Dear Philip Hammond, Chancellor of the Exchequer

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A letter to the Chancellor of the Exchequer from Prue Plumridge

I feel I must write to you in response to your speech at the Conservative Conference in which you referred to the medium-term challenge of dealing with the public finances so as not to burden future generations.

Aside from the fact that your government has been promising to deal with the public finances for the past seven years whilst regularly moving the goal posts for achieving it, failed Tory promises show astonishing ignorance about how the state finances work in practice.

Or, is it, perhaps, that you do know but prefer to keep the public in the dark with fake messages about household budgets, living within our financial means, paying down our debts and saving for a rainy day.

You (and George Osborne before you) have abused the trust of the public with your myths and lies about maxing out the credit card and going broke.  Neither of which can happen in a sovereign currency issuing state.  I’m sure you know that really.  In truth, this has suited the pernicious ideology of the Tory government which claimed that Labour overspent and austerity was unavoidable.  Neither was true.  But, as a result, seven years of cuts to public spending have led to rising poverty and inequality through the redrawing of welfare provision and the decimation of public services not to mention the on-going attacks on employment rights and the rise of insecure working and the gig economy.

And, all the time, while you tell us that there is no money for those services upon which we all depend from the NHS, to public infrastructure and services and local government we are witnessing the ongoing transfer of wealth into ever fewer hands and public money being poured into corporate pockets.

Admit it, Chancellor, this exercise has never been about necessity.  It has always been about ideology which can be best expressed in the words of the former head of John Lewis who said recently ‘the only way to provide good public services is to ensure a vibrant business economy’ …… which is not only neoliberal bunkum trading on the lie of discredited ‘trickle down’ but shows how this false narrative dominates the mainstream and infects public understanding.  To quote Richard Murphy from Tax Research on the NHS  (and whilst he doesn’t mention it, public services too)

there is no reason why we should not have health care in thirty years’ time, whatever that care might be…… All we have to do is decide we want it. Then we can pay for it. It will not be a matter of not affording it. It’s just a matter of setting priorities. “

Moving on to your claim that borrowing takes money from the pockets of future tax payers is plain wrong to put it bluntly.

As the economist Professor Bill Mitchell notes “Each generation chooses its own tax rates and that means that the mix of public and private sector involvement in the economy is a political choice”

In this case yours.  Government spending in the form of deficits (assuming of course a government that takes seriously its responsibility for the well-being of the nation) can work on behalf of citizens to create a healthy economy and a fairer distribution of wealth.  This not only helps today’s citizens but also creates investment in public education, public health and other infrastructure which benefits both current and future generations.  Or, of course, it can, as in the case of the Tories and already noted, represent wealth transfer to the already rich and public money leaching into private corporate pockets.  And just to be clear as I can hear you whispering but what about the printing presses, inflation and Zimbabwe I am not suggesting that deficits don’t matter – they do but not in the way you tell us they do.  The fact is that whilst governments are never revenue constrained spending will always be limited by available productive capacity and resources.  And that is what has to be managed.  It should never be about balanced budgets rather it should be about creating a balanced economy.

So, Chancellor, in conclusion, I will finish by saying that a time is coming when you will no longer be able to fool the public into believing your household budget version of the state finances which has claimed that we can’t afford public services, the NHS and the welfare safety net.  They will then understand that you made a choice to deny them the public infrastructure that ensures a healthy economy and the well-being of their families.  They will understand that you played with their lives and their survival.

It is to be hoped that in the near future you will indeed have plenty of time as a shadow minister in her majesty’s government to reflect on where the Tory party went wrong but then again you probably won’t.

Regards

Prue Plumridge

Jeremy Hunt’s Plan for the NHS

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It may not look like it, but Jeremy Hunt DOES have a plan for the NHS – Caroline Molloy  First posted 23 October 2015 on openDemocracy/OurNHS

The Tories would have us believe that they are backing away from NHS privatisation.  In fact, they’re stealthily laying the groundwork for maximum profit opportunities – and comprehensive healthcare may be their first casualty.

Don’t worry about the fact that 82% of GPs are planning to leave or cut their hours in the next five years. Don’t worry that junior doctors aren’t any happier. And don’t worry that every week reveals another NHS hospital deeply in the red – even ones we thought were ok.

Don’t worry about any of that, because Jeremy Hunt has a plan.

It’s the NHS’s own plan, he repeats in every media interview. It’s the plan it would be a ‘disaster’ to deviate from, he told us before the election.

But what is this plan?

We’ll get to that in a minute.

First, let’s look at what we’re being told it’s not.

