Posts Tagged ‘health Centres’

Private Eye on ChangeUK MP Stephen Dorrell’s Role in Disastrous and Exploitative Tory Policies

May 1, 2019

This fortnight’s Private Eye, for 3rd – 16th May 2019 has an article about the major role the former Tory MP Stephen Dorrell played in creating and promoting the disastrous Tory policies of rail privatisation, the Private Finance Initiative and the privatisation of the NHS. These are policies which the magazine speculates will make him unpalatable to those centrist Labour voters that ChangeUK hopes to appeal to. The article runs

The adoption of former Tory health secretary Stephen Dorrell as a Change UK candidate in the European elections may be a Tory too far for ex-Labour voters wanting to switch to the centrist cause.

Dorrell’s Tory CV harks all the way back to the dying days of the Thatcher era when he was a whip – a supposedly “wet” Tory helping push through her ultra “dry” policies.

Under John Major, he became a Treasury minister, active in the Rail Privatisation Group behind the sale of the railways. Against expert advice, Dorrell was one who pushed for separation of responsibility between trains and track – with dire results. Railtrack, the privatised track operator, eventually collapsed after lethal crashes caused by poor maintenance.

As health secretary it was Dorrell who began the 20-year disaster of the private finance initiative (PFI) in the NHS. “I am a strong supporter of the PFI,” he told the Commons, calling PFI “the best opportunity that we have had in the history of the NHS” to “deliver the best healthcare.” It wasn’t. And it didn’t.

Dorrell launched a failed bid for the party leadership in 1997 and never held a ministerial job again. Later, under the coalition, he was seen as a critic of Andrew lansley’s NHS reforms – but not too loud a critic.

Having left parliament in 2015, he has kept up his interest in giving corporations access to the NHS, chairing Public Policy Projects, a subscription-based outfit “focused on the big issues in health and social care”. His group arranges breakfasts and receptions for businesses to meet political and NHS insiders. Recent events have included meals iwth health secretary Matt Hancock, housing and communities secretary James Brokenshire, Treasury committee chair Nicky Morgan and top NHS officials.

Dorrell has also worked as a healthcare and public services adviser to KPMG since 2014; and last year became an “associate” of Cratus Communications, a lobbyist for developers. If Change UK really wants to fix the UK’s “broken politics”, it may have to cast its net a little wider. (P. 7).

These are all very good reasons why genuine Labour voters shouldn’t vote for him. But they’re also reasons why traditional Labour voters shouldn’t vote for any of the former Labour MPs in Change UK. All of the so-called Labour ‘centrists’ are really nothing of the sort. They’re red Tories, as fanatically keen on privatisation and the dismantlement of the NHS for the profit of private healthcare firms as the Conservatives. Blair was responsible for the introduction of much of the legislation allowing the NHS to purchase services from private healthcare providers, including the operation of the health centres and polyclinics, which he hoped would be run by private firms. His health secretary, Alan Milburn, wished the NHS to become simply a kitemark for services provided by private healthcare firms.

The real centrists and moderates are Jeremy Corbyn and his supporters, who wish to renationalise the NHS, the rail companies, water and part of the national grid. These are policies both the Tories, Change UK and the Labour ‘centrists’ loathe and detest. Just as they loathe and detest his plans to renew and strengthen the welfare state and give workers back proper employment rights and powerful trade unions able to defend them.

As Mike, Zelo Street and the various other left-wing bloggers have described on their sites, Change UK and its mixture of former Tory and Blairite Labour MPs shows that there really isn’t any difference between the two.

Private Eye’s article is thus a very good reason not to vote for Dorrell personally nor his wretched party in general. And the solid support for Blair’s own privatisation and destruction of the welfare state by Change UK’s former Labour MPs and their fellows still in the Labour party also demonstrates why working people need to see a genuine socialist Labour party under Jeremy Corbyn once again in power and winning elections, from the European all the way to Westminster.

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Don’t Let Theresa May Privatise the NHS

June 8, 2017

This is the text of one of the self-published, table-top produced pamphlets I created a few years ago, and which are advertised on one of the other pages of this blog.

As you can see, it was written a year or so ago when David Cameron was in power. Nevertheless, it is still as valid now as it was then. Theresa May has not changed the Tory policy of privatising the NHS one whit.

So, please, read this article, and then vote for Jeremy Corbyn to preserve this most precious of British institutions.

