We have another NHS crisis. It will cost lives, unnecessarily. It will cause untold long term harm as staff give up, voluntarily or otherwise, under the pressure brought to bear on them. And nothing about this crisis is made up: this is the real thing, resulting from real demand, and no edict from Westminster will solve that.
I am not claiming medical expertise. Nor am I suggesting that I can solve all the problems of the NHS overnight. But I do know that the NHS need not suffer a cash shortage. What it is, instead, suffering is a political crisis. I explained why in an article I was asked to write for the British Medical Journal last summer, which did not get published as there simply wasn't time to deal with the shortening in length that the editor requested from me before publication was planned. I share it here instead:
The threat from and to the NHS
There is a widespread belief that the NHS is under threat. A recent conference at the Royal Society of Medicine, which attracted considerable media attention as a result of the exchanges it generated between Jeremy Hunt and Prof Stephen Hawking, was premised on the assumption that this was the case. If this is true it is, however, important to understand why the NHS is itself threatening to some and why those threatened wish to threaten the NHS as a consequence. Without that understanding the threat to the NHS cannot be appraised.
Who and what the NHS threatens
The creation of the NHS has to be seen as the consequence of a circumstance of chance that occurred at a particular point in history. But for the Second World War, the concept of the welfare state to which it gave rise, the election of a Labour government in 1945, the creation of Keynesian economic thinking during the recession of the 1930s and the willingness of that 1945 Labour government to spend despite the massive accumulation of debt that the war gave rise to there would have been no NHS. That this coincidence happened indicates something deeper, which was the creation of a post-war political consensus that meant that the founding principles of the NHS continued in existence after Labour fell from power.
Those three principles were clearly stated in July 1948 when the NHS began to operate. They were[i], in the words of Nye Bevan, that the NHS would meet the needs of everyone; that it would be free at the point of delivery and that its services would be supplied based on clinical need and not ability to pay. The survival of the NHS suggests that these principles resonated across political boundaries. The evidence is that they still do: if the UK has anything close to a national religion in the twenty-first century, it is faith in the NHS.
That faith does, however, reflect a very particular worldview. It assumes that there is a state. Quiet explicitly, it suggests that the state has a role in people's lives. In saying so it explicitly rejects the notion that the market can meet all need. In its place it substitutes central direction of the supply of at least some services and it assumes that hey will be paid for by taxation. Implicitly this assumes that the price signalling mechanism of the market is an unsuitable indicator for allocating resources with regard to health: explicitly need is substituted instead.
This worldview was predominant in 1948, and for a long time thereafter. But this does not mean that there was no other worldview at the time that the NHS was created. In the year before it was founded Frederik von Hayek founded the Mont Pelerin Society[ii]. To do so, he brought together thirty-six academics, journalists, financiers and other interested parties to discuss how their alternative vision of society might be promoted in the face of what they perceived as the threat of socialism, which would lead, as Hayek put it, to 'The Road to Serfdom'[iii]. With the creation of the Mont Pelerin Society, the political-economic philosophy of neoliberalism was born.
The defining principle of neoliberalism is that it is competition for resources that defines their optimal allocation within a society. Alternatively, as William Davies has argued[iv] neoliberalism is hostile to what it sees as political discourse and it seeks to put in its place explicit economic indicators for which the market price system is the model. It does not allow for any alternative: it is this principle that dictates optimal solutions, it says.
A number of obvious conclusions follow from this logic in the context being discussed here. The first is that it is markets that should allocate resources. The second is that the only role of the state is to underpin the smooth functioning of markets. The third is that taxes must be minimal to allow individuals to engage to the maximum possible degree within the market. Fourth, this requires that those engaged in the supply of any service must be capable of failing or the pressure of competition cannot be brought to bear upon them. And, since this pressure is also only possible if the capital available to any provider is limited it also follows that suppliers must either be in the private sector or, at least, be removed from government control and access to its capital.
