Category: health care

Moving full steam ahead towards the disastrous U.S healthcare model?

By Daniel Margrain

Image result for NHS is breaking, pics

The shocking indifference shown by Theresa May towards the plight of stroke victims in the NHS and the systems ongoing crisis in which patients have been photographed sleeping on a hospital floor, is indicative of a public service that the UK government is determined to break. As Dr Bob Gill cogently argued, the Tories are deliberately under-funding the NHS to erode public confidence in order to manufacture consent for privatisation. The governments aim is to reconfigure the service from a free at the point of use healthcare system, towards a fee-paying US model.

In their 2017 election manifesto, the Conservative government said they would increase NHS spending by at least £8 billion in real terms until 2022. But King’s Fund, Nuffield Trust and Health Foundation figures show that NHS spending per person is set to fall by 0.3% in 2018/19 compared to the year before. Research undertaken by the former, indicates that UK funding for the health service is falling by international standards.

The think tanks have argued that even based on the government’s current spending plans, there is likely to be a spending gap of over £20 billion by 2022/23. They have also said that the NHS will need an extra £4 billion next year alone “to stop patient care deteriorating”. In 2013, NHS England said it faced a funding gap of £30 billion by the end of the decade, even if government spending kept up in line with inflation.

Under-funding has inevitably impacted on staffing levels. The shortage of nurses within the NHS has reached dangerous levels in 90 per cent of UK hospitals, and the amount of doctors per capita is the second lowest among eleven European countries.

On six out of nine measures of varying sorts, the UK did worse than any other advanced country in the world. Under the Tories, the erosion of the principle of a free at the point of delivery service is undermining what Sir Michael Marmont refers to  as “the optimal allocation of resources.”

However, despite all the problems the government has thrown at the NHS, the UK is still ranked a relatively respectable 10th in the world in terms of efficiency compared to the U.S ranking of 44. The latter reflects the fact that the marketization of health care in the United States is long established.

Given the figures, one might reasonably ask why the UK government appears to be insistent on dismantling something that, despite its faults, essentially works for the mass of the population, by subsequently restructuring it in the image of a system that doesn’t? The answer to this rhetorical question is, of course, that the said restructuring is intended to maximize profits for the few.

Shortly after president Trump’s inauguration this time last year, UK Health Secretary, Jeremy Hunt made a fleeting visit to the U.S. It was rumored that Hunt took this opportunity to discuss with US financiers moves to carve up the NHS in order to bring it closer to the US insurance-based model.

The U.S model the UK is moving towards

The requirement of the US Affordable Care Act (which was signed into law in March 2010 but in reality is unaffordable for large swaths of the US population), is that people are forced to buy private health care insurance if they fail to qualify for public health programmes – namely Medicare and Medicaid. However, the insurers have created plans that restrict the number of doctors in hospitals.

These “ultra narrow networks” have resulted in the reduction of at least 70% of health facilities within communities throughout the U.S, thereby restricting access to care for people with serious health problems. This means that increasingly Americans are paying higher premiums but are not getting sufficient access to services they need. They are, therefore, having to find money upfront, largely because their insurance policies do not provide adequate cover for their injuries or illnesses.

So America is still seeing high rates of people who are either delaying, avoiding getting access to the care they need, or are being confronted with medical debts. Research shows that tax-funded expenditures account for 64.3 percent of US health spending, with public spending exceeding total spending in most countries with universal care. Yet, 33 million people in the US do not have access to health insurance cover.

The delivery of a NHS-style healthcare system in the U.S is hamstrung by the narrow commercial interests of the corporations who lobby Congress. The conflicting interests that a succession of American presidents face relates to the close relationship they have to members of Congress who need to get reelected. If Congress speak out against the interests who are funding their campaigns, they’re not going to get that funding.

Dysfunctional

Tiny efforts to try and patch together what is clearly a dysfunctional U.S healthcare system is further undermined by the Heritage Foundation. This conservative Think Tank came up with the model of forcing people to buy private insurance and to use public tax dollars to subsidize the purchase of this insurance. In other words, as a result of a process of publicly funded corporate welfare, billions of funds are shifted into the hands of private insurance companies.

America’s healthcare costs are the highest per capita of any country in the world with some of the worst outcomes. Attempts to reform the US system are undermined by the insurance companies whose only function is to be middlemen between the patients and the health professionals.

The U.S government’s treatment of healthcare as a commodity instead of a public good is out of sync with the rest of the developed world and illustrates the extent to which, more broadly, the giant corporations have usurped democracy in the United States.

Currently, the U.S is the only industrialized nation on the planet that has used a market-based model for healthcare. Alarmingly, whether the British public want to admit it or not, this is the direction of travel both the Tories and NHS England, under Simon Stevens, are taking the system of healthcare provision in the UK.

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How the establishment have engineered the NHS crisis

By Daniel Margrain​

A century or so ago, the Russian Marxist Nicolai Bukharin understood that the growth of international corporations and their close association with national states was symptomatic of how both aspects hollow out the parliamentary system. It is now widely recognized that the power of private lobbying money draws power upwards into the executive and non-elected parts of the state dominated by corporations. Consequently this leads to a reduction in democratic accountability and public transparency.

Internal markets, market testing, contracting out, privatization, encouraging private pensions and all the rest, are mechanisms that are intended to depoliticise the process of social provision, so making it easier to refuse it to those deemed not to deserve it on the one hand, and to clamp down on the workers in the welfare sector on the other. This ethos became established in the late 1980s under Margaret Thatcher during her third term in office.

