Many campaigners expressed concerns during the passage of the Lansley nonsense that the NHS was being packaged up to make privatisation easier and a sell off inevitable.

As has been said many times the only way to prevent privatisation is to elect a government that does not do it. Anyway.

The NHS Reinstatement Bill  suggests that the NHS is reorganised so that (around 40) health authorities would be directly funded to plan, organise and provide the services for the relevant area. The health authorities would be under the direction of the secretary of state and their management would be appointed. Oversight would be through a form of Community Health Councils although they would not have any actual powers or duties and again would be appointed. This structure is, as the advocates of the Bill point out, pretty much the same as in the 1980’s before Trusts were invented.

The rationale for the reorganisation is that it would prevent or deter privatisation. Well it may well do the exact opposite and make privatisation far easier.

If we assume that the reinstatement bill is passed and that it can actually be implemented. What would a Tory secretary of state do with the huge powers the bill provides? One option would be to use the powers of direction simply to instruct the health authorities to put all services out to competitive tender. This is what the Tory government did to local authorities in the 1980’s. To make this easier to implement the secretary of state would use the powers of appointment to put supporters in all the right places.

But it could be even worse. Implementing the Bill would achieve the creation of a small number (around 40) of integrated organisations; all the complicated work of TUPE transfers, assets transfers, contract renegotiation, management appointments would all have been done. Changing how such an organisation is managed would be simple. Each heath authority could be privatised easily. This has also been mentioned as a risk to GP practices – if the form much larger groups with a more rational traditional management set up and proper contracts then they become a far more obvious target for private providers.

Implementing the Bill would already have removed many non-executive directors, thousands of governors and millions of members of foundation trusts as well as removing the oversight powers of local authorities and (presumably) the role of Healthwatch. So all the likely centres of opposition to selling of services would already have been shut down.

One protection from privatisation is the complexity of the NHS. Potential privatisers are put off by the instability of the funding, the sheer complexity of all the organisations involved and the public and patient involvement rules which they at least have to acknowledge. Scrapping all these protections could be a terrible mistake.

Perhaps this is all a clever plot?

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16 Comments

  1. Robert Jones says:

    The only way to stop privatization is, as you say, to elect a government which won’t privatize. However, I should have no difficulty with dismantling all of the Lansley reforms, plus the removal of foundation trusts, governors, or HealthWatch – they’re only a bar to privatization if they choose to be; what makes you think they will choose to be?

    According to the HSJ, HealthWatch is being “downgraded” – something for you to investigate?

  2. davidakirby says:

    To describe the authors of the NHS Reinstatement Bill, including Professor Pollock, and its supporters in the House of Commons, who include Jeremy Corbyn and Caroline Lucas, as instigators of a “clever plot”, presumably to facilitate NHS privatisation – perhaps they are secretly shareholders in United Health, ATOS, G4S, Virgin, or Serco? – is not merely to articulate a bizarre opinion. Such an allegation brings the Socialist Health Association into disrepute – is there nobody monitoring this site?

    The allegation also serves in its absurdity to undermine the whole argument, which is based on an inversion of the truth – obviously complexity and fragmentation favours privatisation, as it favours increased bureaucracy, which – contrary to neoliberal rhetoric – go hand in hand. The health service is not being handed over to private citizens, it is being handed over to an alliance of corporate bureaucratic interests and state interests – handed over, in short, to Davos.

    When the NHS was the most efficient health care system in the world (with the possible exception of Cuba’s system) some thirty years ago, taxpayers funded a system for which the Department of Health was ultimately responsible, in which staff (admittedly doctors had too much influence) managed their institutions for the good of the individual users and for the good of the community, the spending monitored by committees composed partly of locally elected people, and the outputs by Community Health Councils. Accountability was not what it should have been, and systems to improve weak points in the system – private out-of-hours services used by some GPs, the serious unevenness of standards in general practice, and the neglect of unglamorous specialties for example – were weak.

    In the bureaucratised and artificially commodified complexity of the developing taxpayer-funded corporate system these problems remain as prominent as then, if not more – but myriad other problems have been added associated with financialisation, with every intervention given an invented financial cost, every intervention monitored and counted, and with the expectation that staff at all levels need to be exploited and should submit to exploitation, to be held by a watchful management balancing always on the edge of exhaustion and demoralisation.

    That past system aspired to harness the needs of the population for health care with their trust and hope which enhanced the vocational aspirations and sense of public service of those who worked in it. Many worked within it as hard as they could consistent with their own health. Neither users nor providers experienced health care in the NHS as a commodity. Obviously there were serious failings, not least because you cannot have socialism in one country, nor in one institution – there were difficulties with the reproduction of class within the institution – cleaners, say, abused and powerless whilst consultants vied for power and lined their pockets with private practice, and difficulties with the interface with corporate capital – free lunches for doctors from Big Pharma, which the taxpayer obviously was ultimately paying for in drug costs, for example. But it was simple and effective, encouraging the behaviour and attitudes from doctors and nurses and cleaners and administators that you would expect from them after a serious natural disaster – that is, committed service. Even to mention such values today after the neoliberal assault seems faintly embarrassing – perhaps what David Cameron calls mockingly being a ‘small c conservative’.

