Nick Clegg has made a deceitful and evasive speech on the NHS. Deceitful since he suggests that all will be well and hiding the fact that the Destroy the NHS bill is intended to reduce the scope of the NHS. Evasive by avoiding any mention of privatisation or the role of private providers. It’s a feel-good speech intended to reassure people that everything is OK, that there is no need to worry, that he, Cameron and Lansley can be trusted to look after the NHS. The lying, evil sods.
We know from the experience of tuition fees and V.A.T. that Nick Clegg is a shameless liar. We know that he lies to decieve people. We know that he’s a slippery shit in the tradition of UK politicians.
Some of the lies and evasions I pulled from his speech today:
“When Beveridge first proposed a nationalised health service in 1942, he didn’t prescribe exactly how it should work.
He called for a comprehensive service to ensure every citizen can get “whatever medical treatment he requires in whatever form he requires it.”
Care, free at the point of use, based on need and not ability to pay.
No government worth its salt – certainly, no government of which I am a part – will ever jeopardise that.”
That’s a lie. The current coalition government – of which Clegg is a part – is intending to do away with a comprehensive health service free at the point of use.
“The comfort of knowing that the NHS will always be there for you.
If you’re in an accident, if you get ill, if your family need treatment.
And it will always be free. No bills, no credit cards, no worries about money when you’re worrying about your health.
That’s why I have been absolutely clear: there will be no privatisation of the NHS.”
There are a few lies here.
Firstly, GP consortia will commission services. They decide which services will be available. With cuts to spending they will cut the range of services available. There will also be some expensively ill people that will likely not have a GP. This means that the NHS will not “always be there for you”.
Secondly, perhaps not an outright lie but certainly intended to mislead and give a fase impression: “it will always be free …”. No it won’t always be free. If you need a treatment that is not provided by your local GP commissioning group, you will have to pay or go without.
Thirdly, again perhaps not an oughtright lie:“there will be no privatisation of the NHS”. There will be private provision of services not offered by a reduced NHS. There will be private providers within the NHS. It will not be wholly privatised but there will be hugely increased involvement of private providers.
Clegg continues by saying “The NHS has always benefited from a mix of providers, from the private sector, charities and social enterprises, and that should continue.”
Notice what’s missing? The public sector. Is he saying that the public sector should not continue to play a role in the NHS?
Charities and social enterprises are private providers in a sense. They certainly are not public sector.
“People want choice: over their GP, where to give birth, which hospital to use.
But providing that choice isn’t the same as allowing private companies to cherry-pick NHS services.
It’s not the same as turning this treasured public service into a competition-driven, dog-eat-dog market where the NHS is flogged off to the highest bidder.”
Choice. People don’t really want choice. They want a good service that doesn’t unduly inconvenience them e.g. having to travel to a distant hospital.
Clegg is deliberately misconstruing the argument, putting up a straw-man by saying that the NHS will not be sold off to the highest bidder. It’s about providing a restricted health service where you will have to pay – or go without – services that are not provided.
[27/5/11 edit: It’s also the first stage in the process of privatisation and transition to a private insurance-based health service on the US model.]
“I’ve heard people suggest that our reforms could lead to politicians washing their hands of our health services, because of the way the Bill is phrased.
So we need to be clearer – the Secretary of State will continue to be accountable for your health services.
This is your NHS; funded by your taxes and you have a right to know there is someone at the very top, answerable to you. With a public duty to ensure a comprehensive health service, accessible to all.”
Clegg is employing the worn-out argument that they have failed to properly explain the proposed changes. The truth is that the more people understand, the more they object.
He’s defending the Health Secretary no longer being responsible for providing the health service, arguing against what Colin Leys said ‘The bill removes the secretary of state’s responsibility to provide a national health service and doesn’t assign it to anyone else. She or he would only be charged with “promoting” it.’
Clegg suggests that this is merely phrasing when it is crucial. If it is only a matter of phrasing, then we’ll have the phrasing that the Health Secretary will provide a health service.
“opening up”…
Clegg is defending the Bill to abolish the NHS contrary to the instruction of his Spring Conference. He needs to be dumped asap.
The NHS is under serious attack from the Tories and faces rampant privatisation. Colin Leys, co-author of a new book on the NHS, spoke to Yuri Prasad about what the cuts mean—and how this is the logical conclusion of policies pursued by New Labour
Many say that if the government’s health and social care bill were passed in its present form it would mean the end of the NHS as we know it. Does that overstate the threat?
