While last night’s vote to approve the health bill marks the end of the parliamentary road – in more ways than one – the future of the NHS is far from being a done deal.
Only royal assent is needed to complete the legislation that brings competition right into the heart of the National Health Service and threatens its future.
And the gushing warmth of the parliamentary congratulations to the Queen on her diamond jubilee – with Ed Miliband suggesting to David Cameron that they should stand to applaud - ensures that happens very soon.
Living in the forlorn hope that Labour will repeal the bill is a waste of time. The ConDems actually built on what New Labour had done, especially in relation to virtually independent foundation trusts.
In any case, we can’t afford to wait until the general election of 2015. For the vast majority whose lives, literally, are bound up with the not-for-profit institution set up in 1948, defence of the principles of universal health care must be along a new path.
The same is true for pensions. Unions yesterday lost a legal battle to stop the government slashing up to 20% off public sector pensions by switching to the consumer price index instead of the normally faster-rising retail price index to calculate cost-of-living rises.
Siding with the Coalition, Master of the Rolls, Lord Neuberger, put it like this: “The government clearly believed the state of the economy was grave, and that any savings which could properly be made should be made – as soon as possible.” Unions are considering an appeal, but they’ll be wasting their time, and their members’ money.
The state of the capitalist economy is worse than grave, and the UK government, like most throughout the world, is willingly submitting to the relentless logic of contraction expressed through the simple measure of the credit rating calculated by agencies representing investors on the global capital markets.
Two of the three - Fitch and Standard & Poor – have already threatened to downgrade Britain’s AAA rating if the Coalition’s intensifying drive to cuts and privatisation continues to fail to deliver. The growth promised in last year’s budget hasn’t materialised, so the austerity assault will be ramped up in today’s budget – despite it deepening the recession.
Everything that can be handed over to the for-profit sector will be, and the latest victim is the handling of emergency calls to ambulance, fire and police, soon to be joined by the roads.
Simon Reed, vice-chairman of the Police Federation, which represents rank-and-file officers, warned that the momentum towards outsourcing was gathering pace. “This is the drip, drip, drip of privatisation,” he said. “They move in on something that might look like a good idea, and before we know it they are working in vast areas of British policing.”
Just as in the revolts of the Arab Spring, the police will soon be faced with a three way choice: to side with the repressive state forces seeking to preserve the status quo; to stand aside as new democratic forces arise; or to join with them in people's assemblies formed from workers in factories and offices, the professions, school and college students the unemployed, pensioners, community groups.
With the state’s forces ranged against the interests of the majority, and the parliamentary process a cul de sac, these new assemblies will become the focus for the democratic process that makes and carries out decisions in the interests of the people and small businesses.
They will work to identify and satisfy the unmet needs of the local population with respect to nutrition, housing, clothing, health, energy, safety, communications, transport, education and self-development, culture, sport, recreation, arts, entertainment, social support including security in older age.
And, as the democratic expression of the majority, they will give themselves the power to acquire the resources, including land, from their present owners in order to satisfy needs. That’s the best way to respond to what happened in Parliament yesterday.
Gerry Gold
Economics editor
For revolutionary solutions to create a sustainable, not-for-profit economy in place of global capital alongside a real democracy based on People’s Assemblies. Visit our web site at www.aworldtowin.net
Showing posts with label NHS bill. Show all posts
Showing posts with label NHS bill. Show all posts
Wednesday, March 21, 2012
Tuesday, March 20, 2012
Market state wrecks public services
The ConDems’ health bill is part of a major shift in the role of the state that dates back to the Thatcher period and the onset of corporate-driven globalisation in the early 1980s. Rather than a roll-back of history, we need real alternatives to what is effectively a market state.
As local councils struggling with reduced budgets prepare to “outsource” huge swathes of their services, and GPs line up to commission health services from all and sundry, the so-called “public services industry” (PSI) is licking its lips.
The PSI is made up mostly of commercial companies, many of them global operators like Serco, as well as some “third sector” voluntary, non-profit organisations. Together they take taxpayers’ money in return for providing services formerly delivered by the state
By 2007, driven by the Blair governments, the PSI had grown to mammoth proportions (link) with revenues of £80 billion year, representing 6% of the economy and employing 1.2 million people. These figures are undoubtedly far higher now.