  3. Robert Jones says:

    To further pursue just one small part of this, on the basis of past experience in housing – the nod to patient and public involvement will do nothing to deter privatization. Those involved are easily misled because, being well-meaning, they’re also ripe for deception. Housing associations have been privatized, merged, taken further and further away from their local communities and into ever larger conglomerates because consultants have been hired to tell tenant representatives that economies of scale will bring huge benefits, small organizations can’t thrive in the “real world” – and so on. The same will be true for elected governors and members of foundation trusts – they won’t be able to resist the corporate maw if it smilingly descends on them.

    This may be one reason for the downgrading of HealthWatch, since it would represent a threat to takeover if it were able to exercise scrutinizing powers such as those held statutorily by CHCs in the past. “Involvement” is a sham in any event, but such as it is it looks like being too much for government.

  4. rotzeichen says:

    Put simply, If Irwin Brown is for it, I’m against it. If he is against it I’m for it.

    One question that I would like answered by Irwin is, do you understand the meaning of a socialist health association?

    I note also that when Dr Allyson Pollock gave her detailed and evidence based reply to his previous attack on this bill, he did not reply with substantive information to the contrary, instead we get a diatribe of worthless opinion.

    Looking forward to seeing real socialist opinion emanating from SHA.

    1. Martin Rathfelder says:

      Irwin is a member. You aren’t.

  5. Jean Hardiman Smith says:

    Irwin has a point, and so does everyone else. To quote G&S
    “Things are seldom what they seem,
    Skimmed milk masquerades as cream”
    and even the best of us can fail to see privatisation traps until too late. Cooperation, and sharing ideas and opinions seems to me to be the most useful option to make us as effective as possible. I have at times found that the way out opinions I dismissed are the ones I should have listened to, not the so called experts. I am even looking beyond health and the NHS, and have been for some time, to learn how to spot tactics in advance. Part of my 1st degree was in business ethics and that helps.

    1. rotzeichen says:

      Jean, this expert describes in detail what is simple logic, you may well feel that modern medicine is not for you and believe in holistic solutions, but that is part of a belief system and we all have the right to believe what ever we like,

      I don’t know if you have seen this video of Dr Allyson Pollock but it explains graphically why private medicine is a nonsense, anecdotally I have a German friend going back to the mid sixties that spent six months working in our local hospitals and she told me then that she had never seen the equipment levels we had in this country in Germany, when I lived with her in Bavaria, she worked at the local clinic, one night she told me that she did not know if she was going to be paid at the end of the month and that they had run out of vital medicines and treated patients with chalk tablets, because they could not afford the prescribed ones. This is anecdotal but we all know what happens in the private sector when profits fall, Hinchingbrooke.

      1. Jean Hardiman Smith says:

        I don’t believe in holistic medicine particularly, Rotzeichen. I have a life limiting couple of conditions, and only conventional medicine is keeping me alive. Without it I would be dead in two weeks. Prognosis is around 5 years, but my conditions are very rare so nobody is quite sure.

        I was referring to people I had met, way back, who told me that the NHS was being privatised. I didn’t believe them because everyone in the various committees of experts I attended dismissed the idea. It took time and evidence before I changed my opinions, but I was still ahead of most, unfortunately.

        I agree about private medicine. It is wrong on every level, but twists its spin to look better. I read a magazine in which a cancer charity head was being interviewed about cancer in the US, and how US citizens were prescribed all sorts of alternative add ons, as well as dietary advice (the latter being good, but I am sure the NHS does it). He wittered on about the difference in survival rates, and how much better the US does it – and he had plainly been sent on an all expenses to visit these organisations BUT I work in the US system and know that people without insurance are not routinely given a post mortem, and the unrecorded cancer death rates are extimated to be very high indeed. Not only that, but even the middle classes may find they have to work through chemo and up to death, or no palliative medication – great yes??

        1. rotzeichen says:

          Thank you Jean, I am sorry to hear of your personal condition and wish you the very best of care. I concur with all you say about the American system and note the experiences of a Canadian member in our group that explained the benefits of the NHS, as he was then suffering from cancer.

        2. Martin Rathfelder says:

          The NHS Reinstatement Bill would give day to day control over the NHS back to Jeremy Hunt instead of Simon Stevens. Would that be an improvement?

          1. rotzeichen says:

            Martin, Simon Stevens is a Neo-Liberal who’s last job was:
            From 2004 to 2006 he was president of UnitedHealth Europe and moved on to be chief executive officer of UnitedHealthcare Medicare & Retirement and then president, Global Health, and UnitedHealth Group executive vice president of UnitedHealth Group. During this time he also served on the boards of various non-profits,

            The difference with the Reinstatement Bill would be the end of the Market, Hunt would not be able to privatise services and those already privatised would come back to the NHS.

