When they talk of a health market they mean health chaos. That, and a nice little earner for someone. We should begin by understanding what is being proposed…
The government’s broad attack on the National Health Service is on several fronts, all aimed at introducing chaos to replace planning.
Firstly, the object is to replace planning with control of capital expenditure and the continuing Private Finance Initiative, PFI. Well-named too – an initiative well and truly for private finance, bankers in particular. It used to be called “the only game in town” because it was, and largely still is, the only way to get a hospital built, so many managers who wanted new facilities had to use PFI to get them.
Hospitals built using this discredited method of financing currently have a capital value of £59 billion. But they won’t cost us that. You and I and our children and our grandchildren will actually pay a minimum of £229 billion for those self-same hospitals. We’ll have to pay 4 times the already-inflated cost just to put more money in the pocket of the profit-mongers, mainly the bankers. And that’s the overall picture – many individual examples are even worse.
Just one of these schemes, the oddly named Princess Royal University Hospital in Bromley, cost £118 million, but the contractor will be paid a staggering £1.2 billion – a built-in profit of more than 10 times. Nice work if you can get it. (Why do I say oddly named incidentally? Well, is there a Princess Royal University? Is there a University at all in Bromley?) And that’s only in building costs; it doesn’t touch the continuing profits made out of the transfer of staff to the private sector with - unless we’re vigilant - lower pay, longer hours and non-existent pensions.
Money from chaos
In PFI lies the ruin of the NHS, as we have always predicted. They can make far greater money from chaos than they can from planning. That’s why they hate planning and fear it so much. They want to see how they can line their pockets most effectively, not how you train the next generation of medical specialists. It’s this incompatibility that is at the heart of class struggle; or it would be if our class would only struggle. We want improvement through planning; the PFI-mongers want profit through chaos.
The second line of attack is directly upon the planning bodies of the NHS. When the last government introduced restructuring of the NHS based on research by Professor Ara Darzi, some brave trade unions welcomed it. Why do I say brave? Well because most change is ritually opposed without examination these days, especially within unions.
A leading academic said that it represented “the re-introduction of planning, at least on a limited scale”. That was true, so it was always a given that Lansley et al would make it their first target, and such it was. Of course they began with a great big lie. They said they wanted, “no top-down reorganisations”. They proceeded to launch precisely a top-down reorganisation to abolish Darzi’s reform process, Primary Care Trusts and Strategic Health Authorities into the bargain.
Actually their first target was the destruction of Healthcare for London, a ten-year programme to improve health standards and care in the capital, only made possible by the professionalism of the London Ambulance Service workforce. Its demise led to the unprecedented resignations of the chair and the majority of the non-executive directors of NHS London. If nothing else proved that support for the limited Darzi reforms in London was correct , then the speed and venom of their destruction by little Lansley should.
The brazen manner in which they say one thing whilst doing the opposite led one ACAS official to compare their propaganda methods to those of the Nazis: make the lie a big lie and keep repeating it. This from ACAS, in which “C’’ stands for conciliation! He was referring to the way in which blame for the financial mess of their system has seemingly been transferred from bankers to, apparently, public service workers, whose “gold-plated pensions” and exorbitant pay have caused the crisis.
The third line of attack is based on as big a lie: that they are decentralising control in the NHS by giving it to GPs. They say that GPs are close to patients and therefore in the best position to run the NHS. That Lansley’s wife and ex-wife are both GPs is entirely irrelevant. It’s a big lie because most GPs don’t agree with it or want to do it, so they’ll engage Kaiser Permanente, or McKinsey or KPMG or Tribal – whoever it is, it won’t be GPs.
A big lie! And it’s repeated over and over again. The truth is that instead of your friendly neighbourhood GP running the show, they’ll either need to get support from a commissioning agency (that’s what PCTs do, so why abolish them?) or a private company. Either way, it’s not what they said they’ll do, it’s the opposite.