It’s not like that toxic Andrew Lansley stuff, the pro-competition 2012 Act, the “reorganisation so big you can see it from outer space”. No, that was Cameron and Osborne’s “worst mistake”, they’ve let it be known. It wasn’t really their fault, of course – they didn’t have “a clue” what the then Health Secretary was up to.

They were so cross with him, they made him a Lord. And he was such a fool, he’s just landed a job at private equity firm, Bain, advising on healthcare privatisation.

But let’s not worry about that. Lansley’s Act is “being ignored” anyway, the pro-market Health Services Journal tells us. Forget competition, forget the idea of external takeovers and internal dog-eat-dog competition between standalone trusts and powerful CCGs – under current Health Secretary Jeremy Hunt and NHS boss Simon Stevens’ plan, it’s all about collaboration now. Even KPMG (who’ve just poached another former Health Secretary, Steven Dorrellsay so.

So what is this plan? And, er, collaboration with whom?

Has Stevens – long-time Blair advisor and former United Health Vice President– really sent the private sector packing? And – after a few brand-damaging failures – have private health firms really scuttled away defeated from the £120bn “unopened oyster” of the NHS budget, deciding the NHS would be ‘shown some mercy’ after all?

It would be nice to think so. The more naïve sections of the liberal media have certainly bought that idea. When Simon Stevens launched his “Five Year Plan” last year, Andrew Rawnsley in the Observer said he had “only one fundamental objection” to the “generally excellent” plan – that it had the wrong picture on the cover. Polly Toynbee in the Guardian told us it was great because “the word competition doesn’t appear once in his 37 page document”. Shadow Health Secretary Andy Burnham appeared to sort of welcome the Stevens plan, then to sort of welcome it not quite so much.

Aside from this site, one of the few mainstream commentators to nail what the Stevens’ plan was really about was Fraser Nelson, in the Telegraph. “Like the best revolutions, it came carefully disguised,” Nelson observes. Yes, “the c-word didn’t appear once” but (like Nelson himself) Stevens still “firmly believes” in the competition/choice agenda – he’s just experienced enough to know that “the secret of successful radical reform is not to announce it with any fanfare.”

Nelson nails it when he says: “Stevens’ Grand Plan is to have no more Grand Plans but, instead, lots of smaller plans.”

So what are these smaller plans – and what do they mean for the future of the NHS?

Whilst even Jeremy Hunt and his regulator Monitor have tacitly admitted that standalone, competing Foundation Trusts aren’t working, Hunt and Stevens see more privatisation, not less, as the answer.

‘Collaboration’ turns out to mean hospital mergers into ‘chains’ – a theme developed in the Stevens report. The man tasked to develop the ‘chains’ plan, Sir David Dalton, has suggested it could lead to more private takeovers. Junior health minister Lord Prior wants private takeovers of hospital chains, too – and he also thinks they should close lots of beds.

As Circle have found in the UK with their disastrous Hinchingbrooke foray, at the moment it’s hard to make a profit from competing to provide full service local hospitals.

As United Health, Kaiser and others have found in the U.S. – profit opportunities are much bigger if you integrate both the purchasing and provisionof healthcare under private control or influence, enabling you to ration or deny more expensive healthcare interventions. And it’s much easier to do that if you use your control or influence to reorganise provision away from full service local hospitals, towards a chain of disparate community-based clinics and far-flung specialist centres. Of course you have to claim all the while that this is all about integration, prevention, empowerment, localism, personalisation, specialisation, reducing ‘variation’, and ‘care closer to home’.

Stevens is pushing this approach through a range of supposedly ‘integrated’ new ‘smaller plans’. Like the new multi-billion pound lead provider framework to ‘help’ with purchasing healthcare (which United Health subsidiary Optum has won a sizeable chunk of). And a ‘prime provider’ framework to ‘integrate’ purchasing and providing (which both Circle and Virgin have won contracts worth billions for already). Not to mention the the array of ‘local’ NHS ‘Vanguard’ projects, which Stevens explicitly suggests could be modelled on US firm Kaiser Permanante’s ‘Accountable Care Organisations’ or similar Spanish companies. The tech-heavy projects are full of private sector opportunities and partnerships – particularly outside of unprofitable acute care. Meanwhile, tariff cuts leave the sword of Damocles dangling over many local full service hospitals.

Profit opportunities also expand if firms set their own easily-gamed ‘outcome based’ success measurements. Out go what Stevens calls ‘mechanistic’measurements (like the requirement to have enough nurses, properly trained healthcare workers, and hospital beds).

Since the general election, Stevens and Hunt have been busy tearing up such requirements.

