Labour’s top election priority must be re-nationalising the NHS in England and halting its accelerating slide into US-style privatisation.
Theresa May, Jeremy Hunt and NHS England chief executive Simon Stevens are dismantling the NHS before our eyes – and getting away with a covert insurance and private sector-linked break-up and takeover which even Margaret Thatcher didn’t dare put into practice.
Our shared public service, based on national funding and pooling of risk, is being fragmented into local health systems designed for corporate takeover and is being put out to commercial tender. In the latest example, Manchester put £6bn of our NHS and care services on the open market. They deliberately did this before the May elections to force the hand of the incoming metro mayor.
Public opinion overwhelmingly supports a public NHS. The public’s ultimate nightmare for the NHS is replacing it with a for-profit system based not on health need but on ability to pay, as existed before Labour founded the NHS in 1948.
The coalition government’s Health and Social Care Act in 2012 – one of the longest pieces of legislation ever enacted – is the enabler for a fully privatised health system. Its architect Andrew Lansley imposed a commercial NHS market based on open competition for service contracts. Large numbers of these newly privatised services have failed due to poor standards of care – including some avoidable deaths.
At the same time, systematic under-funding has placed every NHS region, and virtually every hospital “in deficit”. These deficits are in reality a political construct of the Treasury and department of health. Many consider this to be an intended market failure – creating as it does the perfect storm in which to introduce the hospital and service closure plans, the de-skilled, community based packages of care, the postcode lotteries for cataracts and joint replacements and the personal health budgets, ripe for top-ups, which make up Stevens’ sustainability and transformation plans (STPs).
Stevens has cleverly imposed through NHS regulations the massive re-organisation which constitutes the STPs. He did so without consulting local authorities or the public and, above all, without legislation. This is a national disgrace. Although many Labour councils have spoken out against the STPs – such as Liverpool and several London boroughs – most are rolling over and collaborating now that Hunt and Stevens have forced local NHS bodies to sign the STP contracts. This must stop now and our manifesto must reflect our total opposition to the Tory plans to fragment and sell off Labour’s finest achievement.
STPs don’t merely “save money”: they attack each of the NHS’ founding principles of universal, comprehensive care for all, free at the point of use. STPs are the implementation of the NHS England five year forward view and its “new models of care”. They will be implemented by accountable care organisations (ACOs) modelled directly on the American private health company system. Both the ACOs and their fixed budget packages of care are designed for insurance funding and ultimately, for privatisation.
Their explicit purpose is to “eliminate deficits” in the health economy of each of England’s 44 STP “footprint” areas, and to do so by cutting services, at the expense of meeting local health needs. STPs therefore invert the fundamental NHS principle of estimating a population’s needs and providing services accordingly.
Lack of funding and staff shortages are part of a deliberately manufactured crisis creating a pressure on NHS trusts and commissioners to cut services and concentrate them in fewer facilities. The government must be held accountable – not only for its cuts to the health budget but also for the policies set out in the five year forward view and the STPs. These are government policy goals – a government of which NHS England is a part; these policies are not simply “the NHS’ own plan”, as the government misleadingly claims.
NHS re-instatement bill
The UN has previously been informed that the government’s NHS privatisation policies violate the rights of UK citizens to the highest attainable standard of health. Departure from the EU Charter of Fundamental Rights will reinforce this further.
At the earliest opportunity, a Labour government must enact a NHS re-instatement Bill designed to fully re-nationalise the NHS, comparable to Margaret Greenwood’s current private members bill. This legislation should be a clear manifesto commitment.
The election manifesto
The shadow health team seem to have got the message about re-nationalisation: Jon Ashworth, shadow health secretary, told the recent Unison health conference that “privatisation of the NHS will come to an end. We will reinstate the secretary of state’s responsibility for an NHS publicly funded, publicly administered and publicly provided.”
Ashworth has said he will review STPs and ACOs. I believe halting them is fundamental to stopping NHS privatisation. The Labour election manifesto must commit to full reinstatement of a national health service funded, owned, planned, managed and provided by a public sector for which the secretary of state is responsible. This cannot happen effectively without a full revision of the five year forward view and an immediate freeze on the development of STPs and ACOs.
Labour must fight the general election and the local elections as the party of the re-nationalised, public NHS – universal, comprehensive, free at point of use, publicly provided and publicly accountable. The savings from abolishing the NHS market will make this an affordable promise.
Alex Scott-Samuel is chair of the Socialist Health Association.