Don’t Let Cameron Privatise the NHS
David Sivier

Visiting our local health centre the other day, my parents, along with the other local people enrolled there, were handed a letter, explaining that due to funding cuts the health centre was having to cut back on services. It also advised its patients that if they wanted to raise their concerns about the restriction in their service they could contact:-

1. NHS England at FAO Linda Prosser, Director of Assurance and Delivery, NHS England South West (BNSSG), 4th floor Plaza, Marlborough Street, Bristol BS1 3NX
2. your local MP at the House of Commons, Westminster, London SW1A 0AA

Unfortunately, this is happening to the NHS and GPs’ services all over the country. It is no accident, and it is certainly not the fault of the many dedicated doctors, nurses and other health professionals working in the NHS.
It is the result of over 30 years of privatisation begun with Margaret Thatcher. Thatcher and her former Chancellor, Nigel Lawson, denied that they wanted to privatise the NHS. They merely stated that they wanted to include more private provision in the NHS. This is a lie. Released cabinet minutes showed that Thatcher and Geoffrey Howe wanted to privatise the NHS along with abolishing the rest of the welfare state. They were only prevented from doing so because the rest of the cabinet realised that this would be the death knell for the Tory party. And a fact-finding mission to the US to see how their private healthcare system worked by Patrick Jenkin showed that it was massively inefficient.

Nevertheless, the amount of private healthcare in the NHS was expanded, and state provision duly cut by successive governments. It was Maggie’s government in 1989 that ended the state support for care for the elderly in nursing homes. As a result, the families of those, who need this kind of care, are forced to fund it themselves, often through selling or remortgaging their homes because of the immense expense. It was also Maggie’s government that ended free eye tests, and picked a feud with the doctors that saw the majority of them leave the NHS.

This privatisation has continued under Tony Blair, Gordon Brown and now David Cameron and Jeremy Hunt. Blair and Brown were deeply impressed with American private healthcare firms such as Kaiser Permanente, and wished to reform the NHS on their model. The ultimate intention was to replace the publicly owned and operated NHS with private healthcare funded by the state, but administered by private health insurance companies. As a result, NHS work has been given to private hospitals and clinics, and private healthcare companies have been given NHS hospitals to manage. Alan Milburn, Blair’s health secretary, wanted the NHS to become merely a kitemark – an advertising logo – on a system of private healthcare companies funded by the government.

This has been carried on the current Conservative government. And they have used the same tactics Margaret Thatcher did to force private healthcare on this nation. The dispute with the doctors over contracts a few years ago was part of this. It has left the majority of NHS GPs wishing to leave. Yet elements within the Conservative networks responsible for foisting these demands have seen this as an opportunity for forcing through further privatisation. Penny Dash, of the National Leadership Network, and one of those responsible for the NHS privatisation, has looked forward to the remaining GPs forming private healthcare companies. Furthermore, an report on the Care Commissioning Groups now in charge of arranging healthcare in the NHS by one of the private healthcare companies also suggested that they could form private healthcare companies, and float shares on the stockmarket.

Further privatisation has come with Andrew Lansley’s Health and Social Care bill of 2012. This exempts the state and the Secretary of State for Health from their statutory duty, as the ultimate leaders of the NHS, to provide state health care. It is carefully worded to disguise its true meaning, but that is what has been intended by the bill. Dr David Owen, one of the founders of the SDP, now part of the Lib Dems, has tabled amendments trying to reverse this despicable bill. He and many others have also written books on the privatisation of the NHS. One of the best of these is NHS SOS, by Jacky Davis and Raymond Tallis, published by Oneworld.
This process cannot be allowed to continue, and I strongly urge everyone to resist the creeping privatisation of the NHS, Britain’s greatest public institution.

In the last government, there were 92 Conservative and Lib Dem ministers, who advocated the privatisation of the Health Service, and who stood personally to gain from it. They included Iain Duncan Smith, the minister for culling the poor, the sick and the old. Andrew Lansley, the health minister, openly stated he is in favour of privatising it. So has Nigel Farage, and the Unterkippergruppenfuhrer, Paul Nuttall.

Farage in particular follows the Tory policy going all the way back to Thatcher of promising to defend it while secretly plotting how to sell it off. Thatcher ‘s review into the NHS and its funding in the 1980s. so alarmed Labour’s Robin Cook, that he wrote a Fabian pamphlet, Life Begins at 40: In Defence of the NHS, attacking possible proposals to privatise the Health Service.

Previous reviews had given the NHS a clean bill of health. The extremely high quality of the NHS and its doctors was recognised by the heads of American healthcare firms: Dr Marvin Goldberg, chief executive of the AMI health group, told a parliamentary select committee that the Health Service Provides ‘outstanding health care and British NHS hospitals are at least as good as those in America while British doctors are better.’

The then Conservative MP for Newbury, Michael McNair-Wilson, also testified to the effectiveness of the NHS. He had suffered kidney failure. He had private health insurance, but it did not cover operations such as the one he needed because of the expense. He said ‘I have cost the NHS tens of thousands of pounds – much more than I could have afforded privately … Had my treatment depended on my ability to pay, I would not be alive today.’

