deny it as often as you like

Having denied that the Health and Social Care Act 2012 created a risk of privatisation of the NHS; having denied that the contracting of private providers to replace public provision is privatisation; the latest argument of the privatisation supporters runs something like this:

“Over 4% of the NHS was delivered by private business when Labour left government in 2010. Only  a bit more than 6% is being delivered now. The risk of privatisation was exaggerated.”

In response to the instigators and lazy propagators of this disingenuousness, a few points:

Make your minds up. Is that extra 50% privatisation, or not?

You do Andrew Lansley a great disservice. He was absolutely clear when addressing the NHS Confederation five years before taking up office that in his view previous Conservative privatisations had partly or wholly failed, and that he would have to build a new regulatory structure to create competition between multiple providers and to transfer private provision to multiple private providers. He even had the temerity to tell you this in plain English

I believe that the Conservative Party became confused itself about what the experience of privatisation told us. We interpreted the lessons of privatisation as, literally, that: the transfer of public sector activity into the private sector. With private sector ownership would come enterprise, innovation and, temptingly, private capital off the Treasury’s balance sheet.

Andrew Lansley – “The Future of Public Health and Regulation”, 2005

Not only did Lansley never doubt that

the transfer of public sector activity into the private sector

is privatisation – something,  repeat,  you persist in denying – but he wanted to give you a better privatisation, one not just with added ‘competition’; but competition of a new and magical sort where instead of failing, competing private providers would never fail, but would all drive quality up. He even made up a new saying to prove it, and referred to evidence (though didn’t provide any).

How can competition work, whether on prices or quality, if it does not lead to variation and divergent outcomes? Some will gain. But do others lose? No, the evidence is that in effective competition the response of other producers of good and services is to raise their game, so that even those who are less fortunate or successful purchasers will gain by this. As the saying goes, “competition is a tide which lifts every boat”.

The sheer volume of the Bill would only have shocked you if you hadn’t thought about it as deeply as Lansley: if you had been convinced that all you needed to do was what you had always done: get Goldman Sachs or whoever to create a share issue for the NHS and sell of the lot at one go.

Except, of course, Lansley actually cares for the NHS, perhaps almost almost as strongly as his vision of private competition. He is not like rest of you , who just think it another 60 year mistake, another bit of public property to grab and scarper offshore with, another pile of excuses to help people avoid work. He may not think, as so many of you do that old age is a mistake, and that people with no economic usefulness should be discarded, like old mobile phones.

No, Lansley actually believes in what he did.

That is why the Act was so intimidating even in its first published forms. It simply had to contain all the reorganisation to create his new regulator (Monitor) and all the  foundations of the regulation to create in the real world his vision of competition.

More firmly than you, Lansley had a grasp of what he had to create to push the NHS not into a new state, but in a single and irreversible direction: towards his utopia of proliferating providers,  omniscient customers,  and private capital. In brief:

  1. To  force the NHS to be moved piece by piece from public to private ownership and provision, but never to move in the other direction.
  2. To create, regulate and maintain in perpetuity his vision of competition.
  3. To fortify his machine against attack or disassembly.

Lansley, however, is not so much risk-averse as averse to the very thought of risks (whether to his plan, or caused by his plan), which he sees as mere distractions. Inevitably, he underestimated or ignored some possibilities which became reality: beginning with the risk that not everyone, not even his fellow Conservatives and fellow travellers, would be captured by the brilliance and perfection of his solution.

Political expedience would delay the bill, implementation would eat up two more years of the Coalition, and the practical problems of the privatisations would take up even more time.

