NHS - love is not enough

WE ALL LOVE THE NATIONAL HEALTH SERVICE. Beware the political party that bad-mouths it. It commands almost universal support and enthusiasm. We all of us have our personal story of its invaluable intervention in our or our loved ones’ lives. But after 40 years of right wing entryism, it is now actually a lot more complicated and ambiguous than this might suggest.

It has been reconceived to be as much a source of private profit as of public wellbeing. If we have more than a nodding acquaintance with it as workers or patients, we know that it is actually full of conflicts and contradictions, problems as well as solutions – and serious thought now really needs to be given to its progressive and radical reform.

The NHS’s recent problems can be traced back to the Health and Social Care Act (2012). This unleashed a new wave of privatisation right across the service.

However, the recent changes have to be seen in the context of the New Labour governments of Blair and Brown and their commitment to continuing and accelerating the Thatcher/Major policy of introducing the market into areas of the NHS not previously affected. The obvious area which is causing financial difficulties for NHS hospitals up and down the country is P – the Private Finance Initiative – a Tory policy of the Major government, putting health services in long term hock to private lenders to hide costs ‘off the book’.

It is well documented just what a rip off PFI is, producing ‘super profits’ for the investment companies who trade in hospitals to realise the greatest return for their investment on the sweetest of terms. The Norfolk and Norwich hospital is a defining example as it was one of the first to be commissioned using PFI. The Eastern Daily Press reported in June 2018:

“A week before the Norfolk and Norwich University Hospital (NNUH) was rated inadequate, a private firm – which continues to get tens of millions of NHS pounds a year for building it – reported record profits. Octagon Healthcare, which built and maintains the hospital under a controversial deal, made £14m in pre-tax profit in 2017. Its annual report shows the NNUH paid Octagon more than £50m in 2017 under a PFI deal. The firm also continues to pay out millions of pounds in dividends to its shareholders… Octagon will continue to get tens of millions of pounds from the NHS until at least 2037 under the terms of the PFI deal.Estimates from 2004 predicted taxpayers, through the NNUH, would pay Octagon more than £1bn by the end of the deal – nearly five times the £229m cost of building and opening the hospital in 2001.”

Privatisation and outsourcing has become the norm and now accounts for a third of government expenditure. With Interserve’s collapse last month, hot on the heels of major failures from Capita, Carillion and Serco, we see the real damage private sector delivery of public services does. The people of Liverpool are still waiting for the completion of their hospital with no prospect in sight of it opening.

We now also have a situation where free market buccaneers like Richard Branson and his Virgin Healthcare group can hoover up hundreds of million pounds in contracts and aggressively sue the NHS if they fail to win one in a competitive process. From 2013 – 2018 Virgin and its subsidiaries have won more than £2bn NHS contracts over 400 services. Virgin successfully sued the NHS and pocketed £2m in an out of court settlement after it failed to secure a children’s health contract in Surrey.

Paying little or no tax in the UK they are a marker for the Tory ambition to privatise the NHS and ultimately create the kind of wasteful and defective health system based on private health insurance operating in the USA.

Chris Edwards in his article for Keep Our NHS Public Norfolk summarises the state of affairs:

“Seamus Milne points out that… ‘Corporate capture goes much further than lobbying’. Milne went on to show that the revolving door in the health sector saw Tony Blair’s former health adviser, Simon Stevens, become president of the US company United Health; Patricia Hewitt (one-time secretary of state for health) became a consultant for Alliance Boots and Cinven (a private equity group that bought 25 private hospitals from BUPA); Patricia Hewitt’s predecessor, Alan Milburn, worked for Bridgepoint Capital, and more recently boasted a striking portfolio of jobs with private health companies (Milne, Guardian, 2nd July 2009)… in his recent book, Owen Jones highlighted that Simon Stevens (see above) was appointed chief executive of the NHS in October 2013.”

Patricia Hewitt has been the independent chair of the Norfolk and Waveney Sustainability and Transformation Partnership (STP) since June 2017. She also chairs the STP Oversight Group which is made up of the chairs of the five clinical commissioning groups (CCGs), three acute hospital trusts, local community health organisations and Norfolk and Suffolk county councillors – what could go wrong?

With the move to neo-liberalism has also come a costly new managerialism associated with a culture of bullying, anti-professionalism and the over-loading and devaluing of staff. A new emphasis on regulatory processes has generally failed to protect either patients or workers and we have seen the result in scandals like those of the Mid-Staffs and Gosport hospitals. While the urgent need for whistle-blowers increases, they continue to be offered little real protection and can expect to be made additional casualties rather than rewarded for their decency and determination.

Recent developments show Department for Work and Pensions (DWP) officials going into hospitals to check on Universal Credit claimants and people being sanctioned and losing their right to benefits even when they are in hospital. These show just how far Conservative administrations are now prepared to go in their efforts to restructure social policy as a means of social control rather than social support. Many of the people losing their rights to benefits are cancer patients who in the last months of their lives are subjected to work capability assessments and Universal Credit job search tyranny.

The fact that thousands of people have died within six weeks of being found ‘fit for work’ by healthcare professionals working for Maximus and Atos shows how the hostile environment that has been created cuts across health and welfare benefit systems – and just how connected the two have become. Add this to the deaths and suffering of people waiting for social care assessments and services, and the result is a perfect storm of misery and human rights abuses.

Any defence of the NHS has to begin with an acknowledgement of the damaging effect of past New Labour policy and a return to the democratic socialist values enshrined in the creation of a healthcare system free at the point of need and funded from a progressive system of taxation. But it can’t end there. Renewing the NHS is about much more than challenging damaging right wing reforms. It needs a more fundamental reconception rooted in ideas of redistribution and sustainability.

» First we need to bring out of the shadows and challenge some of the problems modern market policy has overlaid on the NHS. But then we must identify and build on 21st century principles for health and well-being.

» The illness-based health system we have is dominated by acute services but with an ageing population long term health conditions will dominate. The acute bias is anachronistic. That’s why we need to move to social as well as individualistic medical models – and that’s why we need a health – not illness-based system, that truly addresses prevention and public health.

» We need to give real parity to mental health issues, recognising that they can be different to physical health ones, and demand a holistic and social approach beyond present psychiatric and big pharma dominance.

» We have to explore new structures of accountability way beyond organisations like the National Institute for Health and Care Excellence (NICE), that diverts responsibility from policymakers, and the Care Quality Commission (CQC) which is based on inadequately policed bureaucratic standards.

» We need to develop new, more effective and democratising approaches to public, patient and carer involvement in all aspects of the NHS, far beyond present ‘public patient involvement’ (PPI), including in practice, research and governance.

» More value needs to be given to ‘practitioner wisdom’ – the understanding and skill that workers acquire through their experience. And more credibility must be attached to professional discretion and stronger voices offered to NHS workers in all their diversity.

Then we will again have an NHS blessed with the ambition Aneurin Bevan first gave it.

References

» Edwards C, June 2009; Private Gain, Public Loss; the Private Finance Initiative and the Norfolk and Norwich University Hospital.

» Article by Professor Allyson Pollock and others ‘Private finance initiatives during NHS austerity’: http://www.nhsca.org.uk/ docs/allysonp.pdf

» Mark Harrison is director of Social Action Solutions, and Senior Research Fellow in Social Action at the University of Suffolk.

» Peter Beresford is co-chair of Shaping Our Lives, the disabled people's and service users’ organisation and network, and Professor of Citizen Participation at the University of Essex.