Why Jeremy Corbyn should call for the ousting of NHS asset-stripper, Simon Stevens
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.
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 envisaged 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, in areas such as residential care, patients and clients have been recast as customers with one study suggesting that “the privatisation of social care services is arguably the most extensive outsourcing of a public service yet undertaken in the UK”. 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 rather with maximizing their profits.
There exists a symbiotic relationship between the outsourcing process and what Noam Chomsky refers to as a policy strategy of “defunding” as the precursor to future wholesale privatizations of public services. Prior to the last election, David Cameron promised to “protect the NHS budget and continue to invest more” However this promise has been broken.
According to the Nuffield Trust, “government spending on the English NHS is falling as a share of UK GDP – from 6.5 per cent of GDP at the end of the last decade to 6.2 per cent in 2015-16.” Research by the Kings Fund indicates that the UK is ranked 13th out of 15 original EU members. In Orwellian fashion, health under-funding is portrayed in the media as “unprecedented levels of overspending by hospitals and NHS trusts.”
Under-funding has inevitably impacted on staffing levels. The shortage of nurses within the NHS has reached dangerous levels in 90 per cent of UK hospitals. Under the current Tory regime every aspect of the welfare state is under attack. The 2012 Health and Social Care Act removes 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 privatization of the NHS in England and Wales. Already between a quarter and a half of all community services are now run by Virgin Care.
The next stage of the privatization process is to devolve NHS budgets and merge them with social care budgets which largely have already been privatized. This will lead to contamination and the entry-point for patient charges and co-payments. Given that the overall framework for such a system within the NHS already exists, it seems like it’s just a matter of time before such payments and charges are put in place. The stated referencing for NHS funding is a deception, as was the assurance in 2010 that there would be no top-down re-organization of the service. The introduction of the Health and Social Care Act belies this assurance.
The problems associated with governments’ retreating from the principle of the universal provision of health care, 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 elected, he took several steps towards privatization – for example, breaking 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.
In line with Chomsky’s defunding 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. The £11 billion of public money Blair and Brown borrowed from the banks and financiers ostensibly to invest in the NHS through PFI (a sum that has soared to £80 billion which the NHS is duty bound to pay), helps further this eventuality in two ways. Firstly, financing hospitals through PFI displaces the burden of debt from central government to NHS trusts and with it the responsibility for managing spending controls and planning services, thereby hindering a coherent national strategy. Secondly, the high cost of PFI schemes has presented NHS trusts with an affordability gap.
The financing of these legally questionable PFI contracts, which has increased the public’s liability by a massive £69 billion, cannot be examined because they hide behind strict confidentiality rules. Nevertheless, the Labour party in opposition appear to be reluctant to raise the issue surrounding the alleged inadmissibility of the contracts despite the high probability that best value and cost effectiveness criteria were unlikely to have been adhered to in this instance.
Arguably, the most powerful and 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.
The latest controversy to have emerged from NHS England led by Stevens is the proposed introduction of its ‘Sustainability and Transformation Plans’ which forms part of the annual 2016-17 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.
As Mike Sivier puts it: We’re told the project is about ‘strengthening local relationships’ and building on ‘local energy and enthusiasm’ to achieve ‘genuine and sustainable transformation in patient experience and health outcomes’. But in fact, the Guidance contains some very specific requirements that will test these new collaborations to the limits and usher in a new wave of privatisations and huge cuts.
In January, activist Dr Bob Gill from the Save Our NHS Campaign attended a meeting to get some insight into what the position of the 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. This is deeply concerning for everybody who sees in Corbyn somebody who might be willing to take Stevens to task. There is no indication as yet that he is the man who intends to do it.
On the contrary, the narrative of the shadow health team appears to be one of support for both Simon Stevens and the existing regime of privatization that he is overseeing. 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. I would suggest that activists exert political pressure on Corbyn’s team as a matter of urgency to address the rightward direction Stevens is taking the NHS. 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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