Labour must keep fighting for our NHS
Morning Star: By Caroline Molloy, Wednesday 13 June 2012
Back in March, you couldn't open a paper without reading Labour warnings that the Tories are destroying the NHS - "Labour's golden legacy."
True enough - but then why is Labour's new health policy paper for discussion at this weekend's national policy forum so, well, limp?
As a response to the assault it's about as convincing as replacing your light bulbs to stop global warming.
Referring to key planks of the Tory policies such as the Dilnot commission's recommendations on social care as "only part of the solution" and throwing around jargon such as the need to "ensure that collaboration and integration, not competition, is the focus of the NHS" doesn't bode well for a serious fightback.
Rather than the document's bland questions it is time to consider the key issues arising from the passage of Andrew Lansley's Health and Social Care Act.
Who owns our health services? How can we fund them fairly? And what kind of treatment will they provide?
If Labour doesn't step up to the challenge, the Tories will become brazen in asserting their answers to those three questions - that is, "private companies," "we won't" and "that depends on your ability to pay."
Meanwhile NHS privatisers such as Serco, Virgin and Care UK shrug off scandals and laugh all the way to the tax havens.
The key issue is privatisation, as it has been for so many of our public services. Indeed, this rampant theft of popular assets has been compared to a modern enclosure of our public commons.
Labour should commit to scrapping the commissioning support organisations being introduced into the health service, which are key drivers of privatisation.
A strong argument against privatisation in the current "value for money" climate is that it is wastefully, grossly expensive.
Most know that in the US health-care expenditure is far higher yet produces poorer results.
Fewer realise that US taxpayers pay around the same amount per head as the British towards state-subsidised health care and then have to "top up" the same amount again from their own purse to have any chance of decent health care because of the inefficiency of market-based systems.
As shadow health secretary Andy Burnham said back in February "markets in health end up costing more, not less."
Closer to home we can remind people of the subsidies paid to private utilities, particularly rail, where the cost to the public of backing a private system is four to five times what it was when it was state-owned.
There are also plenty of examples of outsourcing rip-offs. And yes, Labour needs to bite the PFI bullet, however embarrassing, if it is to stop the Bransonisation of the commanding heights of the economy.
Fighting privatisation is politically popular and electorally credible. In a YouGov poll in February fewer than one in five people supported more competition in the NHS and these attitudes have hardened since.
Suspicion of privatisation is growing across the board - a majority have long favoured rail renationalisation and a recent poll in the Express of all papers found that 71 per cent want water renationalised.
Labour should commit itself to repealing Lansley's Act. But halting privatisation cannot wait until 2015.
As Grahame Morris MP recently pointed out the party needs to up its game to address the "massive shift towards outsourcing across all our public services" being ushered in by the government, usually under cover of darkness and reports from "consultants."
It's not enough to monitor the impact of privatisation. Once a service is taken out of the public sector, there's no going back - procurement law applies in full force.
Indeed, there appears to be a misapprehension, quietly put about by the pro-privatisation lobby, that there is already a legal requirement to put the NHS and other services up for auction.
There is no such requirement. Recently a 76-year-old local man backed by anti-cuts campaigners took judicial review proceedings against NHS Gloucestershire over its proposed outsourcing of nine cottage hospitals without considering NHS options.
The primary care trust crumbled in the High Court rather than attempt to defend its decision.
Commissioners retain and exercise discretion over the choice between auctioning services off and keeping them in-house. They may incorrectly imply that there is a legal imperative to outsource because they are unwilling to stand up to central government's "direction of travel," but campaigners need to recognise that government policy and legal requirements are not the same thing.
But MPs must be alert to attempts to change this via secondary legislation and attempts to shoehorn the "any qualified provider" clause onto a statutory footing. Is anyone watching the NHS "constitution working party" for example?
The privatisers are constantly looking for ways to shrink campaigners' windows of resistance.
The Tories are for example moving to target local government services by giving charitable (hence private) organisations the "right to provide," which will require a bold response from Labour-led councils who don't wish to revert to a pre-1906, pre-welfare state service model.
Thirty years of experience have shown that tinkering with the market is doomed to failure.
The financial speculators who have brought the world economy to the brink can no longer profit from a vanished demand for consumer luxuries, so they're turning their attention to our basic needs. The strategy is often to use the term "social enterprise" - the spirit of the Rochdale co-operatives and the "John Lewis model" are often invoked but most public-service takeovers do not reflect these.
And while NHS commissioners can keep services in-house legally, they cannot turn them into "social enterprises" without opening the door to EU procurement law. When an initial contract runs out the likes of Virgin swoop, as happened with Surrey Community Health in March.
Co-operatives should focus on mutualising the private sector rather than targeting public services. Looking to co-ops and "social entreprises" to see off the might of international capital as it drools over our public services will result in minnows creating their own shark-filled seas.
Remember where the strongest advocacy for these "social entreprises" comes from - the ultra-Blairite Progress wing of the Labour Party and the Big Society spin of Cameron & Co. Recall the post-election leak of Maude's conversation with the Confederation of British Industry, which identified mutualisation as a key strategy for backdoor privatisation which would minimise "political risk."
It is not for entrepreneurs to decide which of our health and social needs they feel like meeting, particularly in light of an Act which allows providers to choose who they treat. There is a reason why the organised working class fought to replace the "patch-quilt" of local mutuals with a comprehensive welfare state.
For once, the left is not just on the side of the angels but of good economics, good politics and good timing. As Burnham said back in February, "the question we must ask is not which system produces the best individual examples of treatment, but rather which is best for everyone."