Removing the foundations of the welfare state

Following the advice of the then chief executive of Sainsbury’s, Sir Roy Griffiths in 1987, the Thatcher government set about removing the foundations upon which the welfare state had been built. Camouflaged in the language of ‘public-private partnerships’, Tony Blair’s New Labour took this one stage further as a result of his envisaging the state as the purchaser rather than direct provider of services. Whole entities within the public sector have increasingly been outsourced, health and social care services privatized and competition and the business ethos introduced into public services in the form of managerialism and New Public Management.

Thus, within residential care, patients have been recast as customers. The aim is to ensure the domination of the market by a small number of very powerful multinational corporations whose primary concern is not the welfare of the residents in care homes which they own or patients in hospitals but with maximizing profits.

The carving up of the NHS opens up one of the worlds biggest investment opportunities. Indeed, its exploitation by private interests is proceeding at a pace. This is hardly surprising given the 2014 revelation that 70 MPs have financial links to private healthcare firms while hundreds of private healthcare corporations have donated to Tory coffers.

There exists a symbiotic relationship between privatization and what Noam Chomsky refers to as a policy strategy of “defunding”. In line with Chomsky’s notion, the aim over the last three decades has been to shrink the NHS and bring it to the point of collapse as the basis for then claiming the only solution is more privatization. In Orwellian terms, health under-funding is portrayed in the media as “unprecedented levels of overspending by hospitals and NHS trusts.” 

Health and Social Care Act

The 2012 Health and Social Care Act removes the duty on the Secretary of State for Health to provide a comprehensive health service and requires that up to 49 percent of services can be tendered out to “any qualified provider.” As early as 2013, between a quarter and a half of all community services were run by Virgin Care. Three years later, the corporation had won £700m worth of NHS and social service contracts.

The retreating by the state from the principle of universal health care provision, free at the point of delivery, can be pin-pointed to 1988 when Tory politician, Oliver Letwin, wrote a ‘blueprint’ document called ‘Britain’s Biggest Enterprise’ where he set out the stages governments’ would have to go through to achieve a US model of health care without the public noticing. The New Labour government under Tony Blair adopted Letwin’s principles. But prior to the 1997 General Election, Blair had to disguise the strategy by using dissembling language in order to get elected.

Once in power, Blair took several steps towards privatization. For example, he broke up the hospital network into foundation trusts which are essentially separate business entities. He also deliberately saddled hospitals with Private Finance Initiative (PFI) liabilities which involved the government borrowing £11 billion from private banks and financiers in order to justify the sale and breakdown of the NHS further down the line.

This culminated with the New Labour government introducing in 2009 what was termed the “unsustainable provider regime” which is a fake bankruptcy framework to justify closing hospitals. The £11 billion of PFI public money borrowed from the banks and injected into the NHS is, in the words of ‘Save Our NHS’ activist Dr Bob Gill, intended to “set up the infrastructure for the whole scale hand-over of our NHS to American corporations.”

Simon Stevens

Arguably, the most influential individual currently working in the NHS is former Labour councillor, Simon Stevens, chief executive of NHS England. After having served under the Blair government, Stevens went on to work for the US private health care provider, United Health, where he campaigned against Obama Care prior to campaigning for the Transatlantic Trade and Investment Partnership (TTIP) to be included within the UK health care remit. Those encouraged by the election of Jeremy Corbyn are still waiting to hear something from the shadow health team about this troubling development.

Controversially, Stevens introduced NHS England’s ‘Sustainability and Transformation Plans’ which form part of the annual HHS Planning Guidance. ‘Sustainability and transformation’ is Orwellian-speak for the move towards the total reorganization of the NHS predicated on more privatizations and cuts.

Two years ago this month, Dr Bob Gill attended a meeting to get some insight into what the position of the then Shadow Secretary of State for Health, Heidi Alexander, was in relation to the direction NHS England was moving in under Stevens. What he heard were narratives that fitted into the ongoing privatization agenda. According to Gill, Alexander expressed support for Simon Stevens, despite his appalling track record. There is no indication that neither the Labour leader, nor current Shadow Health minister, Jon Ashworth, intend to take Stevens to task.

This is extremely worrying given that Stevens appears to be less committed to ethics and patient care, and more concerned with perpetuating the notion that medicine is a profit-based ‘conveyor belt’ service. Could it be the case that Corbyn has underestimated the extent to which the corrupting influence of corporations and the power of lobbying money have hollowed out the parliamentary system as outlined by Bukharin a century ago?

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No, Jeremy, don’t do it

By Daniel Margrain

Image result for pics of yvette cooper attacking corbyn

Those who were paying attention during Yvette Cooper’s challenge for the Labour leadership last year would have been aware of the undisclosed £75,000 businessman Peter Hearn contributed to the New Labour enthusiasts campaign.

The mainstream media didn’t pay much attention to the scandal at the time. On September 22 of that year, columnist Fraser Nelson wrote tellingly of “the terrifying victory of Jeremy Corbyn’s mass movement” at staving off the coup attempt against him. Two days later, New Labour Corbyn critic and MP for Normanton, Ponefract, Castleford and Nottingley tweeted the following:

Congratulations re-elected today. Now the work starts to hold everyone together, build support across country & take Tories on

Less than 48 hours after her insincere message on Twitter, the Blairite MP engaged in a media publicity stunt intended to draw a wedge between the PLP and the membership.

