back-door privatisation

Save Our NHS – 4th March 2017

Save Our NHS – The NHS was under attack by the Conservatives before it was established in 1948 and has come under repeated attacks since by governments of both major parties particularly since the 1990s.

Providing universal healthcare costs and the current financial year (2023/24) figure of £160.4 billion is around one seventh of total government spending of around £1,200 billion. So it isn’t surprising that governments should wish to see that the money is being spent wisely. But that isn’t was most changes in government health policy have been about.

Even with that large sum, the UK is still getting healthcare on the cheap. According to Statista the spending per person is less than in the US, Switzerland, Germany, Norway, Netherlands, Austria, Belgium, Australia, France, Sweden, Luxembourg, Canada, Denmark, New Zealand, Ireland and Finland and roughly the same as in Iceland and Japan.

It’s perhaps not surprising given this that we often hear reports which compare the results of NHS care critically with those in other countries. But those reports on the BBC and in the papers seldom if ever mention the poorer funding the NHS receives than many of those with better health outcomes.

The US spend per person is considerably higher than all other countries and roughly two and a quarter times that in the UK. But many of the NHS reforms made this century have been based on making our health system more like the American model, which would be a disaster. But it would mean a great opportunity for private healthcare companies, particularly some of those US companies, to make huge profits at our expense.

A surprising number of our MPs have had some financial interest in healthcare either through shareholdings or by sponsorships. The Daily Mirror in 2014 published a list of 70 MPs with links to private healthcare firms which included almost every leading Tory and some from other parties. As well as then Prime Minister David Cameron, they included Former Health Secretary Andrew Lansley, responsible for the disastrous Health and Social Care Act 2012, Health Secretary Jeremy Hunt, former Health Minister Simon Burns, the Work and Pensions Secretary Iain Duncan-Smith, William Hague, Philip Hammond, Sajid Javid, Oliver Letwin, Chancellor George Osborne, Priti Patel, Jacob Rees-Mogg and many other leading Tories, along with Lib-Dems then in the coalition government Vince Cable, Nick Clegg and Simon Hughes.

It’s these people who have introduced policies which have led to large areas of NHS services being provided by private companies, though still retaining the NHS logo and still providing services free to the public. But generally these are the kind of simple, straightforward services and the more complex areas are still left to the NHS.

There is still huge public support for the NHS, despite its problems some of which have been created possibly deliberately by government reforms to erode that support, though more clearly in a drive to make more of its services available to be taken over by private companies.

On Saturday March 4th 2017, thousands came to Tavistock Square, outside the BMA headquarters to march to Parliament Square in protest against the cuts and privatisation of the NHS which they said was at breaking point.

In particular they were protesting the Sustainability and Transformation Plans for hospital closures and cuts in services which had already caused many premature deaths. Doctors and other healthcare workers clearly saw these as a part of a rapid stealthy privatisation with medical services increasingly being run for private profit rather than public benefit.

In 2017 the STPs mutated into Sustainability and Transformation Partnerships and in 2018 these were told to transform themselves into Integrated Care Systems which have now replaced Clinical Commisioning Groups. These plan, buy, and provide health and care services in there areas and are subject to inspection under 70 performance metrics and can be put into ‘special measures’.

According to the Wikipedia article “A report from the Nuffield Trust in December 2021 found that there was very little evidence that integration policies across the UK – including pooling budgets and creating new integrated boards and committees – had dramatically improved patient experience, quality of services or supported the delivery of more care outside of hospitals.” But clearly they had diverted a considerable amount of expertise, time, energy and money away from the real business of the health service – and funding towards private companies.

Estimates for the number on the march varied even more wildly than usual, but it was clearly a large march. My guess was perhaps 30,000 but it could well have been twice that if not the 250,000 the organisers claimed. All the pictures in this post come from the march and the rally before the start, and I was too tired by the time it reached Westminster to photography the rally in Parliament Square.

