Opendemocracy has a particularly enlightening article on the progression of privatisation of the NHS from the era of Tony Blair’s New Labour. This lecture, given at Goldsmiths College, is based on the book The Plot Against the NHS, by Colin Leys and Stewart Player, published on April 14th.
This very condensed account omits several major issues that are covered in the book Stewart Player and I have been working on. Among other things it omits the way the shift to a market has already been anticipated by the Department of Health, in dozens of initiatives and ‘pilots’. It omits the development of the private health industry, which is now on the verge of a dramatic expansion at the expense of the NHS budget. It omits fraud, which is so much part of the history of many of the companies involved, and which seems bound to become as endemic here as it is in the US and other healthcare markets.
But one question can’t be entirely omitted from even this brief account: how could the NHS be abolished as a public service without a debate and without the public knowing? The answer is really the story of what has become of democracy in the neoliberal age, condensed into a single case. Spin, of course, has played a big part – secrecy, misrepresentation, manipulation of statistics, lies and the suppression of criticism. But even more important has been a radical change in the nature of government: in effect, the state itself has been privatised.
First, in terms of personnel, the boundary between the Department of Health and the health industry has become so permeable as to be almost non-existent. By 2006 only one career higher civil servant was left in the Department’s senior management team. The rest came chiefly from backgrounds in NHS management or the private sector. In addition, senior positions in the department were filled with personnel recruited directly from the private sector, while former department personnel (including two Secretaries of State) moved out to firms in the private sector. The revolving door has revolved faster in the Department of Health than in any other part of government except perhaps the Department of Defence. Conflict of interest has become so routine as to be almost unremarked. The idea of a boundary between the public and private sectors, which civil servants and ministers police in the public interest, has gone out of fashion.
Second, policy-making has been outsourced. This is an oversimplification, but not much. A so-called health policy community developed, structured especially around two main think tanks, the Kings Fund and the Nuffield Trust. The current Chief Executive of the Kings Fund was formerly director of strategy at the Department of Health, and so was the current vice chair of the board. Their governing bodies also have strong private sector representation and their seminars and conferences are where the market plans have been developed and disseminated. And this has been done partly at public expense, as these and many other think tanks, some of them militantly neoliberal, are charities, and so tax-funded.
Third, and particularly important in the run-up to the 2010 election, is the health industry lobby. Tamasin Cave and David Miller at Spinwatch have made a remarkable short film on the health lobby, called ‘The Health Industry Lobbying Tour’ which you can watch online at Spinwatch.org. When you have seen it you understand a lot more about Andrew Lansley and where his ideas are coming from.
I’ll leave it there. But just in case you are not convinced of the design behind this, and don’t think it is fair to call it a plot, let me add just one more item. In January there was a discussion on Radio 4 between Matthew Taylor, who was once Blair’s chief of staff, and Eamonn Butler, the Director of the Adam Smith Institute, where Tim Evans also works – same Tim Evans who negotiated the concordat with Milburn and looked forward to the NHS becoming just a kitemark. They were asked if they thought the NHS was really going to become ‘a mere franchise’. Butler replied, quite casually, ‘It’s been 20 years in the planning. I think they’ll do it.’
A few recent news articles concerning the UK’s Conservative and Liberal-Democrat coalition government – the ConDem’s – brutal attack on the National Health Service.
The farrago over NHS reforms risks making the government look impetuous and incompetent rather than bold
A POLITICAL scientist, John Kingdon, once listed three elements needed for bold policy-making. The right political leaders must be in place; they must have the right plan; and—vitally—they must agree on a problem that needs fixing. The confusion surrounding the government’s ambitious bid to reshape the National Health Service (NHS) offers ample evidence for the Kingdon thesis.
The Conservative-led government is in a bind over its proposals, which have run into opposition from health professionals and some Liberal Democrats (the Tories’ coalition partners). On April 6th a grave-faced David Cameron, flanked by his Lib Dem deputy Nick Clegg and the Tory health secretary Andrew Lansley, announced a two-month “listening exercise”, in which the government would seek suggestions for improving the plans.
The policy itself has proved predictably divisive since it was unveiled last summer. Though the individual changes are evolutionary, building on market-based reforms stretching back more than two decades, their cumulative impact and complexity stunned medical leaders. Sir David Nicholson, the health service’s chief executive, joked that the package was so ambitious “you could probably see it from space”. Yet the Conservatives fought the 2010 general election on a pledge to oppose further top-down reorganisations of the NHS, after years of disruptive management changes.
Mr Lansley’s plan would abolish a whole tier of NHS management, known as Primary Care Trusts (PCTs), transferring control over 60% of the NHS budget to consortiums of GPs (family doctors). One underlying political goal is to hand hard decisions about the rationing of care to GPs, the most trusted part of the health service.
A second big plank of the Lansley reforms would extend the scope of competition within the NHS’s internal market, launched in 1990 and expanded since to let private providers bid for work alongside state-run hospitals. Responding to complaints from the health sector and voters’ anxiety about “privatisation by the back door”, the government has pledged changes to stop private companies “cherry-picking” the easiest or most profitable cases, leaving NHS hospitals the expensive conditions and the cost of training doctors. Further concessions could tweak the membership of the spending bodies to be run by GPs, to include other clinicians and perhaps elected representatives.
David Cameron and Nick Clegg, together with Andrew Lansley, started listening at Frimley Park Hospital in Surrey on Wednesday. At least – in their colour-coordinated dark suits with ties in shades of violet at three matching white lecterns – that’s what they said they were doing. They had come to a highly successful foundation trust hospital (close to London) at less than 24 hours’ notice to talk about the health and social care bill that nobody loves. During a “natural pause” in the progress of the bill through parliament, they want to listen, reflect and improve on the bill, they said.
Do they really? At Frimley Park, they did listen to the questions put to them mostly by consultants, all of which revealed genuine anxieties about the government plans. But the answers they gave suggested no hint of movement. This was a defence of the proposals – not a discussion of what might be wrong with them, let alone undertakings to change them substantially.
From my position in the audience, it looked as though Cameron and Clegg had decided that Lansley just needed help in explaining and selling the package. Every question was fielded first by Cameron and then Clegg, who both answered with reassuring generalities, before letting Lansley loose on the details – which he does in such a technical fashion that nobody can follow him. It was Clegg who homed in on the issue that most upset the Liberal Democrats ahead of their vote at the spring conference – privatisation. “There will be no privatisation of the NHS. The fact is that the private sector, charities, social enterprises, have always had a role in the health service … ever since it was founded,” he said. It was no, he added, “to allowing private companies to cherry-pick services”. It was no, too, to “a US-style health system where they check your credit card before they check your pulse”.
Andrew Lansley’s promise to “listen” to health professionals over his plans to reform the NHS was last night branded a sham after it emerged that he had turned down an invitation to attend the nurses’ annual conference.
Mr Lansley is expected to become the first Secretary of State or Prime Minister in eight years not to address the Royal College of Nurses Congress when it takes place next week in Liverpool.
Instead the Government plans to send the most junior minister of the Health Department – Anne Milton – to represent it.
27/11/13 Having received a takedown notice from the Independent newspaper for a different posting, I have reviewed this article which links to an article at the Independent’s website in order to attempt to ensure conformance with copyright laws.
I consider this posting to comply with copyright laws since
a. Only a small portion of the original article has been quoted satisfying the fair use criteria, and / or
b. This posting satisfies the requirements of a derivative work.
Please be assured that this blog is a non-commercial blog (weblog) which does not feature advertising and has not ever produced any income.