25 April 2014 — LabourLeft
Labour must pledge that it believes hospitals and community health services should be publicly owned, publicly run and publicly accountable, writes Kailash Chand OBE.
It is universally accepted that the creation of the National Health Service is the single greatest achievement of the Labour party. The neglect of the NHS was a principal contributor to the downfall of the last Conservative Government and it was a major issue that helped New Labour mobilise mass political support for a landslide general election victory in 1997. Labour’s election manifesto in that year warned that only Labour could “save the NHS”. And they did, a decade of New Labour in government did result in the largest ever sustained increase in healthcare spending in the history of the NHS. Significant improvements were made in the quality of care, with “huge progress” in the reduction of waiting times with more and better services.
However, in 1999 ‘New Labour’ marked the start of a transition of the NHS from a public sector provider to include the private sector under the disguise of choice and competition. New Labour’s reforms of the NHS proved to be highly unpopular both within and outside the mainstream Labour Party.
Why did New Labour take this controversial and unpopular route to the delivery of public services? After four successive general election defeats, Labour’s social democratic model of Keynesian demand management economics, progressive taxation, extending welfare spending and redistribution was no longer seen as a practicable solution. New Labour essentially raised the white flag and inverted the principle of social democracy: society was no longer to be the master of the market, but its servant. Labour was to offer a more humane version of Thatcherism in that the state would be actively used to help people survive as individuals in the global economy. Nevertheless, economic interests would always call all the shots. Professor Anthony King described Tony Blair’s administration as the “first ever Labour government to be openly, even ostentatiously pro-business”.
Thus, New Labour’s leadership had been “converted” from tolerating private enterprise to actively promoting it – a significant political U-turn.
Unfortunately, the last Labour Government laid the groundwork for everything that the Tory-led coalition is now doing to the NHS. Market structures, foundation trusts, GP consortia and the introduction of private corporations into commissioning were all products of an ill-conceived Labour vision of “public service reforms”.
David Cameron aided and abetted by Nick Clegg, has paved the way to turn the NHS over to a plethora of private companies which either commission or provide services, or both. The NHS is being softened up for privatisation which, all along, was the real purpose of the NHS act 2012. Last year seven out of 10 NHS contracts have gone to the private sector.
Who gave this Prime Minister permission to put our NHS up for sale, something which Margaret Thatcher never dared to do? The NHS in 2014 is demoralised, degraded and confused.
Things can’t go on like this. It’s time for the labour movement to raise the alarm again, about what is happening to the NHS and build a campaign for change.
We all know that the British public want the NHS to survive as they know it. The only way forward is for Labour to stick to its 1997 manifesto pledge: “Our fundamental purpose is simple but hugely important: to restore the NHS as a public service working co-operatively for patients, not a commercial business driven by competition.”
Ed Miliband’s pledge to repeal the NHS act is a step in the right direction. But Labour must pledge that it believes hospitals and community health services should be publicly owned, publicly run and publicly accountable. We need to integrate all services to work co-operatively to keep people out of hospital. It doesn’t need a market, just leadership (as is the case in Scotland).
What is required is a policy review to abolish the purchase-provider split and to reintegrate health services. Such an initiative will save on transaction costs, marketing, billing and invoicing. At the same time, it will also ensure that patients are not treated as commodities, and forced to shop around for care.
We should get rid of the foundation trust status and the independent monitor. This will allow reintegration of the health service and bring it back into direct parliamentary accountability, stop the culture of secrecy, corporatism, bullying and commercial confidentiality that surrounds every transaction.
There is a great need to end the “money follows patients” system of resourcing and bring back needs-based planning for geographic populations.
The NHS should terminate commercial contracting for NHS services and abandon proposals to offer GP services to commercial companies. We must analyse the weaknesses of the NHS and work for improvements, such as the benefits of NHS-salaried GP services in health centres and restrict private practice for Hospital consultants. We should restore long-term care and mental health services to the NHS and bring for-profit care homes under NHS control. We should end means testing and cost shunting of services, while public accountability must be strengthened and renewed.
We must restore the principle of fairness through national terms and conditions of service for doctors and all NHS staff. It is imperative that we restore trust between the profession, patients and politicians. Above all, we must allow professional standards to thrive since these are the basis of public and patient trust.
The founding principles and values of the NHS have stood the test of time. Labour’s health team, headed by Andy Burnham, should formulate the policies to fight for those ideals – for comprehensiveness, universality, access based on need and not on ability to pay, for a service that is free at the point of use, for mutuality in which the public accepts that priority should be given to those most in need. Keep markets for profit out of health care delivery. Any adulteration of these principles threatens to cause fragmentation of the NHS with the certainty that never again will such a health service be created. Protecting and pledging to save the NHS from private vultures could be the winning strategy for the 2015 general election.
About the author
Kailash Chand is a retired GP and PCT chair. A health campaigner and founder of ‘Drop the NHS bill E-petition’, he was given an OBE in 2010 for services to the NHS.