The Battle to save the NHS


The crisis in the NHS grinds on inexorably.  In just the last day, former LD health minister, Norman Lamb warns that the healthcare system will crash in two years and says Tories are being dishonest over crisis.   Furthermore, NHS junior doctors have condemned a new contract imposed on them, fearing that it will cut their pay by up to 40%, force them to work more antisocial shifts and put some off becoming GPs or A&E medics.

They have pledged to resist the move by ministers, which they say is “bad for patients, bad for junior doctors and bad for the NHS”. The joint leader of the 53,000 junior doctors in England affected has indicated that they may even go on strike in protest.

Tony O’Sulivan sets out the current position in the piece below, re-posted from openDemocracy

The NHS stays centre stage as the political ground shakes

By Tony O’Sullivan – Consultant Paediatrician and member of Keep Our NHS Public and the Save Lewisham Hospital campaign.  First posted 14.09.15 openDemocracy

The English NHS is likely to stay centre stage in political fights.  New Labour leader Jeremy Corbyn’s first official visit as Labour Party leader was to Camden & Islington NHS Mental Health Trust yesterday.  His new shadow chancellor, John McDonnell, last night highlighted his opposition to the EU/US TTIP trade deal which many see as a huge threat to the NHS.  And – uniquely amongst leadership contenders,  Corbyn is a signatory to the NHS Bill 2015 – which aims to reinstate the NHS and was re-tabled in Parliament by Caroline Lucas, Green MP with cross-party support on July 1st.

Yesterday, Corbyn wrote

“We as a labour movement have to be strong enough to stand up and ensure that we have a system that prevents anyone falling into destitution, supports those going through mental health crises and ends the internal market and privatisation of our health service.”


Later today, parliament will debate a vote of no confidence in health secretary Jeremy Hunt, Health Secretary, after two petitions calling for such a debate attracted over 300,000 signatures – though the Government has relegated it down from the main chamber of the House of Commons, to the significantly more low-key Westminster Hall venue.  Doctors have been asked to ensure their MP attends this debate and to ensure the focus is on Hunt and his record.

NHS campaigners will be out in force to show the Government the depth of feeling for the NHS and against Conservative ideological direction at the Tory Party conference in Manchester on 3-7 October.

The greater openness of political debate, first in the Scottish independence referendum and now in the Labour Party leadership election, means that many more will be ready to get involved.  And we must be ready to respond to every anti-NHS argument.

The ideological untruths and practical assaults on the NHS and public sector that we saw under the coalition government are being ramped up under the new Tory government.

If a public service is starved of essential finance for long enough it will start to fail – and the NHS is no exception.  Just earlier this month, GPs in Worcestershire were told not to refer patients to local NHS hospitals for three months so that they could clear a backlog – and encouraged to pay private hospitals to take patients in the meantime.

The NHS is ‘broken’, wrote James Bartholomew in the Telegraph electing to place the NHS bottom of the pile of European health systems.  He concludes that the ‘failed’ NHS must be replaced by a compulsory insurance system, such as that of Switzerland.

In the UK of course, there is a compulsory contribution to the NHS from public taxation made in the UK.  The great difference is that the UK system is not run for profit and is free at the point of need.

This principle makes the NHS far more cost effective – out-performingSwitzerland in effectiveness and value for money according to a 2015 Commonwealth Fund report.

No doubt other systems have lessons that we can learn from.

But Bartholomew’s argument is a purely ideological one. Like the Government, he wants us to equate publicly funded health systems with failure.

His 2004 book The Welfare State We’re In was praised by Thatcher’s guru, Milton Friedman, as “a devastating critique of the welfare state”.  During the 2010 pre-election period, Bartholomew advocated the abolition of the NHS on Radio 4.

Our NHS has been amazingly effective despite ongoing underfunding compared to other advanced national health systems.  Just why is it that the NHS has lower number of doctors and acute hospital beds per 1000 population and second lowest number of MRI scanners per million compared to other advanced European health systems?  It is a failure of funding rather than a failure of the NHS.  It receives less funding than the OECD average and less than the European comparators.

Nonetheless, the Commonwealth Fund’s comparative analysis of 11 advanced national health services, using data and surveys from 2010-13, placed the USA bottom and the NHS top.  The NHS was best in 8 out of 11 criteria and was the most cost-effective national health system.

In fact, despite significant underfunding, the NHS has punched above its weight for three generations.

