Category: NHS privatization

The systematic destruction of the NHS

By Daniel Margrain

Dr Bob Gill who has worked for the NHS for 24 years, and is currently seeking crowdfunding for his documentary filmThe Great NHS Heist, was interviewed as part of a short video presentation produced by the UK journalist co-operative, Real Media.

In the interview, Dr Gill 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 23 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 five year ‘Sustainability and Transformation’ Plan (STP).
  • The STP 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 drawn-out complexity is yet another part of the plan to deceive the general public and NHS staff alike.
  • NHS reforms are reported in the media in a positive way. This is despite the fact that the said reforms will result in the destruction of the service.
  • The British Medical Association (BMA) is largely complicit in the privatization agenda.
  • 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’.
  • Simon Stevens ambition for the NHS is to hand it over to his former colleagues at United Health in the U.S and the U.S 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.
  • The service is 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 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 is 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 essentially a public relations figure for the government and the corporations it represents. Where the blows of both NHS workers and the public alike would arguably be better targeted is towards NHS England boss, 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 one of the biggest national demonstrations against NHS cuts in London in March last year, it is somewhat perplexing to this writer why Labour’s Jeremy Corbyn in his otherwise excellent post-demo 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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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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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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Why Owen Smith is a Red-Tory

By Daniel Margrain

Last week a prominent independent journalist claimed on Twitter that my assertion Owen Smith was effectively a Tory was “intellectually lazy”. Coincidentally, a few days later on Thursday’s (September 8) edition of BBC’s Question Time during the Labour party leadership debate between challenger Owen Smith and incumbent Jeremy Corbyn, a studio audience member and Corbyn supporter accused Smith of “being in the wrong party”.

Smith responded angrily to this suggestion by denying this was the case and asserted that the claim amounted to a term of abuse. Smith’s view was supported the next day (September 9) on Twitter by Smith supporter, John McTernan who said that such a suggestion was “ludicrous”. Of course, nobody is claiming that Smith, in the literal sense, is a Tory, but his voting record in the House of Commons and his commercial activities outside it, would indicate that he might as well be.

So let’s take a look at his record. Since at least July, the public relations professional, Smith, has pitched himself as a ‘soft-left’ anti-austerity alternative to Corbyn. This implies that Smith is first and foremost concerned with image and branding as opposed to adopting a principled political and ideological position.

The ‘soft-left’ Smith had previously given interviews supporting PFI and, as chief lobbyist for the U.S multinational Pfizer, he actively pushed for the privatization of NHS services. Commenting on a Pfizer funded ‘focus group’ study as part of a press release, Smith referenced and promoted the notion that the precondition for greater availability of healthcare services was the ability of the public to be able to pay for them. This is one of the significant passages from a section of the study that Smith was keen to promote:

“The focus groups… explored areas of choice that do not yet exist in the UK – most specifically the use of direct payments and the ability to choose to go directly to a specialist without first having to see the GP.”

In other words, Smith favours direct payments from the public to doctors as a replacement for current NHS services. This policy strategy is consistent with the 1988 Tory ‘self-funding’ privatization blueprint for the NHS drawn up by Oliver Letwin and John Redwood. In the document ‘Britain’s Biggest Enterprise: ideas for radical reform of the NHS’, Letwin and Redwood suggest that the aim of charging is to “replace comprehensive universal tax funding for the NHS.”

Smith’s conflation of greater choice with an ability to pay, represents one more stage in the execution of Letwin and Redwood’s plans. The implementation of these plans were accelerated by Blair and Brown as documented by Leys and Player in their book The Plot Against the NHS. Smith intends to continue where Brown and Blair – then Lansley and now Hunt – left off as part of the final stages of the wholesale Letwin-Redwood privatization blueprint of which the 2012 Health & Social Care Act  is a major component part.

Since the 2015 general election, the Tory government have explicitly admitted that the NHS should be modelled on US-style “accountable or integrated healthcare” which is where Smith’s connections to Pfizer come in. In addition to his Policy and Government Relations role for the giant US corporation, Smith was also directly involved in Pfizer’s funding of Blairite right-wing entryist group Progress. Pfizer gave Progress £52,287 while the latter has actively pursued the agenda of PFI and the privatisation of NHS services.

