This speech, under the title noted above, was given by the late Frank Dobson MP, who preceded Keith Starmer as Labour MP for Holborn and St Pancras in the UK parliament. He gave it at the TUC Congress on 9 September 2003. Dobson was the first health secretary in Blair's governments, but had gone by then:
The Labour Government's health policies will mean the end of the NHS. It makes me sad to say so, but it's true. The Prime Minister has said he wants a mixed economy in health care. Ministers have started to re-define the NHS as a health insurance system not a health care system.
They want to set hospital against hospital competing for patients. Foundation Hospitals will compete against non-Foundation Hospitals. All NHS hospitals will have to compete with private diagnosis and treatment centres. Hospitals the Government decides are "failing" will be handed over to private managements.
When the Tories introduced competition through their Internal Market, bureaucratic costs soared, hospitals stopped co-operating with one another and the spread of new and better ways of looking after patients was held back. All that was bad for the tax payers and patients alike. Worse still, Bristol University's study of the recovery of patients from heart attacks showed "competition is associated with high death rates, in other words competition is associated with lower quality."
Against these facts the government have not produced a shred of evidence in favour of competition. We can't accuse them of "over-egging" the case for competition. They haven't got a case. All they have is a few assertions from think tanks and a curious faith in the superiority of the private sector.
And the competition is going to be rigged. Foundation Hospitals will have more money, more staff and more freedom than non-Foundation Hospitals. They will have the further protection of legally binding contracts and be allowed to keep all the takings from land sales, instead of sharing them across the NHS.
The new private sector diagnosis and treatment centres will have a much easier task than a district hospital. No fluctuating demands from Accident and Emergency. No emergency admissions. Just a steady flow of patients for a set of standard operations. And, would you believe it, this Labour government has agreed to help them get off to a good start by charging more per operation than an NHS hospital will be paid for the same operation.
And this commitment to commercial health care goes even deeper than that. Primary Care Trusts have been urged by Department of Health officials to approach problems with the same attitude of mind as American healthcare corporations. Perhaps they meant that the NHS should imitate the American system where the insurers and providers try to keep costs down by no covering the old, the sick and the people without jobs. I never thought I'd live to see the day when a Labour Government was trying to remodel the NHS on the lines of the USA.
What the Government should start to do is to ignore the think tanks, the shadowy unaccountable advisers and siren voices from Washington. Instead, they should listen to the people who kept the NHS going through the lean years of the Tories. The NHS ambulance staff, porters, cleaners, doctors, nurses, midwives, therapists, scientists. They must listen to the people who have supported the NHS through thick and thin, the people who believe in the NHS, not the people who have always opposed it.
And above all the Government should stop criticising the NHS and stick up for it instead. It is Labour's greatest achievement. It is a working example of the best instincts of the people in this country. It is the most popular institution in Britain. That is partly because it does a good job for most people in most places most of the time. It is also partly because the people of this country recognise the NHS doesn't just bind the nation's wounds, it helps bind the nation together.
Of course it needs to be improved. No wonder - according to the Treasury it has been under funded by £220 billion compared with European systems. Now it's getting the extra funds. Now it's getting more doctors and nurses. Now the number of beds is actually increasing after decades of decline. Now is the time to let people who work in the NHS get on with the job of looking after patients. Now is not the time to throw the NHS to the wolves.
It would seem that not much has changed. Dobson's warning still sounds right. Wes Streeting is still delivering what Frank Dobson warned about. We still need to worry.
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Private healthcare is immoral. If you can’t afford it, you die.
“New study links hospital privatisation to worse patient care” (Feb 2024)
https://www.ox.ac.uk/news/2024-02-29-new-study-links-hospital-privatisation-worse-patient-care
“The effect of health-care privatisation on the quality of care”, Benjamin Goodair et al (March 2024)
https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(24)00003-3/fulltext
Jacki Baillie followed Ana Sarwar for Scottish Labour today on BBC Radio Scotland; can’t answer a straight question (this time on the NHS and privatisation) with a straight answer. Same old gobbledygook. Nothing has changed. The old Labour machine, circa 1950s is still serving it’s purpose.
Jackie Baillie has confirmed that “Scottish Labour” wants to adopt Wes Streeting’s private sector plans for the N.H.S.
There is no doubt in my mind that Sarwar and Baillie will sell out our Scottish NHS for the benefit of their Westminster masters and, in turn, their own self benefit by way of honours and ermine.
Agreed
He nails it. Two phrases he uses that summarise things for me……
“a curious faith in the superiority of the private sector” – and it is just that – faith (and blind faith at that).
“And the competition is going to be rigged” – it always is because the private sector will always, always “cherry pick” leaving the State to carry the “tail risk”. This is true in any areas where complete failure is “not an option” (Water, power etc.).
Now, Frank Dobson saw the future…. a future that that has played out over the intervening 20 years sincehe made that speech. Yet, despite all the evidence, “a curious faith in the superiority of the private sector” still exists.
Correct
Ah Labour Party ‘Tories’ “We’re going to beat the government into being more efficient with austerity then the rich can also pay less taxes! Of course they’ll then give the party more donations for doing their will, a Magic Money Tree circle!”
