[ I make no apologies that this is a long essay, no pictures of puppies and no music. I will make up for that later. It is only those who can read properly and have serious intent on saving our NHS from the hands of the greedy profit monsters! In fact saving all public services from the hands of antisocial individuals, whose mantra is an impregnable belief in their own entitlement! ]
We owe a huge debt of gratitude to the NHS for dealing with the massive burden of work during the COVID-19 pandemic emergency. The dedication, blood, sweat, tears and sacrifice made by doctors. nurses and staff throughout the caring services is nothing short of exceptional. I love you all. |
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| Photo courtesy theGuardian.com |
I would also like to affirm that I continue wholly to support the institution that is our National Health Service and any government that vows to maintain it and do whatever it takes to uphold its purpose, which is to deliver healthcare free for all at the point of delivery, will get my vote. However, before that happens, a few things are going to have to be put in place. There will have to be far greater transparency in the way it is funded and run. I have grown tired over recent years of the Conservative government’s claims that they have repeated ad nauseam, like a broken record, that they care for the NHS, that it is safe in their hands and, moreover, that they have increased funding to the service to record levels! However, to make their claims credible, a thorny question needs to be answered.
My suspicion is that a far greater proportion of funding of the service is coming from private sources, privately owned healthcare companies and corporations than it was ten years ago. Good news for the hard working tax payer, I hear you say, but don’t be too hasty.
No private company worth its salt, if it wants to continue as a viable business, will invest in anything for free. Only very large wealthy multi-national corporates will be able to afford the ‘long game’, in which investment of funds is only likely to reap financial benefits in the medium to long term. It is to these huge companies that I draw attention. Out of their investment will eventually have to come regular revenue, shareholder dividends and profit. The logical conclusion to this is that the slice of the pie that represents what is paid to shareholders and directors and profits that appear in their Profit & Loss accounts and assets in their Balance Sheets (and overseas tax havens), comes out of that same pie, the remainder of which is required to spend directly on frontline NHS services. I want to see evidence of the balance of sources of funding for the NHS over the last few years, particularly since 2012.
I hear proponents of private healthcare claiming that there will be far greater efficiencies as a result of the involvement of private companies, and certainly they can make waiting rooms and facilities look very pretty and plush, but the claims are poppycock! If efficiency can be improved by private healthcare companies it can also be improved by the NHS, as a public service by its own executive management, given the right incentives and accountabilities.
This post is not, however, about conspiracy theory, as it might have been a few years ago, because there is so much evidence now of the Conservative government’s agenda, which has been brewing in their backrooms for decades and even published by Tory big-wigs. Instead it is simply an attempt to apply some straight forward observation, research and recall and some old fashioned critical thinking. In particular, how it seems that privatisation of the NHS has been insidiously creeping up on us, in such a way so that most people won’t notice, until that is, we begin to find healthcare so expensive, or so poor in what is cast off as unprofitable by the corporate moguls, that we need American style insurance to afford it. The only problem is that the healthcare system in the USA is not only inhumane, it is the most expensive healthcare system in the world. The USA also has the lowest life expectancy and the greatest rate of individual bankruptcy in the western world, due to healthcare bills. So we want to follow that example? Allow huge companies like Serco and Sitel, United Health, and countless others to profit at the tax payers expence? Well, I certainly don’t!
If we look at what has happened over the past ten years and, in particular, some key events and decisions by government, a few key developments are revealed. The UK’s National Health Service, constituted by the National Health Service Act of 1946 (updated in 1977, 1990 under Thatcher, and 2006) brought into being on 5th July 1948 as a health service free at the point of delivery, regardless of ability to pay, is admired and envied around the World.
The first major move by David Cameron’s government within a year of their election in May 2010, was to enable a major rewriting of the legislation of the Health Acts. The crucial Act of parliament, the Health and Social Care Act of 2012, enacted by this Conservative government, radically altered the original and succeeding acts (1946, 1977, 1990 and 2006), by abolishing the Primary Care Trusts and Strategic Health Authorities and transferring £60 to £80 billion of healthcare funds to new Clinical Commissioning Groups, which was to be managed partly by GPs but which also acted as a major point of access for private service providers. In other words this was viewed by those inside the service as a business model to facilitate the privatisation of the NHS. Crucially this act also removed responsibility from the Secretary of State for Health for the health of UK citizens.
Now I have asked myself the question and enquired elsewhere, but have received no logical explanation for why they felt it necessary to remove that responsibility from the Secretary of State. The only explanation I can conceive is that it was so as to divest the government of its legal responsibility for delivery of the service as a public health service (something they seem increasingly keen to do in a lot of areas of our lives - reduce their responsibilities). As far as we can see, it marked the beginning of the end for the NHS as a provider to the public of healthcare ‘free at the point of delivery’, as well as being a way for the government to off-load their obligation in law to deliver the service as it was originally constituted by the National Health Service Act 1946.
This was always a part of the Conservative party’s core raison d’être, to begin unravelling what they considered to be a huge drain on the public purse. A drain that needed the full resources of National Insurance and general taxation to keep it going. As private healthcare increases its grip so too will the cost to us all, but you can rest assured that there won’t be any reduction in National Insurance contributions or tax. The Tory ethos has always been to garner favour with the wealthy, as significant party donors, as well as their central policy of reducing income tax and of course countering anything else that smacked of socialism! The collateral benefit from selling off public services, which Maggie Thatcher started in 1979 - remember BT and British Gas? - was the increasing wealth of individuals whose real estate and net worth began to increase exponentially, simply because public service utilities, including parts of the NHS (thinking today particularly of Virgin Health), were being sold off cheap, enabling short term investors to buy and sell shares and make a little profit. But once in the hands of institutional investors, who have the financial resources to take the long view, those shares began to adjust to the real market values and enabled no uncertain enrichment of their private owners. Yes, there are always losers as well as winners, but you can rest assured that the greatest losers in this redistribution of wealth will be the majority of people of the United Kingdom; those whose resources are limited; those who cannot afford to fight their corner against increasing ownership of public assets, for which so many of us have paid our dues in income tax and National Insurance for decades.
