Doctors advise that you shouldn’t stop suddenly certain drugs such as antidepressants for fear of severe discontinuation symptoms. Privatisation is a drug on which Government has been dependent in the UK for nearly 40 years, and we need to grit our teeth and come off the drug.
In an era long ago, far predating the trials and tribulations of Brexit, the Coalition government of 2010 wondering what to do decided that they would do a ‘shake up’ of the NHS.
Everything was perfect. Andrew Lansley called on his friends in McKinsey’s to take another bite of the cherry following their last monumental cock-up “re-disorganising” the NHS in 1974. Perhaps he had been boyed up by the drip-drip of the ‘Nicholson challenge’ which would impose an austerity agenda on NHS Trusts recently saddled with debt from the policies of PFI from John Major and an incoming New Labour government, ably aided and abetted by a neoliberal consensus from a dying New Labour government in 2010.
New Labour were elected as Conservatives, and governed as Conservatives. The problem is that the relic of the routemap to privatise the NHS wholesale still carried on regardless, that routemap being the famous ‘The Health of Nations‘ document from the Adam Smith Institute. Of course, the list of the supporters and corporate shills is endless, and many people have played their part over the years.
Anyone looking at the Health and Social Care Act (2012) would have needed a degree in international corporate law to understand it. I, for different reasons, worked towards such a degree. Whilst it is 500 pages of incomprehensible company law, it makes perfect sense as a charter to throw the NHS into the hands of private industry. It locks in a mechanism for everything to be up for market tender and market forces, and for failing economic entities to die off like some sort of neoliberal eugenics ‘survival of the fittest’.
This is one of the biggest tragedies of how the NHS has been treated in the last few years. There’s been a massive opportunity cost – the effort and money spent in promoting private companies such as Virgin, arguably, might have been better spent by producing financial resilience to NHS Trusts. NHS Trusts have not been ‘unsustainable’ – they have been simply underfunded.
The physician workforce is relatively under-doctored, and doctors are overstretched. The service has been deliberately run down, to make it attractive for private investors. That is why it is essential to stop journalists from repeatedly telling us private industry is more ‘efficient’.
The history is relevant, so that we do not go down this road again. Lansley simply wanted to sell off ultimately the NHS like the utility companies. The privatisation of the utility companies has generated huge profit for shareholders, has nothing for ‘taking back control’ (indeed has encouraged ownership of essential companies by foreign investors) and not seen better ‘quality’ (as would have been predicted, as they were all selling uniform products which do not vary.)
But the ‘lesson learned’ from the Thatcher era was that these big Leviathans had not been sufficiently fragmented prior to the privatisation. The neoliberal consensus which had emerged and still continues in government, from 2010, was to outsource as much of it as possible with a view to making the NHS so fragmented it can only be sold off.
All of this carries on, and the artist previously known as ‘accountable care organisations’ is simply a New Labour-induced mechanism, perpetuated by the current Government, albeit with a different name, to make the NHS into ‘sellable chunks’.
And this is entirely possible with devolution to atomise the NHS into groups of care providers, but a new direction for the NHS must be to ensure that the dependency on the drug that is privatisation has to stop. We now it has been a disaster for social care, with ’round the year talk’ of providers going bust.
The NHS does need ‘management’, but it very much now operates on the basis of ‘management based medicine’ rather than ‘medicine-based management’.
The problem is primarily of ‘money before health’. Privatisation is a drug which they all would have withdrawal symptoms if discontinued.
And this is seen in all sorts of ways.
Jeremy Hunt abolishing various targets, from A&E waits to cancer waiting times, is a perfect way to let the service come close to collapse, without none of it being discussed effectively. Jeremy Hunt is lucky to have such a pathetic media who can shill on his behalf.
The NHS continues to need its quick fixes of privatisation – getting any old income (revenue) from flogging off the nation’s silver, as the late Harold Macmillan, Tory Prime Minister, called ‘privatisation’.