            The chaos of the market would disappear and Hunt would be directly responsible for properly funding the NHS.

            You know that it is being deliberately underfunded to destroy it, That would be even more obvious under his control, anyway This Tory Government may leave office sooner than any of us could hope for, from their total mismanagement.

            You know that we as a country can never go broke, you have seen the evidence, Osborne borrows money to prop up the Banking system, and has doubled borrowing since he came into office.

          2. Martin Rathfelder says:

            Simon Stevens was a member of the SHA for 20 years until he went to the USA. He appears to be quietly undermining the market. he never mentions competition.

  6. Shibley says:

    Unbelievably bad article from a pretty impotent organisation.

  7. Robert Jones says:

    I’ve little doubt that the Bill is flawed, but more to the point it has almost no chance of success, so much of this is (presently) academic. I don’t have a lot of faith in Stevens – although I’ve none in Hunt – but in theory it should be appropriate for the Secretary of State to have responsibility for the NHS. How that’s administered – at arm’s length, one would hope – is something else again. Not impressed by a system in which the Sec of State can offload the blame when things go wrong with a shrug and a smirk. Hunt has a peculiarly unpleasant smirk….

    The problem of management, administration and so forth is one side of this – does anyone really think the present establishment is sustainable in the longer term? – but the bigger problem is the shower in power, the resources they’re prepared to allot, and the way in which they choose to distribute them, eg through the private sector. I take it that Martin’s view is that a) resources must come before further change to the structures, b) that there have been too many recent changes anyway and the service needs to bed down or risk being driven to chaos by further disruption. I suppose a criticism of that would be that we’re seeing further change all the time in any case – eg with the weakening of Healthwatch (however much or little that matters) and an apparent retreat from the foundation trust model (certainly that appears to be the case where I am), which matters a great deal.

  8. Jean Hardiman Smith says:

    All good arguments, however according to international trade and legal experts and a Nobel Prize winning economist (and lots of other top independent ones), only a swift reversal of privatisation will save the NHS, and we don’t know how much time we have left. Then there is the little known part of the Deregulation Act, which the Government initially said they wouldn’t apply to public services, but have now backtracked on. It was obviously intended for them, and the Government was just waiting for a quiet moment and hoping it wasn’t noticed. It is needed to further the aims of the trade deals in the pipline.The mathematical model big business is using to persuade politicians and the public that we will as individuals and countries come out winners in the trade deals being negotiated, is provably GIGO, which won’t stop the media quoting it as gospel,and their lobbyists arguments are dangerously micro economical, at a time when we need meta thinkers.

    Lobbyists from big business also state unequivocally that public services, like the NHS, are safe (they are not in the UK unfortunately accoding to our legal team) and our worries about the impacts on public health are misplaced. From the latest information about even the so called best, like Gates, they certainly don’t think about the impact on the people who constitute their market, but are using philanthropy as an excuse to enrich themselves even further. From a 1st hand account, and work on business ethics at University I am aware most big businesses (though not necessarily the people in them as individuals in their private lives) are devoid of any sort of ethical codes as we would think of them. An ex-privateer with decades of exerience all over the world informed me that they are laughing at the naivity of politicians and civil servants.

    In the current political climate, even an in depth knowledge of the NHS won’t save it, and no matter how well meaning, a miss step could do further damage. It is why I can’t make up my mind if PFI/PFT is a blessing or a curse, and why I can’t make up my mind about Stevens. for one thing he seems to think LAs should be in charge, I am afraid our people are reporting a disaster where it has happened, and it is increasingly becoming normalised under the name of integration, with LA people taking control of committees etc. US multinationals are already making inroads into an area near me. My local LA has even appeared in Private Eye and on YouTube for its perverse decision in the medical sense, but not in the money making sense (they got a building and land to sell for redevelopement), when they decommissioned a world class service, to commission a much less expert and efficient team and at a higher cost, ditching expertise, training and research work in the process . Neither the service users, the public nor NHS and CCG people, nor even all the other councillors being against this stopped the Mayor nodding it through – he is mates with the builder (allegedly), .From all over the country, the sexual health teams which used to be under the NHS, but were moved to Public Health and the LAs are reporting the same sort of thing – it is a disaster!! From where I sit, and from what members report from all over England, the LAs seem to see the NHS only as a potential source of power and money. Its what they were made and trained to do since Thatcher, and they are no longer attracting people with a public service ethos in the main, while good people are being sidelined or retiring. I am sure people can tell me about good LAs, but according to reports from 1.5 million members it is not as prevalent as we might like.

    I am unequivocal about Hunt, though. Worst smirk I have ever seen, and he stands like a Nazi general with his legs wide apart while he addresses his “troops”. Oh for a slippy floor!!!

  9. mikesquires says:

    My simple suggestion would be that into every contract drawn up by the CCGs should be a clause stating that any surplus made from such a contract be returned to the NHS.
    That would put everyone on a level playing field, NHS providers,private companies etc

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