Category Archives: Your Views

No More ‘Shock and Awe’

Dr Guy Baily gives a personal view on Syria.

There is no doubt that all types of warfare have catastrophic effects on public health. The bar, for military interventions to be acceptable, must always be a very high one. In my view it has not been reached for the Syrian bombing campaign. The recent history of Western military interventions is of a series of calamities.  The reasons why they are so liable to go wrong have been well rehearsed and it should be possible to learn from them.  I suggest that before becoming violently embroiled in other people’s countries, a few conditions have to be met:

1) There must be a humanitarian crisis which cannot be resolved by other means. There are plenty of humanitarian crises about but force is not often the obvious solution.

2) There must be a clear and realistic political and diplomatic strategy that has a probability of returning the recipients of our bombs to stable government. In Syria there is a complete absence of such a strategy.  The local fighters are fully engaged with fighting Assad in their own backyards, while being bombed by the Russians, and have little interest in wandering off into the Eastern desert to take on ISIS. Many of them are radical Sunnis closely allied to Al Qaeda, who we recently invaded two countries to attack.  Where these forces have achieved local power they have shown more interest in feuding than in tolerating other groups or religious minorities. The Kurds, who are well organised and have a coherent government, are very sensibly not interested in trying to control large areas inhabited exclusively by Arabs. Who is going to govern Raqqa after it has been flattened? This needs serious diplomatic peace-brokering.

3) The use of military power must clearly and directly enable the political strategy. As there is no credible political strategy in Syria, this is going to be a hard one to fulfil. Air power can be an effective tool when used in close support of a well organised ground force, such as the Kurdish Peshmerga in Iraq, but otherwise what can be achieved by bombing is limited and the collateral damage to people and infrastructure is huge.  Conflicts can ultimately only be resolved by winning over hearts and minds.  Killing all the bad people – presumably so only good people are left – appears to be the infantile level of military reasoning we have sunk to.  Similarly ‘fighting Islamic fascism’ has a fine rhetorical ring to it but in reality, bombing is more likely to boost recruitment to Islamic fascism than destroy the idea. Their ideology actually requires that we attack them, they desperately need it. And remember it was the excesses of the Iraq campaign that gave rise to IS in the first place.

4) The use of military violence should be the absolute minimum required for number 3. No more ‘shock and awe’.

The argument of self-defence is entirely bogus. Dropping bombs on Syria is not an effective means to prevent attacks on London and is more likely to be counterproductive. Too often, a bombing campaign fulfils an atavistic urge to lash out at the bad guys without any further real strategy. The problem in Syria is not a lack of sufficient high explosives.  Nor is it a lack of different players with different agendas getting involved.  Britain could be so much more useful as a non-belligerent broker between all the competing interests that must be reconciled to bring about the diplomatic deal that ultimately will have to emerge. And we could use the money otherwise spent on those fantastically pricey smart bombs to support the refugees.  But that would not allow David Cameron to feel like one of the cool kids when Western leaders meet.

Labour values, the NHS and me – Marcus Chown

Popular science author Marcus Chown has been a victim of the Labour purge. Here’s his response.

It is 5 days since I received an e-mail from the Labour Party telling me it had reason to believe I did not support its aims and beliefs and it was excluding me from voting in the leadership election. I have voted Labour in every election since I was 18. I have been a full member of the Labour Party and even campaigned on the doorstep. But I did not agree with Labour’s policy of privatisation of the NHS (Public funding of private health companies, according to the WHO definition, is privatisation). So I joined a party, formed by doctors, nurses and patients, to truly defend the NHS.

David Cameron explicitly promised “no more top-down reorganisation of the NHS”. But, when the Conservatives came to power in 2010, they introduced the Health & Social Care bill, which they had concealed from the electorate during the election and which was bigger than the bill that had created the NHS in 1948. It removed the government’s “duty to provide” healthcare for you and your family, a founding principle of the NHS, replacing it by a mere “duty to promote”. Even the health minister would no longer have responsibility for your health. It would be left to the “market”. In effect, the bill made possible to gradual abolition of the NHS.

