By Bob Piper
One of the charges the Tories make against Labour is that we always leave the economy in a worse state than they left it. By that, I suspect what they are really saying is that the level of debt is always higher at the end of a spell of Labour government that at the start. And I suspect they are right, and that they can produce the figures to prove it.
But the level of debt is only one indicator about the health of a nation's economy. When John Major slunk out of Downing Street he might have been leaving a few bob in the coffers, but the country was in tatters. Hospitals, if you could actually get in to them, were in a shocking state. Cleaned, if that is really the right word to use by cowboy outfits paying peanut wages, people dying on trolleys in corridors waiting for a bed to become available, and overworked understaffed and underpaid nursing staff struggling to cope. Schools were even worse. Leaking roofs, windows that rattled in oversized classes where kids shared books, never mind computers. Kids in working class areas trying to get a decent education in slum school conditions.
Now I'm no great fan of PFI. It is a Tory devised scheme, wasteful, bureaucratic, and expensive. But it has built some spectacularly good hospitals, of which the new Queen Elizabeth hospital in Birmingham is a splendid example. Overpriced, massively, but bloody fine building it is. Until the BSF programme was stopped by the bungling Gove, schools too were reaping the benefit of having great new buildings in some of most deprived areas.
But the Tories are back, with all their tales of hardship and austerity. They will cut the NHS to ribbons, privatising it bit by bit. Hand commissioning over to GPs, who don't want it and don't have the resources to cope with it, so with no PCT to turn to, it will be those nice chaps and chapesses in suits from Serco, Capita and Bupa who will be knocking each other over in the rush to win the new business. And then... the provider arms, the hospitals and acute services will start to topple like dominoes.
So, any Labour leadership candidate who can make one single promise, can have my vote, and a damn site more from others too I suspect.
Any NHS organisation privatised by this Conservative-Liberal Democrat government MUST be brought back into public ownership - with no compensation. End of story. And the private companies hoping to make money out of a privatised NHS need to know that before the gold rush starts, so they do not have anything to bleat about later.
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How sad that posters like you don't feel able to contribute with out being barracked or belittled.
It does indeed kill free speech.
Well said and thanks those reasons were amongst the many that left me in a very saddened state during the election campaign and of course why I have little respect for the leadership candidates.
@Chris can only happen if the Labour was to go through a complete change in personel in the PLP. I am afraid it is dream world at the moment as ay in thtree or four years the PLP will simply concede the existing position to the Tories as they lack the ability to act against the private interest that satisifies their sense of celebrity entitlement.
Locally though the Partnership/Community platform is looking to being incredibly useful and Barking and Dagenham Council are now taking some very real steps towards this.
Have to go now, tough cuts are being announced daily and we have some awful decisons to make. But before I go away and start thinking along with my fellow councillors about where the axe must fall I would like to congradulate the Right Wing of the Labour Party.
Because without their little corruptions, their expenses, their attacks on civil liberties, their obessions with themselves and finally their very neo-liberal agenda and Tory personnel (sorry if you find this offensive guys but then I find Tories and their policies offensive no matter what party they claim to serve because of the people who have to suffer, the people too many contributors on here are too quick to forget in their politically illiterate affection of the political unelite).
The Tories would not be able to dress up their ruthlessness under the "big society" if the Right of Labour had not taken our party down that right wing arrogant road.
Because we would have been doing the job of the Labour Party, the job to protect the working people of this country and the people who are vulnerable and needed our help.
We should have made the case for Labour, not be led by elitists who did not understand it and who saw it as something to be embarresed about or ashamed of in the face of the snobs who have continually harmed this country.
These lessons stem from history and the past.
There was once a young man in Germany who made a mistake. He threw away a potential career in architecture as he believed himself to be an artist. During the depression there was no State to protect him and like so many of his people he suffered terribly. Selling his pictures to whomsoever he could to keep himself fed. The desperation of being hungry and in need feeding his anger and making him terribly ruthless, again along with so many at the time, many of whom were starving due to the incredible cost of goods.
