“Keep our babies free at the point of delivery”

Maternity campaigner Jessica Ormerod tells us her concerns about the Americanisation of the NHS.

In the USA having a baby is an expensive business. To bring home a new bundle of  joy can cost the doting parents $42,000 – roughly the same as a mid-range car but with a lot more noise, nappies and, however much you might be tempted, you can’t trade it in for an improved model.

At the moment in the UK, our bundles of joy are free at the point of delivery. Bed, board and midwife are all inclusive. But, in a fragmented and privatised service such as the American healthcare system women are not at the centre of care, profit and the bottom-line is. Insurance based systems are perfect breeding grounds for unregulated intervention. Women and their partners are sold ‘maternity packages’ including regular scanning, epidural, even elective caesarian – never mind if these interventions are medically indicated, never mind that research has categorically shown that allowing childbirth to be as normal as possible is best for the mother and baby. And certainly no thought to public health policy which has years of experience and knowledge about serving the health and maternity needs of our population.

Mothers understand the complexity of maternity care. We believe that every woman should have a named midwife and that women be supported in their choice of where to give birth. We want a woman-centred care model that allows midwives to focus on our needs rather than the gruelling bureaucratic process of administration. We demand a compassionate midwife to woman ratio on our postnatal wards and that women are properly cared for in the community by regular postnatal visits at home. We are fighting for the right for every woman to have a free, safe and compassionate maternity service.

You can read more from Jessica Ormerod on the Lewisham Women blog.

UKIP’s NHS Privatisation Agenda

You may recently have watched the footage of UKIP deputy leader Paul Nuttall calling for “more free market” in the NHS. Hardcore UKIP supporters have responded to the video with claims that UKIP have changed their policy on NHS privatisation since 2011. Let us set aside the obvious argument that UKIP are merely hiding their true colours in order to appear acceptable to the public. Instead, let us look at the much more recent evidence that UKIP want to privatise the NHS.

(If you’re not sure what constitutes privatisation of a public health service, see Clive Peedell’s article on Open Democracy. In this article we’ll consider privatisation as the increasing provision of a public health service by private companies via a free market process.)

Update: Leaked documents show Ukip leaders approve NHS privatisation once it becomes more ‘acceptable to the electorate’

Update: Ukip general secretary calls for NHS to be privatised and compares it to Nazi Germany

1. Nigel Farage

The UKIP leader Nigel Farage called for private involvement in the NHS in an interview with The Telegraph as recently as October 2014: “I genuinely do think, when you hear of a big businessman that says he’d like to run the National Health Service and streamline it, and get better value for money, I think that’s the approach we’ve got to take.

Farage previously told the Telegraph in January 2014 that it would be “ridiculous to protect the NHS from spending cuts“.

Going back further, Farage was caught on camera in September 2012 telling UKIP supporters that the NHS should move towards an insurance-based system run by private companies.

2. Paul Nuttall 

An open letter on Nuttall’s own website opened with “I would like to congratulate the coalition government for bringing a whiff of privatisation into the beleaguered National Health Service“. The letter remained on Nuttall’s site until May 2014.

3. Samuel Fletcher 

In May 2014 Vox Political’s Mike Sivier managed to catch a tweet from UKIP candidate Samuel Fletcher – it read “Personally I would completely scrap the NHS and require everyone to take out private health insurance.

4. Bradley Monk

In May 2013 the Southern Daily Echo had reported on a very similar tweet from UKIP candidate Bradley Monk – it read “The welfare state is massively bloated. I’d scrap the NHS personally, but that is political suicide.

5. Douglas Carswell

In February 2012 Tory defector and UKIP by-election winner Douglas Carswell wrote an article on his website stating his full support for Andrew Lansley’s privatising Health & Social Care Act.

6. TTIP

Regarding TTIP (the privatising EU-US Trade Deal) – UKIP initially came out in favour of TTIP in October 2014 but then quickly back-pedalled. What’s clear is that they would be fully in favour but for their issues with Europe: “Ukip is in favour of free trade but we are opposed to the undemocratic Commission negotiating on our behalf. Of course we look at each trade deal on case by case basis…” So clear as mud, then. At least RT’s Max Keiser seems to know the score.

