown evidence to the contrary. Our role is to ‘promote the principles of socialism’. Our constitution says that.

The role of paid officials and board members

I am still a little unsure about how the Socialist Health Association works in relation to its paid up members. So for instance how was the new chair ‘elected’? I don’t remember being told there was going to be an election. Even if there was only one nomination, I don’t recall having been involved in any of that process. That is what normally happens in a democratic organisation. That point aside, however it would seem to me that the role of anyone in the SHA is to promote the principles of the constitution. I’ve made reference to some of these above, but in none of them can I see anything that suggests we should be supporting privatisation.

These are my views. I would welcome those of other members

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  1. Alex Scott-Samuel says:

    I’m in full agreement with Val Hudson. It has been painful being an SHA member since the turn of the century when Frank Dobson and Tessa Jowell were replaced as SoS and public health minister respectively. Blairism was a populist, anti-socialist aberration but it lives on in SHA and in recent times the new Chair and the Director have shown how strongly they identify with these reactionary ‘christian democrat’ principles. While we are fortunate to retain a true socialist as President, other socialists have been victimised or voted with their feet and there is precious little socialism in the day to day workings of SHA. This needs to change.

  2. Shibley says:

    I was once told that, to explain something to somebody, you have to understand it well yourself.

    Whilst I appreciate that there’s no point preaching to the converted, we should not so concerned about what others think of us in the SHA (i.e. how receptive we are to libertarian or neoliberal ideology).

    I should prefer us to concentrate on us explaining why a socialist system can offer comprehensive, universal care. I can count on one hand the number of times the SHA has been invited to write for right-wing publications. If you feel that this ideal is not attainable, surely the name ‘Socialist Health Association’ is a misnomer?

    Others tell me that the Labour Party has a very clear direction over what it wants to do on the NHS. Although I like the people involved, I do not share this confidence at the present time, unfortunately.

    best wishes.

  3. Val Hudson says:

    I agree with both of the above comments. I am a Labour Party member and activist but I am first and foremost a socialist and I believe it is my job to promote those principles in the Labour Party and elsewhere. I like Shibs would like to see the Labour Party going further to the left on many issues, for instance I’ve promoted a different response to that of the Party on Dilnot in another arena. I believed that the SHA would give me the forum to to expand on & get legitimacy for socialist ideas in health. Sadly not

  4. Martin Rathfelder says:

    A factual response first: Nominations for Chair and officers, and members of Central Council were sent to all members by email and in Socialism and Health in Jan 2013 http://issuu.com/martinrathfelder/docs/s_h_1301 None of the positions were contested, so there was no ballot.

  5. Martin Rathfelder says:

    What we mean by socialist principles is here:

    If socialism only means nationalisation then we are sunk. The influence we exercise on the world, such as it is, is through the Labour Party. Its pretty clear they are not about to initiate a new round of nationalisation. There will continue to be a mixed economy in the health service, as there has been since 1948.

    Privatisation and charging for treatment are two different things. Dentists, pharmacists and opticians have always been private businesses, as are GPs. When they make charges that is because the NHS requires them to. When the NHS tells them to provide services for free that is what they do. They haven’t been privatised.

    Nobody in the SHA is advocating more privately provided services, but we think there should be discussion about what is provided directly by NHS organisations and what is provided by contractors. If Andy Burnham says the NHS would be used first and foremost, then when would it not be used? This is particularly important if we are thinking about social care, where there is hardly any direct provision, and in mental health, where about 30% of the services are contracted in. Are we to plan to nationalise, or municipalise, the existing providers? Or are there other solutions?

    We are not a doctrinaire organisation. We want to promote wide debate, and that includes talking to people we might not agree with. And if you, or anyone else, has something interesting to say about health or social care we want to give you a platform to say it. But we may want to draw your attention to information which you might not have considered.

    That is why I draw attention to the polling evidence that shows that a majority would be happy to use privately provided healthcare if they didn’t have to pay for it. I don’t welcome this fact, but I think we need to consider it.

    1. Shibley says:

      “If socialism only means nationalisation then we are sunk” (Rathfelder, 18/5/13)

      “Taking the N out of NHS” (Burnham, 24/1/13)

      You decide

      (sources above; http://www.mhpc.com/health/one-nation-but-152-nhss-burnham-launches-labours-vision-for-the-nhs/.)