It is now under threat from cleverly disguised ideology, worsening cuts, PFI payments and privatisation, not from its ‘failure’.  The failure to adequately fund front-line NHS services over the last five years has increased waiting lists.  We need more GPs, hospital doctors, more nurses and therapists and better equipment.  Not an insurance based system such as the USA or Switzerland.  The USA spends double the UK on health but over 30% of that funding is wasted on private insurance administration and profit margins.  In insurance-based health systems, the incentive of profit regarding who gets investigations, procedures and treatments, can be a more powerful motive than what is bestfor the patient.

Efforts to privatise whole swathes of health services have failed to deliver more effective care and are proving more costly.  We now face a national health service increasingly without national coordination of standards, with shrinking resources and accelerating fragmentation.  This will devastate patient care pathways which rely on many services cooperating together (including social care).

We must get back the NHS.  In the example of New Zealand we can see the immediate benefits if we succeed.  New Zealand privatised their health service in 1993.  Perverse incentives dominated and costs escalated.  The new 1999 government looked this failure in the eye.  They made a political decision to act on the evidence and renationalised their health service in 2000 with clear benefits.  Following the calamitous Christchurch earthquake of 2010, public conclusions were that the privatised and fragmented health service would not have been able to respond to such magnificent effect as New Zealand’s reinstated NHS.

There is one category where the UK comes out close to bottom in international comparisons like the Commonwealth Fund (though still above the USA).

It’s ‘healthy lives’, a category which reflects more specifically health inequality: the effects of poverty, education and societal attitudes to promoting early child development (see the Marmot Review).

The greatest single determinant of health outcomes is of course poverty. The impoverishment of the British people through austerity, unemployment, low wages and zero hour contracts, the mental and physical stress that places on us, coupled with the assault on the funding of the NHS and escalating privatisation, means that the battle to save our NHS is more important than ever.

With additional reporting by Caroline Molloy.

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The economy is not growing strongly


Crisis hasn’t gone away.  Corbynomics will be increasingly necessary.

By Michael Burke   First posted 17.09.15 at


One of the most widely repeated falsehoods about the British economy is the assertion that it is growing strongly and that the crisis is over.  This is not borne out by even a perfunctory economic analysis but it serves a political purpose.  In the first instance, the assertion was important in order to blunt any criticism of renewed Tory austerity policies, which will begin again earnest with the Comprehensive Spending Review in December.  Now that Jeremy Corbyn has won the leadership of the Labour Party the same falsehood is pressed into slightly different service- with the idea that his policies represent a threat to the current recovery, or are at least unnecessary.

In reality, the extremely limited upturn in output is already giving way to renewed weakness.  UK industrial production and manufacturing fell in July.  Monthly data can be erratic but this is the second consecutive fall for industrial production and manufacturing peaked in March, shown in Fig. 1 below.

Fig.1 Industrial production and manufacturing index from April 2013 to July 2015

Source: ONS

This is not the boom that is repeatedly claimed.  The recovery to date is primarily based on consumption not investment.  Since the beginning of the recession to the 2nd quarter of 2015 consumption has risen by £70bn, a modest rise of 5%.  But investment has risen by just £4bn, a cumulative rise of just 1.3% over 7 years, less than 0.2% annually.

In terms of output and investment, the notion of a boom amid austerity is entirely misplaced.  There is only stagnation.  In fact, the levels of industrial production and manufacturing are effectively unchanged since the Coalition took office in May 2010, despite inheriting a mild recovery.  In May 2010, the index levels of industrial production and manufacturing were 100.2 and 97.6 respectively.  In the most recent data they were 99.2 and 100.6.  The trends in output are shown in Fig.2 below.  They clearly show that under austerity, production has stagnated.

Fig.2 Output trends from January 2008 to July 2015

Far from a boom, the current economic situation is best characterised as stagnation.  In one form or another this also characterises the Western economies as a whole.  Since the recession began in the OECD as a whole, the average annual level of GDP growth has been under 1%.  Consumption has risen by US$2.5 trillion over that time.  But Gross Fixed Capital Formation has declined by $200bn over the same period.

For the British economy, this continued reliance on consumption holds a particular threat. The relative weakness of investment, and hence the relative weakness of productivity, is a chronic one in Britain. The current crisis has deepened these severe long-term problems.  Output has fallen back to levels last seen in the 1980s, as shown in Fig.3 below.  This represents a combination of both the long-term weakness of manufacturing and the decline in the output of North sea oil, a financial windfall that has been almost entirely wasted.

Fig. 3 Industrial production over the long-term

As it is not possible to consume that which is not already in existence, consumption must follow output.  It cannot lead it.  As the output of the British economy is experiencing both a structural and a cyclical decline, its increased consumption has been funded by its surplus on ‘financial services’, the money British banks extort from the rest of the world, and on increasing indebtedness.

