Image: Green Party
The Coalition told us it wanted to hand control of the NHS to patients - but instead is attacking NHS democracy on every side.
Before Christmas, I spent
an evening as an observer with an ambulance team in Brighton. The shift continued well past its official
finish time of 1am. I left with an even stronger sense of the commitment and
dedication of our hard-working, professional NHS staff.
The health service remains the country’s most cherished institution, polls tell us. It is uniquely bound up in our sense of who we are. The memory of Danny Boyle’s wonderful and creative depiction of the NHS at the Olympics is still so vivid because it embodies that sense. Forged in post-war Britain as part of our collective will to build a better, fairer society, we feel that it belongs to us more passionately than we do any other public service.
The outcry at the Health and Social Care Act wasn’t just about the commercialisation of the NHS. It was about an affront to our democratic values. The Conservatives had promised there would be “no more top-down reorganisation of the NHS”. But on gaining office they quickly announced the biggest restructuring of the NHS in its history, a reorganisation so large its head said it was "visible from space".
The new structures are Kafkaesque (I have complicated organisational flow charts on the walls of my office to try and help me understand who is accountable for what).
Another dent in democracy is that private companies providing NHS care can be far more secretive about their activities. They can circumvent Freedom of Information requests on the basis of commercial confidentiality.
The commercialisation of health services that the Act has accelerated adds to the democratic deficit.
Has the Coalition learned its lesson from the wave of public and professional protest against the Health and Social Care Act?
Far from it.
They’re now trying to push through another piece of legislation taking away much of the power of local communities to have a say in what happens to their local hospitals and NHS services.
The Care Bill - reaching
its final votes in a couple of weeks - is by no means all bad. In fact it’s an
important Bill that aims to bring up to date the legal framework underpinning
the care system. But it also contains the frankly outrageous Clause 118. This
clause would give government agents powers to recommend and impose changes not
just to “financially failing” trusts they are brought in to sort out, but also
to neighbouring trusts, potentially denying the public and patients in those
areas any real say.
The move follows last year’s embarrassing defeat in the Appeal Court, which ruled that the Health Secretary did not have powers to implement cuts to Lewisham Hospital’s Accident and Emergency and maternity services.
The Government is trying to sneak through a fundamental shift in the way future decisions about local services are made.
If they thought we wouldn’t notice that backhand attempt to change the rules they were wrong. There is both strong cross party opposition and grass roots opposition to the clause. Democracy hasn’t been smothered yet.
this weren't enough, the attack on the democracy of our most loved national
institution could be ramped up by the Transatlantic Trade and Investment
Partnership (TTIP). If it goes ahead, it could see the multinational health
giants that are circling around and snapping up billions of pounds worth of NHS
contracts file complaints directly to international tribunals, completely
bypassing national courts should they perceive threats to their interests from our
Two other pieces of government legislation complete a five pronged attack on the democracy of the NHS. The Chair of the British Medical Association raised concerns that the Gagging Bill – now sadly law despite public outcry - could prevent people from speaking out against the threat of privatisation, remarking that the Coalition "doesn’t like to hear anyone but themselves talking”. The requirement to divide spending on constituency lines will mean large administrative burdens for many health campaigns, for example against hospital closures that affect more than one area.
Like the Gagging Bill, the Deregulation Bill currently before parliament is wide-ranging in scope. It’s when we look at what it might mean for the NHS that we see why so much in it is absurd. The Bill imposes a new duty on non-economic regulators to promote economic growth. What exactly would that mean for the Care Quality Commission? How exactly would the Medicines and Healthcare Regulatory Agency, which regulates the pharmaceutical industry, promote growth?
Successive governments have talked about the need to empower patients, to make the NHS more accountable and to improve choice. Yet in reality, their policies have often disenfranchised communities, perhaps because their understanding of what choice and freedom mean is inextricably bound up with ideas of markets, and profits, rather than genuine people power.
Nye Bevan famously said that the NHS will last as long as there are folk left with the faith to fight for it. We have a service we want to protect passionately. The democratic tools we need to do so are threatened.
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