It is puerile, in fact dangerous, to suggest the solution to NHS underfunding is private competition

In terms of any other sectors, market competition in perfect markets can often drive down prices and drive up quality.

Prof Michael Porter, one of the heads of department at Harvard, at the Harvard Business School, talks about ‘five forces of competition’, which is close to being taught on every single MBA course in the world.

The ‘Keogh trusts’, demonstrated to be working extremely poorly under the watch of the current Government and their Secretary of State, all have one thing in common. They all demonstrated dangerous levels of understaffing. In fact, the solution has been to remedy these inadequate levels.

Jeremy Hunt has been steadfast in his refusal to implement a minimum level of staffing, preferring to talk of ‘safe staffing’ levels instead.

And yet junior nurses in the National Health Service often remark that their aspirational ‘6Cs’, which include ‘compassion’ so beloved of this current government, are undermined by unsafe staffing.

Even in the private sector in a checkout till on McDonalds, assistants are unable to cope with the demand to buy BigMacs if there is an insufficient number of colleagues. The inconvenience of having queues for Big Macs is one thing. An inability of clinical staff to work safely, putting patients at risk, is another thing.

It is of course unPC to blame the private sector, but NHS Foundation Trusts who have to make regular loan repayments as a major part of their budget may feel that they can get away with understaffing.

They invariably can’t, even if their CEOs move onto different jobs within an average timescale of two to three years.

The pervasive undercurrent in such arguments is that there should be an ideological ‘parity’ between the public and private sector.

And yet public concern at campaigners remain exasperated about private providers, who can fail to be transparent and who can fail to disclose their staffing figures, can hide under the  ‘commercial confidentiality’ cloak in freedom of information requests. Jeremy Hunt, on behalf of the coalition, has stubbornly refused to legislate for this aspect of parity.

The competition argument for the National Health Service has always ignored the traditional powerful arguments of Porter’s ‘five forces’.

They include supplier power, in that the NHS being such a large organisation is able, theoretically, to benefit from ‘economies of scale’ (in a way, bulk buying).

It is not a real market, in that a patient is not a ‘real customer’ wanting to shop around. He (or she) wants simply to go to his most local hospital for an acute life-saving treatment, not go half way up the M1 to the hospital with the best coffee shop and Wifi.

And if the private sector were so confident about their brand, why do they prefer to use the NHS brand?

Would it be puerile to suggest that chronic underfunding of the NHS, sold in the media and by the thinktanks as ‘unsustainable’, could lead the NHS brand to be so tarnished that private sector operators like knights in shining armour might one day feel confident to show their brand for a desperate public?

Sean Worth may call our arguments puerile, but a lack of rigorous implementation of practitioner models of competition in the private sector, derived from the giant automobile sector in the US, coupled with an inability to mention the root cause of unsafe operational issues in the NHS, is far more dangerous argument to run.

The transfer of resources from the NHS to the private sector, also known as  “privatisation”, is directly legislated for in section 75 Health and Social Care Act (2012).

This ‘top down reorganisation’, which David Cameron said would never happen, has so far cost about £3bn so far.

And the most disingenious aspect of the argument is perhaps in this argument arguing for private provision and performance in the NHS is that the Act of parliament, all 493 pages of it, does not contain a single clause on patient safety, apart from one abolishing the National Patient Safety Agency.

But many of us agree, on the left, Sean is a very pleasant man.

Burnham is aware of the influence of the NHA Party. Policy-wise it could be a kick in the goolies.

“I’m gonna find the man who’s selling the NHS and kick him in the goonies” – what @RufusHound‘s son said to him ahead of our euro launch.

— NHA Party (@NHAparty) April 27, 2014

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Clearly this should have read ‘goolies’ ideally, but part of the joke might have been that the remark was made by a six-year old (Rufus Hound’s son).

No offence therefore to any Arsenal fans!

In as much the NHAP has a ‘poster boy’, it is Aneurin Bevan.

