Image: Jeremy Corbyn, NHS worker Judith Clegg & Shadow Health Secretary Jon Ashworth. Ben Birchall/PA Images. All rights reserved.
The current programme of NHS ‘reform’ currently underway has long been hailed as giving private firms “enormous opportunity”.
So – as I suggested in January – Labour’s new commitment to halt these pro-market Sustainability and Transformation Partnerships (STPs) was both welcome assurance to party members, and a break with a damaging 30 year cross-party ‘consensus’ on healthcare policy.
Yet soon after I wrote this, Shadow Health Secretary Jonathan Ashworth joined key architects of the transnational agenda of the global health industry at a conference organised by the Institute of Public Policy Research (IPPR).
The IPPR conference at the end of January was set up to preview a report on the NHS co-produced by the IPPR and the former Labour Health Minister Lord Darzi, who stepped down in 2009 and who in 2015 criticised Labour for its tentative moves away from a pro-privatisation agenda.
The event saw Ashworth sharing a platform with signatories to the above-mentioned consensus, including the Conservative peer Lord David Prior and Lib Dem MP Norman Lamb, plus economists from the Health Foundation and representatives of the health industry and leading consultancies. On the surface the event was largely about the technological drivers of change in healthcare, and how funding mechanisms can be applied to harness these. A closer look however indicates the real intent was to reinforce particular aims and relationships; ones that it would be inconsistent for Mr Ashworth to seem to endorse.
Ten Year Plans and long-term alliances
As I pointed out in January, Lord Darzi has become a key actor in the corporate agenda for health care, having been, for example, a member of both the Steering Groups on the World Economic Forum’s work on sustainable healthcare systems.
It was also pointed out that Tom Kibasi, who was then working for McKinsey and is now chief executive of the IPPR, was the lead author of the reports that informed the WEF’s work, and subsequently presented its findings to the World Bank and OECD. Indeed Darzi’s and Kibasi’s recent collaboration may reasonably be seen as the latest expression of a long-term strategic partnership, with the forthcoming IPPR-Darzi report marking the tenth anniversary of Darzi’s comprehensive report on the NHS for the Brown government, called ‘High Quality Care for All’, for which Kibasi wrote the final draft.
In that initial collaboration Kibasi was on secondment from McKinsey, serving as Senior Policy Advisor to the NHS Chief Executive, Sir David Nicholson. He also worked with Darzi on the latter’s 2008 report for London, which was supported by McKinsey’s leading European partners, Penny Dash and Nicolaus Henke, as well as by the chief executive for NHS London, Ruth Carnall.
Among the Darzi report’s prescriptions for the capital were the development of a system of ‘polyclinics’, or integrated care centres, with a view to transferring 40% of acute sector activity to these clinics, as well as 70% of the primary care workforce. The BMA resisted, amidst concerns that the centres would likely be owned and run by private healthcare corporations adopting the NHS Lift – a kind of Private Finance Initiative for primary care – approach. The plans were eventually abandoned, partly due to the recession and change of government. The incoming Health Secretary, Andrew Lansley, also needed to keep GPs on board, given that he was presenting his creation of ‘clinical commissioning groups’ as supposedly ‘putting GPs in charge’.
This pause in Darzi’s polyclinic agenda has served its purpose. GPs are now firmly on the back foot, with many willing to trade their premises and practice lists – the new currency within health economies - for a semblance of security as salaried employees of the ‘new care models’ that the ‘consensus’ advocates.
Similarly, the government has recently announced that NHS Lift scheme will be rolled out to new areas of the country through Project Phoenix. It appears they are attempting to complete the vision of both government and investors for a privately owned, primary care estate.
New ‘partners’ – and old ones
The McKinsey/Darzi/Department of Health project of 2008 was intended to be a ten-year strategy for transforming the NHS, and while some of the details may have been tweaked in the interim, its fundamentally market-oriented goals remain, and campaigners fear they will reappear in the forthcoming IPPR-Darzi report. Such fears are grounded both in the continuity of the participants involved in helping to produce the report, and also in terms of its associated sponsors and partners.
These include the US pharma corporations Baxter and MSD as ‘strategic partners’. The report’s ‘founding partners’ include another US pharma company, Gilead, the European manufacturing giant, Siemens, and Carnall Farrar Associates. The latter is a consultancy firm set up by former McKinsey alumni together with the afore-mentioned Ruth Carnall.
Similarly, the IPPR’s recent report on STPs, entitled ‘Sustainability and Transformation Plans: What, Why and Where Next’, included the pharmaceutical giant, GSK, as a sponsor. This report fully endorsed the STP model, concluding that the STPs have “correctly identified the most pressing reform solutions, including reconfiguration of the acute sector, movement of care into the community, and delivery of an upswing in prevention, with reform to commissioning, workforce, estates and local innovation infrastructure, all considered key enablers”. The sole caveats were a lack of both leadership and funding with which to fulfil such aims.
Since his participation at the IPPR conference, Ashworth has spoken strongly about Labour’s unwillingness to participate in a cross party consensus on the NHS, arguing instead that what’s needed to rescue the health service is “a government with the political will” to end the punishing funding squeeze; whereas at the Labour Party conference last year he took the IPPR line on STPs, arguing only that they need to be properly funded so they can meet the changing demands on NHS services. It’s to be hoped that the unambiguous rejection of the market-oriented consensus in his recent speeches represents a firm crystallisation of his final policy position.