What’s the surprise?
Starmzcaesar comes to bury the NHS, not to raise it.
His first overseas trip is to the USA, his masters voice.
And yet again his records of meetings will be ‘sparse’
Full speed ahead to becoming an official US state with their medical insurance conglomerates finally getting their greedy fingers on the NHS and dismantling the reality of a free at the point of need medical service once and for all.
Poor people, useless eaters not allowed medical treatment.
Only these considered good employees, doing as they are told, will get medical insurance paid for by their employers.
It is a way of keeping the population docile and subservient.
A fascist Jack boot upon the throat.
In fairness, he did not get to choose his own first visit – that we set for him by NATO
They’re corrupt. They’re getting paid hundreds of thousands to privatise our NHS.
They should be in jail.
Dobson would have been barred from standing for Starmer/Reeves/Streeting’s Labour in this election – as they did with others, such as Faiza Shaheen .
I suppose what’s really depressing in this honeymoon period is that instead of Reeves’ ‘hard deciisons’ to fignt local resistance to big builders, Labour could have taken Starmers’ ‘we are about service’ Downing Street speech to reach out.
They could have talked local communities, covid campaigners, EveryDoctor NHS campaigners – a ‘broad tent’ approach showing they are prepared to adjust their horizons, and not only tour European capitals and talk to devolved UK administrations but also to those with ideas on how things can be fixed.
So stupid of Streeting/Milburn to embrace the private sector ‘solution’ to waiting lists when they know the great majority of people dont believe it and dont want it. Plenty of studies show private sector involvement is bad for the NHS as a system and often bad for individual patients-
But they are continuing the Tory strategy of using the fact that it the NHS has been (deliberately) broken as a reason to privatise it further (‘what would you do if your relative needed urgent life saving treatment?’)
The new Labour government needs to prioritise real growth in the NHS and associated social care sector as its top priority.
Float my boat, Wes.
It ought to be the cornerstone of their growth strategy, along with real growth in education.
Improving and enhancing the nation’s health and overall welfare ought to be a no-brainer as a top priority of government.
There are several linked and interacting reasons. This is far from an exclusive list….
1) The temporary growth of the oldest segments of the population will require an increase in both pensions and associated health and social care;
2) This is not really a fiscal problem, but is more a productivity problem, so requires some kind of balancing economic growth;
3) Genuinely useful economic growth must involve higher productivity to sustain and/or increase tax takes from the employed population;
4) We have an economic inactivity rate of almost 22%, so more than one in five of the working age population are neither in work nor looking for a job. The official figure is about 9.3m people. I doubt these are all lazy rentiers.
5) At the same time that we have major concerns over worker shortages affecting the economy, there has been a 750k increase in the number of persons economically inactive post pandemic;
6) Employment needs to be planned to match proposed increases in investment levels both numerically and in terms of available skill levels;
7) Poor and inadequate health care not only affects immediate economic activity and productivity but otherwise massively impacts on deprivation and all the associated welfare and wellbeing challenges that brings socially;
8) The current level of net immigration is seen as too high politically, at around 650,000 pa, and it will need stabilising, if not reducing;
9) Persistently high levels of immigration actually tend to increase the overall dependency ratio, down to the associated immigration of dependents of new workers, mostly their children. This adds immediate pressure to both education but also child care sectors; (there also then may be increasing demands for ESL etc.,).
10) Reducing the levels of economic inactivity, even by 10-15%, can have a rapid positive impact without increasing aggregate housing demand and adding other social demands.
I shouldn’t need to state that healthcare and public welfare ought not be a punitive system, but sadly the recent reinforcement of the Tory notion of the ‘undeserving poor’, needs to be binned first.
The Tory culture of free markets means deliberately NOT planning for the future demographically, as their chimera of doctrinal purity and utopian ideals of infinitely efficient and immediately fully elastic free markets ( which automatically respond to any and all changing circumstances), is the dominant mindset.
That there are no easily obtainable and routinely published official figures and projections for required increases in the working population for different scenarios says a lot about both conservative government and the ONS.
Mind you, perhaps they just cut the staff as part of austerity.
The UK needs to provide first-class health care through immediate investment in ensuring a well-trained and effective health care professional staff, plus the physical infrastructure of sufficient beds and modern hitech equipment.
This means increasing the actual capacity of the NHS – not outsourcing.
Add education to the absolute imperative for a population that needs top class health care.
Cutting spending or limiting growth in education and training areas has directly related to the decline in productivity growth in the UK, created even worse problems in higher and further education, and will inevitably hold back the best of Reevesian intentions for growth much, much more than failure to attract short term private equity foreign capital.
Thanks
As many contributors have pointed out, in the UK public services, NHS, education, etc are not private companies. They do not generate their income or profits. Instead they are funded by the state.
The central government mantra of running public services as though they are private companies with their own “internal markets” coupled with the Tory policy of austerity. has produced massive underfunding of public services. No wonder we have crumbling schools, huge NHS waiting lists, failing local authorities.