My publisher had got me to do Twitter and, at the start of 2012, I noticed a tweet about Dr Clive Peedell, a consultant oncologist, who was trying to highlight the H&SC bill by running 160 miles to Downing Street from the former South Wales constituency of Nye Bevan, the founder of the NHS. I was training with my wife, an NHS nurse, for the London Marathon. So, on a freezing day, we jogged out to Notting Hill. And that is how I met Clive and ran the final kilometres to Downing Street with him and Clare Gerada, chair of the Royal College of GPs (and her Jack Russell, Lucy). Nine months later, Clive founded the National Health Action Party with ex-MP Dr Richard Taylor and other doctors, nurses and patients who were appalled at the way all the main political parties were wedded to the privatisation of the NHS, which all evidence shows is worse for patients.

I can’t remember how I got invited to an executive meeting (I should stress I have never been on the executive committee) but I remember, when it came to “any other business”, saying the party’s Twitter feed was full of acronyms and doctor jargon. Little did I know that, Clive, sitting across the table, was NHA’s Twitter feed! To his credit, over a cup of tea and cake, he said: “Why don’t you help with our Twitter? Here’s our username and password.”

NHA saw the London euro election of 2014 as an opportunity to raise public awareness of what the government was doing to the NHS, which the UK media had failed to cover or critique, ignoring the overwhelming level of opposition. NHA’s candidate was inner London GP Dr Louise Irvine, who had run the Save Lewisham Hospital campaign. When a court supported her and ruled that the government had acted illegally in downgrading Lewisham’s A&E and maternity departments, the government simply changed the law. Every party was allowed 8 candidates, in the London euro election, with all accumulated votes going to Louise. I got asked to stand and surprised myself by saying, yes. The others included an A&E consultant, a nurse, trainee surgeon, and actor and comedian Rufus Hound.

I should point out that NHA is not a party of power. It has resources only to contest a handful of seats. In the 2015 GE election it was careful not to inadvertently help a Conservative into power, recognising that the Conservatives are a bigger danger to the NHS than Labour.

And so I come to the point of this statement. Rules are rules. I understand that. And, yes, I have helped another party, which rules me out from voting in the leadership election. But NHA, the party I have helped, stands for exactly what the Labour Party should be standing for. I joined NHA in desperation because Labour had been heavily involved in privatisation of the NHS, and PFIs, which have plunged hospitals into enormous debt. Admittedly, Labour’s 2015 manifesto called for the repeal of the H&SC Act. But it pledged simply to “stop the drive towards privatisation” and “cap the profits” of existing private providers. The party said nothing about ending the wasteful “internal market”, which is estimated to divert 15 per cent of NHS money away from patients into bureaucracy.

It seems odd to be accused of not sharing Labour values when I have always voted for Labour and support a party whose values should be shared by the Labour Party – the desire for a publicly funded, publicly delivered NHS, which all evidence shows is the best system for patients not to mention the most cost-effective and efficient. NHA would never have formed in the first place if Labour had been true to its values on the NHS.

It does not seem right to accuse me of not sharing Labour values simply because I have criticised its NHS policy. I would like the Labour party to get into power with a leader who is committed to a publicly funded, publicly delivered NHS, which is what is wanted by the overwhelming majority of people in the UK.

Greece, the NHS, and Democracy

Deborah Harrington draws parallels between the Greek economy and England’s health service.

Three things stand out in the documents Wikileaks published showing the detailed bailout terms for Greece: the removal of political power, giving them no other option but to the privatise their services; the sequestration of their public assets into a private holding company; and the removal of choice over their economic policy. Together these form the effective removal of their democracy.

It is not only the immediate decision that has that effect, but in the long term, what is left for a Greek government to legislate on, other than the deployment of their armed forces and police to quell the riots?