What this analysis makes clear is that the culture of the NHS, based as it is upon universal state provision that has sought to minimise cost by seeking to supply consistent, high quality care in a non-competitive environment, guaranteed by medical ethics rather than by market imperatives, is very different to neoliberal thinking. This would not matter to neoliberal thinkers if the NHS did not work, but it very obviously does. Both its popularity and the success of the NHS in rankings, such as that of the Commonwealth Fund[v], where in 2017 it was found to be the overall most effective health care system in the eleven advanced economies subject to appraisal, spreads this perception that there is an alternative to the neoliberal model. Unsurprisingly those who promote neoliberalism as threatened as a result. Their response is to threaten the NHS.
The origins of the threat
The threat to the NHS has its generic root in the rise of neoliberalism, so successfully related by Nancy MacLean in her 2017 book 'Democracy in Chains'[vi]. As she relates, the challenge to the state and its agencies, like the NHS, is organised and well funded, most especially through secretive think tanks. The Institute of Economic Affairs, the Adam Smith Institute and the Centre for Policy Studies are simultaneously at the forefront of this attack on the NHS[vii] and think tank secrecy in the UK: a 2017 study found they were almost entirely opaque about their sources of revenue[viii].
One paper published by the Centre for Policy Studies is particularly notable in this respect. Written by John Redwood, then (as now} Conservative MP for Woking, and Oliver Letwin, who had then to start his House of Commons career, it was entitled 'Britain's Biggest Enterprise: ideas for radical reform of the NHS' and was published in 1987[ix]. In a quaint reminder of the way things once were, the very obviously type written text remains available on the web. It is laden with barely veiled attacks on the NHS, behind the usual expressions of support for the NHS's long suffering employees encumbered, as they were, by having to work in such a hostile system. But what really matters is the prescription it made for the direction of NHS reform, which it recognised could only be achieved in piecemeal fashion. The incremental goals would, it suggested, be:
- Establishment of the NHS as an independent trust;
- Increased use of joint ventures between the NHS and private sectors;
- Extending the principle of charging;
- A system of 'health credits';
- A national health insurance scheme.
Looking at the NHS in England, it is clear that the first and second goals have largely been achieved and are now deeply embedded within its structures. In social care charging is similarly profoundly embedded. So, too, is the concept of a 'health credit' becoming more commonplace in some aspects of NHS service[x]. That said, whilst it is still appropriate to note that options three and four are far from complete, it is not unfair to say that they are works in progress. In that case, the concern that an insurance system remains the direction of travel, as expressed by Professor Stephen Hawking[xi], appears to be entirely realistic in the circumstances. The neoliberal assault on the NHS is very real.
What I would also argue is that the assault is conducted on more than one level. What might be called the Redwood / Letwin assault is explicit, and direct. It may be thirty years old and only partially successful, but it is well funded and continuing. The assault also exists at another level, for which the last decade has been little short of a gift. This second assault was accurately described by Noam Chomsky in 2011 when he said[xii]:
There is a standard technique of privatization, namely defund what you want to privatize. .... [F]irst thing to do is defund them, then they don't work and people get angry and [then] they want a change.
The threat from austerity
The political choice to pursue the policy of austerity, adopted by the incoming UK government in 2010, has resulted in very limited real-term increases in NHS funding per capita in England since then and no forecast increase at any time in the foreseeable future[xiii]. In the face of changed demographics; real cost increases as better procedures become available, and imposed costs from the reorganisation that have distracted resources from patient service provision the result has been a real reduction in resources available for patient care, a reduction in beds available for the supply of that care and enormous stress on a system that has, in the opinion of many practitioners, reached a breaking point. Many economists, myself included, have argued that none of this was necessary: austerity was a choice and not a necessity. It is indisputable that in 2017, that policy has failed to achieve its stated goal of a balanced budget: in the current financial year, the UK government deficit is expected to exceed £58 billion. The consequence has not, however, been the abandonment of austerity as a policy but is instead its promised perpetuation: the assault on the NHS budget is to continue, remorselessly. That is why the Redwood / Letwin solution has to be still be considered to be on the table.