  1. The Coalition government could never admit what he was actually doing.
  2. Senior members of the Coalition wouldn’t, or couldn’t understand his Bill, or even bring themselves to read it.
  3. The number of Liberal Democrats in Coalition who would jump at the chance to grandstand and to posture.
  4. The sheer length of time it would take to get the bill through Parliament, with Labour opposition and (3) and Cameron and Clegg’s panic and the delay of the “listening exercise”.
  5. The length of time it would take for the reorganisation to be completed after royal assent, even though begun in advance.
  6. Persistent opposition from NHS campaigners, who at least managed to delay individual tenders.
  7. The length of time, the resource requirements, and the effort necessary to complete a commercial tendering process from start to finish, particularly for high-value tenders.
  8. The cuts in funding for the NHS, which would make tenders less profitable.
  9. The poor performance of existing  – or new – private providers, including the fiddling of performance data.
  10. The collapse in morale within General Practice, where funding cuts, unsubstantiated criticisms from the CQC, and constant attacks from government were completely contrary to Lansley’s vision of crusading commissioners.
  11. NHS staff would be busy trying to provide the services it actually provides, with Lansley’s rebuilding going on around them and the CQC waiting to punish.
  12. Lansley’s massive regulatory machine was built with square wheels, with no-one knowing who was in charge and fights for the steering wheel between Monitor, NHS England, the SoS and the CQC.
  13. As Clive Peedell of the National Health Action Party and many others pointed out, the private providers would only ever want the cherries off the top of the cake; the profitable bits.
  14. Monitor and the regulatory regime would never be strong enough to overcome the private bidders, who would want to protect themselves from competition by demanding ever-longer contracts which they designed.
  15. Commissioners, without support units in the first years, would not have the expertise or resources to commission at a high pace.
  16. By the time the reorganisation was complete and the commissioners ready, the next election would be approaching and the Coalition uncertain of victory;  frightening the private providers.

Yet the Health and Social Care Act 2012 and the enabling legislation are on the books, Monitor exists, and the CCGs are commissioning by competitive tender: the NHS is privatising itself, as Lansley envisaged.

To argue that this was never privatisation, or that the amount of privatisation completed via the Health and Social Care Act 2012 is so low as to prove it was never about privatisation, is drivel. The Act was intended to privatise as much of the NHS as possible; to salami slice it into pieces which could never be reassembled.

Either you truly don’t understand what Lansley has achieved and you think he failed (Letwin promised you the NHS would be gone within one Conservative government; the NHS was to be shown “no mercy”, remember?) or you know full well what the Act does and that privatisation must follow and you’re being economical with the truth (or fooling yourself).

Whichever, do us all a favour, and stop insulting us with this nonsense.

 

 

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The NHS (Procurement, Patient Choice and Competition) Regulations 2013. An Idiot’s view.

Statutory Instrument 2013 No. 257 was “Made” on 11th February, 2013; “Laid before Parliament” 13th February, 2013; and is “Coming into force” on April 1st, 2013.

I do not intend a legal analysis, because there’s an excellent one here; neither do I intend a comprehensive translation into plain English. because that’s available here.  I would just like to take a seat on the Clapham Omnibus and make a few observations, and in no particular order.

I don’t read very newspaper or listen to every news broadcast. That notwithstanding, my sense is that without that original blog on the SHA website, written by Dr Shibley Rahman and promoted through the social media by NHS supporters, these Statutory Instruments would have come into force without mention in the mainstream media; which would have remained –  as George Monbiot described the BBC on another matter – “disgracefully incurious”.

The UK system of government – the arcane, unwritten rituals and processes of our Parliament – is a set of Mithraic mysteries (or Masonic) kept so, and quite impenetrable, to Her Majesty’s subjects. It constantly surprises and appals. One day we learn that Lords and Ladies may speak in debates where they have a vested financial interest.  On this occasion we learn that highly significant changes to the lives and wellbeing of everyone in England can “come into force” without debate in either House, let alone a vote. Unless someone says a prayer.

Dr Sarah Wollaston MP tweeted today that she was shocked by the negativity faced by MPs, and how wearing it is . Surely here is an egregious example of why our democratic process is in such a deficit;  MPs almost cannot remain principled when such huge changes are slid into place without public consent (the more cynical amongst us might suggest, deliberately so).

Because as Nicola Cutcher and Lucy Reynolds point out in their blog for Open Democracy, these Regulations implement exactly what former Health Secretary Andrew Lansley said in 2005 that he would do in government. What we have had between that date and now, most especially since the Coalition Agreement and now, and most particularly during the passage of the Health and Social Care Act 2012 (which enables these regulations, and not the other way around) was near silence on this matter; a silence only broken by denials and obfuscation.

The genesis of these Regulations as much as their contents screams at us that our political system is unfit and undemocratic; and that too many of its denizens are (and have been) as dishonest to the public as they are craven to their real masters: the lobbyists, private corporations, the so-called Big 4 accountants, and the mendacious mesh of rightwing thinktanks.