And while we’re on the subject of them lying, never forget this – no party’s election manifesto, nor the coalition agreement they cobbled together afterwards, said they’d do this. In fact, what the Liberal election manifesto said was that PCTs would be strengthened by having elected members added to their Boards!
|Unison demonstration in Glasgow, April 2010|
PCT and SHA abolition means the sacking of nearly 2,000 workers in London alone, 15,000 across Britain with twice as many to come, and it has absolutely zero democratic mandate. So think about that the next time someone suggests that the way to resolve these problems is to vote for someone standing for election for parliament. Who but an idiot would believe ANYTHING any of them ever say again?
What else are they up to? Fourthly, they’re proposing that Foundation Trusts become the sole NHS structure for providing healthcare in the public sector. In other words, every hospital has to become an FT (a very apt acronym don’t you think?) by 2014. What’s the significance of this? Well, it’s that FTs can keep any “surplus” they may make. What counts as surplus in the NHS you might ask? Well it’s the difference between what we taxpayers give the managers of the hospital to perform its functions and the amount they can perform them for. So they can take what we give them, pare the service down to what might be called a ‘profitable’ level, and pocket the difference. At present they’re supposed to re-invest it in the NHS, usually with new building schemes, but the new legislation would revoke that responsibility.
There are already stories of FTs thinking of lending to the private sector. FTs being listed in the Financial Times. Or even GP consortia. Just like a bank. The ultimate capitalist transformation must be to turn a hospital into a bank, which this Health and Social Care Bill is well on the way to doing. Very interesting – in Cuba, the Revolution turned the biggest bank and stock exchange into Havana’s biggest hospital! You couldn’t have a clearer example of the priorities of capitalism and of socialism.
Some of you may recall that a big hoo-ha was made out of the unions wringing from the last government a pledge that the NHS was the “preferred provider” of health services. This was paraded as one of the great victories of social democracy, but actually it was a scandal. Why wasn’t the NHS the only provider of health services? Is that how low we’ve sunk? This new mob have replaced all that namby-pamby Labour tosh with “any willing provider”!
Roll on the Harold Shipman GP Commissioning Consortium…if ever a man has missed his moment it was Britain’s biggest mass murderer! He ticks, or rather ticked, all the government’s boxes. Shipman knew how to stay close to his patients. He certainly knew how to cut waiting lists. And he was a good Tory to boot. It would be like having Dracula running the National Blood Service or Sweeney Todd the meat pie industry.
And the really good thing about this “any willing provider” farrago is that it neatly removes Britain from the regulations which up until now have put the NHS outside competition laws. In other words, now that HMG has declared the NHS to be subject to untrammelled competition, all the barriers must go down.
EU-wide competition will not just be possible – it will be obligatory. As will competition from over the pond – and we know how good the Yanks are at providing health care for their people. Well, apart from the 60 million who haven’t got any at all.
Thatcher created a thing called the purchaser-provider split, whose purpose was not only to introduce private capital into public services but also to make it far more difficult for workers to control those services. This split necessitates the employment of people to do a thing called “purchasing”.
This was then called commissioning in New-Labour-speak and what started off as an administrative function in the finance department of a Health Authority will now be transformed into full-blown private provision, quite possibly by American-owned multinational companies.
At this point of degeneration, the people who have their hands on the levers of control will not be British workers at all but foreign-owned finance companies run by bankers. So the degraded mantra “free at the point of need” will not be worth the invoice it’s written on.
So much for describing our plight: what we might call the working class in disarray. There is, though, much about which to be positive. Stroke care in London is now the best of any city in the world. The public attitude towards the NHS recently tested in opinion polls is twice as positive as it was in 1997, and in the first 10 years of the new millennium life expectancy for men in Britain improved by 3 years.
This is no mean feat and is the result of the diligence and creativity of health and other workers. But now, if we come back in 10 years’ time the odds are ten to one that we’d find life expectancy had not improved over that decade, and had probably reduced.
This article is an edited version of a speech given in March at a public meeting in London organised by the CPBML.