Two other factors contribute to this assault. One is the deliberate creation of confusion within the structure of the NHS in England. The 2012 Health and Social Care Act achieved its goal of shattering the NHS into as many parts as possible with no obvious lines of control remaining intact. This was not by chance: a private sector health service cannot be subject to central control and in England there is no effective way that it is now. In addition, neoliberal dogma demands that this service must have built into it the possibility of failure. Again, that is precisely what the 2102 Act delivered. The fragmented trusts that now make up the NHS, each with a balance sheet left fragile by under-funding, has been created to open the possibility of widespread financial failure, as Chomsky predicted. After all, how can an organisation suffer the pressure of competition if its risk of financial failure is insignificant? That patients might suffer as a consequence of that failure is inconsequential: the dogmatic goal of creating market risk is being achieved, come what may.
The illusion of patient choice is the third component in this process of undermining the NHS. Most practitioners will realise that choice is a token in many cases: in an emergency, it's far from a patient's concern. But for the neoliberal, it exists for a reason: it is there to undermine the idea that the NHS might, firstly, exist to provide universally good care and, secondly, that it is the only option that the state might fund. Choice exists to provide openings for the private sector, and not for patient benefit.
What can be done to counter the threat
The threat to the NHS is not from an ageing population, increasing costs, migration or even, ultimately, from a shortage of trained staff, because all those issues can be managed if the right political will exists. The threat to the NHS is that the political will that it succeed in the task that it has undertaken for the last near-seventy years does not now exist amongst some politicians. The fault is not that of one political party, although it is fair to note that the problem appears to be peculiar to England. The solution to the problem is, in that case, political and particular to the deeply divided English political, social and economic environment, where the relationship between London and the southeast and all remaining regions is one of deep division and significant inequality.
The solution can only be found in a willingness to accept that this division and inequality is similar in effect to the stress that, in a different way and at a different time, gave rise to the need for the NHS. This, then, requires that the founding principles of the NHS be reinstated and that their replacements, which can tolerate so many of the characteristics of the neoliberal vision of healthcare, be themselves consigned to history.
With those principles restated what has to then be understood is that it isn't money that constrains the NHS. That is because the economic reality is that there is no limit to the amount of money a government can create if it so wishes. Money creation is, after all, costless. It is also technically limitless. That does not mean a government should be reckless. There is, of course inflation to consider. But that is what tax is for. It is government spending that creates the ability to tax. Where else, after all, does enough government created money to pay tax come from if government does not create it in the first place? Quite emphatically, it is not tax that creates the capacity for government to spend; that capacity always exists. Instead it is taxation that limits inflation when the government is spending to meet social purpose, for example, by funding the NHS. And spending in that way is always desirable, and there is always a gain to society, until the point is reached then the economy is working at its capacity, from which point the UK as a whole has been so far adrift for so long a time. That's precisely why any constraint on NHS spending is inappropriate at present.
When this is appreciated, it also has to be understood that there is literally no shortage of capital to invest in the NHS at present. In fact there is a shortage of government bonds in issue in the UK right now. That is because government bonds underpin most private pension funds, and as more baby boomers retire, the demand for bonds is growing. In fact, people are queuing up to lend the government the money it needs to invest in the NHS. It is dogma alone that is denying people the chance to save in that way, and the economy (and NHS) the investment it needs. Poor facilities, a lack of training and failed systems all exist because of government choice as a result, and not because they need to. And since, right now the effective interest rate that has to be paid on the funds in question is near enough zero per cent, despite which the funds still roll in, it's almost scandalous not to use them for social purpose and yet that is what is happening.
This is the economic reality that we face. Money is available for the NHS if people are able to work in it. But there is a problem. Because that money would come via the state, and would require central organisation and control to ensure it was well spent (which cannot happen in the current incoherent NHS management structure) there are those who politically oppose that use, not because it is economically rational to do so, because it clearly is not, but because of dogma alone.
The NHS need not be under threat. The NHS could be and should be, well funded. It could be and should be the basis on which opportunity for new generations in need in this country could be built. But that requires a new generation of economists, politicians, healthcare professionals and others to believe, as some did in 1948, that they can make a more effective difference in people's lives through the provision of state-provided healthcare than they could by promoting a market-based system. Those who believed that in 1948 were right. The current threat to the NHS suggests that their vision is at risk. That vision of universal care for people who are, whatever their economic situation, considered to be of equal value, needs to be restored. Nothing else will tackle the threat to the NHS.
