Tag: 2012 health and social care act

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?

If you’ve enjoyed reading this or another posting, please consider making a donation, no matter how small. I don’t make any money from my work, and I’m not funded. You can help continue my research and write independently.… Thanks!


Donate Button with Credit Cards

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.

COPYRIGHT

All original material created for this site is ©Daniel Margrain. Posts may be shared, provided full attribution is given to Daniel Margrain and Road To Somewhere Else along with a link back to this site. Using any of my writing for a commercial purpose is not permitted without my express permission. Excerpts and links, including paraphrasing, may be used, provided that full and clear credit is given to Daniel Margrain and Road To Somewhere Else with appropriate and specific direction to the original content. Unless otherwise credited, all content is the site author’s. The right of Daniel Margrain to be identified as the author of this work has been asserted by him in accordance with the Copyright, Designs and Patents Act 1988.

Make a small donation

If you’ve enjoyed reading this or another posting, please consider making a donation, no matter how small. I don’t make any money from my work, and I’m not funded. You can help continue my research and write independently.… Thanks!


Donate Button with Credit Cards

‘No one is left to speak for me.’

By Daniel Margrain

The systematic redistribution of wealth from the poorest to the richest which began under Thatcher, continued under Blair and currently is increasing at a pace under Cameron, is emblematic of the relationship between welfare state retrenchment and the notion of the role of the state as facilitator of welfare handouts to the corporate sector.

Farm subsidies, public sector asset stripping, corporate tax avoidance and evasion, government share giveaways and housing benefit subsidies are just some of the ways in which the richest 1,000 people in Britain have seen their wealth increase by a massive £155bn since the economic crisis of 2008.

Meanwhile, in June this year, the UK government announced £12 billion of welfare cuts that included the abolition of working tax credits to the poorest and the top down reorganisation of the NHS brought about by the 2012 Health and Social Care Act which removes the duty of the Secretary of State for Health to provide a comprehensive service. The act requires up to 49 percent of services to be tendered out to “any qualified provider” . This will rapidly lead to the privatisation of the NHS in England and Wales.

The punitive attacks on the unemployed, sick and disabled have been stepped up resulting in 500,000 people using food banks in addition to increasing rates of depression, anxiety and incidences of suicides among those on benefits. In social care, a combination of cuts of around 30 percent to local authority budgets since 2010, increasingly restrictive eligibility criteria for services, and inadequate personal budgets will leave millions without the support they need.

Finally, the reduction in housing benefit to the unemployed allied to the bedroom tax is a double whammy that has resulted in growing rates of homelessness and/or the social cleansing and displacement of entire communities, many of them long established.

What are these attacks on the welfare state about? The government have long argued that they are needed in order to reduce the budget deficit. But on the very same day that the bedroom tax was announced in parliament (estimated to “save” the Treasury £480 million) the top rate of tax in the UK was cut from 50 percent to 45 percent, resulting in a loss of revenue of £1 billion.

The only rational explanation is that “austerity” is being used by the Tory government as a pro-corporate ideological weapon against both the welfare state as a concept and the general population who, in one way or another, rely on it in some shape or form. Those affected are not just the poor and traditional blue collar workers but also the lower ranks of the middle classes highlighted by the fact that the cuts are now beginning to have political repercussions within David Cameron’s own Oxfordshire constituency.

An obvious example of how Tory cuts are beginning to impact on the community at large, is in the field of social care for the elderly. In an increasingly aging society, the pressure on the social care system will become more acute as demand for its services increase. But a service motivated by profit is necessarily compromised in terms of its ability to provide a universal service of care predicated on need.

Another example, are the government’s proposals to cut the police budget by 40 per cent with the predicted loss of some 22,000 front line police officers to be replaced by private security firms. These firms will be drafted in by communities in suburbs and villages to fill the gap in neighbourhood policing left by the budget cuts. In an Essex seaside town, more than 300 residents have effectively been forced to club together to pay for overnight private security patrols.

The implications of the drive towards a privatized police force motivated primarily by profit are clear. The tendency would be for any crime not committed on the patch where customers pay privately for their service to be ignored or underplayed. The potential for the creation of protection rackets and vigilantism exists in situations where people who are not in a position to be able to afford for protection live near to people who can.

Justine Greening’s Kafkaesque contention on last Thursdays (November 5) Question Time programme that the reduction in policing in areas where crime is falling, justifies cuts to those areas, illustrates further the political undermining of the concept of universal provision. It’s my view that outsourcing is part of the Tory strategy to run down public services as the precursor to their dismantling prior to them being sold off. In fact, as Noam Chomsky put it, this process is standard practice:

“[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.”  

What underlies the privatization strategy are the various vested interests involved. For instance, the husband of the woman responsible for cutting police budgets – Home Secretary Theresa May – is a major shareholder in G4S. Moreover, 70 MPs have financial links to private healthcare firms, and more than one in four Conservative peers – 62 out of the total of 216 – and many other members of the House of Lords “have a direct financial interest in the radical re-shaping of the NHS in England.” 

For the Tory government, the ideological crux of the matter is that profit maximization for the corporations they represent is regarded as taking priority over the concept of a properly functioning and accountable welfare state and public sector. Profit has become the guiding principle for the organisation of society from which everything is judged including perceptions of success and happiness.

This is reinforced daily on television programmes and in the lifestyle sections of magazines and newspapers. Moreover, power that profit implies, is linked to the concept of biological determinism in that it tries to convince us that the social order is a consequence of unchanging human biology, so that inequality and injustice cannot be eliminated.

Any rejection of this model is regarded by the apologists for the system as being the fault of the individual and not the social institutions or the way society is structured. The solution is thus to change – or even eliminate – the individuals, not to challenge the existing social structures.

It’s the current form of social organisation that biological determinism reinforces which ensures the David Cameron’s of this world secure their place at the top of the food chain. It also highlights to the rest of us the artificial limits that the system driven by profit imposes.