Barely more than a week before  these regulations were laid before Parliament (and don’t fail to consider that untimely haste), the National Health Service had been presented with the third of three man-made (or politician-made) challenges. To the challenge of a reorganisation so large it could be “visible from space”; and the “Nicholson Challenge” to cut an unprecedented £20B in five years; was added the Francis Report: the only one of these three of actual, real relevance to patients and the public, and the only one to base improvement on evidence not ideology or whim.

The Francis report laid bare how the reorganisations and management targets, the bullying and distractions and failures in patient care actually impacted patients and their families. Francis set out nearly 300 proposed improvements, the implementation of  any number of which might conflict  with either the Nicholson Challenge or the Health and Social Care Act. Utterly unbelievably to anyone who has been involved in service or project delivery, that Act was written and put into legislation while the Francis report – commissioned by the very same Health Secretary – was being compiled. It was almost as if Lansley had raced to get the Act into law before Sir Robert could recommend anything. Just in case.

So now, on top of the £20B of so-called “efficiency savings”, on top of the cost and effort, and issues of implementing the Health and Social Care Act, on top of the to date unbudgeted costs and effort of implementing Francis; the Department of Health sees fit to bring into effect major changes through Statutory Instrument.

And how are these changes to be implemented anyway? What well-run business would throw out a major reorganisation (on top of three other major reorganisations) without an implementation plan, a risk register, programme managers to manage the whole thing, and – not least, a budget to pay for it? The whole thing is insanely incompetent.

Let’s not forget that the impact of all this will be – as Francis recorded in his report – suffering, anguish, and unnecessarily and untimely deaths. While the real problems facing care of the sick and elderly in England accumulate, the management of the NHS will be reading through these regulations and buying advice on EU competition law.

As it has for so many years, the actual effort of caring and treating the citizens of England will crash with increasing pressure upon the staff of the NHS. And yes, England. Because England has been singled out by English MPs for this awful experiment and experience.

Coming into force on April 1st. April Fools’ Day. How our political system makes sorry fools of us all (at least, in England).

Camerons Big Society explained

“What’s good for M&M enterprises is good for the country”.

In Catch-22, Milo Minderbinder uses this mantra to justify every action he takes to increase his profits, including shredding the bomber crews’ parachutes to serve up as inedible food (replacing their real food, which he has sold off) and directing US crews to bomb their own airfield. The senior officers are complicit in all his undertakings as they are shareholders.

Heller’s entrepreneur paraphrases that much-used part of the neoliberal creed; the “invisible hand” argument of Adam Smith:

“By pursuing his own interest he frequently promotes that of the society more effectually than when he really intends to promote it.”

In an unintentional homage to “The Life of Brian”, neoliberals re-interpret the text as follows, by replacing:

  • “his own interest” with “his own selfish accumulation of wealth”
  • “he” with “the entrepreneur, banker, hedge fund manager, tax-evader, … “
  • “frequently” with “inevitably”
  • “that of the society” with “your economic well-being”
  • “when he really intends to promote it.” with “any Government can.”

Thus in the heaven (or haven) that is an unregulated, ungoverned, untaxed “free market”, individual acts of self-interest produce a common wealth which is unachievable in the presence of any regulation, taxation, or government.

This “free market” world where not just the best, but the only way to help your fellow human beings is to act only in your own self-interest is what Margaret Thatcher idealised when she declared that there was no such thing as society. To the neoliberal, society is a false construct, a failure.

What Heller demonstrates satirically, but what most of humanity experiences painfully, is that obedience to this text justifies any act, whether it is refusing to pay taxes, selling arms, exceeding the speed limit, expelling toxic substances from your factory, or selling your daughter into prostitution.

Or, indeed, selling your neighbour’s daughter into prostitution. It is unsurprising that in the neoliberal state people are enormously frightened of crime and violence. Government has been reduced to the role of policing the victims of insecure, low-paid employment and unemployment and preventing them from disrupting the upward flow of capital: it has no presence in the domain of securing citizens.

While western politicians envy the absence of workers’ rights in China and the vast profits to be made with such lowered costs, journalist Ed Vulliamy describes the even more perfect  (neoliberal) capitalism of the Mexican drug cartels.