      1. Martin Rathfelder says:

        I don’t think Andy plans any nationalisation. What he’s talking about is uniform standards of provision

    2. Shibley says:

      But likewise Martin does your response imply a half-arsed aspiration to reverse private provision in the NHS?

      1. Martin Rathfelder says:

        Do we want to see Boots nationalised? I don’t think so. Do we want to see an end to a competitive tendering regime? yes.

  6. Brian Fisher says:

    We want the LP to stop the NHS being run on competitive lines. We want a radical reduction in private enterprise in the NHS. We do not want the NHS opened to corporates from across the world. We want social care to be free at the point of use. We want an integrated service centred on communities and individuals. We want efficiency, safety, care and compassion.

    We do not want to eliminate private companies from the NHS. They have their uses.

    Let’s now look at what the details of these policies are and how we can work with the LParty to make them a reality. This will involve compromise. Let’s be prepared for that.

    We have a great opportunity at the moment. Let’s grab it together.

  7. Lewis A says:

    I will leave it to others to spend an inordinate amount of time discussing the definitions of socialism, which I fear will not progress our cause one iota.
    I’d just like to say that, in my ~7 years of membership, it seems to me that the SHA is currently better placed to actually exert some influence on Labour Party health policy than it has been before. This, in my view, is largely due to the willingness to debate policy in a way that is informed by the breadth of members’ experience and views and engages with the pragmatic realities of Labour politics. The Officers and Director deserve credit for that. This blog has been very helpful in doing that.
    The sure-fire way of ensuring that Andy Burnham or anyone of his ilk never listens to the SHA would be to retreat from these forms of broad, and yes sometimes controversial, policy discussions back to an internal search for socialist ideological purity.

    1. Dripedo8543 says:

      <1% of people join political parties. <1% of this 60, male, white & had spent literally decades sitting on various committees. And it showed! They’d prefix their comments by citing a several hundred page report or a conversation with executive directors of their local council/PCT. Yet it was excruciating to see & hear how out of touch they were with ordinary people who didn’t populate town hall/PCT committees. This isn’t a left or right-wing thing, these older gentlemen simply had no idea about the experiences of the other 99.99% of the population.

      New Labour heralded the arrival of career politicians & their crones. Grassroots tories are up in arms at being described as “Swivel-eyed loons” by their leadership, but you find the same utter contempt within the Labour Party. We’ve seen the management consultants & aspiring career politicians arrive in the SHA, with lots of buzz phrases about quality, delivery, performance, wraparound care, personalisation, integration etc. Similarly, <0.01% of the population are Westminster policy wonks, management consultants or aspiring career politicians. Beneath these vacuous phrases, there are no fresh ideas, there is just the same old Neoliberal agenda.

      Forget ideology, its about decent public services. Outsourcing & privatisation has been an unmitigated disaster. Companies like McKinsey, Tribal, Care UK, G4S, A4E & Serco are making billions out of public services, that have got worse. This is apparent to the 99.98% of normal people. There isn’t a single normal person [Remember “normal” excludes political insiders, policy wonks & management consultants] who hasn’t either personal experience or a family member with experience of how the outsource industry fails people. That’s why there is cynicism when political insiders rush out to defend this. Elderly councillors can insist that there are mechanisms to ensure subcontractors deliver. These people are out of touch & its excruciating. Labour nationalised healthcare to serve the interests of ordinary people, who couldn’t afford healthcare. New Labour used vacuous managerialistspeak to justify denationalisation. This will serve the interests of big business but at the expense of people relying on services. That’s why people are angry at the tactics used to portray the membership supporting Neoliberal policies.

      Speak to the 99.98% and they hate outsourcing; they know it means the taxpayer gets ripped off, service users get worse/no care, co-payments are sure to follow, staff get worse pay/pensions and large corporates make big bucks. Funnily enough, the only people promoting it are members of the 0.02%.

      Go ask the public-the 99.98%-what they think about public policy. They think the UK political system is corrupt. They feel betrayed by a political class, who serve the interests of large corporate donors & the city. They are fed up with the revolving door between Whitehall & big business. The public are rightly annoyed that corporate lobbyists have greater access to politicians than they do. The purpose of the SHA should be to promote the intersts of ordinary people: that means speaking truth unto power. The New Labour approach is to lean on the SHA offering the pretence that we’ll get some influence in exchange for not criticising Neoliberal policies.

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