The Tories tell us the NHS is safe in their hands. Labour tells us the NHS - north and south of the border - will be safe in their hands if we re-elect them in 2015. As Scotland considers whether to vote for independence this Thursday, can either be believed?
Sadly, there are NHS villains in both ranks.
NHS villain #1 - Ed Balls
We all know that Shadow Chancellor Ed Balls is desperate to avoid talk of a ‘tax bombshell’, so much that he won't promise anything on NHS funding.
But now we are told Labour Leader Ed Miliband is considering standing up to Balls and might call for an ‘NHS tax’.
Funnily enough, Miliband let this be known just after NHS concerns exploded in the Scottish Referendum debate. Scots were worried that funding cuts in England would affect NHS funding in Scotland, through the ‘Barnett formula’. Health policy is a devolved matter - but health finances are dependent on Westminster decisions.
The NHS concerns shoved the ‘Yes’ vote up 8 points practically overnight.
Labour tied itself in a pickle for a while. “No” campaign leader Alistair Darling suggested that no-one - not even David Cameron - would dare to damage the English NHS so badly that it would affect Scotland too. Meanwhile his English colleagues (and NHS experts) were saying that the Tories were basically dismantling the whole thing.
So what of Labour’s new 'NHS tax' idea? Should that reassure Scots concerned about NHS funding?
So far, Labour has promised us exactly nothing on NHS funding.
A specific NHS-tax is a silly, regressive, market-centric idea anyway, according to the leading progressive tax expert. A simple income tax rise would make more sense, if necessary.
Scrapping the expensive market that drains money from the NHS would make even more sense.
(Scotland shows just how much sense. It was revealed last week that hospital administration costs alone are 25% less in Scotland, than in England’s marketised tangle of Trusts and private providers, most of whom are now in the red.)
The ‘No’ campaign has fought back, desperate to neutralise the NHS issue.
Scotland’s NHS is broke, and independence will just make it broker, they shout, pointing to a planning meeting which mentioned a possible £450million funding gap. They conveniently overlook that NHS England has admitted it is heading towards a funding gap of £30 billion, and discussing raising charges as a result.
The SNP has held down NHS funding rises more than in England, we are told. Yes - because Scotland has stopped wasting bucketloads on market costs (estimated to add £10billion or maybe considerably more to the cost of the English NHS) and has supported social care far better. And as a result, Scottish NHS satisfaction has soared, as England’s has crashed. Aren’t these things we should praise the Scots for?
If all else fails, Scotland can raise its own extra tax for the NHS through the new ‘devo-Max’ offer from Gordon Brown, we are promised. Many doubt if such last-minute promises are to be believed, or if they are likely to be blocked by Tory and Labour backbenchers. But even if it were true - why should the thrifty Scots have to raise extra taxes, to subsidise the English NHS’s profligate waste of money on turning the NHS into a 'market' for the benefit only of their rich friends?
So ditching the English NHS 'market', and only then raising income tax if necessary, is the answer, for both England and Scotland’s sake.
But who will call for that?
Instead Ed Balls is planning a ‘Zero-Based Budget’ - meaning basically that no area of public service can be seen as guaranteed after 2015.
When will Balls put his foot down against the ‘NHS tax’ idea? Let’s see…Friday?
NHS Villain #2 - Sir John Oldham
It’s not just Balls playing the 2015 - Year Zero game which threatens NHS funding both north and south of the border, though.
If you want to know what Labour will do if elected in post 2015, you won’t find much detail in its public pronouncements.
Oldham said nothing about restoring the minister’s duty to secure a fully ‘comprehensive’ health service - a key demand of leading NHS campaigners like Lord Owen and Professor Allyson Pollock. Instead, he recommended more ‘care at home’ and ‘self-care’ (that’s NHS-DIY to you and I). Nor did he say anything much about public provision versus 'markets'. In fact he endorsed, as have others in Labour, the privatised Spanish model, where health & social care provision - and finances - are ‘integrated’ under private management.
And - crucially - Oldham recommended that post-2015, the Labour party take a year zero approach and work with Tories and Lib Dems to comprehensively review ‘the scope of the services provided by, and the future funding of, health and social care’. Music to Ed Balls ears, no doubt.