Cooper’s crude ‘politics of identity’ strategy inferred that shadow chancellor John McDonnell was a misogynist for his use of emotionally charged language in defending the “appalling” treatment of disabled people by the last Tory government.

The context in which McDonnell attacked the former Tory Secretary of State for Work and Pensions, Esther McVey, was set against a backdrop in which she planned to cut the benefits of more than 300,000 disabled people. That Cooper rushed to the defence of a Tory who presided over some of the most wicked policies of arguably the most reactionary and brutal right-wing government in living memory, is extremely revealing.

What was also revealing, were the media’s obvious double-standards. A few days prior to the media’s onslaught against McDonnell’s “sexist” comment, Guardian journalist Nicholas Lezard called for the crowdfunded assassination of Corbyn. Needless to say, there was no media outrage at this latter suggestion.

Selective outrage is what many of us have come to expect from a partisan anti-Corbyn media. In May, 2015, independent journalist and Labour activist, Mike Sivier reported on Yvette “imaginary wheelchairs” Cooper’s criticism of those “using stigmatising language about benefit claimants”.

But as an article from April 13, 2010 below illustrates, while in office as Labour’s Secretary of State for Work and Pensions, Cooper had drawn up plans that would almost certainly have met with the approval of Iain Duncan Smith and the newly appointed Secretary of State for Work a Pensions, David Gauke

Indeed, the policy plans outlined by Cooper were subsequently adopted by the Coalition government under the tutelage of Esther McVey. In policy terms, it would thus appear Cooper has more in common with McVey than she does with McDonnell. This, and her disdain towards both Corbyn and McDonnell and the mass membership they represent, explains her outburst. She was not motivated by sisterly love.

This is the relevant part of the 2010 article implicating Cooper’s policy outlook with that of the Tories she supposedly despises:

“Tens of thousands of claimants facing losing their benefit on review, or on being transferred from incapacity benefit, as plans to make the employment and support allowance (ESA) medical much harder to pass are approved by the secretary of state for work and pensions, Yvette Cooper.

The shock plans for ‘simplifying’ the work capability assessment, drawn up by a DWP working group, include docking points from amputees who can lift and carry with their stumps.  Claimants with speech problems who can write a sign saying, for example, ‘The office is on fire!’ will score no points for speech and deaf claimants who can read the sign will lose all their points for hearing.

Meanwhile, for ‘health and safety reasons’ all points scored for problems with bending and kneeling are to be abolished and claimants who have difficulty walking can be assessed using imaginary wheelchairs.

Claimants who have difficulty standing for any length of time will, under the plans, also have to show they have equal difficulty sitting, and vice versa, in order to score any points.  And no matter how bad their problems with standing and sitting, they will not score enough points to be awarded ESA.

In addition, almost half of the 41 mental health descriptors for which points can be scored are being removed from the new ‘simpler’ test, greatly reducing the chances of being found incapable of work due to such things as poor memory, confusion, depression and anxiety.

There are some improvements to the test under the plans, including exemptions for people likely to be starting chemotherapy and more mental health grounds for being admitted to the support group.  But the changes are overwhelmingly about pushing tens of thousands more people onto JSA. 

If all this sounds like a sick and rather belated April Fools joke to you, we’re not surprised.  But the proposals are genuine and have already been officially agreed by Yvette Cooper, the Secretary of State for Work and Pensions.  They have not yet been passed into law, but given that both Labour and the Conservatives seem intent on driving as many people as possible off incapacity related benefits, they are likely to be pursued by whichever party wins the election…..”

What the above indicates is that Cooper laid the groundwork, and was responsible for, setting in motion the Tories regime of welfare cuts and system of testing to the most vulnerable of our citizens, many of whom would have been Labour voters.

It should be deeply concerning that some activists and others within the party are seemingly prepared to overlook Cooper’s treachery as a trade off for her alleged ‘hard-hitting’ experience. Cooper is one of many Blairites who have suddenly had an apparent Damascene conversation and have seemingly bought into the popular wave of Corbynism.

But activists shouldn’t be fooled. Actions speak louder than words. The plans Cooper drew up seven years ago against disabled people were so brutal, they were kept in place by the hard-line Tory, Iain Duncan Smith, who oversaw the excess deaths of thousands.

My advice to Corbyn, for what it’s worth, is that he should think very carefully before appointing his new team. He should stick as much as possible with those who loyally remained by his side over the last two years and who have worked hardest against those Blairites within the party who would have preferred a Tory landslide over a Corbyn victory. Cooper, who is a cynical opportunist careerist motivated by money and self-interest, is one such person.

I would go further. Corbyn and his team should seriously consider looking at ways to clear-out Blairites at constituency Labour party level. Many people, including millions of Iraqi’s, Libyan’s and Syrian’s would not consider that to be mere spite, rather a small step towards justice.

Compulsory deselection is the obvious way forward but to date, Corbyn has suffered from an inability to influence constituency labour parties at the local level whose full-time paid staff are institutionalized. They see in Corbyn somebody who is a potential threat to the status quo. The General Secretary, Ian McNicol represents the apex of this kind of tendency towards self-preservation.

This explains why during the election campaign the website Skwawkbox was able to allege that “almost no resources were made available for the fight to win Tory-held marginals or even to defend Labour-held ones.” Party officials and national executive right-wingers either assumed that Labour could not win seats or deliberately sought a bad result to undermine Corbyn.

