The NHS is dying, pretty well exactly as I said it would some two years ago now:
Some scandals may emerge in time over ‘backhanders’ paid by the private hospitals to the private commissioners, and in some circumstances it will turn out that the people doing the commissioning are simply commissioning themselves in another name – the whole inefficiency of which the provider-purchaser split was supposed to stop – but it will all be a bit esoteric and complicated for people to understand, and there won’t be much of a fuss.
In fairly short order, we may get these new commissioners creating two tiers of provision from within GP surgeries, with one level of care for those not paying, and those who just happen to have signed the relevant insurance policy forms, which just happen to be in the GP surgery.
Insurance-based healthcare, and the exclusions that this brings, will come not through a government announcement, but by the surgery backdoor……
The consortia [now called CCGs] will end up being led by two or three ‘movers and shakers’ in each area, whose job will be simply to negotiate a decent deal for their colleagues and let the private commissioners get on with the rest. There will be no revolt in primary care, and in secondary care no-one will actually notice till it’s too late.
Two years on, it’s being more widely recognised that, as of 1st April, the NHS privatisation will being quietly but in earnest, as the section 75 regulations kick into gear, Clinical Commissioning Groups with often overwhelming direct financial interests in private providers put services out to the market, public provision withers on the vine or simply goes bust, and private insurance arrangements start to become the norm, initially for (the more profitable) elective healthcare, and then for the rest. As Lucy Reynolds from the London School for Hygiene & Tropical Medicine rightly notes, what comes next in this wildly ‘imperfect’ market is market abuse and health cost inflation. This inflation around the ‘cherry-picked’ services, Lucy might also have noted, will lead to the stripping of resources from the less profitable services – no health budget ring-fencing will protect that.
So what is to be done? By 2015, if and when Labour regains power, the promise of a repeal of the Health & Social Care Act (and the accompanying Section 75 regulations) may be a welcome statement of principle, but it will not significantly change the way in which services have already been privatised, seemingly irrevocably. In many cases, there simply won’t be the public services to transfer them back to, and the incoming government is likely to consider the full-scale implementation of NHS II a little too much of a fiscal challenge, even if the recreation of the cumbersome institutions of 1948 were desirable.*
What Labour can do, though – and needs to start thinking through now – is to tackle the local institutional architecture, in a way which creates the platform both for the establishment of local democratic control of both the type and quality of provision. If it gets this right, this might actually lead, in the medium term, to a better health service than we currently enjoy - as I’ve noted before, it does not become Labour to gloss over the very clear health and social care failings caused by the managerialist ideology that has held sway for the last thirty years.
More specifically in terms of local institutions, the Labour government-in-waiting should first consider retaining the Clinical Commissioning Groups. but diluting the power of GP practices within them by making theirs a minority voting position, through the introduction of members of Foundation Trust governing councils (increasingly focused on quality standards if the Francis Inquiry recommendations are carried through) along with elected councillor representation in keeping with Councils’ new public health function. The immediate impact of this is likely to be presumption against private sector provision where other options still exist (they won’t in many places).
Second, the Labour government in waiting should commit to ensuring that these new-style CCGs adhere both to the letter and spirit of the Public Service (Social Value) Act 2012 under which all CCGs (and the NHS Commissioning Board), have a duty to consider:
(a) how what is proposed to be procured might improve the economic, social and environmental well-being of the relevant area, and
(b) how, in conducting the process of procurement, it might act with a view to securing that improvement.
(Oddly, this is Tory legislation, aimed primarily at breaking the perceived monopoly power of local authorities, but can be used to the same effect against private sector dominance in healthcare provision. That will really piss off the Tories….)
These two relatively simply steps will set the direction of travel back against wholesale privatisation, although of course attempts to terminate contracts are likely to result in lengthy and quite likely unsuccessful legal battles, so early progress is likely to be quite slow.
Nevertheless, institutional change at local level by government, especially if accompanied by moves within the Labour party and the broader movement to re-energise Trade Councils, in a move away from the vapid Tory ‘consumer localism’ and towards a quality-oriented ’worker localism’**, could provide early impetus for the creation of a properly socialist health and social care system – a system fit for the 21st century (whether or not this is tax-based or progressive social insurance based doesn’t really matter as long as it provides for equitable provision) , with private operators increasingly steadily cleared out in favour not just of direct NHS Trust delivery, but also a new surge of worker co-operatives (although charities and social enterprises may also play a valid part).
* It is always worth remembering, in the context of the fetishisation of the 1948-style NHS, that until very late in the day a radically different – and I would argue preferable – NHS structure was being argued for. This was a much more decentralised and locally accountable system, rather than the monolith we grew to love despite it tendencies to managerialism (and I would argue that this is why service standards have declined in the NHS faster than in local authorities, say). See Rudolf Klein’s seminal The Politics of the NHS for more (the later edition is called The New Politics of the NHS but the early chapters are the same).
