Tag: virgin care

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 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.

Price of everything, value of nothing.

By Daniel Margrain

Ever since the Red-Tory government of Tony Blair stepped up the Thatcherite ethos of the British state as purchaser rather than direct provider of services, the outsourcing of these services has continued apace. This neoliberal ideology has, in turn, increased the proletarianization of not just traditional blue collar roles but white collar middle class professions as well.

The intensification of work and the insecurity of working life, short-term and part-time contracts, flexible shift patterns, mushrooming ranks of middle managers and supervisory staff, constant testing and assessments, punitive disciplinary codes, long working hours, short holidays and relentless ‘downsizing’ have materially and dramatically worsened the experience of going to work for many people.

Whereas forty years ago working as teacher or health professional was widely regarded as a stimulating and well paid job that offered a great deal of autonomy, they are now roles that provide a diminishing social and economic status in which the workers concerned have little or no control in their day to day activities.

As the experience of work has become increasingly harsh and coarse for the vast majority, life for the minority of the ruling class and upper ranks of the middle class has taken a completely different trajectory. Just as we entered the 21st century, government figures revealed that Britain’s biggest earners were enjoying their largest share of national income since the Thatcher years.

Within the space of about ten years, the multiple of chief executive pay to average pay for FTSE companies, has moved from 69 times, to 149 times. And that’s just a comparison with average pay, not those paid at the very bottom of the scale which also does not reflect company performance. The New Economics Foundation (NEF) has argued that unless the pay discrepancies are tackled, “by 2030 the UK will have returned to Victorian levels of inequality.”

With Victorian levels of inequality comes a Victorian paternalistic ideology that dominates the governing classes in which the ‘socially excluded’ must be helped to help themselves. Those who refuse to ‘modernise’ must be swept aside. But the maligned are not just the poorest but increasingly extend to enemies of ‘reform’ among the less well off sections of the middle classes.

These are the kinds of people who cannot rely wholly or mainly on private provision for such essentials as health care, pensions, education, care of the environment and transport. They too depend on the welfare state. The scientific work measurement practices of Taylorism traditionally associated with blue collar occupations are becoming a feature of white collar jobs too.

Although some heads of department and heads in schools, lecturers, middle ranking civil servants, managers in local councils and health professionals regret the passing of the public sector ethos even as they preside over its destruction, others like Dr Rob Galloway are beginning to make a political stand against the top down reorganization of the National Health Service (NHS) and the kinds of changes to working conditions that Taylorism implies.

This feeds into the attitudes of the wider public who recognize the connection between the deteriorating working conditions of health professionals, the downward spiral of the NHS in general (both of which are politically and ideologically driven) and their own working conditions and experiences.

The deliberate running down of the NHS is predicated on its eventual privatization related to the fact that 70 MPs have financial links to private healthcare firms. The carving open of the NHS for exploitation by private interests undermines the longstanding obligation of the UK government to provide universal health care free at the point of delivery. The creeping implementation of the former will ensure the ditching of the latter.

On March 20, 2012, MPs passed the Health and Social Care Bill despite the fact that it was not mentioned anywhere in the 2010 Conservative election manifesto, or that nearly every professional medical body fought against it. It was clear that the reason why the Tories were silent on the issue was because to highlight it would have been electoral suicide.

The coalition agreement between the Tories and the Lib Dems of May 2010 had promised: “We will stop the top-down reorganisation of the NHS.” That promise has been well and truly smashed. The NHS bill was opposed by 27 professional medical bodies, including the Royal College of GPs, the BMA and the Royal College of Nurses: that’s all but one of the relevant medical bodies.

Researcher Éoin Clarke has produced a map of England showing the areas affected so far by the NHS carve-up. One of the major corporate players is Virgin Care who won a £500 million contract to provide community services across Surrey and began running these services, as well as the county’s prison healthcare. Hundreds of donations from private healthcare firms to Tory coffers can be viewed here.

Moreover, the website Social Investigations has compiled an extensive list of the financial and vested interests of MPs and Lords in private healthcare. This list, says the site, “represents the dire state of our democracy”. Andrew Robertson, the blog’s founder observes that 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.” 

These unelected peers – with personal interests in insurance companies, private healthcare and private equity groups – were able to help push through a bill from which they will now profit. If they had been elected local councillors, such personal interests would have debarred them from voting. The Tory top down reorganization of the service while spun as a necessary precondition for its survival as a free at the point of delivery service, is in reality the precursor to its demise.

The Tories’ privatization objectives will be made smoother following the introduction of the proposed Transatlantic Trade and Investment Partnership (TTIP) agreement, the purpose of which, if finalized, will be to grant big business the right to sue governments which try to defend their citizens. It would allow a secret panel of corporate lawyers to overrule the will of parliament and destroy our legal protections.

