Deborah Harrington on the latest fallout from the Efford Bill
Labour MP Clive Efford has posted a legal rebuttal to Allyson Pollock and Peter Roderick’s critique of his ‘Efford Bill‘. It is written by David Lock QC – by chance the one-time Labour MP for Wyre Forest who supported the proposed ‘changes’ to Kidderminster Hospital which started the political career of Dr Richard Taylor.
Lock’s analysis is a mixture of legal interpretation and neoliberal ideology. He ‘explains’ why Pollock, Roderick and others are wrong about Efford’s Bill, adding his neoliberal interpretation of the founding principles of the NHS. He seeks to demonstrate that the Health Secretary never had a ‘duty to provide’ healthcare and this is his commentary on the utopian and unachievable aim of a ‘comprehensive’ service:
“There are a multitude of reasons why a comprehensive health service that provides relevant healthcare services to meet the needs of all NHS patients can never be delivered in practice. The understandable calls from patients for such a service are, when properly analysed, calls for a utopian service which no government has ever or could ever deliver because the supply of any healthcare service inevitably creates a demand for further services. At some point the money must run out and the available services have to be constrained by the available resources.”
I doubt very much whether any NHS campaigner has ever thought for one moment that ‘comprehensive’ when properly analysed means endlessly supplying to a demand led health economy in which ‘patient choice’ must been sated in accordance with market rules.
Lock defines ‘comprehensive’ as the opposite to ‘rationed’, based upon patient demand rather than healthcare needs. (A more reasonable definition of comprehensive is covering everything on the base of clinical evidence, clear definitions and sound planning rather than market forces.)
By using these descriptions (and particularly the use of the word ‘utopian’) Lock defines Bevan’s terminology as being merely idealised, rather than prescriptive. That way, he can effectively dismiss them as not to be taken literally.
Specifically he says:
“If there is to be some limitation [on the ambit of the duty under section 3], I ask myself the question: How is the nature and extent of that limitation to be determined? And the only sensible answer that I find it possible to give to that question is that the limitation must be determined in the light of current government economic policy. I think that is quite clearly an implication which must read into s 3(1) of the National Health Service Act 1977 if it is to be operated realistically”
In other words neoliberal economic policy rules supreme over all other considerations. This potentially allows any configuration of services or any number of cuts to be imposed under the mantle of ‘economic responsibility’.
Regarding the status of the NHS, Efford’s Bill uses the legal term ‘services of general economic interest’ rather than ‘non-economic social service of general interest’ – this would seem to run in the face of the ‘social solidarity’ that the Bill attests to elsewhere. ‘Services of general economic interest’ is a term defined in trade agreements, whereas ‘solidarity’ is a stated underlying value of The Single European Act, the Maastricht Treaty and the Lisbon Treaty. A value does not have the precise definition of a clause in law, and thus cannot be used as a trump card this way.
Assuming that Efford actually took legal advice before writing the long title of his bill I also have to point out a logical fallacy. The long title claims to ‘re establish the Secretary of State’s duty to provide national health services in England’. The actual text does not do that. Campaigners objected. And now Lock argues it couldn’t do that because no such duty ever existed!
Furthermore the principles of the NHS 2015 Reinstatement Bill – public ownership, public provision and removing the private sector already there – are now being dismissed as unrealistic by those who have promoted Clive Efford’s Bill. As expected, the neoliberal view in which market forces must rule over healthcare needs is being presented as the only possible option.