As the revenue from financial services has now also gone into decline, so the resources for consuming without producing are increasingly through borrowing.  The broadest measure of Britain’s overseas borrowing requirement is the balance on the current account.  The current account includes both the trade balance and the balance on all current payments , primarily company dividends and interest payments by borrowers.  Any deficit on the total current account must be met by increased borrowing from overseas (or asset sales to overseas).  The latest 3 quarters have seen the worst current account deficits as a proportion of GDP since records began, as shown in Fig.4 below.

Fig.4 Current account blance as a proportion lof GDP

The financing of this deficit depends on the willingness of overseas investors to buy UK assets.  It is impossible to predict the precise point or catalyst for them to stop doing so.  But what is known is that the British economy has faced a number ‘balance of payments’ crises before when the relative level of overseas borrowing was far lower.  One possible way of reducing the current account deficit is to impose higher savings rates on the household sector, raising the taxes and reducing the welfare transfers to them from government, which is one effect of renewed austerity.  But even austerity Mark II will be unable to close the current account gap of this magnitude entirely.Therefore the British economy is facing a series of interrelated crises, of production, slow growth and unsustainable borrowing.  In reality they are key products of a single crisis – the crisis of weak investment.  Contrary to the Tory propagandists, the supporters of austerity and their apologists, the crisis of the British economy has not at all gone away.  As a result Corbynonics, a state-led increase in investment, is vital to end it.

Leo Panitch’s view of Jeremy Corbyn as a National Threat


David Cameron Says Jeremy Corbyn is a National Threat

Blair’s Coup d’Etat or Why the PLP is so right wing


In the same way, as the dark side of the EU project was exposed by the Greek crisis, the campaign leading to Jeremy Corbyn’s staggering win of the Labour Leadership has exposed the gulf between the grassroots and the Westminster establishment.  So how did this happen?  Why are the vast majority of Labour MPs so far to the right of the grassroots’ membership?

The following review of political scientist Lewis Minkin’s book, The Blair Supremacy: A Study in the Politics of Labour’s Party Management  goes a long way to explain how the left were excluded from becoming MPs during the Blair/Brown era.  It is particularly insightful because the review is written by Alan Simpson who was a prominent left wing MP who experienced first hand the Blair years.


The Blair Supremacy under Scrutiny

By former Nottingham South MP Alan Simpson

Reading Lewis Minkin’s new book The Blair Supremacy: A Study in the Politics of Labour’s Party Management is like sitting alongside a skilled forensic scientist as he dissects the multi-layered elements that contributed to the death of the body in front of him.  This isn’t quite where Blair left the Labour Party, but it’s not far short.  The book reads like a thriller.   What makes it captivating is Minkin’s grasp of the scrupulous planning that went into Blair’s managerialist coup, which, for a time, took ownership of both the Labour Party and the country.  Minkin reports a ‘wry comment from Blair describing “New Labour” as “the newest political party on the scene and the smallest.  It has about five people.”’  ‘From within New Labour,’ Minkin continues, ‘the takeover of the party by this small minority was quietly and sometimes boastfully acknowledged to be a coup d’etat over the party.’

Minkin describes it as a ‘rolling coup’ in that ‘it involved a series of unilateral major moves over several years’.  These moves are what the book reveals.

I once described how the Blairite revolution turned Labour from a political party into a Tupperware party, but I was wrong.  The description is far too benign.  No one falls out of love with Tupperware, at least not in the way the country fell out of love with Blair.  Tupperware is also as useful to the poor as to the rich.  And Tupperware never stripped meaning and values from everything it touched.  Blairism did.  In doing so, it ruthlessly exploited (and then dumped) a lot of decent people whose lives had been devoted to the Labour Party.

Even today, many of these – MPs as well as party loyalists – have difficulty acknowledging how extensively, and cynically, they were taken for such a ride.  For them, the book should be compulsory reading.

If it has a weakness, Minkin’s analysis falls short only in the absence of a meta-narrative; this is something like explaining the Chilean coup without any reference to the USA. I shall return to this later.

Reluctant admiration

The Blairite plan was never just to lead the Labour Party, but to emasculate it.  To do so, every aspect of the party’s machinery of governance had to be subjugated to the leader’s whim.  Minkin takes the reader on a step-by-step journey through this process and the machinations that lay behind it.  Minkin describes the greatest unity of the small vanguard of ‘modernisers’ as their shared ‘negative appraisal of the party, including and particularly its affiliated unions and associated collective body – the TUC.’

Minkin’s dissection covers the entirety of my parliamentary life (and more).  It always puzzled me how, despite all the warnings and bollockings, I never got expelled from the parliamentary party.  Now I know.