And in come easily gamed ‘outcome’ measures – exactly what we see in the new style contracts.

Profit opportunities also expand if co-payments (ie, patient charges) are permitted. The right are getting more confident in calling for such chargesLord Prior has tried to launch an inquiry to consider it – and the government has still not clearly disavowed such an inquiry. The growing number of exponents of charges and co-payments are usually keen to stress it would only be for freshly defined ‘non-core’ services which, if you look closely, turn out to mean things like a bed to recover in after your op (£75 a night please!).

And there are many other attempts underway to undermine the comprehensive, universal, publicly funded core values of the NHS, by bringing the ‘undeserving’ narrative from benefits, into the NHS. An early sign is the attempt to refuse people care if they smoke or are obese, for example (cavalier to the fact that it is poorer people who will be disproportionately hit by such clinically uninformed decisions). Whilst Devon’s attempt to do this failed, experts saw it as a sign of things to come.

Stevens has just given all of this a big boost by pushing integrated health and social care budgets (and indeed integrated benefits budgets in some devolved areas, like Cornwall). All of this may be nice in theory, perhaps, but it’s pretty terrifying in a climate of ‘austerity’, where social care users already can, and have to, top-up or co-pay for services (and benefits are already heavily conditional).

And integrated personal budgets – which Stevens has been pushing since day one in the job – are now being rolled out to millions. No-one has yet managed to explain how these are any different from the old Thatcherite voucher plan (which would basically finish the job of destroying the NHS).

Lastly, as a big bonus, once firms nabbing all these contracts have their hands on the patient data needed to commission healthcare (or obtained by delivering it ‘digitally’), they can also make a packet selling our information to data, insurance and pharmaceutical companies – or worse.

Of course this entire bureaucratic market nightmare costs a fortune to administer, though the scale of the fortune is a closely guarded secret. The Health Select Committee pointed all this out in 2010 (referring to earlier data – and we’ve had two or three more tranches of ‘marketisation’ since then).

So if that’s the Stevens plan, what’s our plan B to get out of this mess?

First, the NHS urgently needs a cash injection to get it through this current manufactured crisis (with the DoH handing billions back to the Treasury in ‘underspends‘ in recent years – ‘doh!’ indeed!).

Healthcare needs are not a bottomless pit, as the neoliberal ideologues claim – but the demands of health, insurance, pharmaceutical, data, consultancy and tech companies for profit streams, may well be.

Ultimately, all this destruction is possible, not because of Stevens himself, but because the Coalition government finally removed the duty to secure comprehensive healthcare which was offered to the nation in 1948 and persisted, just about, til 2012. We need to restore that duty.

And we need to recognise that hospitals have been brought low by a combination of PFI debt and the dog eat dog, beggar my neighbour nightmare of even the ‘internal’ market, let alone the external one. We need to get rid of that market – as Scotland has done.

The NHS Bill – sponsored by Caroline Lucas, signed by Jeremy Corbyn when he was a backbencher, and due for its second reading in March 2016 – is a serious attempt to do both.

The market, internal or external, disguised as ‘collaboration’ or not, is not an effective way to allocate healthcare – we’ve known that since the pioneering work of Nobel prize winner Kenneth Arrow in the 1960s. It forces hospitals to hammer down staff costs and offload unprofitable patients, and creates impossible choices between the bottom line and patient safety.

It’s only ideology and vested interests that would seek to persuade us that the answer is more of the same.

And if anyone – Tory, Labour, or ‘non-political’ – says they support the NHS, we need to ask – do you mean an NHS that is comprehensive, universal, publicly funded, high quality, timely and ethical?

If not, they are not defending the NHS as the public understand and love it. And that’s what we need to fight for.

 

This article is published under a Creative Commons Attribution-NonCommercial 4.0 International licence. If you have any queries about republishing please contact us. Please check individual images for licensing details.

Mourning for the NHS and “The Sell Off” movie.

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Mourning for Our NHS

The NHS is  a beacon of achievement brought in by Aneurin Bevan in 1948, and the nation is rightly proud of it. Both recent Conservative and Labour governments have been complicit with efforts to move aspects of our NHS into private hands. In 2002, Blair himself had toyed with the idea of user charges or ‘co-payments’ for public services. (1)

While it has been Labour’s greatest achievement, the introduction of Private Finance Initiatives (PFI’s) by New Labour has been Labour’s greatest betrayal. The politics of recent general elections have often have focused on the issue  of ” wasteful” public expenditure , and claims of inefficiency,  yet resources have been wasted on marketisation. There is now considerable evidence countering the principle of “public bad, private good” .