Endnotes
[i] NHS Choices http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhscoreprinciples.aspx Accessed 3 September 2017
[ii] The website of The Mont Pelerin Society https://www.montpelerin.org/about-mps/ Accessed 3 September 2017
[iii] Hayek, F.A. ‘The Road to Serfdom', 1944. London: George Routledge & Sons
[iv] Davies, W. ‘The Limits of Neoliberalism: Authority, Sovereignty and the Logic of Competition'. 2017. London: Sage Publications Limited. Available at https://uk.sagepub.com/sites/default/files/upm-binaries/79542_Davies___The_Limits_of_Neoliberalism___Chapter_1.pdf . Page 6. Accessed 3 September 2017.
[v] Schneider, E., Sarnak, D., Squires, D., Shah, A. and Doty, M. ‘Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care'. The Commonwealth Fund. Available at http://www.commonwealthfund.org/~/media/files/publications/fund-report/2017/jul/schneider_mirror_mirror_2017.pdf Accessed 3 September 2017.
[vi] MacLean, N., ‘Democracy in Chains'. London: Scribe Publications, 2017.
[vii] See, for example Niemitz, K., ‘Universal healthcare without the NHS'. Lodnon: The Institute for Economic Affairs, 2016. Available at https://iea.org.uk/publications/universal-healthcare-without-the-nhs/ accessed 3 September 2017.
[viii] See the ‘Who Funds You?' website http://whofundsyou.org/ accessed 3 September 2017
[ix] Available at https://www.cps.org.uk/files/reports/original/111027171245-BritainsBiggestEnterprise1988.pdf Accessed 3 September 2017
[x] See, for example, the NHS Choices web page on Personal Health Budgets. http://www.nhs.uk/NHSEngland/patient-choice/personal-health-budget/Pages/about-phb.aspx Accessed 3 September 2017
[xi] Hawking, S. ‘The NHS saved me. As a scientist, I must help to save it'. London, The Guardian newspaper, 18 August 2017. https://www.theguardian.com/commentisfree/2017/aug/18/nhs-scientist-stephen-hawking Accessed 3 September 2017
[xii] Chomsky, N. ‘The State-Corporate Complex: A Threat to Freedom and Survival'. Text of lecture given at the The University of Toronto, April 7, 2011 (Transcript courtesy of Yvonne Bond). Available at https://chomsky.info/20110407-2/ Accessed 3 September 2017
[xiii] I have summarised the data at http://www.taxresearch.org.uk/Blog/2017/08/22/nhs-spending-data-necessary-spend-per-person-is-falling-and-demand-cannot-be-met-as-a-result/ Accessed 3 September 2017
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I hope that the Labour Party will now focus on revealing The Plan behind the NHS cuts. This is a narrative which could make the difference. Make the bastards answer.
I hope so….
Carol,
I don’t think enough of the PLP believe it. (I’m not sure what Labour voters believe anymore, if anything). They think they can afford not to and they remember fondly their days in power under the Blairite neoliberal consensus. Too much of that warped thinking still survives to mount a cogent opposition.
In power, if they ever get there, expect to see a mealy mouthed acceptance of the notion that government shovelling money into the private sector provision of health services is still within the aims and objectives of the NHS. They’ll market it as offering a spurious customer ‘choice’. An army of sharp suited lobbyists will persuade them they are doing the right thing for sound economic reasons.
And they’ll fall for it. I expect they will. Public opinion as ever will be a pushover unless the current leadership is prepared to keep hammering at an alternative narrative, and their first objective needs to be to win-over their own membership.
I know you are wrong.
Whatever the failings of the Blair/Brown government, they put real money into the NHS when it was almost on its knees before. Corbyn/McDonnell are not the idiots you seem to think them and neither are us members.
“I know you are wrong.” I don’t think I’m wrong, Carol.
I’m sure the figures will tell that Blair Brown put ‘real’ money into the NHS and they certainly did seem to make great steps in improving the levels of patient care and good outcomes.
They also introduced the Foundation Trusts structure which at the time I was highly suspicious of: seeing it as a way of splintering the service into bite size saleable chunks.