The Morning Star reported on the case of Mary Griffiths-Clarke, the Labour candidate in Arfon who won 11,427 votes to Plaid Cymru MP Hywel Williams’s 11,519 — missing out on the seat by just 92 votes, or 0.3 per cent of the vote. She told the paper that her campaign had received “no support — not even a tweet” from the Labour Party at the British or Welsh levels.

It was the party machine, not the leadership, which declined to put resources into her campaign, she said. “Jeremy [Corbyn] was amazing. He was in touch throughout the campaign and even on polling day itself.”

But Ms Griffiths-Clarke says she did not get a campaign manager from central office and had been told by an official in Welsh Labour, when she asked for help, that the party’s priorities in north Wales did not include Arfon.

“It was like campaigning for a franchise — I had the logo and the excellent manifesto, and that was it. Labour sent no activists to campaign in Bangor even on the day of the vote.” She said she was speaking out as it was important for Labour to not make the same mistake if another election is called.

Of the 262 parliamentary Labour MPs, roughly 60 hold genuine left-wing views, while a similar amount tread the ground between the left and right. The vast majority of the PLP – roughly 140 – however, are right-wing disciples of the Chicago school  who are unprincipled cynical opportunists or, as Tony Benn put it, “weathervanes”. They will only go with the Corbyn programme if it looks good for their money-making prospects. This illustrates the battle Corbyn and his supporters are up against.

Disappointingly, the influential commentator and economist, Paul Mason, was quick to announce on the BBC that Corbyn’s subsequent electoral “success” should be used to broaden his cabinet and policy platform by bringing Blairites like Cooper back into the fold. I have often found Mason’s commentary to be convoluted at best and highly contradictory at worse.

His latest appeal does nothing to alter my suspicion that he is a controlled opposition figure in much the same way Owen Jones is/was. If Corbyn ends up being too accommodating to the Blairites it will only encourage them, resulting in the blunting of Corbyn’s radical message which is the major part of his appeal and the very reason why Labour voters, especially the young, voted for him in such large numbers in the first place.

Keeping young voters on board is particularly important given the fact that the proposed boundary changes that the Tories will be keen to bring in before the next election will benefit them by 18 seats. This will provide the ideal opportunity for Corbyn to force through the compulsory re-submission of candidates to members who are energized by a very different set of priorities to that of the Blairites.

Those motivated primarily by money will disappear by stealth into the ether. But in order for this to happen, Corbyn needs to grab the bull by the horns by cleverly negotiating the tide of optimism sweeping throughout the grass roots of the party. He must, in my view, seize the moment by taking control of the hierarchy of the party that he currently lacks.

The Blairites are currently on the defensive and Corbyn should exploit this situation to the maximum. The worse case scenario is one in which the former wrestle back significant control. By giving the likes of Cooper prominence, will only encourage this eventuality.

The contradiction between Cooper’s deeds and words outlined above, highlight the extent to which the ideological consensus between the New Labour hierarchy and the ruling Tory establishment, is structurally embedded within a dysfunctional system of state power that is no longer fit for purpose. Corbyn’s task in changing this situation around is difficult but not impossible. He should resist all calls to bring ‘heavyweights’ like Cooper back into the fore.

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How the NHS is Being Systematically Destroyed

By Daniel Margrain

Shadow Chancellor John McDonnell (C) joins protesters through central London

Dr Bob Gill who has worked for the NHS for 23 years and is currently seeking crowdfunding for his documentary filmThe Great NHS Heist, recently released a short video presentation where he discusses how the move towards privatizing the NHS has been an agenda-driven project continued over many years by successive Conservative and Labour governments’. Over the course of the twelve minute talk, Dr Gill highlights some of the issues the NHS faces. These are the key assertions he makes in the presentation:

-The intention of successive governments’ has been to transform a publicly-funded free at the point of delivery healthcare system into something that is driven by the need for profit.

-The privatization agenda has been a well-planned long-term project.

-Successive governments’ have understood NHS privatization is not in the public interest and thus they have devised alternative narratives in order to deceive the public.

-A key component of this deception has been the deliberate cultivation of a ‘scapegoating’ culture in which the elderly, immigrants, overweight etc are blamed for government under-investment in the NHS. This lack of investment is portrayed in the media as NHS Trust ‘overspending’.

-The hospital network has been deliberately saddled with toxic loans.

-In legal terms, the 2012 Health and Social Care Act abolished the NHS. The result was the emergence of a Quango headed by NHS England’s Simon Stevens who has the day-to-day power of managing the service.

-In 2014 Steven’s introduced a 5 year ‘Sustainability and Transformation’ Plan (STP). This will move the NHS closer to the private US insurance system through a process of re-structuring, dismantling, integration, means-testing and merging of existing NHS services.

-Both the NHS workforce and the general public are largely unaware of these plans which have been made deliberately complex and drawn-out over many years. This is yet another part of the plan to deceive, not just the general public, but NHS staff also.

-NHS reforms are reported in the media in a positive way. This is despite the fact that the said reforms will result in its destruction.

-The British Medical Association (BMA) is largely complicit in the privatization agenda as illustrated by their capitulation over the junior doctors contract dispute.

-Jeremy Hunt, whose powers are limited, is being used by the media as a distraction.

-Simon Stevens, who has the real power, has been deliberately set-up by the media as a ‘saviour’ for the NHS, whereas Hunt is portrayed as the ‘bad guy’. This is a deliberate media distraction.