Pre-NHS Britain: Some Areas Completely Without Hospitals

Cook’s pamphlet also graphically described the patchwork state of healthcare in Britain before the NHS. In London, where there were plenty of paying customers, there could be hospitals in neighbouring streets. Out in the poorer British provinces, there were hardly any, and many operations were carried out not by surgeons but by GPs. He cites Julian Tudor Hart’s book, A New Kind of Doctor, to show how bad this could be. Hart described how he joined one of those practices in Kettering. One patient was left under anaesthetic as the London specialist operating on him was called away to continue a stomach operation on a London patient, which the operating GP had been unable to complete.
Cook was deeply concerned that the Tories’ review would not be at all interested in improving quality, only in opening up the NHS to the market and privatisation.

Cook on Private Health Insurance

One of the issues he tackled in the pamphlet was the possibility of the introduction of private health insurance. This covers two pages and a column and a bit in the original pamphlet. This is what he wrote, though emphases and paragraph titles are mine.

The mechanism proposed to square the incompatibility of health care with the market is insurance. All market approaches to the NHS submitted to the Review stress the case for much wider private insurance and almost as frequently propose subsidies to boost it.

Insurance-Based Systems Encourage Expensive Treatment

The first thing to be said is that private insurance does not offer
to health care the alleged benefits of the discipline of the market place. At the point when the individual requires treatment he or she has already paid the premiums and has no incentive not to consume as expensive a treatment as can be reconciled with the policy. The position of the doctor is even more prejudiced in that he or she has every incentive to obtain as much as possible from the insurance company by recommending the most expensive treatment. Both patient and the doctor are in a conspiracy to make the consultation as costly as possible, which is a perverse outcome for a proposal frequently floated by those who claim to be concerned about cost control.

Insurance-Based Systems Encourage Unnecessary Surgery

The compulsion in an insurance-based system to maximise the rate of return is the simple explanation why intervention surgery is so much more often recommended in the United States. For example, the incidence of hysterectomy there is four times the British rate. This is unlikely to reflect higher morbidity rates but much more likely to reflect the greater willingness of doctors on a piece-work basis to recommend it, despite the operative risks and in the case of this particular operation the documented psychological trauma. I can guarantee that an expansion of private insurance will certainly meet the objective on increasing expenditure on health care, but it is not equally clear that the money will be spent effectively.

Insurance-Based Systems Require Expensive bureaucracy to Check Costs

One direct diversion of resources imposed by any insurance-based scheme is the necessity for accountants and clerks and lawyers to assess costs and process claims. The NHS is routinely accused of excessive bureaucracy, frequently I regret to say by the very people who work within it and are in a position to know it is not true. Expenditure in the NHS is lower as a proportion of budget than the health system of any other nation, lower as a proportion of turnover
than the private health sector within Britain, and come to that, lower than the management costs of just about any other major enterprise inside or outside the public sector. I am not myself sure that this is a feature of which we should be proud. ON the contrary it is evidence of a persistent undermanaging of the NHS, which is largely responsible for its failure to exploit new developments in communication, cost control and personnel relations. Nevertheless, there is no more pointless expansion of administrative costs than the dead-weight of those required to police and process and insurance-based system. These costs would be considerable.

Forty per cent of personal bankruptcies in the US are attributable to debts for medical care

Part of this additional cost burden is incurred in the task of hunting down bad debts, which does not contribute in any way to the provision of health care. Forty per cent of personal bankruptcies in the US are attributable to debts for medical care, a salutary reminder of the limitations set to insurance cover. These limitations have three dimensions.

Insurance Cover Excludes Chronic and Long-Term Sick, and the Elderly

First, insurance cover generally excludes those conditions which are chronic and therefore expensive or complicated and therefore expensive. Standard exclusions in British insurance policies are arthritis, renal dialysis, multiple sclerosis or muscular dystrophy. Most people do not require substantial medical care until after retirement. Most insurance cover excludes the very conditions for which they are then most likely to require treatment. Short of retirement, the most expensive health care required by the majority of the population is maternity care, which is also excluded by the majority of insurance policies.

Private Healthcare Limits Amount of Care due to Cost, not Need

Secondly, insurance cover is generally restricted by upper limits which are arbitrary in every sense other than financial. I recently met a psychiatric consultant to a private clinic, who was prepared to discuss candidly the ethical dilemmas of treating patients whose financial cover is fixed at five weeks of residential care, but whose response to treatment may indicate that a longer period of hospitalisation is desirable.