When the first World War came he was grateful because he had a job at last and he even gained a medal for bravery.
He would one day become a terrible political leader. Despration is a terrible thing and it creates politicians far angrier than I am and far more ruthless and able. Because they are driven and will not stop until they reach their objective or die trying.
Hitler would later choose death over exile so as to not enjoy a life of desperation and need again and so remained in his bunker.
The Welfare State has been the mask for political economic failure by both the Tories and Labour. In their snobbery and ignorance they believe that by changing the Welfare State they can change the economy....lol.
What they needed to do but cannot (because the truth is they do not know how) they should address the economy and then address the Welfare State or both at the same time. Sadly they miss this and most of the leadership candidates are still subscribing towards a de-regulated position despite (which I term as a lack of leadership) the fact it has damaged our country so badly which should highlight very clearly where their priorities truly lie.
In the military we use deprivation (very similar to homlessness and and hunger) to create very, very potent people who are most certainly elite in what they do. I think I would be more afraid of one of these elites than the shambolic lazy media luvvies we endure today lol!
Now we have to fight for our communities and as a result of the PLP move to the Right have to compete with the Tories/Libs for it!
Suits me though the People in Barking and Dagenham are lovely!
But your reference to the "politically illiterate defending the political unelite" etc seems mystifying.
Could you give specific examples of what you mean?
Surely there is room for diversity of opinion and approach?
Many of us share the "offence" you refer to, as expressed many times on LL.
I admire all you are doing in Barking Ralph, and despite some of our differences in the past, I wish you luck.
I welcome far more diversity of opinion than you do Hazico as you have disrupted a debate in the past by giving moral lectures on how we should be debating whilst we were debating. We were not even talking to you or referring to you. Manners are good and important but they are not and should not become a hindrance to dealing with people. When you are dealing with people in life, whether on the doorstep or not you sometimes have to accept they do not come from a cultured or privalaged background but the way in which they express themselves can be as equally vaild and important.
I rememeber the days when we had more than just four comments on each article.
No. If you have not recognised the media attention given to people like Mandelson and Hoon and Hewitt by the media and to unelected prima donnas whose role is to be dictated to us then you seriously need get out more who are promoted on LL as with anywhere else. Though I sense an implicite allegation that I am refering to specific people on this blogg site, sorry Hazico...too busy to worry about bloggers.
But in your case Hazico, I actually thing you are a wonderful person, but I am afraid my sense of mischief prevails upon me to test you and yes, push you on occasion. But the net result was worth it. You really have come far since you first came on LL.
You are are always saying I am an asset to Labour. I think you need to look to yourself.
Because you are definitely a positve force in the world and I have frequently told Alex what I think about your comments when you write, sometimes you come out with some wonderful material.
Areas where we should be careful in the use of foul language and harresment as defined by a continual (more than twice if I remember the legal position) on the person. Having been in the military I enjoy a bit of banter which is never personal or designed to hurt people.
However if I see a Tory as defined by a (tax cutting people harming monster) then I will go for them in the interests of protecting and preserving the wonderful and creative and more importantly of all posive Labour Party.
But I won't use foul language and I will substantiate my position when I do so.
I born and bred to take on Tories Hazico, I have done for the last 27 years of my 35 year life. Even now with dodgy health it is in my blood. But I do not do it for it's own sake i do it for a very good reason. When Chris Cook talks about 10% owning 90% of the land whilst young people struggle to find work I use my compassion for them to ignite my imagination and to prepare to do what Labour activists/councillors (I really, really like the councillos on Barking and Dagenham Council and am having a good laugh with them as I develop a deep affection for them all) and some MP's do prepare to fight via democratic means to ensure the people are represented.
My advice hazico is to be strong your beliefs do you credit and nobody can ever take them away from you. It is wonderful to see you applying values and reason together. Very few MP's can actually do this as they try and overplay the intellectual aspect at the cost the wisdom. The public detect it straight away.
You do not need to encourage others. You do so with what you write and the sense that you speak. No more potent encouragement and inspiration do I need.