I was a governor of a Foundation Trust for a term and had direct contact with the people in senior positions in that trust and I was persuaded by their sense of loyalty to the traditional NHS ideals. I fear however for the future of Foundation Trusts when that NHS ethos has been undermined (as it is being) by neoliberal market ideology. There’s new generation of managers on its way up. Management structure (and remuneration deals) ape the private sector. If the longterm strategy was to privatise the NHS (and I’m not saying that was what Blair or Brown actually intended, which is part of my basic point) it was a good transition half step. It has certainly made Jeremy Hunt’s ambitions more achievable. ( I have no doubt JH would privatise the whole shooting match tomorrow if he could, in direct contradiction to the oft stated Tory party policy of commitment to the principles of the NHS)
Now, you can call me cynical if you wish, but I think I have good grounds to be.
I DON’T think Corbyn and McDonnell are idiots. But neither do I think they actually have the philosophical support of the PLP.
As to party supporters you will have to excuse my jaundiced faith when the party’s traditional constituency leaked towards UKIP in England, when my (former) Labour MP was the first to resign in disgust at JC’s election as party leader and his constituency has returned a Conservative member in his place, and when the Scottish Labour leader prior to the GE last year was advising her supporters to vote Conservative (FFS) to keep out the SNP on a false Tory unionist prospectus.
Thirteen Tory seats in Scotland which fell to a tripartite Tory/Libdem/Labour electoral alliance cost the UK as a whole a much needed change of government and kept JC and J McD out of Downing Street. Refusal to support/join the Progressive Alliance cost them a working majority. If hubris demands all or nothing then the latter is always going to be a likely default outcome.
SNP doesn’t claim to be a left wing party but is well to the left and ten years ahead of English Labour.
So I wish you every success in England with shifting the consensus to the left, but you’ll have to live with my lack of confidence that I’m going to see it anytime soon.
I’d love to see a Scottish Labour Party nipping at the heels of the SNP to keep them leftward, but I’m afraid it will need to be electorally anihilated and start again from scratch before I see it happen.
Whatever the failings of the Blair/Brown government, they put real money into the NHS when it was almost on its knees before. Corbyn/McDonnell are not the idiots you seem to think them and neither are us members.
Powerfully & directly put. And we really are at 4 & 5 in the Neolib agenda. The stealth attack on the NHS could well be irreversible once Accountable Care Organisations are instituted, by secondary legislation, in a matter of weeks.
Luckily, the brainiest man on the planet thinks it can be stopped. If you want to join him, follow this link:
https://www.crowdjustice.com/case/jr4nhs-round2/
Have pledged
Thanks for the link Mike – I’m embarrassed to say that I was aware of the case but not the crowdfunding – support duly pledged. It’s close to, but has not yet reached, it’s target hence this extra nudge.
Come on, peeps – chip in. This is important stuff. ‘The brainiest man in the universe’ (copyright!) needs our help!
PS Thanks too to Richard – fine piece.
Steady on, Alan. I only said ‘planet’.
They’re only a few hundred away from their target as I type. I hope Hunt doesn’t back down, then all those who want to listen will hear the arguments from the likes of Allyson Pollock (probably brainier than Hawking on this subject) and the arguments for the alternative from Richard & others.
So if this Letwin/Redwood reform was working how come it costs an extra 44.5% / head to run the NHS now than 30 years ago? (That is taking into inflation into account). Also this only equates to 23.5% of my and my employers NI contributions. Surely that is enough funding in itself.
Your data is wrong….
Would it not occur to you Peter to place the blame on any cost increase you detect for the stupid internal market that has been created? Why do you think we have so many problems on the railways?
I’ll tell you why – because instead of each department working together they are now working to contain costs or maximise income in a narrow minded silo culture.
Whether it is rolling stock operators ripping off service providers so that extra coaches for crowded commuters are too expensive on the railways or hospital wards being closed because they are not always working at so-called maximum efficiency – money and the working to narrowly defined contracts is being put before the needs of people.
The railways are no longer a service; they are now just money generating machine. And the NHS is on the way to being the same.
Or how about the constant stream of change that the NH service has been subjected to for far too long?
All this is being done politicians who know what they are doing. Open your eyes.
My eyes are wide open Pilgrim, it is my sarcasm that may be clouded by cataracts. I totally agree that with privatisation comes greater costs to those receiving the services. It’s called profit and share dividends. Public services and utilities should never have been sold out, least of all to those who cannot afford to run them and require further payments from us as tax payers.