It does not matter, according to the faith of the invisible hand, how we treat any other human: except that we must not have a care to their well-being, and we must avoid collaboration. In the absurd manichaeistic quasi-religion of neoliberalism (“Those who are not with us are against us”) The Muppets truly are Communists, by the argument that 1/ Anyone who is not neoliberal is a Communist 2/ The occupants of Sesame Street help each other to do simple arithmetic and even show interest for each other, therefore 3/ The Muppets are Communist.

The neoliberal trope of “individual responsibility” is in reality its opposite: we are called upon to be irresponsible; to avoid feelings for others and acting to help others. The greatest enemy of neoliberalism is perhaps empathy: it is unsurprising that neoliberal states use an omnipresent barrage of stories and “news” intended to make us see all other humans as being guilty for our own discontents and dissatisfactions. In the neoliberal state, everyone is our enemy.

Cameron’s “Big Society” is thus revealed as nothing more than a new brand name for the “natural order” of “free markets”.  Neoliberal thought is inhumane.

The closed loop of neoliberal political lobbying

The Telegraph today published a proposal from a “leaked” government document, that businesses should not have to use due process to fire an employee. The protection given to employees of making it possible to challenge dismissal as unfair is a regulation – the term usually deployed is “red tape” – which is creating unemployment, because it makes entrepreneurs insecure about taking on employees.

The BBC (the corporation paid for by Uk license payers which has just acceded to implement budget cuts) saw this story as important enough to be published on its News website.

The proposal itself is unsurprising and unoriginal: it derives from the neoliberal logic that all regulation of business interferes with the “natural order” of the markets and is evil and must be stopped. The logic of the proposal itself is unsurprising: the removal of employee security is duplicitously presented as a means to reduce unemployment (a benefit to the unemployed, not the prospective employer). The laying of blame on the shiftless worker for all the trouble is typical of neoliberal attacks on any group they can create as an “other”, prompting the anger of the righteous non-offender..

What the history of this particular proposal demonstrates are the deficit in democratic accountability in the UK, and the difficulty of controlling lobbying in a neoliberal state.

It is easy to imagine the nasty lobbyist squirming and squeezing his way into he position of influence from which he can corrupt a politician from the path of goodness, and this is how it is often portrayed. However, in this case as so often in the neoliberal project, there is no lobbying to be done.

Recently, Chancellor George Osborne announced the Coalition would reduce the number of unfair dismissal claims. The British Prime Minister, David Cameron, asked for a report on employment laws from a Conservative party donor and “venture capitalist” (think hedge funds) called Adrian Beecroft.  The report, which has not been made public, was then “leaked” to a newspaper which has historically supported the Conservatives, which chose to highlight this proposal.

The Prime Minister has effectively been lobbying himself. By asking for the report to be prepared privately by a party donor and “venture capitalist”, David Cameron could be assured that the report would suggest only those actions which his Coalition government was minded to take. He was also assured that no contrary views would be included, and that no criticism of the reports contents could be made until it was leaked. Experienced civil servants and professional academics (and the public) were excluded from the making of the report (and still officially excluded from its findings). It is about as different from evidence-based policy making as it could be.

This process has been repeated continuously since the creation and proliferation of “free-market”, “liberal”, and “right-wing” think tanks from the 1970s onwards. Neoliberal politicians continuously lobby themselves on behalf of the super-rich 1% and large corporations by sitting on “think tanks” and in office. Only neoliberal ideas will be produced by these “think tanks” and taken up by these politicians, because they ensure that any other ideas are excluded. Ironically, this practise  has put David Cameron at odds with his party members over leaving the European Community, particularly with those fanatically Eurosceptic MPs who are either working in thinktanks and lobby groups or who have been trained by them. Many of the new intake of Conservative MPs have no knowledge or ideas other than those they contributed to as “researchers” in those thinktanks and lobby groups, and are consequently rabidly anti-Europe.

This is how the neoliberal project has created such a huge deficit in imagination and knowledge: Margaret Thatcher’s TINA, as Paul H Rosenberg has helpfully explained in his essays on the “13 Deficits” via All-Jazera English, is a self-imposed limitation on scientific and creative thought.  Once again, the picture of neoliberalism as a closed system (or even religion) emerges.

It will be difficult to control politicians who want to be lobbied or who effectively lobby themselves by asking for the policies which they know they will receive. A register of lobbyists will provide limited benefits: the challenge is to break out of TINA and apply knowledge and creativity.