-Simon Stevens has one duty and ambition for the NHS and that’s to hand it over to his former colleagues at United Health in the US and the US insurance industry.

-Stevens is “the most dangerous public servant in the country.”

-The NHS is subject to competition law and is under constant threat from internationally negotiated trade deals.

-As a result of the introduction of a process of data gathering, increasingly the NHS is being geared-up to work against the interests of the patient.

-The NHS is heading in a direction in which doctors will be incentivized to deny patient care.

-The introduction of the principle of private insurance will result in a more expensive system with worse outcomes.

-The plan to fully privatize the NHS is “endemically fraudulent”.

Dr Gill alludes to the fact that the deliberate asset-stripping of the NHS ranks as one of the greatest crimes inflicted on the British people. The jewel in Britain’s crown is being whittled away in front of the public’s eyes. All the while the Conservative government has convinced large swaths of the public that Simon Stevens is the saviour of the service when in truth he’s its principal destroyer. Like a TV illusionist, the government is involved in an incredible sleight of hand – some may say, collective hypnosis of the British people.

The Health Secretary, Jeremy Hunt, is the public’s punch bag whose role, in reality, is little more than a public relations figure for the government and corporations they represent. Where the blows of both NHS workers and the public alike would arguably be better targeted is on the chin of the head of NHS England’s, Simon Stevens whose power to be able to shape the future direction of the NHS far exceeds that of Hunt.

Although it’s highly encouraging that an estimated 250,000 people attended the last national demonstration against NHS cuts in London, it is somewhat perplexing to this writer why Corbyn in his otherwise excellent speech, failed to mention the nefarious role played by Stevens which is crucial to the entire NHS debate. How is it possible for activists and campaigners to get anywhere near the bulls eye with their arrows when the correct target hasn’t even been identified by the leader of the opposition?

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The Government’s Deliberate Destruction of Our NHS

By Daniel Margrain

'Humanitarian crisis' in NHS hospitals, warns Red Cross (Getty) Royal Sussex County Hospital, UK (Photo by Universal Images Group via Getty Images)‘Humanitarian crisis’ in NHS hospitals, warns Red Cross (Getty) Royal Sussex County Hospital, UK (Photo by Universal Images Group via Getty Images)

Pictures that emerged last week from the Royal Blackburn hospital that showed mothers and babies being held in corridors for 13 hours and 89 year old Iris Sibley spending more than six months in a hospital bed because a care home place could not be found for her, are the kinds of incidences that are now becoming the norm in the NHS. Figures from the BBC suggest that nine out of 10 hospitals have unsafe numbers on their wards.

Health Secretary Jeremy Hunt’s comment on Friday (February 10) that the treatment of some patients was “completely unacceptable” in response to the worst A&E waiting times on record, was uttered as if he was absolving himself of all responsibility for the chaos. The reason why he gives the impression that he has no intention to do anything about the unfolding crisis enveloping the NHS, is because the chaos is a by-product of government policy.

The government’s objective is to move more healthcare to people’s homes and the community which will involve the merging of NHS and social care budgets that largely have already been privatized. This will lead to contamination and the entry-point for patient charges and co-payments. Given that the overall framework for such a system within the NHS already exists, it’s just a matter of time before such payments and charges are put in place.

Health & Social Care Act

The stated referencing for NHS funding is a deception, as was the assurance in 2010 that there would be no top-down re-organization of the service. The 2012 Health and Social Care Act undermines this assurance since it removes the duty on the Secretary of State for Health to provide a comprehensive health service, while the act requires up to 49 percent of services can be tendered out to any qualified provider”. Already between a quarter and a half of all community services are now run by Virgin Care.

Since the late 1980s during Margaret Thatcher’s third term in office, whole entities within the public sector have increasingly been outsourced, health and social care services privatized and competition and the business ethos introduced into public services. Following the advice of the then chief executive of Sainsbury’s, Sir Roy Griffiths in 1987, the Thatcher government set about removing the foundations upon which the welfare state had been built. One study suggests that “the privatisation of social care services is arguably the most extensive outsourcing of a public service yet undertaken in the UK”. 

The aim is to ensure the domination of the market by a small number of very powerful multinational corporations whose primary concern is not the welfare of the residents in care homes which they own or patients in hospitals, but rather with maximizing profits. In line with Noam Chomsky’s defunding notion, the strategy of successive governments’ over the last three decades has been to shrink the NHS and bring it to the point of collapse as the basis for then claiming the only solution is more privatization.

Britain’s Biggest Enterprise

The retreating from the principle of the universal provision of free at the point of delivery health care, can be pin-pointed to 1988 when Tory politician, Oliver Letwin, wrote a ‘blueprint’ document called ‘Britain’s Biggest Enterprise’ where he set out the stages governments’ would have to go through to achieve a US model of healthcare without the public noticing.

The New Labour government under Tony Blair adopted Letwin’s principles. But prior to the 1997 General Election, Blair had to disguise the strategy by using dissembling language in order to get elected. Once in office, he took several steps towards privatization – for example, breaking up the hospital network into foundation trusts which are essentially separate business entities. He also deliberately saddled hospitals with Private Finance Initiative (PFI) liabilities which involved the government borrowing £11 billion from private banks and financiers in order to justify the sale and breakdown of the NHS further down the line.