** This is not to argue for the introduction/retention of localised terms and conditions. Trade unions should of course be encouraged to negotiate at national level, and a properly brave/strategic Labour government would use the need to ‘renationalise’ the NHS, and to invest quality in the hands of its staff (as opposed to its bosses) as a rationale for the relatively painless (in terms of reactionary public opinion) repeal of restrictive trade union legislation. Frankly, I’m not holding my breath on this one.
The detective who sought to make money from selling information to the News of the World has been sentenced to 15 months in prison. This is less time in prison than the conviction would normally have carried:
[T]he judge said had that not been the case she would have been sentenced to three years. The judge said he was particularly concerned about the child, and admitted that her absence while she is in prison could be damaging. However, he said that, had she not been arrested, the detective would have returned to work by now, and therefore the child would be cared for by others anyway.
I am pleased that she will spend less time in prison than she might, and that assuming good behaviour she will be reunited with her child in a few months. But what strikes me is that the matter of adoption, as opposed to simply having a child, seems to have been given greater weight than it does in most other sentencing of women, in less high profile cases.
The Corston Coalition points out that:
Imprisonment also has a serious impact on women’s children: ninety-five per cent of the children of women offenders have to leave their home on the conviction of their mother.
But, as the Coalition then points out:
The number of women sentenced to custody has increased by more than half between 1998 and 2008. In 2008, 8,862 women, not including those on remand, were sentenced to custody. In the last decade, the women’s prison population has risen by 44 per cent; in comparison, the male prison population has risen by 26 per cent.
Clearly the judge in this case felt the crime was of such gravity that the need for a prison sentence outweighed the needs of the child. I can (nearly) understand that, given the principle of vengeance written into our criminal justice system.
Yet for the vast majority of women sent to prison, there are clear, viable and effective non-prison options, and they still get sent down.
Let us hope, at least, that the judge’s sentence mitigation in this case will create some form of precedent in less high-profile cases.
The Sun says:
DAVID Cameron wants power to boot out foreign terror suspects as part of a deal to keep Britain in the EU.
The PM’s “bottom line” is to wrest control back from meddling European judges.
He is furious 3,000 criminals and terror suspects are using human rights laws to fight deportation from the UK.
The issue will be his key demand when he sits down to thrash out a looser EU deal.
If that is Cameron’s key demand, it may at least amuse his fellow heads of state when he starts banging his fists at the negotiating tablem given that European Court of Human Rights is an institution of the 47 member Council of Europe, and has nothing at all to do with the European Union.
You couldn’t make it up etc. etc.
In my main post on Cameron’s EU debacle earlier, I noted how the European Union Act 2011, pushed through by Cameron as a way of deflecting attention from his failure to live up to his “cast iron” guarantee on a referendum, is likely to come back to haunt him.
It occurs to me that one part of his speech illustrates this cock-up perfectly. Cameron asks:
And I would ask: when the competitiveness of the single market is so important, why is there an environment council, a transport council, an education council but not a single market council?
So Cameron apparently wants an addiitional institution within the EU to coordinate single market policy. I’m not sure why, but let’s take him at his word.
Now, the function of the transport council, which he refers to by way of comparison, is set out at Articles 90 to 96 of the Treaty on the Functioning of the European Union. Similarly, if a single market were to be established as a result Cameron’s negotiating brilliance, it would also require inclusion within a revised TFEU if it were to have legitimacy
But the European Union Act 2011 makes ot very clear that a change to TFEU which entails “the extension of the competence of the EU in relation to cooridnation of economic and employment policies” (sec 4 (f) will require a referendum for its ratification.
So if Cameron were successful in negotiating a new Single Market coordination function, AND if legislation were introduced for an in/out referendum, we’d be stuck, by law, with two referenda, potentially weeks apart.
Cameron will be giving his big European speech this Friday, then.
In anticipation, Kev Peel at Labourlist has set out the five questions he’ll have to answer. It’s quite good. Kev’s one of the relatively small bunch of Labour insiders who’s bothered to get to grips with the detail on Europe, and it shows.
However, in assessing Cameron’s likely answer to “Exactly which powers does he wish to repatriate?”, he’s missed the possible rabbit out of the hat. Mind you, so has everyone else. Media memories are so short…….
Go back to Spring 2012, and this was aTelegraph story:
The Government is drawing up plans for emergency immigration controls to curb an influx of Greeks and other European Union residents if the euro collapses, the Home Secretary discloses today.
As I set out at the time, the mainstream response to this – that it isn’t possible to do this under European law – was plain wrong. Article 45 of the Lisbon Treaty said then, and continues to say, that there can be exceptions: to freedom of movement:
1. Freedom of movement for workers shall be secured within the Union.
2. Such freedom of movement shall entail the abolition of any discrimination based on nationality between workers of the Member States as regards employment, remuneration and other conditions of work and employment.