Already private companies have been given lucrative easy NHS contracts, the hard stuff stays with the NHS.
Labour’s solution? More of the same. Plus blame the staff, it’s all your inefficient fault.
Health insurance? The public are in for a very nasty shock when the premiums arrive. Think £5-10,000.00 per person per year.
Now this really is “there’s no personal money” to pay for it.
The honeymoon will soon be over.
Aye but Starmer and his minister minions will be rolling in clover from the donations the rich make to them for doing their bidding!
And that’s all that matters to them – not the poor, the disabled, the chronically ill, the children (they don’t give a damn about them and won’t scrap the 2-child cap), the underpaid, the economically inactive (in my case, retired) – just how rich they’re going to become at our expense. That’s what drives the toerags.
The public will get an even nastier shock when those expensive insurance policies refuse to pay out. Claimants will be asked to subject themselves to an examination by the insurer’s medical staff who will stoutly declare nothing to be wrong with them in the face of all and any evidence. This creates conflict of a sort which can only be resolved through the courts. Those would be the courts which are hardly there any more and good luck accessing them at all and getting legal aid if you have little money. This is the American way of doing things. Thanks to political spite it’s what ordinary sickness benefit claimants face now. Readers can inform themselves on the subject by Googling for Unum scandal. Interestingly Peter Lilley, then head of what would evolve into the DWP back in the early 90s, invited a former veep of disgraced American insurance company UnumProvident to the UK to advise, despite clear conflict of interest, on how to run the benefits system. Wonder what they had in mind between them? This was commented on at the time by the then not so supine BBC – I may still have the clip somewhere – and later by other observers too https://www.benefitsandwork.co.uk/news/us-medical-scandal-company-at-heart-of-uk-welfare-reform All this needs to be right out in the open, it’s an absolute scandal.
The private sector does some things well. Healthcare AIN’T one of them (look at the US), not least because consumers cannot readily forgo or substitute it.
And the idea that for-profit firms have an army of idle professionals on their payroll, just waiting for a minister’s call is obvious nonsense.
Streeting sounds like some unpromising Tufton St intern who can’t even get the ‘free market’ shtick right.
Frank Dobson OTOH was bang on.
If the private sector is so bad at healthcare and the public sector so good at healthcare, why have no other countries copied our NHS?
Because private sector medicine objected
You’re a doctor?!
2 other points about a well funded health service, which have been mentioned on previous threads. Really is a no-brainer to invest in the NHS. First is the multiplier effect which is well over 1 and may be as high as 2 or 3, and means the funding is recycled in the community as the extra staff spend money, or businesses take on building work, or supply equipment etc and then it’s recycled as people and businesses pay their taxes.
Second, a better funded health service treats more people more effectively and therefore more people return to employment sooner and fitter (and the government wants more people to be economically active), or they are able to move off social payments, or can resume an active family life, or look after a relative, or volunteer or whatever.
It’s a matter of social justice: the disparity in health outcomes between rich and poor, between ethnicities, or geographic location are a disgrace. Better funding and targeting would start to address some of these issues. More privatisation will do the exact opposite, as is already the case where some of those who can afford it, and some who can’t, go private for things like joint replacement. (and I can understand why someone crippled by arthritis would pay for a new knee if the alternative is waiting several years)
But the healthcare companies who have invested in Streeting and others don’t do social justice and will now expect a return on their investment.
Currently in Switzerland the average “basic” health care insurance for a family of four, (mum/dad/2 kids) is the equivalent of £15k per year.
Full health cover is a lot more.
The Swiss are not happy.
Wow
I recall reading an article by Allyson Pollock several years ago that mentioned that private hospital operations tended to be for fairly routine things such as knee and hip replacement. They wouldn’t have anything to do with issues such as heart problems. But the kicker was that if something went seriously wrong in a private hospital during a ‘fairly routine’ operation, the patent would be transferred to an NHS facility for them to deal with it. I’ve no idea if this is still happening but wouldn’t be surprised if it was and if it is, it needs to be highlighted as a real world reality of the very serious private medical system limitations and the financial consequences to the NHS of healthcare privatisation.
Allyson was right on this
She was good in PFI
But not everything
Oh, this happens. No doubt about it. I speak as a, now retired, NHS ambulance dispatcher and we used to pick them up for transfer to an NHS A & E when things went drastically wrong.
They don’t do emergencies. That’s left to the NHS to fix.
Which is why private hospitals are usually very close to NHS hospitals. And where do they get all their trained staff from..? Time the private health sector had to contribute to the training of their staff by the NHS. And pay the full cost of emergency work they dump on the NHS when things go wrong.
My son and family live in the US where I am now. Their experiences of US healthcare have been dreadful. You are just an open wallet to be emptied. Give me the overloaded NHS any time. To be fair, my brother is French and there are things to be learnt from the French system, which I’ve experienced first hand. The not for profit sector plays a big role in much of Europe. Different to the rapacious purely private system of the US, which seems to be the only one our politicians look to for ideas.
Correct re private hospitals
Often in the grounds of NHS ones
Wes Streeting is a threat to the NHS and we must scrutinise and expose all his deslings with private providers.