Has democracy in the UK already gone the same way, but with the cooperation of the government in our case? Our public assets are being sold off at extraordinary speed, and have been transferred into private company portfolios pending sale. The NHS is being privatised in profound ways. The Health Secretary is no longer legally responsible for the NHS. We no longer have a right to healthcare. Austerity and privatisation were forced on Greece; here our government accepted them voluntarily.

Selling England By The Pound

Hospitals we used to own are being demolished whilst the new PFI ones are not in our ownership, but in private consortia. We have to lease them back and are tied into maintenance contracts whose combined cost can be more than 20% of the annual budget, financially destabilising the hospital and damaging patient care.

All this and more – contracting out, complex relations between different fund holders – has enormous cost attached. This is not about ‘NHS management’ but about the proliferation of private healthcare management companies involved at every stage – negotiating contracts for PFI, drawing up tender documents for every kind of service from cleaning to cancer care and advising on the financial ‘viability’ of hospitals, which can now be bankrupted as they are businesses, not public assets. When the Trusts are put into liquidation the administration process is also run by these companies.

We are so deeply enmeshed in this ‘depoliticising’ of our administration that we can’t even see it. Where was the outcry when the ownership of some of our schools and hospitals was found in the offshore tax avoiding accounts of HSBC who had been advised by PwC? Why is PwC still involved in advising at government level and running our public sector at operational level when the Public Accounts Committee said they were responsible for ‘industrial scale tax avoidance schemes’?

Like Pasok in Greece, the Labour Party agrees with the political Right that management of the economy under austerity rules is the only acceptable proposition. They may (possibly) deviate on the means to achieve it, but not the principle. We have a dominant political voice agreeing that There Is No Alternative. Labour and Tories alike have called for the state to be reduced and ‘resilient’ communities built. (A resilient community is one that can survive on an individual and collective level without state support mechanisms.)

NHS Healthcare on a par with NHS Dentistry?

The list goes on… but the NHS won’t. The devolution project will split the national NHS budget into a hundred pieces to be privatised by local councils and city mayors. As with social care the NHS will become a last resort for the poor, whilst the rest will end up as means tested and chargeable, either through co payments or insurance. Imagine the health service being operated on the same lines as dentistry and you’ll get the picture. Local authorities will provide a minimal service for the poor, in health, social care and social security combined. At the dentist the free or low cost treatment is called ‘NHS’ treatment, but it’s as far a cry from the principles of universal, comprehensive and equitable treatment that have characterised the NHS as it can possibly be.

Those people who keep saying ‘it doesn’t matter who provides the service’ had better buck up their ideas and start fighting against this. Otherwise we may well find, as in Greece, that when the NHS is gone, democracy has gone with it.

The Serious Implications Of Planning Policy On Our Health

From a letter to The Guardian by Jessica Ormerod:

The Guardian’s revelations of the extent of corporate influence on the housing policies of government and their implementation by local authorities of all political persuasions is shocking, but not unexpected. The displacement of council tenants and leaseholders in areas of high land value in favour of the development of their old homes into homes for profit is the same transfer of provision being carried out across all sectors of public service, including the NHS.

Adequate access to decent housing is a growing problem for all income groups, leading to overcrowding and stress as people struggle to meet high housing costs. These policies, which focus relentlessly on ‘economic value’, are the drivers of greater inequality which is having a dangerously adverse effect on the nation’s health.

We are particularly concerned for the future of the children in families who are being moved out of their communities with increasing frequency, fragmenting their education, friendships and family connections. These are well researched indices of poor outcomes in both health and educational attainment. We are seeing that the real effect of privatisation, as demonstrated so clearly in these revelations, is to reduce the availability of services to the public in the name of profitability. That goes for genuinely affordable housing, NHS services, social services and all other public sector provision. Businesses need to flourish, but not at the expense of the public health. We have been badly let down by successive governments who fail to grasp this basic point.

