With under a week to go till the Labour leadership election closes, how much do we know about the candidates’ positions on the NHS?
“PFI on steroids”? More like an NHS debate on tranquillisers
By Caroline Molloy
first posted 4 September 2015 at openDemocracy
In last night’s last televised Labour leadership hustings, Yvette Cooper launched a broadside against Jeremy Corbyn’s idea of a ‘People’s Quantitative Easing’ to fund hospitals and other vital infrastructure, calling it ‘Private Finance on steroids’.
It’s obviously a soundbite she’s proud of, having used it earlier in the week.
But it’s a senseless, illogical critique.
Corbyn’s proposals to pump government cash into investment in vital public service infrastructure to boost jobs and the economy – are the mirror opposite of Private Finance, which sought private alternatives to government cash, even at the cost of inflated interest rates and inflexible, long-term maintenance contracts.
And logically, Cooper’s criticism only makes sense if you think private finance (PFI) schemes are ‘a bad thing’. (After all, you don’t criticise an opponent by calling their plans a super-powered version of a good thing!).
But – whilst Corbyn himself has put forward a powerful critique of PFI, and widely-praised proposals to save hospitals from it, Cooper shows no sign of thinking PFI is a bad thing.
Cooper was Chief Secretary to the Treasury in 2008/9 whilst it signed off nearly 50 new PFI schemes, including many in the NHS.
In 2009, she told parliament “PFI projects have consistently demonstrated value for money and high levels of user satisfaction in vital areas of public service delivery….” She added that it was best to stick with the PFI structure because the private sector will “continue to bear the risk of cost overruns and delays” (even as she handed the private firms a £2bn public bailout).
The Commons Treasury Committee disagreed, saying “Private Finance projects are significantly more expensive to fund over the life of a project…We have not seen clear evidence of savings and benefits in other areas of PFI projects which are sufficient to offset this significantly higher cost of finance.”
But Cooper appears never to have accepted these criticisms.
Even as she berated Jeremy Corbyn for ducking her questions about “free money” at last night’s Sky hustings, she ducked his question about whether she would pursue still more rip-off PFI, as her “credible alternative” to “printing money”.
And what of the other two Labour Leadership candidates?
Shadow Health Secretary Liz Kendall of course is always right on the New Labour message that Private Finance schemes were the only way to rebuild hospitals that had crumbled under Thatcher – an argument rejected by the BMA, the medical Royal Colleges, the National Audit Office, and campaigners, who point to the spiralling long-term costs now pushing hospitals like Peterborough and Barts to the brink of ruin.
Shadow Health Secretary (and former Health Secretary) Andy Burnham’s mood music has been different , and he has admitted that some PFI schemes were bad value (though when OurNHS asked him, he couldn’t name any that were good value). And when we asked him whether he would commit, at the least, to no more PFI, his team told us “that was a matter for the treasury” – hardly reassuring.
It’s a pity that in the debate the media has failed to properly grill the candidates on their position on PFI – just as before the election, they failed to ask Ed Balls if, having abandoned the idea of ‘invest for growth’ in favour of ‘no new government borrowing, even for capital projects’, he was still wedded to the ‘off-balance sheet’ trick of PFI (though experts suspected that is exactly what he meant).
Much of our media is befuddled on the NHS issues more generally – from privatisation and funding to staffing and the big questions of entitlement to comprehensive health care.
Corbyn is the only candidate to have signed the “NHS Bill”, developed by Professor Allyson Pollock alongside many other campaigners, and put forward as a cross-party bill by Caroline Lucas.
The Bill – which has won huge support amongst NHS campaigners – calls for THE restoration of the Secretary of State’s duty to ensure a comprehensive health service for all, which was finally abolished by Cameron’s 2012 Health Act.
The loss of this duty was behind situations like that in Devon, where last year the unaccountable and cash-strapped local ‘Clinical Commissioning Group’ tried to ban all obese people and smokers from having any routine operations on the NHS. And it’s behind the mounting rhetoric about the ‘undeserving’ (starting of course with politically unpopular groups like migrants, fat people and addicts) who should be made to pay for their health care.