As for the policy proposal itself: at a time of increasing unemployment, when individuals are already facing uncertainty and saving rather than investing or purchasing, you might just question whether increasing fear of unemployment is the right direction.

Why do the eurosceptics keep banging on about the EU?

It would be interesting to see whether there are any “eurosceptics” in the Conservative party who are not also fundamentalist “free-marketeers”: and even more enlightening to know whether there is a clear mapping between the most fanatical eurosceptic MPs and MEPs and those Conservative party MPs and MEPs who are closely associated with the US corporate lobbyists through the network of “think tanks”, lobbyists and “charities”.

As an example, Daniel Hannan (the Conservate MEP who rubbished the UK National Health Service from the safety of a TV company office in the USA in a trip allegedly linked to The Atlantic Bridge) has been involved with a “Tea Party Rally” in Brighton and is a vocally fanatical anti-European.

The Conservative view of the EU is an ideological neoliberal view, and it seems curious that The Observer’s Andrew Rawnsley has to ask, rhetorically, why the Conservatives have to keep “banging on” about Europe despite the  inconsistencies in the Eurosceptic view.

The first is that the Eurosceptics do not seem to accept that the European project has itself been usurped by neoliberalism, and is very different in practise from the vision of such as Jacques Delors. The central European states whose membership Prime Minister Tony Blair so enthusiastically endorsed joined the EU as their own newly independent economies and political systems were invaded by the Chicago Boys. The result, as Blair clearly so heartily wished, was to switch the balance of thinking in Europe away from the post-second world war consensus and to the free-market fundamentalists.

The policies of austerity which Germany is imposing on Greece, with the radical destruction of public services and creation of mass unemployment and impoverishment are from the neoliberal textbook: take a crisis and turn it into a catastrophe, and use “the markets” as an excuse to expropriate public goods (see above, the four logics) and create opportunities for corporate exploitation. This is all being done (and Spain, Portugal, and Italy being threatened with the same medicine) in order to appease “the markets”.

The deification of “the markets” and their acceptance by governments as the unquestioned arbiters of economic policy is the clearest sign that governments have ceded control and responsibility. It is one of the most extraordinary successes of the neoliberal project that a man-made construct – “the markets”  – has been given divine authority, like the pig’s head on a stick in Golding’s The Lord of the Flies.

The neoliberal project is transnational, and its mechanisms (the movement of capital, particularly through the tax havens) global. From the eurosceptic perspective, the European project as originally set out would have been a counterweight to the scale of the project, with nations supporting each other against the neoliberal project and its mechanisms (such as the IMF) as states are now learning to do in South America. This eurosceptic Conservative Party wishes to remove all trace of European legislation from the UK so that it can be replaced with neoliberal policies: reducing taxation, removing regulation of business, and dismantling the welfare state.

The less openly eurosceptic Conservative party – which includes several members of the Coalition junta,  including David Cameron – are prepared to use EU legislation now it is available, for example in the use of EU competition law do drive markets into the National Health Service. They seem to recognise that the EU has already been won and can be used to the project’s advantage.

The Conservative eurosceptics are not against an idea of a united Europe, but it is a Europe united by the logics of the project. The Eurosceptic vision of Europe is a free trade, free-market zone without overarching government or regulation. This is what they repeatedly promise will be created through a referendum of the UK electorate; that the UK will have all “the benefits” of an open market without the “disbenefits” of regulation.

There is a clear “doublethink” on free labour markets, however: the deal offered to the UK is that labour markets will be freed but immigration ended. Immigrants are a targeted group in the UK, another symptom of neoliberalism (and of fascism).

It is not surprising then that the Eurosceptics keep “banging on” about the EU. Many are linked to the US supporters of “The Tea Party” and many have places in the vast infrastructure of neoliberal think tanks. Many of the younger Conservative MPs were trained – indoctrinated – by the thinktanks, as tracking alumni quickly shows. The neoliberal project, like any fanatical religion, does not permit backsliding and has no patience (particularly now that the Coalition junta and the economic crises created by the banksters has created an opportunity for plans long prepared to be put into action). Europe must be returned to small member states, each individually incapable of wresting control from a transnational and far more wealthy movement. Europe still means regulation and welfare to the eurosceptics: both of which must be removed to put in place the neoliberal state.