I worry about pressures spilling over into Wales (where I live), because of the sheer size of the private shark organisations.
Thank you for this.
It is superb writing Richard. Honestly.
‘Defund’ – I like it and I’m going top use it in my continuing discussions with others.
I should have persisted with the BMJ
“I should have persisted with the BMJ”
Instead of doing what? You do not have infinite time.
I think the BMJ probably has more resources than you do and could have offered to edit or serialise. Did they do either?
They have more authors than available slots
Calls for NHS reform, supposedly stimulated by concern for an NHS in crisis, as represented by Bruce Keogh writing in the Guardian the other day, follow the typical pattern of the Hegelian dialectic: Problem/Reaction/Solution, in which people are manipulated and conditioned to accept otherwise unpalatable changes. They (successive neoliberal governments) create the problem (deliberate underfunding), the right-wing media stoke up the outcry and public dissatisfaction (the reaction), and lo and behold, the ‘reformers’ come up with the solution. This time the solution is the ‘ACO’. Of course, the real agenda underlying all of this is privatisation.
Your conclusion is right, I think
Duly noted, and pledged. I suppose there’s a chance yet another nail in the coffin of the NHS will be stopped, just as there’s a chance Brexit might not happen.
Pretty slim chances, but you have to cling on to a faint ray of hope, don’t you?
Yes…
Much as I would wish to disclaim him as my MP, I’m afraid that John Redwood is MP for Wokingham in Berkshire, not Woking in Surrey.
Apologies!
Peter
Noted – thank you.
‘For every pound raised by the sale of land and assets the treasury will give two.’ ( Dr. Bob Gill)
The NHS is a ‘two for the price of one’ deal. The Naylor Report was barely discussed with real transparency in the lead up to the election.
Is the Naylor report still being talked about?
See: http://www.youtube.com/watch?v=S8w7ojXPoyw
Not enough
Hi Richard,
A very clear argument. I must admit that I had never thought of the right’s antipathy towards the NHS in quite those terms; I just thought they wanted the opportunity to make money from it.
This could also explain the vitriol that is directed the way of the BBC by similar groups. The BBC is also funded from taxation (albeit in a regressive fashion) and has approval ratings that politicians could only dream of.
Thanks
Superb piece Richard which I’ve retweeted
I’d agree with many of the sentiments expressed here and in particular that this is government strategy to undermine confidence in the NHS. Hunt’s history makes it clear that this is what he would like to happen. I have the misfortune to live in Hunts constituency and was involved in the Progressive Alliance efforts to support a very good NHA party candidate, Dr Louise Irvine. Labours actions on in blocking support and expelling local party members was disgraceful, given they had no chance whatsoever of winning the seat.
Depressing that Channel 4 News had Kate Andrews from IEA on last night supposedly joining the experts on the NHS. Those who know the IEA and Andrews will know that they are a purely political organisation promoting the most extreme neoliberal orthodoxies and are notoriously secretive about who funds them. There are plenty of people out there who know what they are talking about (Kings Fund, Kerslake) without having such a naked but undeclared political agenda.
Ive found Roy Lilley to be a good source of thinking on the NHS (@roylilley) and one of the few people coming up with positive ideas to tackle the very real challenges the NHS faces, building on its strengths. There is an alternative view of ACOs that recognises that getting better, closer linkages between health and social services and GPs has to be a good idea. Hunt and co are probably using it as a vehicle to package up the NHS for sale, but that does not mean that it is necessarily a bad idea in principle. Though I’d sympathise with NHS folk who feel they’ve had enough of reorganisation.
Louise is great, and a lovely person
I have met Roy too: I was impressed and like his stuff
He’s also an annoyingly good iPad artist….
Kate Andrews said last night on Channel 4 News that there was no such thing as a Magic Money Tree.
She lied and got away with it. Kate Andrews is a bare faced liar. And it went unchallenged by the reporter. The idea of the MMT should have been explored but it was not.
Andrews also pointed to how low down the NHS was in other tables of performance without telling us if those ratings were post 2010 when the Tories essentially have been defunding the service.