Lobbying organisations such as the CBI Public Services Strategy Board, the PPP
Forum, the Business Services Association and the NHS Partners Network (which is actually part of the NHS Confederation) have developed close relations with government and the media.
Contractors have recruited many former government ministers and senior civil
servants as directors and advisors. Former health secretary Alan Milburn took several jobs with private health companies after leaving office.
The NHS concluded a contract with Bridgepoint Capital’s daughter company, Alliance Medical, six months after Milburn joined the parent company. Under the contract, Alliance Medical agreed to supply 130,000 MRI scans, of which fewer than half were eventually used. The government was nevertheless compelled to pay the full £16m contract price. The full scale of the revolving door between Whitehall and big business was revealed by Transparency International in its report, “Cabs for hire”.
Failure by contractors in areas like health service data management, the upgrade of the London Underground and care homes has left the state to pick up the financial pieces. Twenty-two hospitals face bankruptcy because they cannot meet exorbitant “private-finance initiative” contracts. Even the ConDems have had to come to the rescue with £1.5 billion of taxpayers’ money.
The ConDems’ bill to restructure the NHS in England is the latest chapter in a 20-year journey from a planned system to a competitive market for the supply of health care services. This began with the development of the internal market in the 1990s and the New Labour government extended it with the introduction of “patient choice”, foundation trusts, payment by results and independent sector treatment centres (ISTC).
There are nearly 35 ISTCs now operating alongside the NHS, carrying out surgical and other medical treatment on the basis of local contracts. Information about ISTCs is hard to come by on the grounds of “commercial confidentiality”, but a British Medical Association report says:
“The BMA is concerned because what evidence does exist suggests that where patients’ care is bought and sold, and where hospitals, doctors, nurses and carers have to compete with one another like businesses, we find poorer health outcomes for patients, lower quality care, rising bureaucracy and the erosion of relationships where co-operation is replaced with competition.”
As the state’s role is to enhance the development of capitalism, none of this should come as a surprise. As opportunities for making profit out of producing things declined in Britain, markets in public goods emerged to compensate. The private sector in turn drove down wages and conditions when they took over. Now the ConDems plan to drive down wages in the public sector to create a “level playing field” with big business.
Outsourcing state services is a project that all the major parties have championed. So returning to some mythical golden age of state ownership and provision is impossible. Instead, we need strategies aimed at ending the rule of the market state altogether, with policies and plans that shape a democratic future beyond profit and capitalism.
Paul Feldman
Communications editor
As local councils struggling with reduced budgets prepare to “outsource” huge swathes of their services, and GPs line up to commission health services from all and sundry, the so-called “public services industry” (PSI) is licking its lips.
The PSI is made up mostly of commercial companies, many of them global operators like Serco, as well as some “third sector” voluntary, non-profit organisations. Together they take taxpayers’ money in return for providing services formerly delivered by the state
By 2007, driven by the Blair governments, the PSI had grown to mammoth proportions (link) with revenues of £80 billion year, representing 6% of the economy and employing 1.2 million people. These figures are undoubtedly far higher now.
Lobbying organisations such as the CBI Public Services Strategy Board, the PPP
Forum, the Business Services Association and the NHS Partners Network (which is actually part of the NHS Confederation) have developed close relations with government and the media.
Contractors have recruited many former government ministers and senior civil
servants as directors and advisors. Former health secretary Alan Milburn took several jobs with private health companies after leaving office.
The NHS concluded a contract with Bridgepoint Capital’s daughter company, Alliance Medical, six months after Milburn joined the parent company. Under the contract, Alliance Medical agreed to supply 130,000 MRI scans, of which fewer than half were eventually used. The government was nevertheless compelled to pay the full £16m contract price. The full scale of the revolving door between Whitehall and big business was revealed by Transparency International in its report, “Cabs for hire”.
Failure by contractors in areas like health service data management, the upgrade of the London Underground and care homes has left the state to pick up the financial pieces. Twenty-two hospitals face bankruptcy because they cannot meet exorbitant “private-finance initiative” contracts. Even the ConDems have had to come to the rescue with £1.5 billion of taxpayers’ money.
The ConDems’ bill to restructure the NHS in England is the latest chapter in a 20-year journey from a planned system to a competitive market for the supply of health care services. This began with the development of the internal market in the 1990s and the New Labour government extended it with the introduction of “patient choice”, foundation trusts, payment by results and independent sector treatment centres (ISTC).