Private Health Care Geared to Selling to Healthy not Sick

Thirdly, insurance cover is further limited by exclusion of those most likely to claim on it. I am often struck at the sheer healthiness of the patients who illustrate the promotional literature of BUPA and PPP who appear in such pink of good cheer and fitness that it is difficult to figure out why they are in a hospital bed. These models are though in a sense most suitable for the purpose as the objective of insurance companies is to attract the healthy. They therefore claim the right to screen for the unhealthy and reject them from cover. This discriminatory approach was defended earlier this month by the managing director of WPA, Britain’s third biggest health insurer, on the principled grounds that it meant ‘essentially healthy people are not penalised by unhealthy people.’ This statement has the advantage of originality in that it perceives healthy people as the vulnerable group and proposes a market remedy that protects them from the inconvenient costs of the unhealthy.
Given this limited character of health insurance in Britain, the private sector is patently not in a position to substitute for the NHS and to be fair most directors of BUPA or PPP would be horrified at the notion of accepting the comprehensive, open-ended liabilities of the NHS. It is therefore perplexing that so much effort in and around the Review appears to be addressed to the issue of how the private sector may be expanded rather than how the public sector may be improved. Two major devices are being canvassed to boost private cover-tax relief on private cover or opt-out from public cover, or for all I know both of them together. Both would be a major mistake.

Tax Relief on Private Healthcare

Tax relief is open to the obvious objection that it targets help most on those who need it least – the healthy who are most likely to be accepted for private cover and the wealthy whose higher tax rates make relief most vulnerable. These are curious priorities for additional health expenditure.

Tax Relief Does Not Create Higher Spending on Health Care

Moreover, even in its own terms of stimulating higher spending on health, tax relief is likely to prove an ineffective mechanism. If for example the average premium is £200 pa the cost of tax relief for 6 million insured persons will be £300 million. The numbers under insurance need to increase by a third before the increased spending on premiums matches the cost of the subsidy and provides any net increase in health spending. Up to that point it will always produce a larger rise in health spending to increase the budget of the NHS by a sum equivalent to the cost of tax relief.

It is apparently being mooted that these objections could be circumvented by limiting the tax relief to the elderly. At this point the proposal moves from the perverse to the eccentric. This restriction targets help for private insurance on the very group for whom private cover is most inappropriate as their most likely health needs are the ones most likely to be excluded from cover. Only a moment’s reflection is required on the multiple ways in which we need to expand our health provision for the elderly to expose the hopeless irrelevance of tax relief as the solution for them.

Opt-Out Penalises those who Remain in the System

Opt-out is even more objectionable. The basic problem with opt-out is that it requires the payment towards the NHS of every individual to be expressed in a manner that gives him or her something to opt-out from. The principal attraction to Leon Brittan of his proposal for an NHS insurance contribution appeared to be precisely that it paved the way for opting out (A New Deal for Health Care, Conservative Political Centre,, 1988). Nor is this inconvenience confined to the need for a whole new element in the tax system. If one in ten of the population chose to opt out, it would be remaining nine out of ten who would have to prove they were not opted-out when they went along to seek treatment. With the new contributions comes a requirement to maintain a record of payment of them, and presumably a mechanism for credits to those not in work but who do not wish to be counted has having opted out of the NHS.

Private Healthcare Undermine NHS as Universal System

The more fundamental objection both these proposals is they explicitly threaten the NHS as universal health service catering for everyone. Moreover, they threaten its universality in the worst possible way, by encouraging those with higher incomes and lower health needs to get out, leaving behind the less affluent and the less fit. In this respect such an approach to the NHS would be a piece with the Government’s strategy of erosion towards the rest of the social services-housing, pensions, and now education, where the Government has encouraged those who could afford it to opt-out of public provision, leaving behind the poor who could be expected to put6 up with a poor service.

This is the reality of the private healthcare system which Cameron, Clegg, Farage and the rest of the Right wish to introduce. It is expensive, bureaucratic, does not stimulating further spending, and excludes those with the most acute and expensive medical need, especially the elderly.
And the Tories and their counterparts in UKIP and the Lib Dems know it. Why else would the Tories spend their time trying to deny what they’re doing? Why does Farage appear to be advocating retaining the NHS, while arguing for an insurance based system, like America? It’s because they know that private medicine does not provide the solutions they claim. It is only source of further enrichment to them and their corporate donors.

And since Cook wrote that pamphlet, more than 20 per cent of all Americans can no longer afford their healthcare. It’s why the firms are trying to get their feet under the table over here. Don’t let them. Ed Miliband and now Jeremy Corbyn have promised to reverse the privatisation of the NHS. Please support them.