Andrews also said that there was only so much money between the NHS and say HS2 and that one of the projects or services would have to be cut! It was a choice between one or the other apparently!
The Labour rep in the piece – Eleanor Smith did her best – but over-did the outrage bit and should have focused on how the Tories can print money for the DUP, for the private rail companies and also how Government was able to print money for QE to bail out the FS as evidence that there was a MMT and also as evidenced that Andrews had lied. I still think that too many opposition politicians are badly briefed about potential macro economic tools to address this problem. They’ve got to bloody well sort this out at Labour HQ.
The best contribution was from the young doctor to be honest who was telling it how it was.
And as for Hunt………………..to sit in a studio previously and pretend to be grateful to NHS staff and to say that the Government was doing what it could…………well if the public fall for that then well…………!!!!!!?
And again – the fact that his administration had not funded the NHS to meet need whilst printing adequate money to bribe the DUP to prop the Tories up and bail out private railway companies who had stupidly underbid to get contracts was not even mentioned by Channel 4 News.
We are increasingly being failed by our institutions that at are meant to hold our politicians to account.
If this continues then I can see a time where there will have to be accountability by more forceful means.
Thanks Pilgrim – thats exactly what I was thinking as I watched Channel 4 last night. They are usually better than that – well, better than the BBC at least. As you say, Andrews just spouted the kind of ideological claptrap you’d expect from the IEA and from someone who knows little about health. The others in the studio were pretty weak and it was left to the junior doctor to spell it out.
On a positive note, its been encouraging to hear more and more consultants being frank about the state of the NHS and the lack of funding behind it
Agree on the last
I did not see C4
Whether their policies work or not – or even make sense – is immaterial to the neoliberals.
What matters is whether they can sell it to – or keep it secret from – the ignorant plebs and whether they can profit from it.
That and maintaining their hegemony if it takes recession, war, famine or plague.
We need to be rid of them before AI/robotics makes them invincible.
Richard, thank you for this brilliant article, lots of people are not aware of the Tories long term strategies but these two papers spell it out in detail:
The first is from Nicholas Ridley in 1977, a misnomer if ever there was one, “Tory research document”, in it they explain how they will dismantle the nationalised industries, use the apparatus of the state, undermine the unions that would resist it, use the army and police, and stock pile coal to beat the miners, all of this long before Arthur Scargil even got wind of it. This document can be found in the Margaret Thatcher foundation under reference: THCR 2-6-1-37 (177) JPG
http://fc95d419f4478b3b6e5f-3f71d0fe2b653c4f00f32175760e96e7.r87.cf1.rackcdn.com/FABEA1F4BFA64CB398DFA20D8B8B6C98.pdf
This next document is Margaret Thatcher’s secret 1982 cabinet papers that was released in 2012 under the thirty year rule. Explaing how they will continue to dismantle the state, the NHS and education, all because they pretend that rising costs mean we can’t afford them, as I know, you well know, total bunkum and fabrication but that is what the public have been indoctrinated in for over forty years now: To view the document please click on where it says SHOW IMAGES.
http://discovery.nationalarchives.gov.uk/details/r/C13318082#imageViewerLink
Thanks
Noted
Richard
Thanks for your long memory Mervyn Hyde. Any such Tory position paper was known at that time as ‘Selsdon Man’ after a hotel I belive, south of London where many future Tory ministers and theorists created the future Thatcherite framework. For them it succeeded handsomely. For us voters, we suffer each new wrinkle the neo-libs bring to fruition.
Hello Richard,
I wrote to Nicholas Soames MP regarding the money laundering loophole in the government’s own rules.
Below is my letter and I thought you might like to see his reply and reasoning.
Dear Sir Nicholas Soames,
Re; UK money laundering loophole
It appears the UK has a loophole which allows money laundering to occur.
This loophole may have been deliberately created by the government and must be now closed.
If it is not closed immediately we can only see that as verification of the claim that it is deliberate and the government’s own rules are deliberately and deceptively being undermined by the government itself.
This looks like a very high level of dishonesty somewhere in the government and I would be grateful if you could point this out and have this loophole closed. We all know we need to stop the fraudsters and it is disheartening that the government deliberately leaves holes for the dishonest to get round the intention of the law.
I hope you can do something about this.