Colin Leys I don’t think it overstates the threat at all. The bill removes the secretary of state’s responsibility to provide a national health service and doesn’t assign it to anyone else. She or he would only be charged with “promoting” it.
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Selected excerpts from ‘The Plot Against the NHS’ by Colin Leys and Stewart Player. Chapter One is available here. I highly recommend this book available from Merlin Press for £10.
A year ago Peter Martin, the chief executive of Tribal Group plc, which describes itself as a “leading provider of commissioning services to the NHS“, presented his view of the future for the health sector in England. He was bullish. Although he described market conditions as “challenging”, he saw an “improved flow of service delivery opportunities” that would significantly support Tribal’s revenue growth. Andrew Lansley’s 2010 white paper would bring “major changes in structure of UK health markets”. Martin’s goal was to focus Tribal’s health business on the profit-making opportunities these reforms would create. He set out five growth priorities: commissioning for GP consortia, clinical support services, patient management services, informatics outsourcing and hospital management services.
This is the future for the NHS that David Cameron and Nick Clegg have planned for us since the launch of the coalition. Despite their claims to the contrary, they have been laying the ground for wholesale privatisation of the NHS, the destruction (without any democratic mandate) of one of Britain’s most cherished and effective postwar institutions, and the transfer of its stewardship and operations to organisations concerned only with maximising revenues and reducing costs. The word “quality” appears nowhere in Tribal’s vision as communicated to investors.
How has the NHS arrived at this moment of crisis? Colin Leys and Stewart Player provide an indispensable guide to understanding the origins of what they call a plot against the NHS. Surely this is an exaggeration? Not so. Cameron, Clegg and Lansley are merely continuing two decades of policies – begun by Tony Blair, endorsed by Gordon Brown, and supported by successive Labour governments – aimed at introducing markets into the health service. Where Labour tried to hide its intentions, the only difference with the Conservative-Liberal alliance is their shameless transparency.
Looking back at Labour health policy now, I have to ask myself how so many of us were unable to see through the mists of what Leys and Player call the “misrepresentation, obfuscation, and deception” perpetrated by Blair, Brown, and a host of health ministers all too willing to genuflect to the market zeitgeist. Too many of us – whether doctors, nurses, or just members of the public – were willing to be bewitched by Labour’s mellow language of reform. The words are all too familiar now: modernisation, choice, empowerment, diversity, plurality, improvement, contestability, and, most beguiling of all, patient-led.
The Department of Health created a commercial directorate to oversee the plan to privatise the NHS. A group of passionate market advocates were hired to transform a public sector institution into a target for private sector takeover. People such as Mark Britnell, who was the Department of Health’s director general for commissioning when Labour was in office and who later joined KPMG – able to sell his experience in government to the world of management consulting – have now been outed as agents for the merciless dismemberment of the NHS. There was a revolving door between civil servants in the department and McKinsey, KPMG and Deloitte. Ex-ministers, such as Patricia Hewitt and Lord Warner, traded their knowledge of NHS privatisation with those who could benefit in the commercial sector.
Doctors’ leaders were little better. The British Medical Association’s John Chisholm and Simon Fradd, who led negotiations with government to revise the GP contract in 2002, won a huge victory by making out-of-hours care for patients optional. Nine out of 10 GPs stopped offering services to patients from 6.30pm to 8am. This withdrawal of NHS care allowed private providers to step in and take over. After Chisholm and Fradd had succeeded in putting out-of-hours care out for private tender, they set up Concordia Health, a private company, that offered to run those very same services, only now at a profit to themselves.
The networks of health institutions that propped up the case for marketisation and privatisation of the NHS were intricate. They include private providers, such as UnitedHealth (whose president of global health, Simon Stevens, was once a key Labour adviser); thinktanks, such as the King’s Fund (whose trustees have included Stevens and Julian Le Grand, his successor in Number 10); and lobbyists, including several NHS outsourcing and private equity businesses.
Having anatomised the diseased political corpus that has begun to infect the NHS with a commercial ethos that will increase costs, cut services and reduce quality, Leys and Stewart try to look to the future. They mount a strong defence, claiming there is no evidence the NHS is in urgent need of fundamental reform. Given the statement by Steve Field, who is leading Cameron and Clegg’s pause to review the Lansley reforms, that the current Bill could “destroy key services” and destabilise the NHS, it seems that the gathering momentum for markets as the solution to whatever ills the NHS might have could be about to stall.