My YouTube Video Urging People to Vote Labour to Defend the NHS

April 30, 2017

I’ve had my own YouTube channel for a few years now. I haven’t posted anything on there for quite a while, and most of the stuff I have posted up there is about archaeology, early musical instruments and few home-made space videos. However, today I put up a video urging people to vote for Jeremy Corbyn’s Labour to prevent the Tories privatising the NHS.

I state that it began when Margaret Thatcher came to power as part of her campaign to dismantle the welfare state, but that Thatcher was stopped from doing so by her a cabinet revolt and her Personal Secretary, Patrick Jenkin. The cabinet realised that if she did privatise the NHS, it would immediately result in the Tories losing an election. Also, Jenkin went to America and realised just how bad the American system of private healthcare was. So Maggie settled for trying to expand private healthcare in Britain, aiming to have 25 per cent of the British people take out private health insurance.

A few years later in the 1980s there came a dispute between her and the dentists, which resulted in very many of them leaving the NHS. The result of that is that, while there still are NHS dentists, you need to look for them. And private dental care is not cheap. So people are going without proper dentistry.

After that, Peter Lilley in John Major’s administration introduced the Private Finance Initiative, under which private corporations build and manage hospitals for the NHS. It’s essentially a scheme to keep the costs of construction and management off the books. In practice it’s massively more expensive than simply having them build by the state. Those hospitals, clinics and other medical services built through it also tend to be smaller than through ordinary hospitals built by the state. See the chapter in George Monbiot’s Captive State. This was all done to open up the NHS to private investment.

This programme was expanded by Tony Blair, as he, like the Tories, was approached by private healthcare firms such as Unum, Virgin Health, Circle Health and BUPA to privatise more NHS services. His health secretary, Alan Milburn, wished to reduce the NHS to a kitemark for services provided for the state by private healthcare companies. He split the NHS up and handed its management to CCGs – Community Care Groups. This was supposed to be giving doctors greater freedom and more choice. However, it doesn’t do this as most doctors simply don’t have enough time to spend on administration. The CCGs were given the power to raise money privately, and commission services from private healthcare providers. Again, hospitals and the health centres or polyclinics Blair also built were also to be managed by private companies.

This programme did not stop when David Cameron’s new Conservative government was voted into power in 2010. Cameron had claimed that he going to stop further cuts in the NHS. He didn’t. He expanded the privatisation programme even further. The 2012 healthcare act formulated by his health minister, Andrew Lansley, is a convoluted document, but it removes the Health Secretary from having to provide medical services. Furthermore, the Tories have also passed legislation allowing the NHS to charge for services, even ambulance care. And this is still going ahead under Theresa May.

There is a real danger that the NHS will be abolished, and the country will return to the way it was before the Labour government introduced it. Private healthcare is not more economical and efficient than state healthcare. Private insurance companies and hospitals spend much more on management, including advertising, legal teams and simply trying to raise money from investors, to make sure their shareholders see a profit. There are about 50 million Americans without health insurance. 33,000 Americans die every year from lack of medical care. And it was like that before the NHS, when the charity hospitals, where people were sent if they didn’t have private health insurance, or weren’t covered by the state health insurance scheme, spent much of their time trying to raise money. And millions of people were denied healthcare, because they couldn’t afford it.

Jeremy Corbyn has said that he will renationalise the NHS. Dr. David Owen has also sponsored a bill to renationalise the NHS. They need our support. And so, if you want to keep the NHS, you should vote for Jeremy Corbyn.

For further information, see the following books:
NHS-SOS, edited by Jacky Davis and Raymond Tallis (London: OneWorld 2015)
Dr. Youseff El-Gingihy, How to Privatise the NHS in 10 Easy Steps (Zed Books)
and my own, Privatisation: Killing the NHS, published by Lulu.

Vox Political: Tories Nudging People into Paying for Healthcare and Part-Privatisation of Hospitals

December 21, 2016

On Monday Mike also put up a very alarming post about the numbers of patients that have chosen to pay for private treatment in NHS hospitals. Previously, the number of private patients NHS hospitals could take was capped at 2 per cent. The Tories have passed legislation allowing hospitals to raise 49 per cent of their income from private patients. In the last four years, the number of patients choosing to pay has risen to 23 per cent. Most of these are people desperate to avoid long waiting lists. The figures reveal that the number of people waiting more than 18 weeks for treatment has risen by 54 per cent.

Mike makes the point that he is not surprised people are paying for private care on the NHS, because the Tories have tried to ‘nudge’ people into going private because of the way they are deliberately underfunding the NHS to create the long waiting lists patients wish to avoid. as Mike says

They are softening us up for full NHS privatisation.