It has just transpired, in the latest stunt, that the NHS is privately marketing a 100-year-old hospital building that provides affordable housing for 52 nurses and other key workers to property developers to create a One Hyde Park-style complex of luxury flats overlooking Hampstead Heath. A password-restricted website set up by the Royal Free London NHS foundation trust describes the 1.6 acre site as “the last major development site in Hampstead with an unrivalled position between the heath and Hampstead Village”.
A cross-party body to shape the future of the NHS would lock in the neoliberal consensus for good, ultimately sealing the fate of the NHS to the coffin. Astroturfers of course thrive, even with some NHS campaigners being head-hunted by US free-trade gurus.
Astroturfers need zombie policies, like hypothecated tax. The TV licence is a current example of hypothecation, as the revenue raised is earmarked for the BBC. Gordon Brown’s decision in 1999 to allocate additional revenue raised from real increases in tobacco duties to health expenditure is an example of weak hypothecation.
But it is plainly obvious that health spending should be determined by ‘need’ or ‘demand’ for a service, rather than how much a tax raises. Strong hypothecation ties spending to a single tax revenue, and would thus make health expenditure dependent on macroeconomic performance. And we know that the current economic performance, a nation no longer of shopkeepers but couriers and drivers on zero-hour contracts, cannot sufficient monies to get us through paying for Brexit even let alone the NHS.
Spending on health would be exposed to macroeconomic shocks that have nothing to do with the health of the population. Furthermore, tax revenues would fluctuate over the economic cycle, which risks insufficient funding for health services during economic downturns, and wasteful spending during booms.
And the corporate sleaziness continues .It has just been revealed, somehow, that a £330 million deal between NHS England and Capita to outsource administration and transform services, in part due to a legacy IT system NHS England considered unsustainable, had the potential to seriously harm patients. The National Audit Office heavily criticised the seven-year deal struck in 2015 with Capita, a professional services firm, to undertake the duties of a newly formed unit named Primary Care Support England – all while cutting costs by 35%.
Politicians got onto this can-be-fatal privatisation drug, and they do need to wean us off it asap. But Rome wasn’t built in a day?
John McDonnell, shadow chancellor, said last week that the collapse of Carillion had highlighted the catastrophic failure and inadequacy of the UK’s regulatory regime, as well as shortcomings in the audit market. Mr McDonnell said Labour had commissioned an independent review. The review will be led by Prem Sikka, a professor of accounting at the University of Sheffield and an outspoken critic of the big four audit firms: PwC, Deloitte, KPMG and EY.
We need to face facts. Private companies have absolutely no interest in the health of the nation, otherwise it would care about contributing to the training budget of clinicians in the NHS where ultimately most if not virtually all private clinicians in the UK have been trained. They only care about lining their own pockets.
It’s all a question of £ first – under the cloak of the logo of the NHS.
Disgustingly, a GP practice taken over by Virgin Care has just been placed in special measures after going from an official rating of ‘outstanding” to “inadequate” in less than two years despite increased funding. The Sutherland Lodge practice in Chelmsford, Essex, was taken over by the private provider in July 2016 after the previous partners handed back their contracts following £400,000 funding cuts to their contract with NHS England.
The arguments against the atomisation of the NHS and social care are not simply economic – e.g. the increased cost of bureaucracy, commissioning or litigation. Experience from devolution in Manchester has now shown that a major barrier to integration of health and social care policies has been ineffective inter-agency working, for example in sharing safeguarding concerns, or in communicating about which providers can provide in a timely way home care packages.
One thing leads to another. It is no surprise, given the parlous state of social care infrastructure, then, that delayed transfers of care have gone through the roof, so that even if you can get into hospital you can’t check out. In a way, it is even worse than Hotel California, where you could at least check out?
All of this dependence on privatisation has been carefully sold to the public, avoiding any public panic by avoiding any talk of ‘Tell Sid’. It’s been ideologically-driven, but has nearly killed the NHS off for good. Unless we stop the atomisation of the NHS, death by a zillion cuts, making what’s left of it into sellable bite-size chunks, we will have no universal, comprehensive, free at the point of need NHS.
The problem has been for 40 years “money before health”.
But look on the bright side – we can sell off what’s left of it in a trade deal to Donald Trump.
That last sentence was sarcastic, by the way.