In other words, nothing about the English NHS is guaranteed. Politicians of all the main parties may promise they’ll NEVER start charging for the NHS - but will they simply redefine the 'scope' of what the NHS actually covers, and start charging for the rest?
Cameron’s chief health advisor comes from Reform, and that’s exactly what they suggest.
But Oldham’s report is just one of a number of worrying signs that’s also what Labour might do, too.
For example this month the Kings Fund suggested splitting off some ‘NHS beds’ from ‘NHS care’ and charging for the beds. Andy Burnham said Labour ‘welcomed’ the report.
Burnham often talks a good talk on the NHS. But his big solution always comes back to ‘integrating health and social care budgets’. Common sense perhaps. But the sticking point is that nowadays in England, social care is not universal and free, but hugely underfunded, privately paid-for, and privately delivered.
Does Burnham have NHS-saving answers to this sticking point? Or will NHS principles of free, tax-funded, publicly provided, comprehensive care, be sacrificed to a cut-price vision of ‘integration with social care’ that private companies like Kaiser Permanente and Care UK are waiting in the wings to offer?
Burnham has been being asked these questions for a while, and answers aren’t yet forthcoming.
Perhaps he’ll come up with answers at Labour Party Conference - after the Referendum vote. Or perhaps not…
NHS Villain #3 - Simon Stevens
The new Chief Executive of the English NHS, Simon Stevens, isn’t a great defender of a comprehensive, fully tax-funded, public NHS either. He wrote Blair’s 2000 NHS Plan that first opened up chunks of clinical services to private companies. He then spent a few years as a senior executive at US health conglomerate United Health.
Stevens said shortly before taking over at its helm, that the tax-funded model of the English NHS was a problem. Now he’s busy coming up with all sorts of wheezes to reduce reliance on central government funding for healthcare, too. His first big policy announcement was to roll out personal budgets across the English NHS. That’s Thatcherite vouchers, to those with long memories. Stevens’ plan has few real safeguards to prevent cuts and top-up payments from our own pockets, following soon behind.
Again, Labour is all too quiet on Steven’s plans for personal budgets. Ambitious Junior Health Minister Liz Kendall (formerly special advisor to New Labour Health Secretary Patricia Hewitt) defends them staunchly even in the face of evidence they are costly and damaging, and Ed Miliband seems to be a fan too.
On appointment on 1st April, Stevens gave himself 180 days to consider what radical changes the NHS needed to make.
Will Stevens now echo NHS England’s Chair, Malcolm Grant, who has already suggested that the English NHS is such a mess that post-2015, governments will have to consider introducing charging, to supplant central NHS funding? Perhaps starting with a few tentative personal budget top ups, employer ‘support’, or separating off luxuries like face to face appointments and hospital beds?
Stevens will share his thoughts with us on 1st October - a couple of weeks after the referendum.
NHS Villain #4 - John Healey MP
Yes campaigners have suggested that the level and pace of NHS privatisation in England would embroil a non-independent Scotland in an ever-more grasping international health market. They argue that if Scotland was an independent member state, it could exempt itself from existing and forthcoming international trade and competition laws.
Many of the concerns have focused on the forthcoming EU/US Trade Treaty. Certainly few would have any faith in Cameron’s team to protect our health system from this corporate bonanza. Cameron has refused to ask - as a sovereign state leader could do - for health to be exempted. Lord Livingston told us last week that they don’t need to exempt the NHS because it won’t be affected. But Lord Howe gave the game away over the weekend, saying they have to include health in the deal, for the sake of Big Pharma.
As for Labour, Burnham has - again - talked tough. But Labour’s response to TTIP is being led not by Burnham but by figures like former shadow health secretary John Healey, who chairs the All Party Parliamentary Group and has led a reassuring charm offensive to campaigners and unions. It’s all great, he reassures us, though experienced trade campaigners see this as ‘bamboozling’. Interestingly, Dennis Skinner’s eviction from Labour’s ruling NEC, which prompted an outcry from traditional Labour supporters, wasn’t anything to do with Skinner himself - they just wanted to make sure Healey was on the NEC.