In fact I am waiting to hear about what you are doing in your local CLP and I hope you will consider putting yourself forwards as a candidate at some stage because the Labour Party need positive people who are intelligent and who have a good sense of right and wrong (please do not get involved in freedom of speech though lol keep to your strengths lol!).
Your initial "accusation" about disrupting a debate was, as I recall, me questioning someone's use of the word "cancerous" to describe the Labour party, in graphic terms.I was questioning that.
You then followed on from that discussion to write long tirades about me and make all kinds of assumptions which were unfounded and unfair.
I don't think I have ever gone out of my way to insult you Ralph. Challenge views sometimes, but not personally directed.
So if you are prepared to make a simple apology, and refrain from these tirades and lengthy advice; maybe we can both stick to the points of debate and nothing else.
I will say again Ralph- please please do not make assumptions about me and post all over LL.
We may disagree on interpretation over politics; but it's still possible to be respectful and not put each other down.
I have nothing but respect for what you are doing in Barking; but in turn I'd like respect for my life experience and where I am coming from.I have seen and done a great deal in my working life.
I think politics is fundamentally about people; and we can all share insights and experiences that add to the debate.
We are not trained politicans or journalists; but even they do not have all the answers.
I don't believe there is only one way of looking at things.
And as a general comment about all of us, I also don't think a tone of respect on LL is a huge amount to ask.
But thankyou for the positives; and I hope you continue to be a valuable contributor to LL Ralph.
lol
Sorry Hazico I really do not have time for this. There are far more important things to think about.
If you read my contribution a second time you will see it mostly reconciliatory.
I am sorry as well I am not seeking the last word and please feel free to respond if you feel to so that you may have that privalage ;)
Have a lovely evening Hazico I think you can see clearly now why it is best if we do not engage in any form of dicsussion whatsoever ;)
lol.
@Ludwig
Its a personal opinion he does not have to "justify it" only factual information which we reference when building an argument requires justification if not validated sufficiantly in a discussion.
If you do not have the good grace to make a simple apology and move on, then it is indeed a waste of time.
If you honestly think I have the time and energy to endlessly try to pacify and rise above all the sarcasm and innacuracies directed at me and others like Ludwig and Mike in the recent past, then you are wrong on that too.
There are indeed far more important issues to be focusing on- and you do not have a monopoly on that.
I'm sorry it's come to this; but quite frankly I would like to offer some support too LL and try to focus on thie issue without being belittled if I don't agree with some sort of consensus.
I've noticed recently a few may have "clubbed" together as a kind of faction, and I find that in itself stifles a wider debate.
This is a democratic forum, and all views have equal validity and each poster deserves respect for opinions.
I have in the past otherwise had some really productive discussions with you Ralph; so I don't understand why you seem so much more hostile these days to the likes of me Ludwig, Mike and a few others.
Fair enough, there are differences of opinion, but that does not justify belittling and patronising people.
I would like this to be able to move on Ralph, at the very least on behalf of other posters and readers.
I genuinely wish you no bad feeling Ralph, but equally I do not accept being misrepresented or spoken down to.
I also find it amusing that they must oppose for the sake of opposing and think that by repeating the same old dross people will somehow believe it. I strongly recommend you read Cruddas's piece below.
The endless tirade of backslapping for those who share the same approach and be respectful as a retort to uncomfortable reading is tiresome in the extreme. Jo you absolutely in my humble view seem to try to drown out debate that is not pro plp and that is contributing to the lack of comments on this site. Ludwig simillar. It has to be said you are just not helping. The old adage applies when you have lost the argument talk about it. LL must be far far more critical.
http://news.sky.com/skynews/Home/Politics/Labour-Leadership-Contest-Jon-Cruddas-Says-Candidates-Running-Away-From-Brown-Legacy/Article/201007315666918?lpos=Politics_News_Your_Way_Region_4&lid=NewsYourWay_ARTICLE_15666918_Labour_Leadership_Contest%3A_Jon_Cruddas_Says_Candidates_Running_Away_From_Brown_Legacy
This is not a club.
What incredible assumptions from a complete stranger.