3. It shall entail the right, subject to limitations justified on grounds of public policy, public security or public health:
(a) to accept offers of employment actually made;
(b) to move freely within the territory of Member States for this purpose;
(c) to stay in a Member State for the purpose of employment in accordance with the provisions governing the employment of nationals of that State laid down by law, regulation or administrative action;
(d) to remain in the territory of a Member State after having been employed in that State, subject to conditions which shall be embodied in regulations to be drawn up by the Commission.
Cameron’s team has had months now to think through the logistics on this one, and while I doubt there’ll be an announcement on its immediate of this get-out clause in the Treaty, I would n’t be at all surprised if Cameron makes an announcement about a big step forward towards its use, under the guise of repatriating powers.
Unless of course this blogpost is read by Labour policy types, and they get in ahead of the speech. Here’s hoping.
Economist commentator Daniel Knowles seems surprised:
This is bizarre – do Tories not understand that housing benefit is ALREADY determined by geographical location? http://www.telegraph.co.uk/news/politics/conservative/9782816/Tory-manifesto-blueprint-lower-benefits-for-Northerners-and-longer-school-days.html …
He’s referring to the Telegrpah’s coverage of new report to Osborne from the Tory righwing 2020 group Agenda for Transformation, in which:
One of the report’s most controversial suggestions is introducing different levels of welfare payments around the country. House prices, travel fares and some other living costs are significantly higher in London and the South East than elsewhere.
I’m not sure why Daniel’s so suprised, other than the obvious reason: he’s not been taking much notice. The proposals for variable welfare payment rates across the board date back at least to 2009, when Tory Essex County Council submitted a formal proposal under the Sustainable Communities Act 2007 for devolution of benefit eligibility- and rate-setting powers to local government level. They submission argued:
As this proposal seeks to tackle worklessness it will be essential that control over the eligibility criteria and payment rates for Job Seekers Allowance, Income Support and Employment Support Allowance be transferred to ECC. This would put us in a powerful position to tailor the most important work-related benefits to local market conditions and ECC skills and training programmes.
The 2020 group’s recommendations are simply an attempt to push through this long-desired localisation of all benefits. As Carl has predicted (though I think he might have been copying), 2013 will see the rise to real power of the far right within the Conservative party, as electoral defeat looms, and Gove and his allies set their agenda for opposition.
This shouldn’t be a surprise: it’s been coming for a while.
A week or two ago John Cruddas, Labour’s newest guru, edited One Nation week at Labourlist. I understand he commissioned everything himself (apart from my contribution, which I snuck in under cover of darkness), so I think it’s safe to assume that the article have at least a rough fit with emerging thinking in Labour HQ.
Most the articles were so-so, but I quite liked the two pieces on how workplace democracy needs to be established as the sensible way to run things. There was Sonia Sodah, Ed Miliband’s erstwhile adviser, on Building the institutions of economic democracy:
Giving employees representation on company boards is important but it will achieve little unless it is accompanied by a revitalisation in workplace democracy, through employee associations supported in their work by modern trade unions.
Then there was Sue Ferns of Union 21 on What kind of trade unions we need for the decade ahead
So our agenda must be about fairness at work, investing for good performance and contributing to economic efficiency. And to produce real change it has deliver against all three objectives, not cherry pick……..Times of crisis of necessity impact on trade union priorities, and it is right of course that we stand up for and defend the living standards and job security of our members. But we need both tactics and strategy to build a better future and, whilst understandable, there are dangers in focusing too closely on the tactical response to the day-to-day challenges that confront us.
All very promising. Come Thursday, though, normal service was resumed.
Ed Miliband’s response to Cameron’s statement failed to make any reference whatsoever to the potential for the people who actually create newspapers – the journalists – to be involved in maintaining press standards. It was left to old-fashioned leftie John McDonnell to build on the excellent work of the National Union Journalists as part of the Levenson Inquiry, and put Cameron (and later Clegg) on the spot:
I wonder whether we could achieve consensus on one of the recommendations in the report, where Leveson recommends the consideration by proprietors of the introduction of a conscience clause to protect journalists who refuse in any way to go against the code of practice. Will the Prime Minister join me in urging proprietors to meet the National Union of Journalists and whoever else to start working on introducing a conscience clause in contracts?
Cameron agreed immediately.
This is of course an important step forward, as it potentially opens the door to the NUJ’s re-recognition by News International, and I suspect the News International hierarchy will be quietly fuming at what they may see as Cameron’s cavalier acceptance of this particular Levenson recommendation.
So it’s hats off to John McDonnell for this victory for the union he has worked so hard to support, but a warning that there may still be quite a gap between One Nation theory and One Nation practice when it comes to the Labour leadership.