And it was Labour who negotiated and enacted EU law that begins to wrap our markets up in competition law, as soon as we let private providers in just a little bit. In fact John Healey himself, at the Treasury at the time, helped steer the key 2006 Regulations through. None of this automatically forced the NHS open to competition on either side of the border. But privatisation of the English NHS accelerates towards the tipping point where it will be judged to be a fully-fledged market, no longer allowed to exclude the private sector even if it wanted to. Will it drag a non-independent Scotland with it, with or without the TTIP Trade Treaty? We won’t know until a court challenge comes along - and by then it could be too late.
NHS Villain #5 - Frances Maude MP
Frances Maude has been quiet since the petrol can debacle. But he’s described as Cameron’s ‘ideological commissar’ for good reason. His Cabinet Office portfolio gives him free range across all public services. He’s essentially Cameron’s closest policy aide.
And he has a plan for the NHS.
Maude wants the NHS - in fact, all public services except the military and police - to leave the tax-funded public sector, and become ‘enterprises’, reliant on raising money as businesses do - from private finance.
The plan is ‘a drug, addictive’ to him, he’s said. In August he invited every acute NHS hospital in England to start the process of leaving the tax-funded NHS to become so-called ‘mutuals’, potentially in a ‘joint venture’ with private companies.
New Lanark Mill, this ain’t. Staff support and public consultation are entirely optional. And a City of London-led coalition including Deutsche Bank has just launched the first ‘social impact bond’, designed to be the funding behind just these sort of plans.
It’s like PFI for public services not just buildings - buy now, pay (over the odds) later.
What does this mean for Scotland? Mortgaging ourselves to the bankers - again - would enable the English government to cut central government expenditure on public services - for a while. Without independence, Scotland’s funding would be cut through the Barnett formula as a result.
Maude has ‘missionary zeal’ for the plan.
He has Cameron’s ear.
And - so far - he has little in the way of opposition from Labour. New Labour stalwart Hazel Blears helped launch the plan. The right-wingers who’ve hijacked the Co-op Party love it. Key Labour leadership figures like Shadow Business Secretary Chuka Umunna and NHS Villain #4 John Healey tell us that our financiers are chastened post-2008. “Good capitalism” through Deutsche Bank style bonds is our best hope for “social investment” now. We can’t seriously expect bankers to pay much tax, but they will loan us the money for public services - if the return is good enough, and their public image is rehabilitated into the bargain.
And this, we are told, is “Beyond Left or Right”. Westminster was a-chuckle last week to images merging Che Guevara with Margaret Thatcher, Karl Marx with Boris Johnson. It’s all about getting the market and big finance to meet social needs, said the report it advertised. Supposedly left-wing journalists like Zoe Williams popped up to advocate this 'social enterprise' approach as the progressive way forward - labelling those who’d defend genuine public ownership as ‘orthodox’ and ‘myopic’, even as privatisations failures become increasingly apparent. Actual public ownership is just so last century, we are told.
Will there be a reaction against such piffle at the Labour Party Conference following the referendum? A resurgence of proper Clydeside-style socialism? It seems unlikely. The Labour Conference programme is littered with fringes extolling just this sort of third way, so-called ‘good capitalism’ model for public services.
This spin surfaced not long after the 2008 crash. Though its spinners obviously forgot to brief the City bankers (from Deutsche Bank, funnily enough) who waved banknotes to taunt nurses and doctors marching against Cameron’s NHS Act a couple of years back.
It’s a spin entirely alien to most Scots, who mostly rejected Thatcherite ideology and held fast to the principles of social solidarity and sensible collectivism.
Actually it’s a spin pretty alien to most English people too - 4 out of 5 of whom want the NHS, the railways, the power companies and the water board, properly renationalised, not this faintly pink response.
But - unlike the Scots - we don’t have a chance to escape Westminster’s City-dominated rule on Thursday.
Labour loyalists cite Clive Efford MP’s private members bill as addressing some of the NHS concerns - but there is no detail on that bill, even if it had much chance of becoming law. Will it do enough to stave off the fragmentation - much of it introduced by Labour - that increasingly exposes the English NHS to the quagmire of competition law and threatens to do the same to Scotland? Will it do enough to stop the NHS being saddled with market costs so expensive that the English NHS is increasingly talking about introducing charging, running a railroad through the Barnett formula funding?
Efford hasn’t shared his work on his bill with NHS campaigners, we won’t know until after the referendum.
If I lived in Scotland, I wouldn’t take the gamble.
I’d vote yes on Thursday to protect the Scottish NHS.
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