Sunday 28 July 2013

Bennett: 5 steps to restore the NHS to the proud state Bevan intended

Green Party leader Natalie Bennett has identified a series of actions that need to be taken to save and restore our publicly owned and publicly run NHS.

Bennett was speaking at the Call 999 for the NHS rally in Darlington yesterday, organised by a concerned group of local campaigners.

She focused particularly on the need to pass Lord Owen's Bill to restore the duty of the Secretary of State to provide healthcare, and on the need to allow commissioners to choose "preferred providers", removing the pressure to put services out to tender.

Here is the full speech:

I have to begin, by congratulating the organiser of this rally, Joanna Adams. She’s demonstrated what one person can achieve when they say ‘I’m not going to take this any more’.

And congratulations to you for being hear to listen, on this glorious sunny day when the park looks so attractive.

Earlier this year, I came down with labyrinthitis, an infection of the inner ear. It isn’t a serious condition, but it is a rather dramatic one. The world suddenly started to spin wildly, and I found myself in the Green Party office, head down on the desk, unable to move.

An ambulance was called, and I was carted down in the lift and out of the office on a stretcher. As I lay on the trolley in that ambulance, a kind officer offering reassurance while filling in her paperwork, one political thought did flash through my head – “at least I’m not in America”.

I didn’t have to think about the cost of the ambulance, the cost of the high-tech tests to check I hadn’t had a stroke or didn’t have a brain tumour. I didn’t have to think of the cost of drugs, or have to leave hospital before I felt ready because of the bills.

So I was thinking – thank Nye Bevan for the NHS, for the principle, fought for and won more than six decades ago, of treatment on the basis of need, free at the point of use.

And, later, when the world had stopped spinning, I thought again, often, of how important it is to defend it.
In common with many healthcare experts, I could see even before it came into effect that the Tory-Lib Dem government’s Health and Social Care Bill was the gravest threat that the NHS had ever known.

I, with the rest of the Green Party, joined the campaign against the pernicious Bill, and Green MP Caroline Lucas voted against it.

And we pointed out the democratic deficit: that voters had not been presented with this option in any party manifesto, and that 70 MPs and 142 peers - a significant proportion of those voting on the bill - have or have had financial interests in private health care companies. (And of course we’ve seen an increasing revolving door between private sector executives and senior public administrators.)

But on that day in January, on the ambulance trolley, the campaign had a new, real, intensity for me.
It has become horrifically, horribly clear since the Bill was passed and begun to be put into effect that the worst fears of  experts like the Royal College of General Practitioners and Unison who had opposed the now Act were entirely correct.

We’ve seen an acceleration of the already extensive privatisation of health services that began in the Thatcher era and was embraced wholesale by the last Labour government.  A privatisation that saw more than 100 NHS PFI schemes signed off, with projects valued at £11 billion, and index-linked contracts which are already bankrupting NHS Trusts. (As many as 70 of these are now owned off-shore, meaning the profits are beyond the reach of British tax.)

The NHS spent £8.7 billion on private medical services last year, out of a total budget of £104 billion and that figure is expected to rise fast.  As we heard only this morning from the Guardian, the “biggest privatisation yet” is set to see a single contract worth £1.1bn let for “care for older people including end of life care” in Cambridgeshire and Peterborough.

And the existing NHS services are highly unlikely to be able to bid for it. Virgin, Serco or Circle, the usual roll call, are expected to bid to make profits out of care for older people.

The former Labour Government explicitly embraced competition, arguing that it was needed to make NHS providers more productive - the "grit in the oyster" argument.  But in fact, there’s strong evidence that  cooperation, not competition,  delivers the best, most cost-effective, results for patients.

Furthermore, efficiency savings were imposed on the NHS by way of the "Nicholson Challenge" and Labour didn't commit to maintaining real term health spending increases in the 2010 election.  The current government has risen to this so-called challenge with relish, overseeing  £20 billion  of  “efficiency savings” that are really just a transparent fig leaf for cuts.

We’ve seen a huge push towards private-style structures – particularly “foundation trusts” -  in the public hospitals built with public funds and often also large charitable donations.

But there’s even worse on the horizon. The drive to soften up the public for “co-payments” – to end the “free at the point of use” principle that is the most essential NHS principle at all – has clearly begun.

In April, Malcolm Grant, chair of NHS England, said he personally wouldn’t support charging for NHS services. But then went on to say: “It’s something which a future government will wish to reflect [on], unless the economy has picked up sufficiently, because we can anticipate demand for NHS services rising.”

That idea was backed by leader articles in the Financial Times and  Daily Telegraph, which also reflected on the supposed “inevitability” of charging for NHS services. This week we saw a survey of GPs encouraging the idea.

BUT – it’s not too late. It’s important to say that loudly and clearly.

The public is increasingly concerned about the state, and fate, of our NHS, despite concerted campaigns to run it down.

We’ve seen a clear attempt to stigmatise, to smear, to attack, the NHS.  Clearly, there are problems – some related to privatisation and the managerialism brought in by Labour to facilitiate it – Private Eye pointed out this week that all of the hospitals identified as problematic either were foundation trusts or were seeking that status. Some of the problems are related to underfunding, and some related to real problems of management and organisation. And they cause reasonable concern.

But it’s also clear that the public fears that privatisation – the introduction of the profit motive into the NHS – is undermining the very principles and  future of their health service. And they are right!

And so there are five clear steps that we can – and must - take.

First, we must back the National Health Service (Amended Duties and Powers) Bill proposed by Lord Owen in the House of Lords.