Mike makes the point that he doesn’t blame those, who have chosen to pay. But those who cannot afford to pay must still wait. And if the NHS is fully privatised, they will be unable to afford healthcare.

He also makes the point that it is unknown what sacrifices people are making now, in order to pay for the healthcare.

See: http://voxpoliticalonline.com/2016/12/19/the-evil-tory-policy-that-nudges-people-into-paying-for-their-healthcare/

This is a very important article, as it shows how far we are teetering over the precipice of a fully private healthcare system.

This follows more than three decades of Thatcherite policy. Thatcher wanted to privatise the health service, but was prevented by a cabinet revolt. And also that her personal secretary, Patrick Jenkin, had told her just how bad private medicine worked after she had sent him to investigate it in America. She therefore contented herself with setting the target of getting 25 per cent of the British public to take out private health insurance.

This was followed by the gradual, piecemeal privatisation of parts of the NHS, beginning with opticians and dentistry, the introduction of privately managed hospitals under PFI during John Major’s occupation of No. 10, and then the further privatisation of the NHS by Tony Blair and Gordon Brown. Alan Milburn wanted the NHS to be a just a kitemark on services provided by purely private medical firms. The Blairites passed legislation splitting the NHS up into Community Care Groups, which can also raise money through private means, and encouraging NHS trusts to buy in services from private healthcare contractors. The policlinics and health centres they encouraged to be built were intended to be operated privately. This policy has been extended and advanced even further by Jeremy Hunt and the Tories. Hunt has even publicly attacked the NHS, stating that it should be broken up and privatised.

As for what happens when people cannot afford healthcare, and the sacrifices they have to make, you only have to look at America. About 20 per cent of the US population were unable to afford medical care before Obama introduced Obamacare. Medical bills are the leading cause of bankruptcy, or at least one of the top three, in the US. A study in Texas of the poor, who were unable to afford medical treatment, investigated how they coped. They found that people borrowed drugs from neighbours, or, in a small number of cases, used medicine intended for animals they acquired from vets.

A Tory friend of mine, who hates private medicine, told me some real horror stories he’d heard about America. Over there, some people with a terminal illness, have chosen to forgo treatment, as this would eat up the money they wish to pass for their children.

And he also had a few sharp things to say about the Australian healthcare system. He believed that if a person called for medical treatment for someone, who didn’t have insurance, the person calling for the treatment could be saddled with the bill. And so there is a strong disincentive for people not to call for medical aid, including for those seriously ill.

If the Tories realise Thatcher’s dream of privatising the health service, this will come to Britain. Don’t let it.

Michelle on NHS Privatisation: Useful Info and Links

June 19, 2016

Early this morning I put up a piece about how my local health centre in Whitchurch, Bristol, has fallen victim to NHS cuts, and has written to their patients explaining that they are having to cut back on services.

This is, scandalously, not an unfortunate accident, and it has nothing to do with the people running the health centre. It is the result of Cameron and co.’s campaign to privatise the NHS, a programme that has been carrying on since the days of Maggie Thatcher by successive right-wing administrations, including Blair and Brown, or as they should be regarded, Smarmy and Grumpy.

Michelle, another of the great commenters on this blog, posted up this piece in response to it, discussing an exhibition against the NHS’ privatisation she attended in Stroud, and giving links and information to people and organisations campaigning against it.

Here’s her post.

Really important post Beastie, yesterday I spent most of it in Stroud at the Stroud Valleys Art centre where they had a thought provoking exhibition by Marion Macalpine on the creeping privatisation of the NHS called ‘How come we didn’t know’ there are photos with facts about the corporate creep: http://www.marionmacalpine.org.uk/how-come-we-didnt-know.html

Stroud Against the Cuts had organised a whole weekend of events and workshops so that local people could be better informed and equipped to react to the break up of the NHS. For example I attended a workshop given by Corporate Watch on how to investigate the companies involved in local or national privatisation plans. REF: http://stroudagainstcuts.co.uk/fightback/healthcarecuts/38-healthcare/203-nhs-2016-event.html
and http://us10.campaign-archive2.com/?u=0f6f30d699716abfdb139d100&id=e9c651a1d4

Caroline Molloy was also there and she has much helpful info: https://www.opendemocracy.net/author/caroline-molloy

People can also find their local group to help protect their NHS: http://keepournhspublic.com/support-konp/find-a-local-group/
or their local 38Degrees group may also have some events and actions to help defend our public health service.