There are nearly 35 ISTCs now operating alongside the NHS, carrying out surgical and other medical treatment on the basis of local contracts. Information about ISTCs is hard to come by on the grounds of “commercial confidentiality”, but a British Medical Association report says:
“The BMA is concerned because what evidence does exist suggests that where patients’ care is bought and sold, and where hospitals, doctors, nurses and carers have to compete with one another like businesses, we find poorer health outcomes for patients, lower quality care, rising bureaucracy and the erosion of relationships where co-operation is replaced with competition.”
As the state’s role is to enhance the development of capitalism, none of this should come as a surprise. As opportunities for making profit out of producing things declined in Britain, markets in public goods emerged to compensate. The private sector in turn drove down wages and conditions when they took over. Now the ConDems plan to drive down wages in the public sector to create a “level playing field” with big business.
Outsourcing state services is a project that all the major parties have championed. So returning to some mythical golden age of state ownership and provision is impossible. Instead, we need strategies aimed at ending the rule of the market state altogether, with policies and plans that shape a democratic future beyond profit and capitalism.
Paul Feldman
Communications editor
Monday, March 19, 2012
Tory master plan for a new social order
“Our school is being absolutely bullied, and we are sick to death of it”, said one parent outside Downhills Primary School in Tottenham, North London, after the sacking by the government of the entire board of governors. “Absolutely appalling. Almost like a dawn raid. We live in a democracy, I thought,” said another.
Teachers, parents, councillors, the local MP and the (former) governors at the school are resisting a decree by Michael Gove, the education secretary, for the school to be transformed into an business-sponsored Academy. A plan for improving Downhills was in place and working, say campaigners, and an Ofsted inspection in September bore this out.
The Academy programme, together with the encouragement of so-called Free Schools, is the principal way in which the government is fragmenting — perhaps “fracturing” would be a more accurate word – the state education system. Academies, which are better resourced, will inevitably lead to even greater social divisions as parents try to get their children into the best schools.
The old arrangement of co-operation between schools within a local authority is rapidly being replaced by competition between them. Running parallel to this assault on the state schools is the opening up of the National Health Service to the market place and to the private sector. Their plans require that services and courses of treatment be put out to tender. This will inevitably lead to the dismantling of the old NHS as a universal provider of healthcare at the point of need, as different suppliers compete for business for profit.
In its haste to transform both basic education and health provision, the ConDem coalition has been forced to face down almost universal condemnation of its plans by the professionals who work in the services. Only last weekend, in a poll conducted by the Royal College of Physicians, seven out of 10 hospital doctors wanted the health and social care bill to be withdrawn. In fact the entire medical community is almost unanimous in its opposition.
So why is the coalition government ignoring health and education professionals? We were given a clue over the weekend when it announced that national pay rates for teachers, nurses and civil servants (among others) were to be scrapped. Workers in poorer parts of the country will have their pay frozen until they come into line with local private sector rates.
In the name of “more flexibility”, “genuine decision-making at the local level” and a “modern and responsive work-force”, the government is in fact driving fast towards a society where trade unions are sidelined, an atomised society divided in countless ways, but especially in the quality of health care and education on offer to different income groups.
Driven by the rolling economic crisis and by private sector outfits expressing their “dismay” at the quality of education and demanding a slice of the NHS and education budgets, the government is feeling its way towards a new social order with tax cuts for the rich, unemployment and poverty for the working-class youth. As a statement from the Anti-Academies Alliance puts it: “There will be winners and losers, mergers and acquisitions and fear and uncertainty as the grip of corporate raiders tightens on our schools”. And on our NHS it could be added.
Looking to the Labour Party for leadership, as most of the trade union leaders still do, is the road to ruin. The last Labour governments, after all, developed the Academy programme and accelerated the privatisation process in schools and the NHS. Labour's priority, like that of the Tories and the Lib Dems, is to save the capitalist system whatever the human cost.
So how else can the gathering opposition to this government be manifested except through local people’s assemblies where all community groups — including parents, teachers, health workers and users of NHS services — can work out new policies based on the needs of the people in general? A mass challenge aimed at replacing Tory rule for good is the only option left.