That's a huge statement. Would you care to justify it?
I think that's a distinction without a difference. Jo's quotation might have been more of a precis, but the message is the same.
I'm glad Ralph is back commenting in his vigorous and inspiring way. But since nobody agrees with everything I say, I don't think any of us should expect the same in reverse.
I have no 'affection' for political unelites. But sometimes I think their policies are more sound, or more viable, than some of the more radical solutions others propose. That's all. That doesn't mean I have 'affection' for anyone. In fact, it's just a hard headed political calculation, given the vagaries of the electorate and (Ralph is right about this) the corrupting and distancing effects of Parliamentary power.
I'm not complacent about this - just realistic about changing it overnight.
In terms of radical vs viability, I think that we need leaders both with long term vision AND short term pragmatism. I wonder if the first few years of New Labour were strong on vision but short on pragmatism; which is why so many great ideas got bogged down in red tape and waste.
What I'm not getting from *any* of the current leadership contenders, DA included, is the feeling that they have much in the way of long term vision for where they want to lead the *Labour Party* over the next decade.
But on the pragmatics: I really feel the electorate is in great flux. No-one really won the last election, and given the huge potential social and economic changes ushered in by the credit crunch and prolonged recession, nobody has quite formulated a response. The Tory/Liberal assumption of 'minimal state/big society' only tackles one half of a bankrupt equation. Just as the state has been discredited as a command and control monolith, finance capitalism has shown itself even more remote from our needs and even less sustainable.
My feeling is that we're midway through some historic shift, and in this sense, I'm not sure I want any of the leaders to come to a too early conclusion. My main ideal is a more equal society - and more equal societies are provably better educated, healthier and happier.
How to achieve that politically is the hard part.
http://www.thestirrer.co.uk/phpBB3/viewtopic.php?f=1&t=8891&start=100
I am ianrobo and Fergus is a local tory councillor who claims France based roughly on what they want is the ideal model which is not state based.
I would be interested on others thoughts on how our system and the French does compare as they use it seems a form of private insurance.
However, at the weekend I ordered a big pile of books about health policy including this one which should turn up tomorrow. :-)
Reading your conversation I note that Fergus is well versed in Hilton's strategy. It is nonsense to say that you must look at outcomes rather than outputs. Outcomes are very difficult to measure and by their nature are measured well after the fact. At that point it is too late for a large number of patients. That is why you have to have outputs: they are things that you can measure at the time of treatment and (as long as you are measuring the right thing) you know at that point whether improvements need to be made. Andrew Lansley knows this and he too is taking a tick box approach.
Please sit down before reading the rest.
At the moment we have 8 or 10 targets that are used for performance testing of hospitals. There are about 50 targets in total, but just 10 or so that are used to determine the quality of the treatment at a hospital.
Lansley will introduce 150 "quality standards" all of which will be used for performance testing (hospitals are supposed to publish their results online and patients - the poor buggers - are supposed to try and make out what they mean and then exert their "patients' choice"). Each "quality standard" will have 5-10 "quality statements", which appear to be tick-box items and determine if the "quality standard" for your treatment has been achieved.
The white paper says NOTHING about how outcomes will be measured or what penalties there will be. The tories have a policy document from 6 months ago and you can find my fisking of this on my site. (In effect, the doctor who treats you will determine the outcome, and the outcome will determine how much the doctor is paid for the treatment. Hmmm.)
Outcomes are a useful measure, but they are too long term to be the only measure. But now we have 150 targets :-)
I would have thought there must be some way eg
Patient Opiniopn
of involving patients in assessing the outcomes as well?
ignored it, the French system is good from all reports but they are ignoring it is a two pronged approach of loads of cash and a different system
and a non profit centre at the heart of it.
so they intend to just take one bit and pretend it should be the model, just like in education
health insurance as per Clegg will be planned soon, you watch it
Since the US government also on average put more money in as a % of their GDP than us, I'm not sure that's compelling. In any case, I don't know anyone who would argue that the French system is private: it's mixed, as I understand a fair few reckon all systems are eventually going to have to be if we want to benefit from some of the best but most expensive treatments for things like cancer.