This culminated with the New Labour government introducing in 2009 what was termed the “unsustainable provider regime” which is a fake bankruptcy framework to justify closing hospitals. The £11 billion of public money Blair and Brown borrowed from the banks and financiers ostensibly to invest in the NHS through PFI (a sum that has soared to £80 billion which the NHS is duty bound to pay), helps further this eventuality in two ways.

Firstly, financing hospitals through PFI displaces the burden of debt from central government to NHS trusts and with it the responsibility for managing spending controls and planning services, thereby hindering a coherent national strategy. Secondly, the high cost of PFI schemes has presented NHS trusts with an affordability gap. The financing of these legally questionable PFI contracts, which has increased the public’s liability by a massive £69 billion, cannot be examined because they hide behind strict confidentiality rules.

Nevertheless, the Labour party under Jeremy Corbyn appears to be reluctant to raise the issue surrounding the alleged inadmissibility of the contracts despite the high probability that best value and cost effectiveness criteria were unlikely to have been adhered to in this instance.

Simon Stevens

The most powerful and influential individual currently working in the NHS is former Labour councillor, Simon Stevens, chief executive of NHS England. After having served under the Blair government, Stevens went on to work for the US private health care provider, United Health, where he campaigned against Obama Care. Stevens then argued for the Transatlantic Trade and Investment Partnership (TTIP) to be included within the UK health care remit. Those encouraged by the election of Jeremy Corbyn (myself included) are still waiting to hear something from the shadow health team about this troubling development.

The latest controversy to have emerged from NHS England led by Stevens is the proposed introduction of its ‘Sustainability and Transformation Plans’ which forms part of the annual 2016-17 HHS Planning Guidance. “Sustainability and transformation” is Orwellian-speak for the move towards the total reorganization of the NHS predicated on more privatizations and cuts. As Mike Sivier puts it:

“We’re told the project is about ‘strengthening local relationships’ and building on ‘local energy and enthusiasm’ to achieve ‘genuine and sustainable transformation in patient experience and health outcomes’. But in fact, the Guidance contains some very specific requirements that will test these new collaborations to the limits and usher in a new wave of privatisations and huge cuts.”

Last January, activist Dr Bob Gill from the Save Our NHS Campaign attended a meeting to get some insight into what the position of the Shadow Secretary of State for Health, Heidi Alexander, was in relation to the direction NHS England was moving in under Stevens. What he heard were narratives that fitted into the ongoing privatization agenda. According to Gill, Alexander expressed support for Simon Stevens, despite his appalling track record.

Concerning

This is deeply concerning for people who see in Corbyn somebody who might be willing to take a man who appears less committed to ethics and patient care than to ensuring medicine is a profit-based ‘conveyor belt’ service, to task. Unfortunately, there is no indication that he is the man who intends to do it. On the contrary, the narrative of the shadow health team appears to be one of support for both Simon Stevens and the existing regime of privatization that he is overseeing.

A year down the line since Dr Bob Gill’s revelation and with no action taken by Corbyn against Stevens, it’s now a matter of urgency that activists exert political pressure on Corbyn’s team to address the rightward direction Stevens, in conjunction with the Tories, is taking the NHS. Prior to the last election, David Cameron promised to “protect the NHS budget and continue to invest more.” This promise has been broken. According to the Nuffield Trust, “government spending on the English NHS is falling as a share of UK GDP – from 6.5 per cent of GDP at the end of the last decade to 6.2 per cent in 2015-16.”

Research by the Kings Fund indicates that the UK is ranked 13th out of 15 original EU members. In Orwellian fashion, health under-funding is portrayed in the media as “unprecedented levels of overspending by hospitals and NHS trusts.”Under-funding has inevitably impacted on staffing levels. The shortage of nurses within the NHS has reached dangerous levels in 90 per cent of UK hospitals, and the amount of doctors per capita is the second lowest among eleven European countries.

Overall, on six out of nine measures of varying sorts – five year survival rates for breast cancer; the same for prostate cancer; the number per capita of MRI scanners, CT scanners, angioplasty operations, hip replacements and knee replacements; waiting times to see a specialist and the OECD assessment of outcomes compared to money spent – Britain did worse than any other advanced country in the world. Under both Stevens and the Tories every aspect of the NHS is under attack.

At the time of writing, Virgin Care is in control of well in excess of 200 contracts across the UK while administration for the new NHS market alone, costs tax payers £1 in every £10 the NHS spends (4.5 billion). The carving open of the service for exploitation by private interests is proceeding at a pace and the government shows no indication of wanting to reverse the process. This is hardly surprising given that 70 MPs have financial links to private healthcare firms while hundreds of private healthcare corporations have donated to Tory coffers.

The erosion of the principle of a free at the point of delivery service also undermines what Sir Michael Marmont refers to  as “the optimal allocation of resources.” This, in part, explains why a country like the United States where the marketization of its health care system is long established, is ranked 44th in the world in 2014 in terms of efficiency compared to 10th for the UK. Given these figures, one might reasonably ask why the government appears to be insistent on dismantling something that, despite its faults, essentially works, and then restructuring it in the image of a system that doesn’t?

The US model we are moving towards

During his recent trip to America following Trump’s inauguration, it is likely that UK Health Secretary, Jeremy Hunt, took the opportunity to discuss with US financiers further moves to carve up the NHS in order to bring it closer to the US insurance-based model. The requirement of the US Affordable Care Act (which was signed into law in March 2010 but is actually unaffordable for large swaths of the US population), is that people are forced to buy private health care insurance if they fail to qualify for public health programmes, namely Medicare and Medicaid. However, the insurers have created plans that restrict the number of doctors in hospitals.