It should not be forgotten that it was a previous Conservative government in the 1990’s, starting with Margaret Thatcher’s ‘internal markets’, that started the Private Finance Initiative (PFI) that enabled a rather ‘under the radar’ approach to allowing private health companies and other utilities to invest in the NHS, in ways that do nothing but add long term potentially punitive financial burdens on the NHS, who were effectively mortgaging themselves out of control, because of a real lack of proper funding for the service. This involved, for example, the sale of land or buildings to the private sector for which in return the NHS had to pay ‘rent’ and enter into long term lease arrangements. It also, under the current government, involved far more buying in of services like ambulance, transport, laboratory and other services, not to mention the thorny problem of controlling excessive procurement costs for major technology, pharmaceuticals and medicines. There is also no doubt that Tony Blair and Gordon Brown’s ‘New Labour’ government, sadly, continued to implement PFI’s throughout the thirteen years of their time in office, but I am also in no doubt that the Conservatives have accelerated the involvement of the private sector with a vengeance, all the time increasing the proportion of the tax payers’ burden going, either directly or indirectly, into private pockets. They even at one stage set what effectively amounted to coercive ‘bribes’ for hospitals who needed funds to buy major new equipment, by coercing them to agree to sell certain assets to private concerns so as to raise the funds required.
At this stage, it is worth reminding ourselves we should not forget that, much to its dissonance with the philosophies of Tory thinking, the NHS is not a vehicle for revenue generation. It is not a profit making business. It is a social service, albeit one with a huge responsibility to deliver healthcare as efficiently as possible, but one that has been an example to the World, of how to enable decent health care for all, regardless of their ability to pay. Seemingly beyond an ambitious Tory’s comprehension; it is not in their DNA! It’s almost as if it’s the word ‘social’ that they can’t understand!
All this might have changed five or six years ago, when the full weight of corporate America descended on Brussels to negotiate a Transatlantic Trade and Investment Partnership (TTIP) with the EU. The clear threat of the Americans walking all over hard won EU regulations, protecting the environment, food standards, employment legislation and more, as well as - maybe the last straw as this probably turned public opinion against the USA’s attempts, mostly behind closed doors, to seal the deal - was the institution of sort of ‘kangaroo courts’ that would be run by corporate lawyers and adjudicate on cases where governments were deemed to pass legislation that would adversely affect corporate profits. The EU flexed their not inconsiderable trading muscle and threw the Americans out! The latter have no doubt been smarting from this decision ever since and there is no doubt in my mind that they will have jumped on the UK’s decision to hold a referendum on whether to remain as members of the EU. They knew, as did the Russians, that the UK’s Conservative government had a hard core of Euro-sceptics, who had long schemed to get us out of Europe.
Both Russia and the USA and possibly China feel threatened by the fact that the EU is the largest trading bloc in the World. Breaking it up would always enable a lever to break open cracks in Europe’s predominance. And so Brexit came about. And so we now find ourselves threatened with a TTIP style trade deal with the Americans, but this time our negotiating position is far weaker than when the EU was leading the talks on behalf of all its member states. In fact our healthcare, food standards, environmental protections and employment laws are under threat like never before. And if you look at the unelected bureaucratic aides at the centre of Boris Johnson’s cabinet office like Cummings, Mirza, the Cox sisters, Warner brothers et al, with their somewhat disturbingly extremist views on human rights, eugenics, chemical interventions, artificial intelligence and data gathering, you can begin to see how extremely right wing this government really is. Propped up by an electorate, it seems, whose abilities to read beyond a tabloid press headline and apply critical objective thinking to issues is clearly somewhat lacking plus a smaller proportion of the electorate, who clearly have serious vested interests.
What is clear is that there will be a greater darkness just before the dawn. How long it will be before we see that dawn, is hard to predict. So much will depend on how dark the coming Winter will be, mired by the continuing threat of the COVID-19 pandemic; mired further by the threat of a no deal Brexit, which it can be argued this government in their utter arrogance, has wanted all along. At least with the pandemic they’ve got plenty of ammunition to fight off accusations of incompetence in governing this country, plenty of distractions and smoke screens that are blurring our ability to see what they are actually doing to us all.
We need to keep our eyes peeled and our hearing sharp. This is not the time to bury our heads in the sand. Democracy is under threat now as ever it was from power grabbers, but never to a greater degree than it is now in the UK as it is in the USA and elsewhere in the developing world, not so much from visible leaders, but from the corruption that has enabled the wealthy to become extremely rich, and otherwise referred to as oligarchs - and not just the Russian variety - who continue to line up their ducks. Those with the hardest heads and the most ruthless ambitions will prevail at the expence of a majority of us, unless we stand up to be counted, difficult as this may seem to be.
For my part I am going to start with a letter to our new Conservative MP. It may not seem much, but it would be progress if I got an answer, as I frequently did from our previous Labour MP. The sitting incumbent didn’t answer my last letter earlier in the year, but I live in hope.