Peter Arkell
Teachers, parents, councillors, the local MP and the (former) governors at the school are resisting a decree by Michael Gove, the education secretary, for the school to be transformed into an business-sponsored Academy. A plan for improving Downhills was in place and working, say campaigners, and an Ofsted inspection in September bore this out.
The Academy programme, together with the encouragement of so-called Free Schools, is the principal way in which the government is fragmenting — perhaps “fracturing” would be a more accurate word – the state education system. Academies, which are better resourced, will inevitably lead to even greater social divisions as parents try to get their children into the best schools.
The old arrangement of co-operation between schools within a local authority is rapidly being replaced by competition between them. Running parallel to this assault on the state schools is the opening up of the National Health Service to the market place and to the private sector. Their plans require that services and courses of treatment be put out to tender. This will inevitably lead to the dismantling of the old NHS as a universal provider of healthcare at the point of need, as different suppliers compete for business for profit.
In its haste to transform both basic education and health provision, the ConDem coalition has been forced to face down almost universal condemnation of its plans by the professionals who work in the services. Only last weekend, in a poll conducted by the Royal College of Physicians, seven out of 10 hospital doctors wanted the health and social care bill to be withdrawn. In fact the entire medical community is almost unanimous in its opposition.
So why is the coalition government ignoring health and education professionals? We were given a clue over the weekend when it announced that national pay rates for teachers, nurses and civil servants (among others) were to be scrapped. Workers in poorer parts of the country will have their pay frozen until they come into line with local private sector rates.
In the name of “more flexibility”, “genuine decision-making at the local level” and a “modern and responsive work-force”, the government is in fact driving fast towards a society where trade unions are sidelined, an atomised society divided in countless ways, but especially in the quality of health care and education on offer to different income groups.
Driven by the rolling economic crisis and by private sector outfits expressing their “dismay” at the quality of education and demanding a slice of the NHS and education budgets, the government is feeling its way towards a new social order with tax cuts for the rich, unemployment and poverty for the working-class youth. As a statement from the Anti-Academies Alliance puts it: “There will be winners and losers, mergers and acquisitions and fear and uncertainty as the grip of corporate raiders tightens on our schools”. And on our NHS it could be added.
Looking to the Labour Party for leadership, as most of the trade union leaders still do, is the road to ruin. The last Labour governments, after all, developed the Academy programme and accelerated the privatisation process in schools and the NHS. Labour's priority, like that of the Tories and the Lib Dems, is to save the capitalist system whatever the human cost.
So how else can the gathering opposition to this government be manifested except through local people’s assemblies where all community groups — including parents, teachers, health workers and users of NHS services — can work out new policies based on the needs of the people in general? A mass challenge aimed at replacing Tory rule for good is the only option left.
Peter Arkell
Wednesday, March 07, 2012
'Big Bang' moment will shatter NHS
Even as the bill dismantling the health service completes its journey into law, older people in care homes have already been abandoned in a foretaste of what’s to come.
There are 376,250 older people living in 10,331 care homes in England and many are frail and vulnerable, with more health needs than most of the population. Around 40% have dementia, many are on cocktails of medication, and the average lifespan in a care home is one to two years.
The residents needed a whole range of medical services, including mental health teams, dietetics, occupational therapy, physiotherapy, podiatry, continence, falls and tissue viability (dealing with wounds, pressure sores and ulcers). Yet only four out of ten soon-to-be abolished primary care trusts (PCTs) make these available to care home residents.
In place of the ineffective PCTs is, however, a new system of commissioning that will put price competition with the corporate sector at the heart of deciding what patients will get. This will tear the heart out of an NHS already ravaged by budget cuts, dodgy “private-finance initiative” deals and the conversion of hospitals into business trusts by New Labour.
Opposition to the ConDems bill even forced its way into the discussion at the Bath Festival of Literature, when leading health academics Colin Leys and Allyson Pollock issued a rallying call to everyone who wants to save the NHS.
"This Bill will destroy the NHS," said Pollock, London University professor of Health Policy and Health Services Research. "If you care for the future, you need to focus now on stopping the Bill. This is a terrifying, Big-Bang moment, because Lansley and his team are moving us to a mixed-financing system similar to that in the US."
Leys forecast that "it will be the end of free care for all". The future he foresaw would be one in which "community care will contract and decline, everyone who can afford to will go private and all we'll be left with is a much-reduced service for the poor".