These “ultra narrow networks” have resulted in the reduction of at least 70 per cent of health facilities within communities throughout the US, thereby restricting access to care for people with serious health problems. This means that increasingly Americans are paying higher premiums but are not getting sufficient access to services they need. They are, therefore, having to find the money upfront, largely because their insurance policies do not provide adequate cover for their injuries or illnesses.

So America is still seeing high rates of people who are either delaying, avoiding getting access to the care they need, or are being confronted with medical debts. Research shows that tax-funded expenditures account for 64.3 percent of US health spending, with public spending exceeding total spending in most countries with universal care. Yet, 33 million people in the US do not have access to health insurance cover.

When Obama came into office in January 2009 there were approximately 15 per cent of American’s who had been uninsured for at least a year which meant that unless they had access to a significant amount of money, they could not go to a doctor when they or their children fell ill. During this period, surveys showed that two-thirds of all Americans favoured a single payer health plan (ie a publicly financed system of universal health care provision free at the point of delivery for all, similar to the NHS) but Obama rejected it outright. This was despite the fact that war veterans and senior citizens have a variation of publicly/privately delivered and funded arrangements already in place within the existing system.

These limited single payer systems have also proven to be cost effective with good outcomes. In addition, Obama was riding high on a wave of popular support following his election victory. Not only did the Democrats control the White House and Senate but they also commanded a majority in the House of Representatives. It would appear that the $20 million Obama received from private health care companies during his election campaign helped sway his decision not to introduce the single payer system across the board despite the fact that nearly 80 per cent of Democrat voters support the introduction of such a system.

Obama, in other words, had the democratic mandate to introduce the extremely popular single payer system universally but instead he turned his back on the people who elected him into power. The conflicting interests that American presidents like Obama face relates to the close relationship they have to members of Congress who need to get reelected. If Congress speak out against the interests who are funding their campaigns, they’re not going to get that funding. Commenting on a report from the National Journal, Ashlie Rodriguez wrote:

“Health care interests have given $46.6 million in campaign donations since 2005 to [the] 21 lawmakers” at the bipartisan healthcare summit, including Senator Max Baucus, Senate Minority Leader Mitch McConnell, House Minority Whip Eric Cantor, and to the summit’s host, President Obama.”

And Citizens for Responsibility and Ethics in Washington found that:

“health professionals, political action committees, hospitals and nursing homes, pharmaceutical and health product companies, health services firms, HMOs and accident insurers have given heavily to all summit attendees.”

Dysfunctional

Tiny efforts to try and patch together what is clearly a dysfunctional system is further undermined in as much as that patchwork involves another obvious paradox. This is highlighted by the origin of the Obama Care Plan which has its roots in the Heritage Foundation, a conservative Think Tank, which came up with the model of forcing people to buy private insurance and to use public tax dollars to subsidize the purchase of this insurance. In other words, as a result of a process of publicly funded corporate welfare, billions of funds are shifted into the hands of private insurance companies.

Nevertheless, this was passed into law in Massachusetts under governor Mitt Romney who was Obama’s Republican opponent in the race for the White House. Almost exactly the same plan was passed by Obama at the national level. This led to the insane situation in which the Democrats were essentially championing a Republican plan in which the latter subsequently distanced themselves from. Instead, the Republican policy under Trump is for everybody to pay privately with no public provision and no safety net of any kind in place.

America’s health care costs are the highest per capita of any country in the world with some of the worst outcomes. Attempts to reform the US system are undermined by the insurance companies whose only function is to be middlemen between the patients and the health professionals.The U.S government’s treatment of health care as a commodity instead of a public good is out of sync with the rest of the developed world and illustrates the extent to which, more broadly, the giant corporations have usurped democracy in the United States.

As things currently stand, the US is the only industrialized nation on the planet that has used a market-based model for healthcare. Alarmingly, whether people want to admit it or not, this is the direction of travel both the Tories and NHS England under Simon Stevens are taking the system of UK healthcare provision. In other words, we are heading for a potential nightmare.

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Killing them softly

By Daniel Margrain

The 30 minute documentary film Killing Us Softly (1979) based on a lecture by Jean Kilbourne focuses on the effects of advertising on women’s self-image and the objectification of women’s bodies. Kilbourne argues that the superficial, objectifying and unreal portrayal of women in advertising lowers women’s self-esteem and that sexualized images of women are being used to sell virtually all kinds of goods.

Kilbourne then goes on to posit that these images degrade women, encourage abuse, and reinforce a patriarchal and sexist society. She also makes the connection between advertising and pornography, stating that “the advertisers are America’s real pornographers”.

Below is a video of Jean Kilbourne almost four decades later discussing her ideas as part of a campaign to bring her film to a new audience of young people. Significantly, she says since her film’s initial release in 1979 things have got worse, not better.

Thirty-six years after the release of Killing Us Softly, Channel 4 News reported on the inquest of 21 year old bulimia sufferer Eloise Perry who on the April 12 last year died at the Royal Shrewsbury Hospital one week after having swallowed eight unlicensed fat-burning pills that she purchased from the internet.

The pills, which the Food Standards Agency describe as being illegal to sell for human consumption, contained DNP which is an industrial chemical historically used in the manufacture of explosives and fungicides. Website companies who sell this chemical depict DNP as a fat burning product and some even use the tag line “getting leaner through chemistry” as a marketing tool.