Six Reasons Why Privatisation Is Bad For Our Health

Public health expert David Lawrence explains why competition and marketisation aren’t the change that the NHS needs. 

The NHS in England was once a collaborative and cooperative public service, with the aim of reducing our suffering, and improving our health. Over the last 30 years, successive governments have introduced more and more elements of competition, contracting and privatisation, including the purchaser-provider split, the Private Finance Initiative and ‘any qualified provider’. There are several reasons why this is not good for us.

1. Competition Creates Bureaucracy

Public financing, using general taxation and public, non-profit healthcare, has lower costs than a part-market system with for-profit providers and mixed public and private financing. The traditional NHS (pre-1980s) had low management costs of around 5%. That was perhaps too low, and required more expenditure on expert management data collection and systems management.

The Health Select Committee has noted that, by 2005, the internal market had increased the administration costs of the NHS from 5% to 14% of the total NHS budget. Large costs are associated with the purchaser-provider split and competition, such as accountants and lawyers, and transaction costs associated with tendering, contracting, procurement and the regulation of for-profit companies. This management cost difference is nearly a tenth of all NHS expenditure; the amount wasted is estimated conservatively at £4.5bn per year.

2. Markets and Healthcare Don’t Mix Well

Certain conditions have to be met for market-based systems to be effective and efficient; they are not met in health care.

First, consumers have to know what they want and understand what they have been given (‘consumer sovereignty’). As patients we do not know always know enough to assess what is being offered to us, and thus rely on the clinicians and hospitals to treat us fairly. This creates an asymmetry in the market, making less knowledgeable patients vulnerable to being ripped off by exploitative market practices.

Secondly, a market requires multiple firms competing in the same area. Having several competing hospitals in one place is wasteful, even in cities. Outside cities, it does not work at all. The inevitable result is one of the firms going bust, or both firms becoming mediocre in order to cut costs.

Thirdly, competition works well with mass-producible goods, whereas healthcare is a bespoke, craft service – economies of scale do not apply. Building two competing hospitals would mean doctors and nurses not getting enough experience and expertise, forcing both hospitals to try to take on simpler cases in order to increase throughput and maintain funding. Regional centres of excellence depend on collaboration, not competition, being the norm.

Finally, use of a market requires management strategies to focus on targets, threats of competition and closures. In healthcare, attention also has to be paid to matters such as quality improvement, morbidity and mortality, and training of junior staff.

3. Pay-For-Access Will Become The Norm

The more a privatised competition-based market system is introduced, the more there will be restrictions on the publicly-funded NHS, forcing many NHS users to pay more for care, or get top-up insurance, as in many other countries. This is already happening with certain rationed operations in the UK, with NHS patients charged five figure sums to jump the queue.

4. Private Firms Cherry-Pick The Easy Work 

Competition-based marketisation, especially from using private providers, produces ‘cherry picking’ of less expensive patients, leaving the NHS public service to pick up the tab for more complicated and long-term cases. In the cases where private companies do take on unprofitable work, they will either drop their contract after a few years or end up taking on further NHS contracts in order to stay in the black.

5. Competition Prevents Integrated Care

Service fragmentation, characteristic of marketisation, allows the government to have a more ‘divide and rule’ regime. Separate service providers can blame each other for failures. It also makes it far more difficult for patients to access services, as their GPs have to climb false walls to organise integrated care. Transfer of staff expertise is restricted.

Though there is already a ‘postcode lottery’ in the NHS, there is at least a recognised NHS ethical-legal basis for clinical decision making policy which limits it. A market-based system makes it more difficult to allocate resources fairly and ensure equal access to care.

6. Private Firms Don’t Pick Up The Pieces

The existing legal duties on the public NHS are in danger of being undermined if private corporations make treatment funding decisions and provide care. The various forms of creeping privatisation will soon put control in the hands of firms who have little interest in the long term outcomes of patients, provided that contractual obligations have been fulfilled.