Incidentally, we have "non profit" health insurance companies in the UK too (I worked at one briefly). They are still decidedly private sector. And its worth noting that France also has pure private insurers, as well as the mutuals.
I'll dig up the figures if you want, but the French put in a couple of percentage points more than us of through taxation and government funding.
The US spend much more than either country as a percentage of GDP and with much worse outcomes. The bulk of this cost has been (apart from Medicare and Medicaid) through private insurance premiums. These, like all health care costs, are rising dramatically (new medicines, treatments and almost infinite demand). But America is more expensive and less effective for an obvious reason.
The key difference between the two socialised systems (i.e. UK and France) compared to the US's model of private healthcare (virtually an exception in the civilised world) is the administrative costs.
Last time I looked the NHS overhead for administration was 8 percent. In the US it was 16 per cent.
This is partly due to the complexities of US insurance - all the pre certifications and procedures designed to prevent claims. None of that happens in France. It is also due to duplication and the strange exemption health insurance companies have had from trust busting legislation.
But above all that extra 8 percent of US healthcare costs represents the premium drawn off in private profits and dividends to shareholders.
The reality is - as Richard Blogger and my own contacts will confirm - American HMOs are hovering around the NHS expecting the White Paper to lead to privatisation of the GP fundholders. This means that Lansley and his lobbyists are expecting to emulating the American system, leading to profit taking, higher administrative costs, and a depletion of the service.
In other words, we're heading towards as US system just at a time the US - the only major country in the civilised world to run health that way - is moving away from it.
We should all, as Richard Blogger says, be more angry about this than the Poll Tax
Interesting, but not entirely relevant to what I was getting at. Yes, I know the French government spends more on healthcare than ours (my point was that so do the Americans, so it's not really a useful measure); we're probably all going to need to. The French also, though, have significant more private money coming in, both from insurers and out-of-pocket expenses from patients and it doesn't seem to do their system any harm.
As to the administration expenses, that again is interesting (although are you sure of the numbers: this suggests US admin costs are 7% http://wapedia.mobi/en/Health_care_in_the_United_States, and the figures for the public expenditure part are apparently 5%).
Richard clearly is better informed on the UK health system than I'd even want to be, but he's also not exactly nonpartisan and I'd argue that it's massively unlikely we will have anything like a US-style healthcare system in the UK at the end of five years.
However, I don't really fell well placed to debate the merits of the Conservative proposals, which is why I didn't address them. Rather I meant to simply hint that the choice in running healthcare is not simply between the US and UK models; there're plenty of stops in between.
However, "They will cut the NHS to ribbons, privatising it bit by bit." is out by several orders of magnitudes. Have a look at my series of blog posts on the White Paper (I have one more blog to write on this series and a concluding article which will give the despicable truth about this nasty pla).
First, there will be be no bailouts of GP practices nor hospitals - if they go into debt they will have to take out commercial loans (and make cuts to eventually pay off the loan - impossible as I'll explain next) or be taken over by the private sector.
Second, hospital payments will be at the rate of the most efficient hospital in England. This means that only a handful of hospitals will balance their budgets, so most will go into deficit with no chance of getting out of debt (this will have the same result as the terrible "competitive tendering" policy in the NHS on catering and cleaning introduced in the 80s).
Third, all hospitals have to become Foundation Trusts but without the current quality control that we have now (so it will be FT in name only), and all FTs will have to become "employee led social enterprises" that is, management buyouts. The white paper says that they will change FT governance (most likely to get rid of public involvement) and they say nothing about public accountability or governance of "social enterprises" because these are private companies.
If some hospitals refuse to become a "social enterprise" then the regulator, Monitor, will have the right to allow private companies to go into NHS hospitals and take over services. Monitor will also have the ability to force NHS hospitals to allow private health companies to have access to their facilities (so BUPA will be allowed to scan their patients in your NHS hospital's MRI scanner, there are no safeguards that NHS patients will come first).