7. The UKIP 2014 manifesto

UKIP spokesman Keith Rowe’s website summarised UKIP’s NHS policy in May 2014, stating: “UKIP will abolish the complex competitive tendering rules which currently make it very difficult for smaller companies to bid […] the UKIP will require the NHS to use people with commercial experience to negotiate with the private sector.” In other words, they wanted to make it easier for small private companies to take over NHS services, and they want to put privateers in control of the process.

8. The UKIP 2015 manifesto

The current UKIP manifesto claims “UKIP will ensure the NHS is free at the point of delivery and time of need for all UK residents“. UKIP have said nothing about stopping NHS privatisation – they have not claimed that they will ensure a publicly-funded, publicly-run NHS. So, if you’re trying to claim that UKIP aren’t going to privatise the NHS, copying and pasting the UKIP manifesto proves nothing.

“This is why I fight”

Mike Stafford tells us why a public NHS is indispensable for all of us.

I picked up my prescriptions again last week. Every time I visit the doctors, I’m reminded of my most dramatic trip there back in late 2010.

I’d been having bouts of illness for several months. Fatigue to the point where walking across the room was a challenge, frequent vomiting in the mornings, and endless feelings of dehydration. I was working from home but still managed to end up too ill to work for seven days during the year.

Then, in October, I was taken out of action for a whole week. I spent four days on the sofa, wrapped in a fleece and a blanket, shivering to my bones. On Wednesday, my wife dragged me to pester my GP again; they took blood tests and called me back on Friday. By Thursday night, it took me three attempts to walk up the stairs, and I was mumbling deliriously as I did so.

On Friday, they called me in to discuss my results. After months of suffering with this mystery illness, just to hear it given a name was a huge relief. That name was Addison’s Disease. Invariably fatal at the time Dr Thomas Addison first discovered it, these days it’s medicated with steroids and has no effect on quality of life or life-expectancy at all. I was in the midst of an Addisonian crisis, the stage of the disease that comes just prior to death by circulatory collapse. Pleasant, eh?

I was taken to the Medical Assessment Unit at the Royal. Given the state I was in when I got there, the nurses informed me that the Intensive Care Unit had been notified of my arrival. It’s all of about sixty feet from the main doors of the Royal to the corridor off towards the MAU. Walking that distance was one of the most physically strenuous things I’ve ever done.

At the MAU, I was hooked up to a drip, given anti-vomiting drugs, injected with steroids and talked through the process by a medical staff whose bedside manner was invariably superb. At each stage, they let me know what they were doing and why they were doing it. From being on the brink of death on Friday morning, and having had half a Pot Noodle to eat all week (it’s funny what you can get down when you’re ill), by tea time I was in a fit state to eat, and enjoy, a whole meal. By Saturday morning, after a sleep in my own en suite room, I was ready for release. Walking through the lobby 24 hours earlier had been like climbing the north face of the Eiger. Leaving, I strode across it easily, and when I got to the car park did some Dick van Dyke heel clicks for my wife’s amusement. It was the fittest I’d felt in years.

The staff of the NHS saved my life that day, and did it with smiles on their faces and decency radiating from them throughout. As I type this I still feel a profound sense of gratitude.

When all this happened, I had less than fifty quid in my bank account. I’m a father of three; I’m not poor but I’m not exactly flush with cash. When I hear plans bandied around suggesting we need to abandon the founding principles of the NHS in order to save it, my blood begins to boil.

It takes a long time to diagnose Addison’s disease. Several trips to the GP, in fact. How many trips could I have afforded if plans to charge for GP visits had been approved? When I arrived at the hospital, what standard of care could I have expected on a ward run by the cheapest possible provider? As soon as she made the diagnosis, my GP was on the phone to the hospital to give them a heads up I’d be arriving. Could I have expected two rival private firms to co-operate so freely and effectively?