Today sees two separate rallies in Central Hall Westminster organised by the union Unite and the TUC. But you’d hardly know it. The TUC clearly doesn’t want and isn’t expecting many to turn up. It’s webpage for the event says “Places at the London event will be limited due to seating capacity”. The TUC and Unite and clearly of one mind. Unite’s transport details list consists of one coach each from Southampton, Oxford and Bristol. And that’s it.
Why is the organised opposition so muted? Answer? They simply don’t have an alternative. The not-so-stirring right-to-know demand to publish the Department of Health’s risk register into the impact of the health Bill on services, from Len McCluskey, Unite’s general secretary is about as far as it goes.
Just as on the pensions fight, the continuing wage freeze, public sector job and services cuts and every other reactionary ConDems policy, the union leaders have led one retreat after another. McCluskey’s call for civil disobedience and strikes during the London Olympics is just bluff and bluster to disguise the rout.
There is absolutely overwhelming opposition to the NHS bill, even among Tory supporters. A mass campaign of strikes, sit-ins, marches and rallies should have been organised with the aim of bringing down the government. But compromised by years of watching Labour governments undermine the NHS, and warned off confrontation by Ed Miliband, the TUC has organised a rally just as the bill is about to become law.
The fight to defend the NHS will take something quite different from the approach of the hardly-organised ranks of the opposition. Taking profit-hungry corporations into social ownership will be high on the list of tasks for a new democratic network of Peoples’ Assemblies.
Gerry Gold
There are 376,250 older people living in 10,331 care homes in England and many are frail and vulnerable, with more health needs than most of the population. Around 40% have dementia, many are on cocktails of medication, and the average lifespan in a care home is one to two years.
The residents needed a whole range of medical services, including mental health teams, dietetics, occupational therapy, physiotherapy, podiatry, continence, falls and tissue viability (dealing with wounds, pressure sores and ulcers). Yet only four out of ten soon-to-be abolished primary care trusts (PCTs) make these available to care home residents.
In place of the ineffective PCTs is, however, a new system of commissioning that will put price competition with the corporate sector at the heart of deciding what patients will get. This will tear the heart out of an NHS already ravaged by budget cuts, dodgy “private-finance initiative” deals and the conversion of hospitals into business trusts by New Labour.
Opposition to the ConDems bill even forced its way into the discussion at the Bath Festival of Literature, when leading health academics Colin Leys and Allyson Pollock issued a rallying call to everyone who wants to save the NHS.
"This Bill will destroy the NHS," said Pollock, London University professor of Health Policy and Health Services Research. "If you care for the future, you need to focus now on stopping the Bill. This is a terrifying, Big-Bang moment, because Lansley and his team are moving us to a mixed-financing system similar to that in the US."
Leys forecast that "it will be the end of free care for all". The future he foresaw would be one in which "community care will contract and decline, everyone who can afford to will go private and all we'll be left with is a much-reduced service for the poor".
Today sees two separate rallies in Central Hall Westminster organised by the union Unite and the TUC. But you’d hardly know it. The TUC clearly doesn’t want and isn’t expecting many to turn up. It’s webpage for the event says “Places at the London event will be limited due to seating capacity”. The TUC and Unite and clearly of one mind. Unite’s transport details list consists of one coach each from Southampton, Oxford and Bristol. And that’s it.
Why is the organised opposition so muted? Answer? They simply don’t have an alternative. The not-so-stirring right-to-know demand to publish the Department of Health’s risk register into the impact of the health Bill on services, from Len McCluskey, Unite’s general secretary is about as far as it goes.
Just as on the pensions fight, the continuing wage freeze, public sector job and services cuts and every other reactionary ConDems policy, the union leaders have led one retreat after another. McCluskey’s call for civil disobedience and strikes during the London Olympics is just bluff and bluster to disguise the rout.
There is absolutely overwhelming opposition to the NHS bill, even among Tory supporters. A mass campaign of strikes, sit-ins, marches and rallies should have been organised with the aim of bringing down the government. But compromised by years of watching Labour governments undermine the NHS, and warned off confrontation by Ed Miliband, the TUC has organised a rally just as the bill is about to become law.
The fight to defend the NHS will take something quite different from the approach of the hardly-organised ranks of the opposition. Taking profit-hungry corporations into social ownership will be high on the list of tasks for a new democratic network of Peoples’ Assemblies.
Gerry Gold
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