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NHS Birthday Celebrations

NHS Birthday Celebrations: Today the National Health Service marks its 75th Anniversary, founded thanks to the efforts of the Labour Party and in particular Aneurin Bevan, following on from the 1942 report by Liberal economist William Beveridge which had proposed wide-reaching social reforms to tackle the “five giants” of “Want… Disease, Ignorance, Squalor and Idleness” (Idleness meaning of course unemployment.) The pictures in this post come from the 65th anniversary ten years ago today, Friday 5th July 2013.

Beveridge was opposed to means-tested benefits which he stated were unfair on the poor, and although the wartime coalition government set up committees to look at how his reforms could be put into practice they were from the onset opposed by many Conservatives and some on the Labour right.

But Labour stood in the 1945 elections promising to put the proposals into effect, and after their victory passed the National Insurance Act 1946, the National Assistance Act 1948, and the National Health Service Act 1946 and other Acts to do so, founding the UK’s modern welfare state.

Bevan was the wizard who integrated the multifarious per-existing medical services into the single functioning state body of the National Health Service, though he had to make many compromises to do so, working against considerable opposition both political from the Tories and from the medical bodies which were dominated by old men, many with fixed ideas.

The 75 years since then have seen many changes in the NHS, not all for the good, with both Conservative and Labour governments determined both to penny-pinch and bring in private enterprise to profit in various ways from our health service. The last 13 years have been particularly tough for the NHS, with disastrous reforms brought in and cuts which have made it impossible for NHS workers to provide the services and care they desperately want to do.

Covid of course didn’t help – and the failure to provide proper protective equipment, with too many contracts going to cronies who didn’t deliver – and fraudsters – was a real disaster, killing far too many health and other key workers. Despite a magnificent effort by health workers too many died, and the only reward for the huge efforts made by the NHS was claps.

Currently we have a government which refuses to talk sensibly with workers across the health centre, instead simply saying that the below inflation rises it is offering – essentially wage cuts – are fair. It obviously hopes that by provoking strikes and getting its friends in our billionaire owned right-wing press to condemn the strikers for the cancellations, increase in waiting lists and possible deaths it will get the public on its side against the NHS.

Instead we need policies which will engage with the problems the NHS faces after years of underfunding, overwork and shortages. The recently announced workforce plan at least is a plan to do something, though it seems unlikely to prove workable. The shortage of doctors, nurses and other medical staff has been clear almost since the start of the NHS, and certainly critical for many years.

We need to both increase the number of training places and tackle some of the other causes. Private hospitals rely on publicly funded doctors and nurses – and should at least have to pay the training costs for those they employ – although personally I’d prefer to see them being brought into public ownership. As well as poaching staff they also cherry-pick offering care for simpler cases but largely passing back more critical care to the NHS.

There needs to be an end to the expensive and somewhat unreliable use of agency staff, at least by the NHS setting up its own temporary staffing organisation and also by ending payments for work at above normal rates. The NHS also needs to become a much friendlier employer in terms of flexibility of shifts etc.

And of course we need to remove the caps on training for doctors, nurses and other staff, and to provide proper bursaries to cover both fees and maintenance for these vital workers. The proposed ‘apprenticeship’ scheme for doctors seems unworkable as such, but all medical course are already in some part apprenticeships, including some on the job training. Finding the additional mentors needed for more work-based schemes seems an example of cloud-cuckoo land thinking, and the setting up of a two-class system of doctors seems highly undesirable.

Importantly too we need to drastically reduce the bureaucratic workload of all doctors and health staff at all levels. Theoretically the increased use of IT could play a role in this – although the NHS has been disastrously shafted by its IT providers in the past, promising much but delivering mainly greater complexity. So far bringing in IT has increased the amount and time spent in form-filling at the expense of treating patients, partly because the various levels of administration up to the government has seized the opportunity for the greater demands it makes possible.