So while Smith’s image is largely predicated on his attempt to convince the Labour membership that in policy terms he publicly supports Corbyn’s position that the NHS should remain a universally free at the point of delivery service, in reality nothing could be further from the truth.

Smith also supported Blair’s city academies that have continued under the Tories as well as assiduously courting the arms industry of which his support of Trident is a reflection. Arguably, most important of all, is that Smith effectively lined up with the Tories, alongside another 183 Labour MPs in July last year by refusing to vote against the Conservative governments regressive and reactionary policy of welfare cuts to some of the most vulnerable people in society.

In an Orwellian rejection of socialist values, Blairite Iraq war apologist and establishment gatekeeper, John Rentoul, affirmed his support for the policies of Owen Smith on Twitter:

As the graphic above shows, and as Craig Murray correctly posits:

“There is no evidence whatsoever that Smith is a left winger. There is every evidence that he is another New Labour unprincipled and immoral careerist, adopting a left wing pose that he thinks will win him votes.”

The graphic below highlights the hypocrisy of Smith and, by extension, his total contempt for ordinary Labour party members.

 

 

Smith’s acquiescence to corporate power is indicative of a wider democratic deficit within the liberal democracies of the West in an era of globalization more generally. But his close relationship to the PLP and the Tory-Labour establishment consensus that they represent, reflects a relatively recent historical pattern in which governments of both the left and the right have prioritized the interests associated with private capital over and above that of labour.

Thus the first serious attacks on the welfare state in Britain came not in 2008, or even with the election of Margaret Thatcher in 1979, but several years previously, with that of a Labour government in 1974. Contrary to popular belief, dismantling the welfare state was not a key priority for Thatcher following her election in 1979. It was not until her third term of office in 1987 that Thatcher and her advisers (notably the Sainsbury’s chief executive Sir Roy Griffiths) began to develop the neoliberal ideas of the Chicago School.

These ideas were subsequently picked up and developed by New Labour under Tony Blair following his election victory in 1997. It was during this point that the introduction of competition into public services, ideas about the state as purchaser of public services and the outsourcing and privatization of health and social care services, became the norm.

The privatization of the NHS, made possible by the 2012 Health and Social Care Act, arguably poses the most immediate threat to the welfare state in the UK in its totality in which the outsourcing of services becomes the default position. The functioning of a welfare state that increasingly serves the minority interests of capital at the expense of fulfilling the needs of the majority of the population, is a process driven by a neoliberal-driven ideological consensus rather than any pragmatic attempts at ameliorating deficits and the encouragement of socioeconomic and environmental sustainability.

It’s the continued satisfying of minority elite interests rather than the wider public good that Owen Smith and the establishment – of which he is a part – are embedded. That’s fundamentally the reason why there is nothing that separates Owen Smith from the neoliberalism of Blair, Brown, Miliband, Major, Thatcher and May.

Whether one agrees with Jeremy Corbyn’s politics or not, he at least offers a genuine alternative to the consensus view that Smith represents. Even the right-wing commentator, Peter Hitchens, recognizes that the emergence of Corbyn is important to the adversarial nature of political discourse and, by extension, to democracy itself. If the UK was a healthy democracy instead of an effective corporate-political-media oligarchy, this development would be welcomed. Instead, Corbyn is demonized and smeared at almost every opportunity.

 

Why Tories & Blairites are an affront to democracy

By Daniel Margrain

In 1978, the Australian social scientist, Alex Carey, pointed out that the twentieth century has been characterized by three developments of great political importance: “the growth of democracy; the growth of corporate power; and the growth of corporate propaganda as a means of protecting corporate power against democracy.”

The corporations that now dominate much of the domestic and global economies recognize the need to manipulate the public through media propaganda by manufacturing their consent. This is largely achieved as a result of coordinated mass campaigns that combine sophisticated public relations techniques developed in 20th Century America with revitalized free market ideology that originated in 18th Century Europe.

The result is the media underplay, or even ignore, the economic and ideological motivations that drive the social policy decisions and strategies of governments’. According to Sharon Beder:

“The purpose of this propaganda onslaught has been to persuade a majority of people that it is in their interests to eschew their own power as workers and citizens, and forego their democratic right to restrain and regulate business activity. As a result the political agenda is now largely confined to policies aimed at furthering business interests.”