It wasn’t that Blair’s ultras lacked a desire for purges; it was just that they screwed up more often than they expected.  Their ‘managerialist’ obsessions, which politically house-trained the party, created a space in which MPs, whips and others still backed away from pooing on their own carpet.  The machine knew that Blair would get the blame – ultimate proof that his control‑freakery had no limits.  And since protecting the leader had already displaced promoting the party as the Supremacy’s overriding duty, the hounds always got called off.

To be fair, some of this was also down to the wiser counsel of whips such as Nick Brown and George Mudie.  Both were better people than the Supremacy deserved, and it was good to see Minkin recognise this in his description of events.  I guess that many of the Labour rebels were also saved by divisions between the Blair and Brown camps, in what was to become the running distraction throughout the Labour years in government.

The Blair-Brown distraction

For me, the friction between these two characters – equally damaged, equally obsessive – was often a manipulated divide, spun out to lock the parliamentary party into the smallness of playground politics rather than the bigger canvas of real politics.  Loyalty invariably displaced integrity (or clarity) in the debates of the day.

Minkin captures this brilliantly in his description of the seminal moments surrounding New Labour’s first internal rebellion – the vote on lone parent benefits.  ‘Dealing with the issue of a cut in lone parent benefit became a significant landmark in the early management of New Labour in government, and had major consequences.  For Blair and Brown,’ Minkin surmises, ‘showing prudence and control on this was all the more important because the left-wing Campaign group appeared to them to be the driving force of a limited opposition.  They, the usual suspects, had to be faced down and publicly pulled into line some time or the other, so why not over this early issue and now?’

Minkin describes much of this as a tactical misjudgment on Brown’s part rather than a cynical move on Blair’s.  Standing in the middle of it felt slightly different.  Many of us saw no real divide between Blair and Brown.  Neither showed an ability to step back and accept they may have got something wrong.  Both were obsessed with demonstrating their power as leaders.  Loyalty and obedience became articles of faith, outside of which Labour’s world would crumble.

In the same way that the Mafia asks you to destroy something precious to demonstrate loyalty, Labour MPs were asked to give a kicking to some of the most vulnerable in society.  This was a difficult step for many to take.

For the machine, however, it was the first big test of their ability to put the squeeze on people; and there were members of both the Blair and Brown camps who loved it.  MPs could be leaned on, cajoled, abused or bullied, all in the name of loyalty.  Many had their constituency officials phoned and told to kick their MPs into line.  Some had their families phoned and told not to get too comfortable with an MP’s life because they would be thrown out before the next election.  All were told it was New Labour (i.e. Blair) that they owed allegiance to.  Conscience was a liability, not an asset.

Both Blair and Brown may have wished to run with their ultras’ demands for a purge of the 47 rebels who ignored these entreaties, but the impact on the parliamentary party was different.  Most were reluctant to expel those who went into a division lobby that their hearts told them they should have been in too.  It established an achilles heel that was (fortunately) to remain throughout the Supremacy.

Lies, damn lies and New Labour

One of the strengths of Lewis Minkin’s book is its description of how all the groundwork for this managerial coup had been done long before the 1997 election.  The machine may have been surprised by the scale of the Labour victory but it already knew that it would rule by manipulation and disinformation, rather than through a new era of democratic engagement.

When Blair talked of ‘an unbroken line of accountability’, he meant everyone, and everything, being accountable to him.  His (initial) personal popularity was played out in talk of ‘direct democracy’ – a leader connecting directly to the people.  It was a great way of sidelining every structure of accountability that the party had ever created.  Minkin describes this with painful accuracy.

Minkin details how ‘the Blair coup’ set out to turn the parliamentary left into ‘a sealed tomb’: one that would not be re‑opened by new, dissenting, Labour MPs entering parliament.  Under the guise of ‘improving the quality of candidates’, Blair’s machine filleted the panel of those approved for selection by ‘eliminating candidates who “appeared not to have a pragmatic line on policy disagreements”’.

At the heart of what Minkin calls the ‘rolling coup’ was Blair himself – vulnerable, charismatic, insecure and obsessive – the centrepiece of a giant political Ponzi scheme.  Truth was always a moveable feast.  Statistics, or supportive polling data, would always be found to justify the latest move to ‘marketise’ and individualise everything advanced by New Labour.  It wasn’t just Clause Four that Blair wanted shut of; it was the whole notion of collectivism.  Business, particularly big business, wanted none of it.