Burnham has signed a Labour bill put forward by Clive Efford which provides some similar wording, and did manage to get a commitment to ‘restoring the Secretary of State’s duty’ into the health manifesto – though not the wider Labour manifesto.
Burnham won many friends amongst NHS campaigners for saying that “we let the market in too far” and that the NHS should be the “preferred provider” (along with charities). And for beginning to talk about privatisation (though too often the language was of ‘fragmentation’ or ‘top down reform’, which seemed a lukewarm language). Such language appeared a welcome respite from the Blairite mantra (still espoused by former Health Special Advisor Kendall, of course), that “what matters is what works”. The extensive evidence of privatisation’s unnecessary expense and failures is dismissed as ‘ideological’ by these ideologues.
But the Cross-Party Bill signed by Corbyn goes a lot further in saving the NHS from expensive privatisation. The NHS Bill calls for the hugely expensive and bureaucratic NHS ‘market’ of ‘Trusts’ competing with each other and private firms – a system Burnham and Cooper consistently voted for, and Corbyn consistently opposed – to be largely scrapped, as it has been in Scotland.
Meanwhile Burnham has repeatedly refused to say just how much the market and private firms should be allowed in to theNHS, or to speak out against plans currently underway to turn a clutch of NHS hospitals into independent ‘social enterprises’, or to address concerns that merging the NHS into already privatised social care might undermine our ability to see off further compulsory privatisation under existing EU law.
This integration of health and social care remains Burnham’s “big idea” for the NHS – an idea echoed by Kendall, Cooper, and indeed the Tories and Lib Dems. It’s a holy grail that has been chased for years, of course.
But worryingly, Burnham has been a lot clearer about his desire to leave a legacy of a ‘National Care System’ than he has about his commitment to ensuring that, whatever happens to social care, our ‘National Health System’ will remain comprehensive and taxpayer-funded, as polls show the public want.
Burnham told a Kings Fund audience that we would have to “have a big conversation” about what social care and health care we were entitled to, and how we pay for it, after the General Election.
And he recently told the Guardian that he wanted a “means-tested levy” to pay for his “integrated health and social care system”.
Perhaps Burnham didn’t mean to suggest that health care provision would in future be means-tested, just like social care. His personal manifesto, released a week later, was more carefully worded. But his lack of clarity and – yes – bite worries campaigners. When OurNHS exposed that the government was planning an inquiry into funding the NHS through means-testing, co-payments, insurance or other means than tax, Burnham’s response was curiously muted. Did the Shadow Health Secretary build on the widespread outrage at this apparent back-tracking on all Cameron’s lofty pre-election promises about protecting NHS principles? No – he merely asked for the “terms of reference” of the inquiry.
And whilst neither Burnham nor Cooper have shown quite Liz Kendall’s enthusiasm for an NHS funded through ‘Personal Budgets’ (an idea strongly redolent of Thatcherite vouchers and clearly opening the door to co-payments as with social care), there’s been no criticism from Burnham of this scheme, currently being rolled out by the NHS boss to millions of the sickest patients.
It is perhaps a little unfair to criticise Burnham for his silence on these issues, without acknowledging that (apart from Kendall’s cheerleading) the other candidates haven’t said an awful lot about them, either.
The failure here is the media’s. Despite being the number one issue before the election, little of this has come out in the debate. The candidates get away with mentioning the NHS only as part of a litany of great things about Labour they are proud of. They usually add in an emotive mantra about relatives that struggled in an era before the NHS, or couldn’t have survived without it.
This is no more convincing when it’s Yvette Cooper’s great auntie than when it’s David Cameron’s son. Without strong commitments to a comprehensive, universal, quality, ethical, timely and tax-funded, NHS, such mantras are merely a haze.
To be fair to Burnham, neither Cooper nor Corbyn have fully engaged with these issues, nor would they really be expected to understand the detail of issues outside their briefs. But Corbyn’s willingness to listen to the united voices of NHS campaigners who said “THIS Bill is a big part of the solution”, bodes well, if he should win.
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