Most importantly, in Clause 1, the Bill restores the Secretary of State for Health’s duty to provide the NHS in England. (This duty was abolished in 2012 – with responsibility to determine what is provided free transferred to the new clinical commissioning groups, which have no public accountability.)

This clause will also restore the duty to promote a comprehensive and integrated service, which the Coalition split between the NHS Commissioning Board, clinical commissioning groups, Monitor, and Health and Wellbeing Boards.

Second, we must allow commissioners to use a public “preferred provider”, rather than forcing them to put services out to tender and they must be allowed to make decisions in the public interest without being called ant-competitive. After all, we know that  private companies – not just multinational healthcare
companies but also giant feeders at the public teat such as G4S, A4E, Atos, Serco, Virgin, Circle - can demonstrate their one great skill and competitive advantage: the ability to make attractive bids for contracts, yet  as we’ve all too often found to our cost, they are not always so successful at delivering on them.

Third, we can encourage patients to give their GPs notes or postcards, as provided by the Keep Our NHS Public campaign, expressing their preference for being treated by public rather than private providers whenever this is possible.

Fourth, we must demand health funding is maintained. Spending on health fell in real terms by 0.7% in 2010 and a further 1.2% in 2011. This must not be forgotten, especially after the Coalition promised to protect NHS spending from cuts.

Finally, we must challenge every person or organisation that pushes us down the slippery slope towards “co-payments”.

We only have to look to the United States of America to see what we must avoid. We don’t want to mimic a health system that costs 18% of the GDP of the world’s wealthiest country, yet puts the US 17th out of 17 developed countries when ranked on the state of its national health.

We don’t want to emulate a system where vast profits are made by a few giant companies, which want to cherry pick the easy patients, the simple operations and conditions, while driving staff wages down and down, and leaving patients with complex needs and needing high-cost treatments stranded.

And above all we don’t want to copy a system where your access to the best health care, be it a good local GP or a specialist cancer surgeon, is determined by your ability to pay, or by a private healthcare provider’s decision on whether you meet its criteria for treatment.

We have a system which has worked – provided excellent health care free at the point of use – for 67 years. We do not want a system in which the standard of healthcare is dictated by cash, where those able to pay more are simply less likely to die than those who cannot afford to.

Let’s join together and say NO.

Let’s restore our publicly owned and publicly operated health system to the proud state that Nye Bevan intended – the health service that was established to give every Briton the best possible health care, local to them, when they need it, driven by a philosophy of care, not profit.

That’s what the Green Party believes in, what we are fighting for and what we have the genuine principles to deliver. And I know many other individuals and organisations will too. Let’s join together to rescue the NHS, and win. The principle of publicly provided healthcare free at the point of use is just too precious to lose.


trevor said...

There Will never be a Truly Good Health service when that service is in the hands of people aka members of parliament who Take the health of the people for Granted.
They put profit before Principle and therefore give their consent for all kinds of Health ruining ideas to take root and even when the health service it self begins to collapse they just carry on regardless.
This is the norm in so called Great Britain and therefore it is inevitable that the public will continue to suffer as the NHS continues going down
as the politicians become more desperate.

Anonymous said...

What an excellent assessment of the problems facing the NHS, and what needs to be done to protect it! Thank you for publishing this speech, Martin.
I write as someone who was diagnosed with Type 1 Diabetes in my late 20's. My care through the NHS for more than 35 years must have cost a lot of money, but because of it I was able to continue with a relatively normal working life, and pay large amounts of income tax and NIC. That, to me, is the way things should be. Hopefully, with a newly-diagnosed Type 1 diabetic in the cabinet, there might be a better appreciation of the NHS within government, but I won't hold my breath!
I spent 25 years of my working life as a Tax Inspector, and in the early 2000's had to consider the first accounts of a company which had won a PFI contract to build a small hospital and provide all of its support services for 30 years. I was concerned at the odd accounting treatment of the transaction, which it appeared would guarantee that the company would automatically make losses (for tax purposes)until the final year, when it would make a huge profit. The losses each year would be set against the trading profits of the two large groups which owned the company 50/50 (one a construction group, the other a major services provider).
I asked for a copy of the PFI contract, and other supporting documents, to see whether I could challenge what looked like artificial tax avoidance, and after a lot of delay and prevarication, I eventually received them. The contract was about 150 pages long, and very complex, but effectively meant that the NHS (or hospital trust involved) would repay the £30m capital cost of the building, plus a generous rate of interest on the "mortgage" for this amount, over the thirty years. The company could charge whatever it wanted to (with very little chance of the NHS being able to challenge the amount) for the services provided during the thirty years, with no chance of the hospital renegotiating the contract, finding another provider or taking the services back "in house".
How had the NHS allowed itself to be tied up in such a bad contract? Because of instructions from the government that, in order to encourage private companies to get involved in PFI projects, it would guarantee to pay their legal and professional costs of entering into contracts. So, in the case I was looking at, the NHS had paid £1.5m for the company's lawyers and accountants to draw up a contract which "stitched-up" the NHS and gave the opportunity for tax avoidance by the two big groups behind the PFI company (one of which had a former cabinet minister as its Chairman).
Why were Chancellors Ken Clarke and Gordon Brown so keen on promoting PFI contracts? Because it kept the cost of providing major capital projects "off Balance Sheet" as far as the government's accounts were concerned. They could claim to be providing new hospitals without this being charged against their budget deficit, even though the eventual costs of doing things this way would be much higher (hence NHS Trusts going bust).
I'm afraid that the Official Secrets Act prevents me from identifying the hospital and companies involved, or from disclosing the outcome of my investigation of the accounts, but it was an episode towards the end of my career in the Inland Revenue that left me frustrated by the actions of my "masters" in the Treasury!