Finally all NHS hospitals will be subject to UK and EU competition law. So if you have an excellent NHS hospital and hence no one in the area buys private healthcare, the OFT can tell your hospital to close a service (ie, make itself crap) to open up the market for the "competition". Further, the EU competition commissioner can do the same thing to open up the "market" to EU providers.
Andy Burnham said these plans made him weep. They make me very angry. More angry than I ever was about the Poll Tax.
Your points are excellent and are a pretty devastating critique.
So if you have an excellent NHS hospital and hence no one in the area buys private healthcare, the OFT can tell your hospital to close a service (ie, make itself crap) to open up the market for the "competition".
I don't believe that even the most insanely pro-competition regulator would in fact be able to get away with this surreal approach. But what your suggestion does do is illustrate the Achilles Heel of the whole Con Dem proposal, and the opportunity which it represents to NHS staff, to their unions, and to local communities.
A 'Community Health Partnership' - which I believe may perhaps be an optimal 'social enterprise' framework agreement for health provision - would have the following stakeholder members:
Custodian - Existing foundation trusts would become pure 'custodian' asset-holding entities, probably community interest companies.
Health Service Provider - all staff would become members of staff co-operatives, using whatever structures, and would be members of consortia working with not for GPs.
Health Service User - members of the community would form a Health Service User group or 'club', as an unincorporated association.
Investor - investors in an agreed affordable rental paid for the use of the assets held by the custodian. Somewhere between 1.5 and 2.5% index-linked rate of return would be quite feasible. (eg Wessex Water's 1.49% index-linked long term return)
Since there is no debt - this being essentially a dividend from partnership equity - the financing costs would be slashed, maybe by as much as 80% compared to PFI. Indeed, perhaps the greatest saving to be made in the NHS right now would come from refinancing existing NHS debt with a new form of non-toxic Health Equity.
I digress.
The outcome of a Community Health Partnership is a co-operative of co-operatives. Payments for health services made by or on behalf of the community would be shared between the Health Service Provider consortium and the Investors - many of whom can in fact be expected to be staff (pension investment) and community (better return than in most building societies).
In this structure any participant who is paying returns to 'unproductive' shareholders will be at a competitive disadvantage, and moreover, one which no regulator would be in a position to do anything about, because private operators would be competing on a level playing field in every other respect. It's just that shareholders are a handicap.
Any savings made by the Health Service Provider would be shared in agreed proportions with the Health Service User, either as better service, or in lower charges. If new investment is needed then the resulting benefits are again shared proportionally. The foundation trust entity would have representation from all stakeholder groups, and the users would participate and provide feedback also through the custodian, while all financial information would be transparently available to stakeholders via the custodian, as well.
I hope you are also drafting a resolution to Labour Party Annual Conference 2010 as well, let's aim for a 2/3rds majority on a card vote.
but some things should be protected and stood up for, our principles have to be simply adhered to with a thick line drawn in the sand, this far and no further.
The reason why Burnham will not make this pledge is because he was planning similar things: Practice Based Commissioning, mutualisation of hospitals and handing control of services over to charities, a right to get private healthcare on the NHS (seriously) and patients' budgets.
All nasty policies. When I read that section in the Labour manifesto I immediately thought that it was watered down (but substantially the same) policy as the Tories. Yeah, I wept that day.
But let's see if the other candidates stick to the principles of the NHS.
Is anyone attending the next husting? Please can you challenge the candidates to make this pledge?
In fact Richard when I look at who drafted the manifesto I am shocked to read it again in the cold light of defeat, it is a question we should all ask ourselves.
- "Foundation Trusts will be alloweed to increase their private services". No, they should be NHS only
- "We will support an active role for the independent sector
working alongside the NHS in the provision of care" No all studies have shown that ISTCs were a failure: both too costly and they did not complete their contracts
- "Patients requiring elective care will have the right, in law, to choose from any provider" no this is NHS money going to private care, this was a Tory policy at the 2005 election
These three are taken from the Labour manifesto, but also appear in the Tory draft manifesto published 4 months before. has Ed M been cribbing from the Tories (or was it Andy B)?