I was born before the NHS and looking at it in recent years I’ve sometimes wondered if my own death will be due to its stuttering demise. I hope not. But the NHS is certainly not safe in the hands of the Tories, and little that we have so far seen about Labour’s plans give me confidence it will be safe in theirs.

The two events I photographed on the NHS’s 65th Birthday were all concerned with its problems and doubts about its future, The GMB trade union came to Parliament with 3 vintage ambulances saying the NHS Is At Risk, campaigners at Lewisham Hospital celebrated hoping and fighting to keep their busy, successful and much needed hospital open and stop it being sacrificed to meet the disastrous PFI debts of a neighbouring hospital. I’d taken my bike to ride to Lewisham, and made a leisurely ride through Deptford on my way back to Westminster.

At the Ministry of Health, then still on Whitehall, Dr Clive Peedell was about to begin his 65 mile ultra-marathon run to David Cameron’s Witney constituency where he was to ceremonially bury the NHS coffin and launch the National Health Action Party plan by doctors and health professionals to revive the NHS. Their 10-point plan included “policies to restore the duty of the Secretary of State to provide comprehensive NHS care, and return the NHS as the preferred provider of services.”

More about the events on the 65th Birthday of the NHS – from which all the pictures in the post come – are on My London Diary.

Ministry of Justice cleaners protest – 2018

Ministry of Justice cleaners protest – 2018 Four years ago today we were in some ways in a very different place. For one thing it was pouring with rain on Thursday 9th of August and for another Labour’s Shadow Justice Minister had no doubts about coming to join a picket line as United Voices of the World cleaners and supporters celebrated the end of their 3-day strike with a rally outside the Ministry of Justice in Petty France with a lively protest despite pouring rain.

But in other ways it was depressingly similar. We still have a Tory government that was determined to ignore the needs of the poor and low paid – and Boris Johnson is still prime minister, if not for long. But whichever of the two candidates wins to succeed him, the country is bound to lose, with the wealthy getting wealthier and the rest of us suffering.

And of course in some ways things have got worse. We have now left the EU and are slowing finding out what a terrible deal was negotiated, largely thanks to a combative approach rather than trying to work with Europe to reach sensible solutions – and in part because of the overriding political need to “get things done” rather than read the small print.

*A cleaner is waiting for a back operation for a work injury – NHS underfunding and privatision mean long waits*

And we’ve had Covid, most of us several times, with a failure to take sensible actions in time that led to thousands of extra deaths, saved from being far worse by a successful vaccination programme with at last some competent planning and hard work beyond their duties particularly by NHS workers and many volunteers. But Covid also led to huge waste of public money in contracts awarded to mates of the Tory party who too often failed to deliver – or even didn’t really exist.

*Leaflets tell workers leaving the Ministry of Justice why the cleaners are striking*

The protest in August 2018 marked the end of a three day strike by United Voices of the World cleaners at the Ministry of Justice, but also at Kensington & Chelsea council and hospitals and outpatient clinics in London run by Health Care America. At all three workplaces they were demanding the London Living Wage and better conditions of employment.

*UVW’s Petros Elia tried to take protesters in out of the pouring raid but is stopped by security*

It seemed impossible to believe that workers at the Ministry of Justice should not be paid the London Living Wage. The LLW was introduced in 2002 following an initiative by the London Citizens coalition and was taken up by the Mayor of London and was calculated by the Greater London Authority until 2016. A UK Living Wage was also established in 2011. The levels are now calculated based on the real cost of living by the Living Wage Foundation, with the 2022 London Living Wage being £11.05 per hour, and the UK Living wage £9.90.

*I’m getting soaked taking pictures – and Susanna from the UVW holds up an umbrella over me*

In the 2015 budget, Tory Chancellor George Osborne announced a ‘National Living Wage’, replacing the earlier National Minimum Wage and almost certainly intended to counter the success of the living wage campaigns, setting the amount at a lower level. Currently this is £9.50 – even in London where it is £1.55 less than the real living wage.