So it was that, under the guise of new social partnerships, huge tranches of the social fabric of Britain were transferred into the pockets of the private sector.  My only quibble with Minkin is that this was as much Brown’s agenda as Blair’s.  The debacle of PFI and PPP debts that remain tied round the neck of public services is their common legacy to the country, not just a Blairite one.

The shadow of Nuremberg

Without doubt Blair was a consummate performer, with an unparalleled ability to lie for any cause.  It is only fitting, however, that his greatest lie should be the source of his ultimate undoing. On most issues he simply moved on and the machine behind him swept contradictory evidence under the nearest carpet.  But war doesn’t work like that – not, at least, when it is a war of choice.

As the chair of Labour Against the War, I knew how far we had gone to bring real ‘evidence’ within the reach of MPs.  Weapons inspectors had come into parliament, assuring us they had no evidence of any remaining weapons of mass destruction (WMDs).  International diplomats had arrived urging more time, and more diplomacy.  We even circulated our own detailed pamphlet to all Labour MPs on the eve of the Commons debate, dismantling the claims made in Blair’s ‘dodgy dossier’.  But most of us knew that Blair had already promised Bush the war he was looking for.  Nothing was going to deflect Blair from his own jihadist inclinations.

Minkin is right in depicting the debate as one of Blair’s most outstanding parliamentary moments.  It was where he pushed ‘Trust me’ and ‘If you only knew what I know’ to its limits.  It was some achievement to get decent people to vote in ways that Nuremberg would have judged an inadmissible defence.

But the war, its consequences and the absence of WMDs turned out to be Blair’s unforgivable sin – the lie that will dog him to the end of his days.  Hubris had given the public, and the party, something to hate him for.

The meta-narrative

The only thing Lewis Minkin’s book lacks is a wrap-around.  For all we come to understand about the ‘how’ of Blair’s rolling coup, there is nothing that addresses the ‘why’.  It isn’t enough to put it all down to control-freakery.  To learn anything from this, we have to put it in a context.  Psychologically, Blair was always drawn towards wealth and celebrity, and has draped himself in more of it than can ever buy forgiveness.  His favoured acolytes all went the same way, becoming payroll beneficiaries in everything Blair privatised.  But the brains are to be found elsewhere.

My take is that Blair had long been groomed by the neoliberalism that was running away with American politics.  The agenda was not to make Labour ‘business-friendly’ but big business-compliant.  The global agenda of the time was about turning public services into corporate profit streams.

Deregulation of financial markets, the World Trade Organisation, the TRIPS agreement on intellectual property rights and a series of US adventurist wars were all part of a bigger project.  The creation of new global creatures – corporate citizens – required the creation of new cultural norms within which they could flourish.  Rights were to be transferred from citizens to corporations.  Duties went the other way.  Somewhere along this trajectory from citizens to serfs is where we are now.

Blair was not the architect of this.  His shallowness, vanity and venal interests just made him a willing partner.  The real Supremacy lay elsewhere.

Accolades to the invisible

Some, in parliament, understood this.  And it is in a tribute to them that I want to end this review.  The Campaign group of Labour MPs barely figure in Minkin’s book, but they were the only bolt-hole of real political thought that I found throughout my parliamentary years.  Some of their leading voices get no mention at all, yet they were the MPs you would always find on picket lines, at trade union and social movement rallies, on anti-war marches and at the forefront of campaigns to restore rather than exploit the planet.

Epitomised by Tony Benn, these were the Labour MPs – socialists – who set out to explain that we always had bigger and better choices open to us than the Supremacy would have had us to believe.  Of course, it is sad that neither the trade union movement nor the party had the courage to wrap itself around those holding out this bigger vision.  But if Labour is to salvage anything from the superficiality of the Blair experience it will be the knowledge that we cannot manage our way out of the current crisis, any more than we can shop our way out.

The world is locked into a series of crises for which corporate feudalism has no answer; crises not susceptible to individualised solutions.  Tomorrow’s security will only be found if we grasp just how interdependent we really are.  Solutions will have to be on the scale of a new post-1945 settlement – with the planet as much as ourselves.

Tony Blair was never going to be relevant to this.  But the very thing whose removal came to symbolise his rise to the Supremacy – Clause Four of the Labour Party constitution – could well be.  What if common interests and common ownership/stewardship turn out to be the only viable form of tomorrow’s politics?  Think about it: the return of Clause Four – in local, national and global terms.  Now that would really piss him off.

The Blair Supremacy: A Study in the Politics of Labour’s Party Management by Lewis Minkin is published by Manchester University Press. Alan Simpson was the Labour MP for Nottingham South from 1992 to 2010

Campaign briefing – CLPD Autumn edition 2015 issue no. 79

First posted in Red Pepper 

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