Dr Clive Peedell and Dr Richard Taylor
Having witnessed what is surely one of the greatest betrayals in British parliamentary history, we have formed the National Health Action party to raise awareness about what is happening to the NHS and the glaring deficits in our democratic parliamentary process. It will offer practical policy solutions for the NHS and stand up to the political obfuscation and sleaze that is endemic in today’s political class. NHS supporters and the general public now have a genuine opportunity to get behind a political party that is fully behind defending the NHS, and serious about holding the political class to account. This is why we set it up and why we think it’s needed:
Prior to the 2010 General Election, the NHS wasn’t one of the key election battlegrounds because despite the financial crisis, all 3 main political parties had signed up to maintaining NHS spending levels. Moreover, David Cameron had repeatedly promised that there would be “no more top-down reorganisations” of the NHS. Following the election and formation of the Coalition Government, this promise was reinforced by the Coalition Agreement, which specifically pledged to “stop the top-down reorganisations of the NHS that have got in the way of patient care”.
Yet within 2 months, Andrew Lansley had published his White Paper Equity and Excellence: Liberating the NHS, which was widely acknowledged across the NHS stakeholder community as the most radical plan for NHS change since its inception. The NHS Chief Executive, David Nicholson famously described the changes as so big, they could be “seen from space”. This clearly called into question the democratic legitimacy of these reforms.
Moreover, the Government had systematically failed to make the case for such radical change to the NHS. This was well summarized by Professor Kieran Walshe of the Manchester Business School, writing in the BMJ:
“Patient and public satisfaction with the NHS were at an all time high and the case for change was never properly articulated”.
In fact the Commonwealth Fund Report had recently shown the NHS to be one of the most cost effective and highly performing healthcare systems in the world.
Of greatest concern, however, was what the Health and Social Care Act actually meant for the NHS. Health policy academics and lawyers with expertise in public, constitutional and commercial law, published evidence in the Lancet and BMJ, explaining how the Bill would lead to the abolition of the NHS in England. They detailed how the legislation would fundamentally undermine the founding principles of the NHS by setting the legal stage for private companies to be entitled to run much of the NHS, and for competitive market forces to determine the way many health services would be provided. The public did not vote for this.
Not surprisingly, there was unprecedented opposition to the reforms from across the full spectrum of NHS stakeholders including patient groups, the BMA, RCN, Royal College of Midwives, and the medical Royal Colleges. Remarkably, the BMJ, Health Service Journal and the Nursing Times published an unprecedented joint editorial condemning the reforms as an “unholy mess”, which had “destabilised and damaged one of this country’s greatest achievements: a system that embodies social justice and has delivered widespread patient satisfaction, public support, and value for money”.
Yet despite the lack of democratic legitimacy and widespread professional concern and opposition, the Health and Social Care Bill was still railroaded into legislation by coalition MPs and peers. This was particularly problematic for the Liberal Democrat leadership who needed to use all their political skills to overcome the democratic will of their grassroots members and even their own health policy advisors. This was epitomized at their 2012 Spring conference with the skullduggery of the infamous “Shirley Williams motion”, which was used to block another motion calling for the bill to be killed off. The Liberal Democrats had put the survival of the Coalition ahead of the survival of the NHS. In fact, the coalition nature of Government had ensured that the crucial pro-market and pro-privatisation clauses and sections of the Bill went through relatively unscathed because the Government had a majority in both Houses.
To many, including the founding members of the National Health Action party, the parliamentary passage of the Health and Social Care Bill was an embarrassment to our democracy. Yet, this was not the only impetus for the formation of a political party to defend the NHS. It was more the straw that broke the camel’s back. The key political issue has been the fact that over last 2 decades all 3 major political parties have supported the role of the market in healthcare and other public services, with an increasing role for private sector provision of services. These policies are firmly based in neoliberal ideology, which has dominated political and economic thinking since the oil shocks of the late 1970s (which led to a collapse in confidence in Keynesian demand management economics), and the fall of the Berlin Wall 1989. Neoliberalism is based on the idea that maximum market freedom with minimal state interference is the best and most efficient way to organise society. It was epitomised by Reaganomics and Thatcherism and then embraced by Tony Blair as New Labour’s “Third Way”. This was well summed by Labour MP Jon Cruddas in the New Statesman in 2007:
“After years in opposition and with the political and economic dominance of neoliberalism, new Labour essentially raised the white flag and inverted the principle of social democracy. Society was no longer to be master of the market, but its servant. Labour was to offer a more humane version of Thatcherism, in that the state would be actively used to help people survive as individuals in the global economy - but economic interests would always call all the shots.”
What this meant for public services was perfectly summarised up by Labour MP and former Cabinet Minister, John Denham MP in an article in the Chartist (2006):
“All public services have to be based on a diversity of independent providers who compete for business in a market governed by consumer choice. All across Whitehall, any policy option now has to be dressed up as “choice”, “diversity”, and “contestability”. These are the hallmarks of the “new model public service”
This is why New labour ramped up Thatcher’s NHS internal market with their own market system based on the idea of patient choice to drive competition between a plurality of any willing providers (AWPs), driven by the Payment by Results (PbR) system – “money following the patients”. So New Labour’s NHS reforms have built the perfect foundations for Mr Lansley’s more radical pro-market reforms. The Health and Social Care Act is a clearly a catalyst for yet more NHS commercialisation and privatisation, which is in keeping with the Coalition Government’s broader neoliberal supply side economic policies to replace large swathes of the public sector with the private sector. This is also in keeping with the political thinking of the Orange Book Liberal Democrat leadership who have proposed that the NHS should become a European style social insurance system.
In summary, none of the main political parties can be trusted with the stewardship of the NHS, because they all believe in using the flawed market model to deliver healthcare. This is despite the overwhelming evidence that market failure is an inherent problem in healthcare, and incompatible with the founding principles of the NHS. Hence, those who value the idea of a publicly funded, provided and accountable NHS have been left with nowhere to go politically. Although, the Labour party have said they will repeal the Act, we would still be left with their own marketised system. We therefore need a new political party that can be trusted by the public to defend our most cherished institution: the National Health Action Party.
*The NHAP intends to stand about 50 candidates at the next General Election, as well as candidates for local and European elections. Seats will be selected strategically and although candidates will have independent Manifestos, they will all support NHA health policy and act in the wider public interest.
The party aims to start campaigning in the next few months and will have its inaugural Annual General Meeting later this year. The party welcomes all members of the public to join as members, not just healthcare professionals..