On Sunday morning London will be alive with energy and celebration as 35,000 runners and perhaps a million spectators come together for the London Marathon 2012. The power of the London Marathon is formidable. It binds individuals to charitable causes, it inspires runners to conquer their personal limits, and it joins all kinds of people in a celebration of effort and endeavour, in a celebration of public space, in a celebration of us.
All this good feeling has tangible commercial value, as evidenced in corporate eagerness to hitch their brands to the event. The lead sponsor, for the third year in a row, is Virgin. “We love that the London Marathon is both a world-famous sporting occasion and a massive fundraising event,” says the company. “It's become a national institution. The atmosphere and camaraderie is like nothing else.”
The depth of Virgin’s respect for camaraderie is questionable. It is one of the companies rushing to grab a slice of another of our national institutions, the NHS.
The Health and Social Care Bill and Our Society
On Tuesday 27 March, the Health and Social Care Bill, which reconfigures the entire structure of the NHS, was made law. Despite the profound impact that this Bill will have on patient care and broader society, media coverage has hit an all time low. RIP the BBC as our trusted provider of “independent, impartial and honest” coverage.
The Bill’s endorsement of the private provision of NHS services has triggered fervent opposition from patient groups and the medical profession. Conservative Health Minister Simon Burns boldly stated in his blog on the 22 February, “Just in case there’s any doubt, we are not privatising the NHS. This Bill is not about privatising the NHS.” We await his retraction. The NHS is being carved up for corporations like Circle Health, Virgin Care and SERCO at an alarming speed. It is clear the wheel was in motion long before the Bill was ratified in law.
Without even mentioning inherent market risks, increased advertising and transaction costs, escalating legal fees, and the position of profits and shareholders in the equation of health delivery, privatisation of health care could fundamentally change the grains of our societal fabric. Since 1948, health has been a shared right. Everyone has received the care they need regardless of their wealth and status. The NHS is not perfect and some services do suffer from limited resources and inefficiencies, but experts advise that inequalities and inefficiencies may rise as a direct consequence of these reforms.
The Bill changes the meaning of the NHS so it can offer less. Although NHS services will still be “free at the point of delivery,” what constitutes an NHS service in the climate of efficiency savings, totalling £20 billion by 2014, is being radically redefined.
Our new NHS
So now for the entry of the two-tiered system, where the affluent purchase the extra health care that they need and the rest of us go without. The burden of ill health will no longer be shared across society between the healthy and sick, the rich and poor; it will be each for their own. Perhaps appropriately, this resonates in the tag line for the until recently favoured bidder to run services for disabled and vulnerable children in Devon: “Virgin Care: Providing NHS Care good enough for our own families.”
Just for your own families and not for every family? Good enough, maybe, but how much health care? What will be provided and how much will the extras cost? And where is the voice to represent the families struggling to protect their children? Where is the voice of the clinicians? Local Health Watch is the new body to represent the voices of the public, but it is not independent. It is commissioned and funded by the same body that picks the health provider.
Circle Health’s takeover of Hinchingbrooke Health Care NHS Trust as part of a £1 billion 10 year contract and Virgin Care’s contracts in Surrey worth £500 million could be the source of new energy and innovation.
In a heavily publicised speech at Ealing Hospital last May, Prime Minister David Cameron told NHS workers and the wider public “We have an institution – a precious idea – that says we are in this together; looking out for each other. So this government will never, ever take risks with the NHS. We will make it better.” Out of the reform package would come “choice for patients, not competition for its own sake,” and “innovation and improvement, not breaking up efficient and integrated care.”
The Virgin Care website hosts an impressive portfolio of projects. My favourite is Virgin Care’s innovative sexual health service, which combines sexual health, family planning and genitourinary medicine services. Any sexual health clinician could tell you that combining sexual health and family planning is a good thing, not least in terms of reducing our teenage pregnancy rate. Has it taken these reforms to shift the monolithic NHS structure and allow for innovations in services, or was it just that previous successes were uncelebrated? What will be the cost of using the private sector to drive ‘innovations’ instead of empowering clinicians to make changes from within?
What has contributed to Virgin’s unprecedented winning streak in securing health contracts? The answer is its large base of equity, part of which came from the government’s discount sale of broken banks. On November 2011, Northern Rock plc. joined the Virgin Empire at the bargain price of £747 million. The charge for Virgin with time will amount to £1 billion, but this is still less than the estimated £1.4 billion of taxpayers’ money which was injected into the bank; net loss to the government of £400 million.
Northern Rock has however been projected as a great governmental success. The combined sale of Northern Rock plc. to Virgin and profits from Northern Rock Asset Management (the part of the old bank that is still owned by government), is forecast to generate £11 billion in profit over the next 15 years. However, viewed over this extended timeframe and against the £37 billion invested by the government, it amounts to only modestly more than inflation. Compare this to the Private Finance Initiative (PFI), which has delivered us £64 billion worth of infrastructure in the form of hospitals, schools, public housing and defence since 1991, in return for £230 billion from HM Treasury.
PFIs will continue to cause discomfort for generations to come. Private finance schemes gave birth to Virgin Care, which started life in 2006 as Assura Medical, a division of the Assura Group. Two years ago Virgin Healthcare bought a 75 per cent stake in Assura Medical, with the Assura Group retaining a minority stake, or, as the company puts it: “Assura will preserve the upside to the business through its 25 per cent stake, whilst focusing its activities on its profitable property and pharmacy businesses, capable of paying attractive dividends."
Meanwhile, Assura Group is nurturing six Local Improvement Finance Trusts (LIFTs), the younger sibling of PFI, conceived to facilitate private investment for primary care facilities. The Democratic Health Network reports that LIFT “has all the disadvantages of PFI schemes, plus a few new ones.” Assura’s directors openly aim to use their “strong relationships with the professionals working in primary care” to build their capacity to generate profits. With Assura’s stake in Virgin Care, and Virgin Care’s growing presence in General Practice, there is considerable scope for conflicts of interest to arise.
Still buzzing from running the Marathon, or just enjoying the whole experience, how many of us on Sunday will call friends and family on a Virgin mobile, travel home on a Virgin train or plane for that matter, or choose to open up a Virgin bank account? Are we consuming or being consumed?
Instead of buying into billionaire Branson’s world, we need to open our eyes to what is happening, what Stuart Weir has called in these pages a “modern enclosure movement” in which the remnants of the public sphere as a whole are being wrestled from the people.
True camaraderie means taking action to protect the services that should work indiscriminately for each and every one of us. By making connections from individual to individual, between civil society groups, academics and professionals, we can all join the debate for solutions. We can ask the difficult questions and decide what we need for our health, for our education system, for our society, our climate and economy.
This is the era of laptop revolutions, of mass emails and social media. Beyond the notices for Amazon recommendations and discounted shoes, our inboxes should be the source of ideas sown between individuals; they can be our formidable power. With three years to go in the run up to the next general election, we have time now to write our own vision for the future and to see it translated into action.
I will be running the Marathon on Sunday for Spinal Research, and when that’s over I will be following these links, staying informed and taking part in the debate.
- 38 Degrees
- Left Foot Forward
- Intergenerational Foundation
- Keep Our NHS Public
- Think Left
If you agree this is an important, public interest story please act now: join and support openDemocracy, it's up to you to decide the amount. You'll get the short weekly email summary for supporters, and help spread the word. Thank you.
Get our weekly email