It goes deeper than that though. The NHS cured me because I am a member of the community, because I was sick and needed to be made well, nothing more. This is not the remit of a private firm, nor will it ever be. Only a publicly-funded, publicly-run health service can be trusted to place the patient at the heart of everything it does.

You can read more from Mike Stafford on his blog, ‘Returning the Favour‘.

Why Abolish Tuition Fees?

Until 1998, there wasn’t such a thing as a fee for going to university. Higher education was free and accessible to all, regardless of economic background. Then things changed.

Although the inquiry into tuition fees was launched by John Major’s Conservative government, it was a Tony Blair’s Labour government that voted to introduce fees of up to £1,000 per year. Future Mayor of London Ken Livingstone reportedly accused Labour of “whipping away a ladder of opportunity which they themselves had climbed”. Labour stated in their 2001 manifesto that they would “not introduce top-up fees”, but in 2004 raised the fee limit to £3,000 per year. And while it was the Conservatives and Liberal Democrats who subsequently raised the limit to £9,000 in 2010, they acted on the findings of a report commissioned by Gordon Brown’s Labour government.

Labour are supposedly promising to cut fees to £6,000 per year, but if Nick Clegg’s previous empty pledge not to raise tuition fees is anything to go by then we shouldn’t hold our breath. Regardless, the National Health Action Party believes that the government should end tuition fees entirely, as has already been done in Scotland and in Germany. But why should we abolish tuition fees? Here are a few reasons:

  • Equal access – if you believed what some Tory candidates have said in the past, then your children apparently need to come from a rich, private school background in order to get a university place. Historically this has been complete nonsense, with a combination of free higher education and grants for poorer students allowing everyone access to university. Now, an Ipsos Mori poll has found that the increase in tuition fees is putting off the majority of students from disadvantaged backgrounds from applying. To have a strong, healthy society, higher education cannot be the preserve of the rich – universities must be accessible to all.
  • The graduate premium – it is often claimed that graduates from university enjoy an overall increase in lifetime earnings of up to £100k, thanks to their increased earning potential. This ‘graduate premium’ is calculated based on various assumptions – that the student spends three years in university and then gets a job commensurate with their degree on leaving university. There are many obvious exceptions, such as medics and vets who spend at least five years at university, and teachers and nurses whose starting salaries may not reflect their level of education. Even for those who enter a high-earning job straight out of university, the graduate premium is already shrinking thanks to rising fees and competition from an ever-growing body of fellow students. Is it really fair to sell students a dream of a better future, then leave them saddled with debts while they struggle as an over-qualified employee of the catering or retail sector?
  • Affordability – as mentioned, fees didn’t exist in the UK until 1998, and Scotland has already done away with them entirely. And believe it or not, it was a conservative government in Germany who abolished fees after only a brief flirtation with the idea of charging. Both countries recognise that free higher education is entirely affordable, and that charging students to go to university is both unfair and deeply unpopular.

Should Clive Peedell be invited on Question Time?

The BBC’s Question Time has a well-known panel format – since 1998, a panel of five has been invited for each episode. Usually this includes a representative for each of the ‘big three’ parties, often augmented by a leading figure from a smaller party. The remainder of the panel are non-partisan.

The BBC has been criticised, and not infrequently, for inviting UKIP to the panel a disproportionate number of times – 21 appearances since 2009, compared with 11 for the Greens. George Galloway’s Respect party, the SNP and Sinn Fein have also featured, and there was even the occasion back in 2009 when the BBC invited the BNP to appear, resulting in protests at the studio gates.

Given that the format is open to smaller parties, it begs the question – should Dr Clive Peedell be invited to at least one episode of Question Time between now and the 2015 General Election? We give our reasons below:

  • Subject matter: the NHS is a key election issue. An Ipsos Mori poll in September found healthcare to be one of the leading electoral issues (29%), second only to immigration (30%) and the economy (31%). Clive Peedell’s area of expertise is thus as important to voters as Nigel Farage’s beloved immigration issue.
  • Balance: with the new ‘big four’ parties all offering similar neoliberal policies, it would bring much-needed balance to the panel to have someone speaking against the privatisation of public services.
  • Quality: Clive Peedell has a known ability to provide good copy on national media, including Sky News, Channel 4 and Radio Five Live. His opinions are well-researched and where possible based upon current evidence.
  • Variety: it may well be refreshing to have someone who isn’t a career politician appear on the Question Time panel. Equally, it might be a break from the norm to invite someone who doesn’t just want to debate populist topics like immigration.