The War and Socialist Demands for a National Health Service before the Beveridge Report

February 18, 2016

This is following a debate I’ve recently had with a critic, who stated that the National Health Service had its origins in the Beveridge Report of 1942, and was endorsed by Winston Churchill and the Conservatives. This is true, up to a point, though Churchill was initially very cautious about the foundation of a National Health Service. After the War he made a radio speech denouncing the Labour party’s plans for a complete reconstruction of Britain as ‘a Gestapo for England’. However, Michael Sullivan in his book, The Development of the British Welfare State (Hemel Hempstead: Prentice Hall/Harvester Wheatsheaf 1996) also points out that before the publication of the Beveridge, there had been a long process of negotiation and demand for some kind of comprehensive, free healthcare for working people, and that this had become official Labour party policy in the 1934. He writes

Discussions about the reform of British health care had, in fact, occurred between the National Government and interested parties during the 1930s (Abel-Smith, 1984, pp. 424-7). The starting point for these discussions was the extension of health insurance rather than the position adopted by the Socialist Medical Association in the early 1930s. These latter proposals, which became Labour party policy in 1934, included the provision of free services to patients, the establishment of a corps of full-time salaried doctors and the introduction of local health centres which would be the hubs of the health care system. The discussions between doctors and government had emphasised the need to cater for the British Medical Association’s preference for the retention of a large private sector in health and the extension of health insurance to cover hitherto uninsured groups. (Leathard, 1991, p. 24).

During the early war years the departmental civil service encouraged the continuation of these discussions and received deputations from the medical profession and the Trades Union Congress. Events, however, overtook these discussions. The formation of the Emergency Hospital Service had, as we have noted earlier, the effect of providing a planned health service, albeit in the conditions of war.

By 1941, civil servants in the ministry of health, perhaps influenced by the running of the EHS, suggested a comprehensive national health system in which general practitioners would be grouped in health centres associated with local hospitals. In October of the same year, the Minister of Health, the Liberal, Ernest Brown, announced that some sort of comprehensive service would be introduced after the war. The organisational and funding arrangements of the service remained unclear, though the minister did suggest that patients ‘would be called on to make a reasonable payment towards cost, whether through contributory schemes or otherwise (Hansard, 10 October 1941). At this time, a survey of hospital provision was also set under way.

At the same time, professional interests were attempting to influence the shape of any future national health system. First, the voluntary hospitals, which had been in financial difficulties before the war, started to plan to avoid the return of financial ill-health after the war. Their suggested framework for a national health system included a closer co-operation between the two existing hospital systems in which local authority hospitals might buy service from the voluntary sector, a call echoed of course in the 1980s, if in a slightly different form and from a different source!

The British Medical Association and the Royall Colleges were also active. Charles Hill, better Known to a generation earlier than that of the author’s as ‘the radio doctor’, and later to become a Conservative Minister of Health, argued that those who planned first would be more likely to influence the final form [of the health service].’ That planning initially included an acceptance of the ideas emerging about General Practitioner (GP) health centres, as well as those of central planning and of a universal and free service. (Pp. 40-1)

He then describes how the BMA later changed its opinion, and became resolutely opposed to the idea of socialised medicine.

Of the contribution of the Conservative Health Minister, Henry Willink, he says

The White Paper, introduced by the then (Conservative) health minister, Henry Willink, conceded very little to the doctors and the voluntary hospitals. Indeed it was, at first sight, almost as radical in intent as the National Health Service came to be seen. Under this plan, a national health service was to be comprehensive and free and financed out of general taxation and local rates. A closer look at the White Paper reveals acknowledgement of some of the doctors’ concerns, however. The planned service would, as far as the ministry was concerned, be free and comprehensive. There would, nonetheless, be no compulsion for doctors or patients to use the planned public service but doctors who opted into the system would be offered the opportunity to become salaried employees of the central or local state. This latter offer, of course, flew in the face of the formal position adopted by the BMA. (p. 41).

He also points out that Willink appears to have retreated from several of his initial positions due to lobbying from the BMA:

In the succeeding months, political lobbying was intense. BMA leaders engaged in secret negotiations with Willink and appeared to have achieved a large degree of success. It seems that the minister colluded with the BMA in dismembering the proposals contained in the White Paper. First the idea of Central Medical Board was dropped to be followed by the demise of plans for a salaried service organised around health centres. Local authorities, it was now decided, would build health centres, but not control them. Instead GPs would rent the buildings, would be remunerated by capitation fee and be entirely free to engage in private practice. (p. 42).

He also argues against the view that the War was ultimately responsible for the creation of the NHS, and that it was the result of an overall consensus in which there was little left for Labour to do but decide the final details. He writes

The war cannot sensibly be regarded as the midwife of the NHS. Some account must also be taken of pressure for change in health policy during the inter-war years.