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Selected excerpts from ‘The Plot Against the NHS’ by Colin Leys and Stewart Player. Chapter One is available here. I highly recommend this book available from Merlin Press for £10.
Selected excerpts from ‘The Plot Against the NHS’ by Colin Leys and Stewart Player. Chapter One is available here. I highly recommend this book available from Merlin Press for £10.
p.148~154 References in the original.
Within the BMA a strong challenge emerged to the leadership’s position of ‘critical engagement’ with the government’s plans, and a demand for outright opposition. The development of serious opposition from a large part of the medical profession, and especially from GPs , was significant, because Lansley constantly claimed to have their support.
The false case for the Health and Social Care Bill
The government’s claim that the NHS was in urgent need of further fundamental reform was also becoming more and more obviously false. During the previous ten years, while the NHS was being covertly marketized, the Labour government had raised NHS funding rapidly towards the average level of spending of the other major countries of Western Europe. Spending on the NHS still remained significantly below that of the richer EU nations, and a significant portion of the new funding was absorbed by the cost of market creation. But the extra cash also produced some important improvements. Staff levels were improved, waiting times for elective care were sharply reduced, facilities were renovated or replaced.
This was reflected in the high marks given to the NHS in the Commonwealth Fund report cited in chapter 1. And by 2010 the particular charge constantly made by the marketizers, that England lagged behing European countries in the survival rates for major killer illnesses, was ceasing to be true. Lansley repeatedly declared that a wholesale restructuring of the NHS was ‘a necessity, not an option’, and David Cameron asserted that ‘pretending that there is some “easy option” of sticking with the status quo… is a complete fiction’. But in January 2011, coinciding with the publication of the Health and Social Care Bill, a paper by the King’s Fund economist John Appleby, published in the BMJ, showed tha t the marketizers’ charge was unfounded. It turned out to rest partly on the use of European data that were not comparable with the English data (and in some cases highly unreliable), and partly on selecting static data instead of trends over time. For several of the conditions usually cited English survival rates have in fact been improving so fast over the last 30 years that if the trends continue they will overtake
European rates by 2012.
The real choice
The choice is not between change and no change. It is between handing over a public service to be developed by private enterprise in the interests of shareholders, and ensuring that it develops in the interests of the public – and as the public sees those interests, not as politicians declare them to be. To maintain that there is no capacity for improvement within public provision is empty rhetoric. What evidence is there that public servcies are incapable of change and improvement (provided they are not undermined by financial starvation or market-driven disorganization)?
Around the world there are various examples of excellent public and publicly-provided health services, and all of them need to be studied for ways to improve the NHS in England – and beginning with an examination of those that are developing within the UK itself. The national media largely ignore what occurs across our nearest borders, but what is happening there, and especially in Scotland and Wales, raise crucially important questions about the future now being charted for the NHS in England.
Looking at Scotland
Even before devolution health ministers in Westminster had been too aware of Scottish sentiment to risk pushing the internal market very far there, and the Labour-Liberal Democrat coalition governments that held office in Scotland after devolution, from 1999 to 2007, recognised that voters would not support them if they followed England’s path to a healthcare market. Scotland’s Area Health Boards remained in place, foundation trust status was not introduced, nor was payment by results. The PFI was used for three Scottish hospital-building schemes, and one Independent Sector Treatment Centre was opened at Strathco in Angus. But these measures provoked intense controversy and in 2003, responding to pressure from both doctors and the public, the coalition government ended the purchaser-provider split, restoring direct administration to the NHS in Scotland and decisively closing off the market option. Also in response to public opinion, in 2002 the Scottish Labour-Lib Dem coalition made personal care for the elderly free, instead of means-tested as in England.
The 2007 elections, however, led to the formation of a minority SNP government, and yet further departures from the market-driven policy that was being pursued in England. In 2008 hospital car parking charges – a significant deterrant for families – were abolished, except at PFI hospitals, where legal reasons prevented it; and in 2010 plans were announced to abolish prescription charges from 2011. No further PFI schemes have been undertaken. Glasgow’s biggest acute hospital is being built with public funds, the ISTC at Stracathro was taken into public ownership, and plans to outsource the management of a health centre in Lanarkshire to a private company were dropped. Out-of-hours care is publicly provided.
Perhaps most significant of all for the future, in 2009 elections were introduced for the majority of the members of Scotland’s Health Boards, beginning with two pilot schemes to be evaluated after four years. This means that in addition to professional medical judgement democratic representation, rather than individual ‘patient choice’, could become a significant element in determining the direction of future change.