Loss of Representation in the Two Party System

The UK’s political system, as it currently stands, is a two party system. This has been in large part due to the First Past The Post (FPTP) system, in which only those voting for the winning party in their constituency are actually represented in parliament. If your favoured candidate doesn’t win, then your vote is essentially discarded.

Contrast this with proportional representation such as used for European Parliament elections, where constituencies are larger and elect a small batch of MEPs. In this system, the winner still gets the most seats, but the second and even third place parties are also rewarded in proportion to the votes they receive. If your favoured party doesn’t win, you don’t automatically lose your say on who gets elected – and more voters are actually represented in parliament.

As a result of First Past The Post, it’s common for the two largest parties to gain a disproportionately large number of seats in parliament. Worse, most of these seats are ‘safe’ to varying degrees, meaning they are unlikely to change hands. The outcome of each election depends on a small number of ‘marginals’ where undecided swing voters decide which mainstream party gets to have an MP in that constituency. Whoever wins back the greater number of marginal seats wins overall power (unless of course there’s a tie, in which case either a hung parliament or a coalition government will emerge).

As a result, we see a system where one party will have a clear majority, and will be able to push more or less anything they want through the Commons. To make sure that their MPs all vote the ‘correct’ way, each party will have up to fourteen MPs nominated to be party whips – so-called because they whip their fellow MPs back in line. Failing to follow a party whip’s instruction can lead to an MP being expelled from their parliamentary party, so they will usually toe the line. With the exception of free votes and outright rebellions, MPs will therefore vote the way that their party tells them, rather than doing what their constituents want.

NHS England and the £30bn Funding Gap

Simon Stevens (pictured) of NHS England will shortly be unveiling an NHS roadmap of sorts for the next parliament. Looming large is the matter of the claimed £30bn funding gap, an artefact of the Tory policy to stagnate NHS funding rather than commit to real-terms growth. As you’ll recall, the coalition government already subjected the NHS to £10bn worth of ‘efficiency savings’, the majority of which came from pay freezes and cuts to staffing and acute beds.

As Dr Clive Peedell puts it:

[Stevens] must make the point that flat funding of the NHS is a policy mistake […] per capita spend on the NHS has fallen under the coalition. Efficiency savings are effectively cuts and they have gone too far. Patient care and patient safety is at risk. The NHS clearly needs more investment and it needs to be at least a 4% increase year on year. This could be funded by addressing the […] internal market, that is estimated to cost the NHS at least £5bn per year.

We know from economic studies that an increase in healthcare funding would have a multiplier effect on the economy. That’s to say that for every extra pound put into the NHS, we’d see the overall economy benefit by several pounds. That’s because healthy people are productive people – investing in preventative measures and treating patients in a timely manner will help our economy recover. With the NHS currently one of the cheapest healthcare systems in the western world, we can clearly afford to fund it properly; in fact, with the benefits to people and to the economy so clear, we can hardly afford not to fund the NHS properly.

EDIT: Here’s further reaction from Clive Peedell to Simon Stevens’ report:

Stevens is a long way from securing the £8 billion extra by 2020 that he admits is needed to make ends meet even after extraordinarily ambitious efficiency savings of £22 billion.

None of the three main political parties is committed to raise NHS spending by anything like as much as £8 billion: the Tories are sticking rigidly to their planned further five-year freeze to 2021, the Lib Dems have offered two related injections of £1 billion from 2017, and Labour has promised £2.5 billion also in 2017 – by which point the financial crisis already brewing in the NHS will be boiling over into cuts and closures.