The mechanism through which this is achieved is known as investor-state dispute settlement. It’s already being used in many parts of the world to kill regulations protecting people and the living planet. It could also be used to smash any attempt to re-regulate the banks, to renationalize the railways, to leave fossil fuels in the ground and to save the NHS from the kind of corporate control envisaged by the Tories.

Just as the government attempted to hide from the public their intentions for the NHS prior to the 2010 general election and then subsequently spin their way out of the reality faced by junior NHS doctors, they are also maintaining their silence over the proposed undemocratic TTIP agreement which will be used to further their privatization agenda.

Why is Tory economic dogma seen as mainstream, but Corbynism extreme?

Sixty-six years after the foundation of the welfare state, under the current Conservative government, every aspect of it is under attack. The 2012 Health and Social Care Act, for example, will remove 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 [1].

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 and increasingly dependent on the family, and in particular women family members [2].

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 have contributed to 500,000 people being forced to use food banks, and a bedroom tax affecting around 600,000 people will increase the number of children living in poverty by 200,000 [3].

All of this has been underpinned by a brutal ideological offensive against people on benefits which explains the reason for the growing rates of sickness benefit claims are for those who suffer from depression and anxiety [4], as well as the increase in the rate of suicide among those on benefits [5].

The ideological attack on the poor is predicated on the governments’ insistence that those able to defend themselves least, pay the costs for a global economic crisis which began in 2008 but was not of their making [6].

Over the last forty years, successive Labour and Tory governments’ have been committed to rolling back the post-war welfare settlement under the guise of debt reduction premised on neoliberalism which involves a change to the function of the state as less ‘welfare provider’ to more ‘pro-business facilitator’.

Many people believe that the neoliberal assault that embody these changes began with the 1979 Thatcher governments’ limited (by today’s standards) publicly-owned asset stripping. But this is a myth. It was actually under the Callaghan administration that preceded Thatcher that the initial structural changes happened  As Colin Leys (p.41) notes:

From 1976 onwards Labour…. became “monetarist”. It’s leaders accepted that full employment could no longer be achieved by government spending but must be sought through private sector growth. For the necessary private investment to take place, prices must reflect real values, and this in turn required “squeezing” inflation out of the system and permitting the free movement of capital. In 1978 Treasury officials began preparing to abolish capital controls

But it is the assault by the trio of Cameron, Duncan Smith and Osborne on, not just the welfare state, but the entire ethos of the public sector in general, that has taken things to a new level. This is demonstrated, in part, by Osborne’s intention to sell off £31bn of public assets in 2015-16. It is clear that the Tories are using austerity and the neoliberal ideology that underpins it, as an excuse to expand the pro-business facilitator model to areas within the public sector that Thatcher could only in her wildest of dreams imagined.

That said, this approach has limits in terms of maximizing utility to capitalists within a modern state. It is precisely this kind of rationale that explains why the former governor of the Bank of England announced that the current situation is “the worst crisis at least since the 1930s” [7].   

As this writer has pointed out previously, even venture capitalists realize that proper welfare provision for those not working as well as a substantial increase in the the minimum wage for those in work, is necessary to prevent the capitalist system that they benefit from collapsing in on itself [8].

In 1943, the Tory MP Quintin Hogg warned that “If you don’t give the people social reform, they will give you social revolution” [9]. This is as relevant today as it was then.

It’s therefore in nobody’s interest that wages are kept depressed and the unemployed and sick are continually made to suffer. The fact they continue to suffer unnecessarily is the reason why a political space has opened up for the likes of Jeremy Corbyn to move into.

Although much of the mainstream media are characterizing Corbyn’s policies as unworkable, misguided and extreme – and seemingly doing everything in their power to undermine and discredit him -, these are nevertheless policies that are, in truth, mainstream and pragmatic. This explains why an increasing number of economists have publicly come out in support of the kinds of economic policies Corbyn articulates [10].

These policies are economically credible, popular with the public and, for most of the world, regarded as mainstream:

In 2009, most of the world was following mainstream economics of the kind that Corbyn is proposing today in undertaking a fiscal stimulus to combat the impact of the financial crisis. But in the UK a certain politician decided to ignore ‘economic credibility’, and instead proposed doing the opposite: what has subsequently become known as austerity [11].

The imposition of 40 years of neoliberal economic dogma pursued by successive Labour and Tory governments’ has failed the people of Britain who rightly, in my view, see Corbyn as the catalyst for change. As time goes on there will be increasing pressure not just from below, but from the top, for the Tories to change course.

As the open letter to the Guardian by over 40 leading economists illustrates, this is already starting to happen. If the government refuse to acknowledge that austerity and neoliberalism have failed, and thus continue to stick rigidly to their failed ideology of cuts and austerity, the British people will eventually elect a figure like Corbyn into power on a mandate to do something about it. That time is coming closer with every passing day.