In face of all this the marketizers inevitably portrey Scotland’s NHS as a failure, with the usual misuse of statistics to support their claim. For example they routinely state that Scotland’s waiting times are worse than England’s, because no element of competition has been introduced into Scotland’s. In fact an analysis of newly-consolidated data concludes that since 2005 waiting times have fallen faster in Scotland than in England. In each year since then Scotland has actually had either the second shortest or (more often) the shortest waiting times of the four nations in the UK. And over the ten years from 1999 to 2008 Scotland’s mortality rates for all causes of death declined almost exactly as fast as England’s. As Dr Matthew Dunnigan, the author of the waiting times analysis, says, the objective comparison of English health statistics with those for the three devolved nations is now a very important task.
Looking at Wales
The story in Wales has many similarities to Scotland’s. For the first eight years following devolution a Labour minority government was in office, only giving way to a Labour-Plaid Cymru coalition in 2007. But as in Scotland, even the initial Labour-led Welsh Assembly Government did not dare follow the English path. The purchaser-provider split remained, but Wales did not adopt foundation trusts or payment by results. Development remained based on collaboration and planning, rather than on a market system with legally enforcable contracts and all the tensions and extra administrative costs involved.
And after 2007, under the Labour-Plaid coalition, the purchaser-provider split was dropped. In 2009 a major reform resulted in the formation of just seven integrated Local Health Boards to plan and operate the NHS in Wales. These are very like the Area Health Boards in Scotland, but also have overall responsibility for all aspects of health, including public health, with a strong emphasis on linking health and social care.
The Local Health Boards in Wales are not elected but they must have members representing local primary care, community care, public health, local government and voluntary organizations, as well as lay members. In one Local Health Board (Powys) the purchaser-provider split was abolished earlier and the Board was integrated with primary care and community health service providers. Other Boards are set to follow suit – exactly the opposite direction of change from that taken in England, where even community health services have been forced into the marketplace.
Wales also declined to use the PFI for hospital-building, led the way (in 2007) in abolishing prescription charges, abolished hospital parking charges, and dealt with the vexed issue of means-tested personal care for the elderly by widening the definition of what is considered nursing care (and therefore free), and by setting a flat-rate contribution to the cost of personal care throughout the whole country.
Considerations for England
We need to ask ourselves why Scotland and Wales opted to keep the NHS as a public service, and even extend the principle of free acess. Longstanding Scottish and Welsh cultural traditions are certainly important, especially a deeply-embedded commitment to social democracy in public life, and in the medical profession, which politicians of all parties have to respect. But another key reason is cost. Next to education health is by far the most important and expensive devolved publis service. Even before the financial crisis politicians of all parties in Scotland and Wales realised that if they followed the English route, and allowed the costs of operating a market to start soaking up ten per cent or more of the health budget, health services would be liable to deteriorate, with dire political consequences for themselves.
They know that the public spending cuts imposed by the government in Westminster will hit Scottish and Welsh health services. But they also know that the effects will be smaller that they would have been had they opted for a market, and that whatever they have to do will have a legitimate foundation in public opinion, which remains at the base of decison-making about the NHS in both countries. And when the crisis has passed they will still have a public health service, not a three-tiered healthcare market and a low-risk playground for healthcare corporations and ‘doctorpreneurs’.
Scotland and Wales don’t exhaust the alternatives for the future in England. Other good models of publically-provided health services exist and deserve study. But the successful evolution of the NHS in the rest of the UK shows that Cameron’s assertion that ‘we can’t afford not to modernise’ – meaning that we have no alternative but to accept the abolition of the NHS as a public service – is pure bluster. It has no foundation in evidence and serves no interest except that of the private health industry. In the parts of the UK that the plot against the NHS couldn’t reach, people see through it. They know that good health care for all means excluding profit-making, and have shown that with sufficient public backing that principle can prevail. We need to insist that in England too the NHS is not for selling.
Nick Clegg has made a deceitful and evasive speech on the NHS. Deceitful since he suggests that all will be well and hiding the fact that the Destroy the NHS bill is intended to reduce the scope of the NHS. Evasive by avoiding any mention of privatisation or the role of private providers. It’s a feel-good speech intended to reassure people that everything is OK, that there is no need to worry, that he, Cameron and Lansley can be trusted to look after the NHS. The lying, evil sods.