The sorry saga of deficient PIP breast implants shows up a situation that will now occur much more widely. In the case of failure of a private health care organisation, private insurers are unlikely to pay out, leaving either the public or patients themselves to cover the cost of remedial treatment.

No Child Wasted: Why We Have A Responsibility To Vote

An NHS campaigner shares their thoughts on why it is vital to exercise our right to vote.

Children can’t vote. So they rely on the rest of us to cast ou​r votes in a way that will protect them. Protect them from hunger, deprivation, exploitation, lack of hope, so that they can grow up healthy, happy and productive. And therefore able, in their turn, to exercise the same protection for the next generation. That is why voting is not just a privilege of adulthood but a responsibility – however onerous and frustrating it may be.

Most of us in Britain have grown up protected, at least in principle, by a system that was created after the Second World War to ensure that no child should ever again be wasted – as poverty, ill-health and inequality had wasted British children by the million in generations gone by.

After 1948, a child born in the NHS would be nurtured and cared for – free – until he or she reached adulthood. Would be educated – free – to reach their full potential as citizens. And, if his or her potential was such, would be supported through a – free – university education. And when these children had children of their own, they too would all have access to decent housing – privately or council-owned – regular employment and world-class healthcare, free at the point of need.

In this way, it was hoped, no child in the post-war world would suffer the full effects of the poverty or disability or death or separation of their parents. No child would be penalised for their parents’ inability to advance the career of their children through their own wealth and contacts.

A terrible war had shown that every person had something to offer; henceforth no child would be wasted. That was the promise the post-war Welfare State made to all the people who had fought, together, for freedom against the forces of darkness and destruction.

It wan’t a promise that was always fulfilled by any means. But for the passage of a generation there was no real challenge to the idea that the protection of all our children, collectively undertaken and collectively paid for, was a noble – a sacred – trust.

But then, even as the nation as a whole became richer, a new force, a new idea, started to gain ground in some elevated circles, which argued, “Why should the rich and powerful pay to put their children on a level playing field with the children of the poor?” This was not an electoral pitch that would gain sufficient votes to secure power from the necessary non-rich of course, so it had to be couched by the grandees in slightly different terms if it was to appeal to the masses.

The appeal to selfishness of, “Why should you pay to support the well-being, and the prospects, of someone else’s child?” – which attracted the immediate, obvious, riposte of mutual benefit and therefore greater security for all – also required that the “someone else” be demonised in order to work to an electoral asset. Demonised as foreigners wherever possible of course but, as Enoch Powell showed, that could be counterproductive. However no one seemed to have any interest in defending the foreigner within – the “undeserving poor” of the Victorian era, now revived and reinvented to play The Other again in right-wing demonology.

The more recent pejorative of “council-house kid” was clearly no longer of any use as an alienation tool once doctors, lawyers, movie stars and Cabinet ministers nurtured by the Welfare State could boast proudly of having been a council-house kid themselves (thus showing that it was nurture, not nature that had kept the poor down for so long). But, in this new vision, anyone who was lucky enough to secure one of the deliberately dwindling supply of council houses was to be envied by many, and so could be dubbed with the working-class insult “scrounger” – and if they could be shown to be foreign too, so much the better.

And, even if not literally foreign, they could be made to seem so. With the eager assistance of a crass and compliant media, the affectionate chavi, meaning child in the Romani language, quickly became a viral hit of hatred that dubbed the disadvantaged child as a separate nationality, confirming just how alien it was to respectable society: The Chav. Even if they had money, and few did, they spent it on the wrong things, the wrong clothes, the wrong food, the wrong home gadgets. So there was no point in taxing away your hard-earned money just to waste it on a Chav child.

Even before the coining of the term ‘Chav’, the groundwork for this was well-laid. In 1974, Sir Keith Joseph warned that “our human stock is threatened” by the breeding of young mothers in social classes 4 and 5. Where once our proud British commitment was to every child that was born,now we were told that: “A high proportion of these births are a tragedy for the mother, the child and for us.”