No sooner had the UK authorities made attempts to close down these sites, they reappeared under different names and hence it’s clearly a battle that they are losing. The fact that informed young people like Ms Parry who are aware of the risks, are so desperate to lose weight that they are prepared to go to such extreme lengths raises wider questions about the nature of the kind of society we live in.

The social pressures for young women (and increasingly young men) to conform to certain expectations placed upon them by the media are immense. The upshot is that they are involved in a constant psychological battle between myth and reality. In Britain, for example, the average size of a woman is now 16 but the ‘aspirational’ size is zero – an unobtainable goal.

The contradiction between reality and aspiration is undermining many of the gains that women made in the feminist debates of the 1960s and 1970s. What Ariel Levi terms “raunch culture” is another symptom of the undermining of the gains made.

A tour by High Street Honey’s that involves women employed by lads mags touring the various university campuses throughout the country dressed as porn stars, is yet another social layer as part of the pressure for young women to conform to certain body-image stereotypes placed upon them.

The notion that pole dancing which is sold as exercise classes at some universities and widely regarded as being empowering for women in terms of getting them in touch with their inner sexuality, is in reality, setting back women’s rights decades. Activities like this inhibit the way women (and increasingly men) feel about their bodies and therefore they cannot be disentangled from the tragic case of Ms Parry.

The normalization of sexist imagery in pop videos and television commercials and the sexualization of young girls clothes is another illustration of raunch culture outlined by Levi in which fantasies, desires and ambitions are transformed into commodities to make money.

The growth in cosmetic surgery is another factor that increases expectations on women’s appearances. Ninety-one per cent of cosmetic surgery is undertaken on women of which the most popular is breast enhancement. I was astounded to learn that in the U.S it’s widely considered normal practice for girls to be given a breast enlargement as a graduation present.

It’s a fact that a growing number of girls who suffer low self-esteem perpetuated by a media system that constantly portrays an ‘ideal’ body shape is a tendency that’s less common in the developing world.

This would seem to suggest that mental illness, of which eating disorders are a reflection, is to a large extent symptomatic of the growth of the consumerist capitalist society in which human relations are objectified. In Marxist terms, objectification is the process by which human capacities are transferred to an object and embodied in it.

Young females who read fashion magazines tend to have more bulimic symptoms than those females who do not – further demonstrating the impact the media has on the likelihood of developing the disorder. As J. Kevin Thompson and Eric Stice have shown, individuals first accept and ‘buy into’ the ideals set by fashion magazines, and then attempt to transform themselves in order to reflect the societal ideals of attractiveness.

The thin fashion model ideal is then reinforced by the wider media reflecting unrealistic female body shapes leading to high levels of discomfort among large swaths of the female population and the drive towards thinness that this implies.

Consequently, body dissatisfaction coupled with a drive for thinness is thought to promote dieting and its negative affects, which could eventually lead to bulimic symptoms such as purging or binging. Binges lead to self-disgust which causes purging to prevent weight gain.

Thompson’s and Stice’s research  highlights the extent to which the media affect what they term the “thin ideal internalization”. The researchers used randomized experiments (more specifically programmes) dedicated to teaching young women how to be more critical when it comes to media, in order to reduce thin ideal internalization. The results showed that by creating more awareness of the media’s control of the societal ideal of attractiveness, the thin ideal internalization significantly dropped.

In other words, less thin ideal images portrayed by the media resulted in less thin ideal internalization. Therefore, Thompson and Stice concluded that there is a direct correlation between the media portrayal of women and how they feel about themselves.

Social media also plays a part in how young people feel about themselves. A recent two part study [1] looking at social media sites, such as Facebook, researched influence and risk for eating disorders. In the first part of the study, 960 women completed self-report surveys regarding Facebook use and disordered eating. In the second part of the study, 84 women were randomly assigned to use Facebook or to use an alternate internet site for 20 minutes.

What this cross-sectional survey illustrates is that more frequent Facebook use is associated with greater disordered eating. The survey indicates a close correlation between Facebook use and the maintenance of weight/shape concerns and state anxiety compared to an alternate internet activity [1]. Other research suggests an etiological link between eating disorders and the tendency towards self-harming [now referred to as Non Suicidal Self Injury (NSSI)] [2].

In terms of prevalence, over 1.6 million people in the UK are estimated to be directly affected by eating disorders. However, the Department of Health estimate that the figure is more likely to be 4 million due to the huge level of unmet need in the community [3].

Recent studies suggest that as many as 8 per cent of women have bulimia at some stage in their life. The condition can occur at any age, but mainly affects women aged between 16 and 40 (on average, it starts around the age of 18 or 19). Reports estimate that up to a quarter of Britons struggling with eating disorders may be male [4].

 

References

1.Mabe AG, Forney KJ, Keel PK. Int J Eat Disord. 2014 Jul;47(5):516-23 Do you “like” my photo?  

2.Colleen M. Jacobson and Cynthia C. Luik, Epidemiology and Sociocultural Aspects of Non-suicidal Self-Injury and Eating Disorders 2014

3. Joint Commissioning Panel For Mental Health (www.jcpmh.info/wp-content/uploads/10keymsgs-eatingdisorders.pdf)

4. http://www.nhs.uk/Conditions/Bulimia/Pages/Introduction.aspx