As we have already seen, the SMA were successful in placing these recommendations for a national health service on the political agenda during the 1930s. These proposals for a free and comprehensive service with a salaried staff formed the basis of Labour party policy as early as 1934. The proposals put forward during this decade by the BMA were, of course, less radical but acknowledged that there were fundamental weaknesses in available medical cover. On two occasions in the 1930s, it published reports which recommended that each citizen should have access to a family doctor and to the services of appropriate specialists. These recommendation, like later proposals from the BMA, fell far short of a national, or nationalised, health service; the financing of the service was seen as best achieved through a system of health insurance. The BMA were even unwilling to accept the recommendations of its own Medical Planning Commission about the scope of a health insurance scheme (Sullivan, 1992). Nonetheless, the BMA during the 1930sa was ready to concede that co-ordination of any post-war service was most satisfactorily located at the national level. (pp. 42-3).

He also notes that even in the 1920s there were calls for some kind of national health service.

There had, of course, been an even earlier call for a national health service. In fact in 1926 the Report of the Royal Commission on National Health Insurance was published. It acknowledged that the insurance system established in 1911 by a reforming Liberal government had become an accepted part of national life. It suggested, however, that ‘… the ultimate solution will lie we think in the direction of divorcing the medical service entirely from the insurance system and recognising it, along with all other public health activities, as a service to be supplied from the general public funds (HMSO, 1926). (p. 43).

Of the supposed consensus produced by the War in favour of an NHS, he says

While it is undoubtedly the case that the experience of war played some part in promoting ideas about changes in the principles and practices of health care (ultimately represented in the 1944 White Paper), it is far from clear that this process represented a new beginning. War may simply have achieved the acceleration of an already established process of policy movement.

Nor should we fall into the trap of seeing the development of war-time health policy as consensual, leaving a Labour government only to decide on the best way to implement agreed policy frameworks. Though many doctors, even in war time, supported the idea of a health system funded from general funds and including a salaried service, there was critical resistance to some of the measures outlined in Willink’s White Paper. that resistance, from the BMA leaderships and, it must be said, from a small majority of doctors responding to the BMA survey, included resistance to the idea of doctors as public servants and, sometimes, to the idea of comprehensive health system itself.

Even among those medical and other interests favouring the establishment of a comprehensives system, there were conflicts about other issues. While the SMA and the Labour Party and Service doctors supported the idea of financing the service from the national Exchequer, most other doctors and certain elements in the Conservative Party favoured a system of health insurance, either publicly or privately administered. While the former grouping favoured control of the health service by central or local government, many doctors opposed government activity that went beyond central planning functions. While the SMA, Service doctors and local medical officers, the Labour Party and some ministers in the Coalition government favoured a salaried service, this found very little support in the wider ranks of the medical profession.

By the end of the war there was agreement of only a limited nature, which masked a wide divergence of opinion amongst interested parties in the health field and in the wider social politics of health. (P. 44).

He concludes

War-time health policy seems, then, to be of less significance than some claim in defining post-war health policy. Though limited agreement on the need for a comprehensive system had emerged, conflict remained over the nature of that system. More than this, inter-war factors seem to be not insignificant in the growth of pressure for a comprehensive health system. War undoubtedly accelerated the acceptance as orthodoxy hitherto contested arguments. Nevertheless, as Aneurin Bevan was to find out, that orthodoxy was still some way short of a national health service.

It’s therefore clear then that sections of the civil service was aware of the defects in existing health provision in the 1920s, and that the Labour Party was demanding something like an NHS from 1934 onwards. The proximate cause of the emergence of the NHS was indeed the emergency health care system set up in the war to treat victims of bombing and evacuees. I concede to my critic the fact that Churchill was, at times, cautiously in favour of an NHS, and that Henry Willink did advocate a free health care system, although his was not ultimately as radical as that set by Bevan.

Nevertheless, ultimately it was Bevan and the Labour party that set up the NHS in 1946. Furthermore, even though there were elements in the Tory party that certainly supported the creation of the NHS and welfare state, there were still many others that opposed it.

Furthermore, the origins of the National Health Service in a fragile war-time and post-war consensus does not, unfortunately, alter the situation today. The Tory party is determined to privatise the NHS by stealth. Jeremy Hunt has said that he wants the NHS broken up and replaced with private health care. Another Tory apparatchik stated that by 2020, if his party had its way, the NHS wouldn’t exist except as a clearing house for health insurance. This was later denied by the Tory spin machine, would claimed that he instead said that the Tories would succeeded in removing unnecessary health regulations and bureaucracy. In the last government, there were 95 Tory and Lib Dem MPs with interests in private health firms, hoping to profit from the NHS’ privatisation.

The only remaining clear champions of the National Health Service as national, free, universal system are the anti-Blairite wing of the Labour party under Jeremy Corbyn.

And that’s my last word on this issue. At least for now.