The under resourcing and under funding of large swaths of the public sector is part of the Tory strategy to run down public services as the precursor to their dismantling prior to them being sold off, precisely with the aim of furthering the business interests of those involved. In fact, as Noam Chomsky put it, the defunding process is standard practice within Western liberal democracies:

“[T]here is a standard technique of privatization, namely defund what you want to privatize. Like when Thatcher wanted to defund the railroads, first thing to do is defund them, then they don’t work and people get angry and they want a change. That’s the standard technique of privatization: defund, make sure things don’t work, people get angry, you hand it over to private capital.”

A century or so ago, the Russian Marxist Nicolai Bukharin realized that the growth of international corporations and their close association with national states were 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, privatisation, 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.

Tied into this ethos is the move to dismantle the welfare state completely, which contrary to popular belief, was not a key priority for Thatcher following her election in 1979. It was not until her third term of office in 1987 that her advisers (notably the Sainsbury’s chief executive Sir Roy Griffiths) began to develop the ideas which were to be picked up and developed by New Labour under Tony Blair. Dressed in the language of ‘public-private partnerships’, the state under Blair was envisaged as the purchaser rather than direct provider of services.

To enable this to happen, whole entities within the public sector were 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; and the recasting of patients and clients as customers.

It would be foolish to understate the changes that more than two decades of neoliberalism have wrought on the welfare state. Areas such as residential care are now overwhelmingly located in the private sector, with one study suggesting that “the privatisation of social care services is arguably the most extensive outsourcing of a public service yet undertaken in the UK”.

The outsourcing process emanates from the policy of defunding which consequently is leading to a crisis in social care resulting, in part, to a shortage of nurses within the NHS that have reached dangerous levels in 90 per cent of UK hospitals. The aim is to expand the ethos of competition into residential social care and to ensure the domination of the market by a small number of very powerful multinational corporations (including, for example, the Royal Bank of Scotland and the Qatar Investment Fund). The primary concern of these corporations is not the welfare of the residents in the homes which they own but rather with maximizing their profits.

When they fail to do so sufficiently or where there are larger profits to be made elsewhere, then they will simply pull out, creating massive instability in the sector and undermining the continuity of care which is a key element of good quality social provision. The collapse in 2011 of Southern Cross, until then the largest provider of residential care for older people in the UK, is the most glaring example.

Under the Tory government of David Cameron, every aspect of the welfare state is under attack. The 2012 Health and Social Care Act removes the duty on the Secretary of State for Health to provide a comprehensive health service, while the requirement in the act that up to 49 percent of services can be tendered out to “any qualified provider” will rapidly lead to the privatisation of the NHS in England and Wales. Already between a quarter and a half of all community services are now run by Virgin Care.

A combination of cuts of around 30 per cent to local authority  social care budgets since 2010, increasingly restrictive eligibility criteria for services, and inadequate personal budgets, will leave millions without the support they need and increasingly dependent on the family, and in particular women family members.

And in place of what was once called social security, unprecedented cuts across all areas of benefits, especially disability benefits, the introduction of sanctions regimes which as Christmas fast approaches has, according to figures from the Russell Trust, contributed to over a million people being given emergency food and support in 2014-15.

Meanwhile, a bedroom tax affecting around 600,000 people will increase the number of children in poverty by 200,000 as well as harming their learning amid stress and hunger. It has recently been reported that a DWP study indicates that nearly half of those affected by the tax have gone without food so that they can make ends meet.

What drives the different rationales—economic, political and ideological—behind the current Tory government’s assault on the public sector, is the desire of the one per cent to shift the costs of a global economic crisis onto the 99 per cent. One important political consequence of this socioeconomic realignment in favour of those at the top of the pyramid is the shifting of the relationship between the state and multinational capital.

This has heightened the sense of popular alienation from the huge bureaucratic structures that dominate the lives of ordinary people which has magnified by the sheer scale of the institutions – state and private – that confront the mass of the population. Consequently, public confidence in big business and the civil service has declined dramatically, particularly since the 1997 election of Blair.

The appalling treatment meted out by Facebook to the family of Hollie Gazzard, is an example of how there seems to be no way to successfully complain or protest against these kinds of mammoth institutions and corporations. Changes supposed to make them more accountable to the public, in practice only make them more subject to central control. Far from increasing public trust, they often have the opposite effect.