Like the baying of hounds in pursuit of a fox, you could tell by the sudden surfacing of a whole coven of furious private sector apologists that something had changed.
One after another the spokespeople for corporate interests vied for headline space in the Daily Mail, the Telegraph, Times and broadcast media. Alan Milburn, Labour minister turned shameless millionaire adviser to health privatisation firms was quick on the draw, followed by Lord Hutton - Labour minister turned director of failing private health company Circle. Lord Darzi, Labour minister turned Boris Johnson sidekick, popped up on Newsnight to have his two-pennyworth, backed up by Blairite academic and pro-market fundamentalist Julian Le Grand.
Then came the tax-dodging billionaire boss who flogged Boots to US retailers Walgreen, insisting that a Labour government would be a disaster. Backed up by Sir Stuart Rose, formerly of M&S and now with a wide range of business interests including the owners of Care UK and other health firms.
What’s triggered this disparate bunch of right-wingers?
Labour’s new 10-Year Plan for Health and Care was released a week ago. It goes further than previous statements in shedding the enthusiastic promotion of market competition that so discredited the last Labour government.
Labour’s right-wing critics are especially furious that Labour should return to the designation of the NHS as “preferred provider”. The Plan questions the fundamental right-wing premise that the private sector has a central role to play in delivering health care.
In the Telegraph, columnist Charles Moore responded with paroxysms of rage, lashing out with an extended diatribe denouncing the NHS itself from its very origins, even while rather awkwardly trying to argue that Churchill (who opposed the NHS Bill all the way through parliament) was somehow the real founder of the NHS.
Whatever problems campaigners and health workers might see in the new Labour policy, the fact that it incurs such venomous responses from the usual suspects on the right must mean there is something going for it.
Labour has finally cottoned on to the NHS as a prime election issue, and at least partially remembered it is supposed to be an opposition.
Among the Tory-led government’s failures, Labour (perhaps surprisingly) includes:
“Putting the wrong values at the heart of the NHS, with a rampant postcode lottery, increasing rationing of treatments, and an ideological market framework which puts competition before collaboration and profits before patients, and which is seeing large amounts of money wasted on competition bureaucracy and competition lawyers.”
It’s all true – except that all of these problems began under Labour, as a result of the decision by Blair, Alan Milburn as Health Secretary and his successors to create a competitive market in health care. This was Labour policy from 2000 to autumn 2009, when Andy Burnham took over and made the NHS the “preferred provider”.
However Labour’s plan now is not to dismantle the market in healthcare that has been created in the last 25 years, encouraging private providers to take over vital services, but to tinker with it.
The 10 Year Plan promises to scrap the competition rules, and once again establish the NHS as the “preferred provider” of health care: but there are no bold plans to follow Scotland and Wales and abolish the split between “commissioners” and providers of health care, which the Tory Health & Social Care Act has widened.
If the NHS is to be a “preferred” provider it’s clear other providers will still be in the frame: indeed Andy Burnham and other Labour leaders still explicitly argue for a continued ‘supporting role’ for the private sector.
The 10-Year Plan commits to early action to “repeal the Health & Social Care Act”, including the hated Section 75 and its regulations, and “replace the current NHS market …” But in contradiction it also insists Labour will not impose a ‘major top-down reorganisation’, so leaving the market split in place.
Labour also promises to re-impose strict limits on private patient income for Foundation Trusts, extend Freedom of Information legislation to cover all providers of NHS services, and protect the NHS from the EU-US TTIP treaty that could force open services to competition.
All this looks fine on paper – but if this is what they plan to do, why would Labour refuse to amend the wording of the private members’ Bill from Clive Efford to repeal the HSC Act, which defined the NHS in terms that would leave it wide open to EU competition law and TTIP?
There is also a promise to increase NHS spending by an extra £2.5 billion, and invest most of this in an extra 20,000 more nurses, 8,000 more GPs, 3,000 more midwives and on top of that recruit 5,000 new homecare workers, to be employed by the NHS.
These are all good proposals, but far from quick or simple to achieve. It takes seven years to train a GP: so how many more will be in post before the 2020 election? An estimated 6,000 nurses had to be recruited from overseas in 2013-14 – mainly from the EU because of racist immigration laws – to keep NHS hospitals running. Labour promises to train more, but says nothing about the freeze that has slashed NHS pay by 16% in real terms since 2010, making it harder to recruit.
New money is also needed for the NHS: but the £2.5 billion promised by Labour is not enough. It falls far short of the £8bn NHS England boss Simon Stevens says is needed, alongside to partially counteract the staggering £22billion “efficiency savings” his Five Year Forward View suggests will be necessary to bridge a projected £30bn spending gap by 2021.
There is also a predicted £4bn gap in funding for social care, which has ever more restrictive “eligibility criteria” excluding all but the most vulnerable from any support. To improve social care means relaxing these strict rules, expanding services – and proper funding.
Labour proposes to remedy the “neglect of social care,” tackle “exploitation” by banning zero hours contracts, and drive out “the culture of care visits limited to 15 minutes”. It wants services run from a single budget, led by the NHS.
This is welcome news: but the exploitative regime in social care flowed from thewholesale privatisation of domiciliary care, much of it under Labour, driven by constant year-on-year cuts in the budgets of local councils who commission services.
To reverse the process, bring social care back into public ownership and control, improve pay and conditions and enhance the quality of services would be expensive. Many councils – probably including some Labour councils – will stand out against these changes, especially since Labour is reluctant to impose them from above. This would bring a new “postcode lottery” on social care.
Now Andy Burnham says he is proposing to hand NHS commissioning over to council-led Health and Wellbeing Boards, which would be advised by the existing Clinical Commissioning Groups. This is a massive gamble on the largely unknown capacity of HWBs to take on such responsibility. No councils have made use of the flexibility in the Health & Social Care Act to make these broad, inclusive, dynamic bodies questioning the levels of local health services.
Many HWBs are virtually invisible to the local public, effectively no more than closed meetings of council and NHS bureaucrats discussing public health and health promotion. They are at best obscure and unexciting, and at worst an obstacle to local change.
Would councils be funded for the extra work? Are councillors and unelected council officers really to be put in charge of much larger NHS budgets? Isn’t this a large-scale top-down change?
With all these gaps and contradictions in their new policy, Labour could well fail to convince sceptical health workers or many others who were aghast at their marketisation experiments last time in office.
However on paper these latest Labour policies, however flawed, do seem to at last to offer an alternative to the Tory-led coalition: the proof of sincerity will be in Miliband’s willingness to address the weaknesses highlighted by campaigners and deliver the promised changes without further concessions to a hostile Blairite and Tory opposition.
One thing’s clear: whatever your opinion of Labour, a majority Tory government back for five years in May would spell the end of the NHS.
It’s harder now to argue there’s no difference between the main parties: but if Labour wins, campaigners will still have to be ready to fight to make sure Labour stick to the promises made here, go further to scrap the market and its wasteful bureaucracy, and roll back the disastrous tide of privatisation.
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