And by the time these “tragedies” had reached the age of 11, their educational future was in the hands of this same Sir Keith Joseph. It had been placed there by Margaret Thatcher who, in her own “milk-snatcher” days at Education had, according to Cabinet minutes: “Said that she had been able to offer the Chief Secretary, Treasury, rather larger savings than he had sought on school meals, school milk, further education and library charges.”

And it was Thatcher who, as Prime Minister, destroyed our manufacturing base in which so many of these “tragedies” one day hoped to work, sold off our houses in which they one day hoped to live and raise a family, and gave away our national and municipal assets that served to keep those families’ needs within the reach of a single living wage.

A consensus on the utter worthlessness of The Others was built up through a co-operative media under the governments of Margaret Thatcher and John Major, but did not die with the massive public rejection of Toryism in 1997. Tragically, it remained largely unchallenged through the ruthlessly vote-chasing years of New Labour, which abandoned Old Labour’s principles of solidarity for its “hard-working families” mantra. For reasons of its own, the party machine shunned association with the millions cast to the bottom of the pile by unemployment – even in areas strip-mined of employment by Tory policies.

By the time New Labour collapsed in a morass of unregulated bankers, super-casinos and ID cards, even Dave “hug a hoodie” Cameron and Nick “scrap tuition fees“ Clegg offered a more hopeful and humane vision to a wavering, betrayed and bewildered electorate.

Once in power, of course, it was business as usual with the likes of Lansley and Duncan-Smith unleashing a venomous assault on The Others that Thatcher and Joseph could have only dreamed of.

Money is drained from the budgets of the poorest families with a VAT hike that subsid​is​es a cut in the higher tax income rate for the rich. Money is drained from the education of all our children to subsidise the education of those in new, privately run “academies”. Money is drained from the benefits safety-net we all pay into, in order to subsidise corporation tax cuts for below-living-wage employers. Money is drained from our National Health System to subsidise tax-dodging corporations who spy a profit to be made by taking small bites out of it, and who walk away leaving a service bleeding if it turns out there isn’t.

In 2015, the ranks of The Others are now bursting at the seams and, it seems, could soon encompass us all. If you are a child whose parents are unemployed, you’re in. If they are working, you still have a pretty good chance of being in. If they – or you – are disabled or have mental health needs then you are definitely in.

And even if you are not included in the ranks of The Others today, your prospects of staying out for long are dwindling fast. By 2020, on this government’s own figures, 21% of British children will be living in absolute – not relative – poverty, up from 17%  in 2010-11.

So take five children: one will live in a financially secure home 2020 (so long as it is spared family bereavement or bankruptcy); one will be in absolute poverty (and possibly homeless); the other three teeter somewhere between, hopeful to rise and fearful to fall.

Currently, at least all five would be guaranteed the very best medical care available, free at the point of need, through our NHS – although hunger and poor housing would put some in more need of it than others. In 2020 that may no longer be so. In a Britain incalculably richer than the one that set up the Welfare State, it seems we will no longer be able to afford, as they did, to give them even an equal chance to be born healthy.

Already we can see how, as in Morecambe, the drive to marketise the NHS has helped to cause the actual deaths of actual babies. Get used to it. As the drive to privatise our National Health System drains more and more money from what it offers,​ free and equal to all, and pushes more and more services into ability-to-pay disparity, this will only get worse.

And, horribly, all that this Labour Party seems to be offering is that it will all get worse a fraction more slowly.

But look back to the beginning of this article and to the commitment that the post-war Labour government made to all the children of Britain – born and yet-to-be – in 1948. If it still seems to be as sane, humane and worthwhile a commitment to you as it seems to us, then all you have to do is vote for it to bring it back into our national life. Not just in the coming general election, but there and within your union and within any other bodies you belong to and with your feet and with your voice and on the streets and wherever you can make yourself heard.

How can it make sense to vote for anything else?