Jeremy Corbyn has never supported the plans to bring the private sector into the NHS.

He said at his recent rally in Nottingham,”If I said to you , do you all value the national health service, you’d say, “why is he  the asking the question, it’s obvious we do!”

Of course it is. The NHS is the most civilised, greatest achievement politically ever made in this country. It was the culmination of those who fought for the right to vote, those who got the right to vote for women, those who campaigned for all the things that brought about the 1945 Labour government and it was an amazing achievement.

And it was quite moving when we had a rally in Tredegar, a week and a half ago on the very spot where Aneurin Bevan used to speak to his constituents, and in the window of Nye Bevan House, he questioned rhetorically.  He said, ” Can a society that denies medical care when it is available, to those that cannot afford to pay, call itself civilised?”

aneurin1

Nye was right, and it’s very dangerous what’s happening to the NHS at the moment.

The internal market, the bringing of the private sector to run whole sections of it, the profit-taking out of the NHS, the continual limiting on the availability of expensive special medicines and all that, leads me to think that the Tories have got their real eye on making the NHS a privatised service of last resort, in order to promote a private medical system of first choice for those that can afford it.

And so, we have to defend that principle of an NHS free at the point of use. We have to defend that principle and also end the internal market, repeal the health and social care act, and be proud of our NHS.”

The Sell Off

Sell-Off is a full length Movie. It is essential viewing and sharing for people who want to keep the NHS out of private hands, and recommended.

If you want to know a bit about Peter Bach, who produced the film, you can watch the second half of this episode of The Keiser Report.
http://rt.com/shows/keiser-report/200435-episode-max-keiser-673/

Published on Nov 5, 2014

Donations welcomed: http://www.selloff.org.uk/nhs/default…

For more information: www.facebook.com/selloffnhs

  1. Tony Blair”Where the Third Way goes from here, Progressive Politics, Vol 2,No 1, 2002
  2. NHS PLC – Allyson M Pollock, published by Verso
  3. YouTube Clip: “The Sell Off”
  4. The Keiser Report
  5. Government proposes inquiry into moving to a ‘pay NHS’
  6. Who said, “The NHS will be shown no Mercy?”
  7. For Richer, For Poorer, In Sickness and in Health
  8. The Systematic Dismantling of the NHS.

Fight the Trade Deals or lose our NHS and public services for good

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Whatever politicians and corporate lobbyists tell us, our public services and the NHS are absolutely under threat from the EU-US trade deal (TTIP), the EU-Canadian trade deal (CETA) and the even more secret Trade in Services Agreement (TiSA).  We are in danger of losing any control.  These deals bind in future governments, under international law, and are intended to be irreversible.  In other words, they supercede the democratic decisions of national governments, both now and in the future.

Furthermore, they may be called ‘free trade’ but what they mean, is freedom for corporations and banks not for ordinary people.  They say that they are about removing ‘barriers to trade’ but what they mean is removing protective employment and environmental legislation.  They use the word ‘liberalisation’ which may sounds quite friendly but what they mean is that democratically elected governments cannot reverse privatisation of public services.

John Hilary from War on Want (in the 15 minute video clip below) explains the detail of how these trade deals fit together and build upon each other.

It is worth noting that a You Gov poll for CLASS found  ‘a lack of faith in private sector control of public services, with 12 to 1 people against the NHS being run by the private sector.  67% in favour of Royal Mail being run in the public sector, 66% want railway companies to be nationalised, and 68% are in favour of nationalised energy companies.’  

So much for the democrat will of the people, because regardless of public wishes, the EU Commissioners and our government are going ahead anyway.  We can and must stop them.  The only thing that frightens politicians is widespread public opposition – that’s why the trade deal negotiations are shrouded in secrecy and weasel words.  Sign War on Want’s petition before 10th October – 2 million signatures already and still rising.  Join local groups, get informed and support protests such as 38 degrees day of action on 22nd August 2015. The more we can spread the word, the less likely it is that these destructive and undemocratic deals will be implemented.

 

Trade agreements (TTIP, CETA, TiSA) and public service

Published on Aug 1, 2015

John Hilary, Executive Director of War on Want, talks to Carrie Cracknell about the threat from free trade agreements to public services, in the context of TTIP, CETA, TiSA and other treaties.

Addendum

Earlier this year (well before the Labour leadership contest) Jeremy Corbyn wrote:

‘TTIP will allow companies to control governments …. And from what little has penetrated the veil of secrecy surrounding negotiations, it appears increasingly that any potential positives for workers, and on environmental issues and public services are being sidelined in favour of greedy bankers and multinationals which see vast profits to be made.’