*Speeches continue in the pouring rain under umbrellas*

While a considerable number of employers do now pay a real living wage, others still fail to do so. Too many hide from meeting the obligation to give their staff a living wage and decent conditions of service by outsourcing low paid workers to contracting companies, who usually stick to the basic minimum of legal conditions and pay, while all decent employers give significantly greater benefits and the living wage.

*The rain slackens off for Richard Burgon to speak*

Shadow Justice minister Richard Burgon came to support the workers and brought a message from then Labour leader Jeremy Corbyn, who promised that a Labour government would end the outsourcing of low paid jobs. Since Keir Starmer became leader, Labour’s policies have changed, and ministers who stand with workers are liable to be sacked. It now seems to be the Labour party only in name.

American healthcare companies have now taken over even more of our health facilities, and earlier this year the High Court dismissed a legal challenge against the takeover by Operose Health, a subsidiary of American health insurance giant Centene, of GP practices in London. This is a significant stealth privatisation of part of the NHS, with Centene now running 58 GP services.

Privatised GP practices generally have failed to employ permanent doctors and rely instead on locum provided care, which greatly reduces the quality of service. Takeovers like this have also meant many doctors leaving the profession early – and we are currently short of 9,000 GPs.

*And the protest ends with dancing in the street*

You can read more about the protest which was supported by other groups including Class War in My London Diary Ministry of Justice cleaners protest.

NHS Birthday March – July 5th 2011

The UK’s National Health Service began on 5 July 1948, 73 years ago today. Earlier in 1946 doctors had voted 10:1 against, but compromises were made to bring more of them on side. It had taken the Labour government a fierce battle to get the proposals through parliament, with the Conservative Party under Winston Churchill voting against its formation 21 times when the bill was being passed.

Churchill followed the example of a former chair of the British Medical Association and compared its formation to Nazism, calling it the “first step to turn Britain into a National Socialist economy.”

It was their often unprincipled opposition that lead Aneurin Bevan to make a famous speech two days before the NHS began that included the following:
“That is why no amount of cajolery, and no attempts at ethical or social seduction, can eradicate from my heart a deep burning hatred for the Tory Party that inflicted those bitter experiences on me. So far as I am concerned they are lower than vermin.”

In recent years various Tory MPs have claimed that the Conservative Party should be credited for setting up the NHS, when in fact the party fought tooth and nail against it. They also claim that the NHS is ‘safe in their hands’ while increasingly selling off parts of it, largely to US based healthcare companies. Many MPs have financial interests in healthcare and their votes reflect this, in what seems a clear conflict of interest.

One of the compromises needed to get the bill through was that GP surgeries would remain private businesses that could be bought and sold. Doctors in general practice were to remain independent, with the NHS giving them contracts to provide healthcare. What is now happening is that GP surgeries are increasingly becoming owned by large healthcare companies who organise how they are run and employ doctors.

At the moment we still get to see the doctor for free, though it has become more and more difficult for many to do so, in part because of the systems set up by these healthcare companies. But we have now and then heard proposals for charges to be introduced. We do currently have to pay to see a dentist, and even with these charges it has become difficult for many to get dental treatment under the NHS. Many cannot afford the higher charges for private treatment and even the lower rates under the NHS are a huge problem for those on low pay who are not entitled to exemptions.

This year there were protests around the country last Saturday, a few days before the NHS’s 73rd anniversary. Ten years ago around a thousand people marched through central London on the actual 63rd anniversary of the foundation of the NHS in a protest to defend the NHS against cuts and privatisation, ending with a rally outside the Houses of Parliament. The changes then being debated under Andrew Lansley’s bill made radical changes which brought in private companies to take over the straightforward and highly profitable areas of NHS services. Now a new bill is under consideration which will make for further back door privatisation of the NHS.

More at NHS 63rd Birthday.

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