I leave a part of the blog by Richard Murphy on this email with the full relevant documents attached.
Yours
Ron Lawley
Dear Mr Lawley,
Thank you for contacting me about money laundering, Trust and Company Service Providers (TCSP), and Companies House.
Companies House has a statutory duty to incorporate and dissolve limited companies, register company information, and make it available to the public. Unlike TCSPs, which are already supervised for anti-money laundering purposes under the money laundering regulations, Companies House is not a private-sector profit-making business. The registrar has no discretion in law to refuse or decline a request to incorporate a company. Companies House therefore cannot decline to establish a business relationship in the way that firms regulated for anti-money laundering purposes must when they cannot discharge their customer due diligence obligations. Due to its statutory obligations, Companies House is not considered to be a company formation agent.
I understand that the issue you mention has been raised with Ministers before, and is being monitored on an ongoing basis. However, the Government’s view is that measures to in some way extend the TCSP rules to Companies House would impose unnecessary burdens on both Companies House and on legitimate companies, and would delay the company formation process.
The Office for Professional Body Anti-Money Laundering Supervision (OPBAS) is also soon to be established. OPBAS will work to ensure consistently high standards of anti-money laundering supervision, and Ministers have expressed the view that it is right to establish this body first and then take account of its conclusions around TCSP supervision before taking any further action.
Thank you again for taking the time to contact me.
Yours sincerely,
The Rt Hon Sir Nicholas Soames MP
House of Commons
London
SW1A 0AA
Tel 020 7219 4143
nicholas.soames.mp@parliament.uk
http://www.nicholassoames.org.uk
Now a blog
Thank you
A great piece, I’ll be copying it around my NHS contacts…
…although having been in charge of sorting out a failing bit of the NHS some years ago, I am highly persuaded that whole-system working with a total budget from all the statutory agencies is the only way to ensure seamless care and joined up services – and that is very close to being an ACO…
Explain
I write as a 30 year practicing manager rather than a researcher.
My observations are that firstly the boundaries between organisations encourage organisations to work in their own interests rather than those of the patient, or indeed of the wider system. So effort gets put into shunting costs, rather than into better productivity.
Secondly, that not having a system control total encourages organisations to expect or believe that they will get bailed out by some unidentified third party, rather than taking ownership of their budget and of their quality outcomes.
So a single organisation system holding the whole Parliamentary vote for that population feels like a good model. So long as the organisation is held to account for the comprehensive coverage of services for its population, that starts to look like an ACO.
Given that the mess of the Lansley redisorganisation does not allow for other than competing autonomous bodies, until the law changes then ACOs will more likely need to be AC Systems. But that still looks like a move in the right direction.
I would much rather it was called a strategic health authority and was under public control…..
Then I would agree with you
But ACOs are privatisation Trojan horses without even a statutory basis
I recognise your concern about the potential Trojan Horse… And I regret the passing of SHAs – however much I criticised them at the time! They met in public, and published their minutes and papers. Now all that is hidden from public scrutiny.
Thank you for an excellent article.
Ed, I am not sure If you now Dr Allyson Pollock one of the authors of the Reinstatement Bill, but this video of her speaking to a packed audience in Exeter, shows how the Tory Disorganisation has greatly increased bureaucracy and shows how important structure is to any system.
https://www.youtube.com/watch?v=Cz5dl9fhj7o
Your point about boundaries is well made. Many years ago when working on Total Quality, a rule was that the biggest delays and costs happened at boundaries, internal and especially external. Much effort went into eliminating or at least minimising those boundary costs.
Years of reductionist management thinking in both private and public sectors has gone in the opposite direction, with everything seen as a cost/profit centre and outsourcing left, right and centre. That then adds bidding and contracting to the boundary overheads. Accountants have a lot to answer for…
The NHS is just another example, but a critically important one. A mole working near the top of the NHS did suggest to me that there are people there opposed to J Hunt who do see ACOs as a way of getting back to SHAs. Breaking down the many boundaries that have been created by Lansley and Hunt. That assumes they can avoid May and Hunts privatisation agenda.
If ACOs were SHAs and had a staturoity basis and were emphatically under democratic control (thsoe are all very big ifs) then I would support them