Numerous offerings from the NHAP have elaborated on a theme of how good it would be if the ‘fight for the NHS’ , which no-one really expected, could pay due respects to the origins of the NHS and the “spirit of ’45”.

The NHAP had its launch for the European elections this morning at the Roxy Bar and Restaurant, Borough High Street, London SE1.

Previously, in the campaign trail, there had been eyebrows raised at something which came from the NHA Party’s direction.

Rufus Hound, a confirmed atheist, is without doubt a compelling force to be reckoned with.

Hound, who announced his desire to stand for the NHA Party on the BBC “Jonathan Ross Show” at the end of January 2014, had made in parody the remark, “David and Jeremy love your children so much they could just die, squealing in ecstasy”.

Even candidate Louise Irvine had been asked about the general area of comment by Andrew Neil.

But Irvine gave an explanation for the comment, and Neil was clearly going through the motions in political discourse.

Here is Louise Irvine’s pitch from today.

Hound explained beyond any reasonable doubt that the comment had been meant as a joke, making a passing reference to Toby Young of ‘free schools fame’, and son of the very influential Labour peer Lord Young.

One of the biggest bits of news of the day was that Marcus Chown, @marcuschown, author of “What a wonderful world: one man’s attempt to explain the big stuff” and other hugely popular science books, announced his intention to stand in the European elections. This is a major coup for the NHA Party as Chown has a remarkable social media presence.

A recurrent theme, unsurprisingly for the European elections, was how the transatlantic trade treaty between the EU-US could, unless properly negotiated, give excessive negotiating power to multinational corporates.

This is now a significant issue in the way the NHS is run, as it potentially takes away too social, economic and political sovereignty through what is technically known as the ‘investor protection clauses’.

It has been frustrating for many that there has been thus far little discussion of this matter in the traditional media, though the people I spoke to this morning, quite unrepresentative of the usual general public, were extremely well informed about the issue.

Dr Clive Peedell MRCP, one of the Co-Leaders of the NHA Party, is a Consultant Oncologist (Physician) in the NHS, with insights into how marketisation in the NHS has gone catastrophically wrong.

He kicked off with the issue this morning:

And resuming the football theme, Hound likened the NHS to a “political football” which was “gradually becoming deflated due to all the kicking by all the major political parties.”

It is inconceivable that the NHA Party will form the next Westminster government on their own, but they have never had public aspirations for that. Because of the way that the European elections work through proportional representation, they have a chance to  make an impact in the European elections, though heavily disadvantaged by lack of interest from the mainstream media.

But these are issues which resonate with many.

For example, many people are concerned in the stranglehold that the private finance initiative, criticised recently by Margaret Hodge MP in the influential Public Accounts Committee, has had on NHS policy.

Various frontline nurses explained to me their concerns about unsafe staffing, in not being able to deliver the care that they would like to deliver.

One candidate has  even been a registered nurse for 35 years, now specialising in the tricky area of pain management.

 

The unanimity in the ‘efficiency savings’ in national policy weighs heavily against them.

The analogy to football may not be the right one.

Rugby may be more suitable. It’s possible that an incoming Labour government might have to pick up the ball on May 8th 2015, and issues such as the notorious efficiency savings, PFI and even TTIP might have to be settled by the Chancellor of the Exchequer rather than the Secretary of State for Health at the time.

So continuing the sporting analogies, the ball might end up out of Burnham’s court, and this would indeed be very disappointing for many grassroots activists in the meantime.

But, notwithstanding, the NHA Party, whatever their ultimate fate as individuals, are clearly a bunch of plucky determined individuals who feel they’ve made the correct diagnosis, and do not wish to step back and do nothing. They should be given enormous credit for that, at least.

Let’s stop using vacuous phrases to improve Labour’s draft health policy, shall we?

The list of vacuous phrases to do a critique of the NHS is getting ever longer.

It’s a list which has a semblance of ‘motherhood and apple pie’ or ‘chocolate and biscuits’, or whichever overworn bland meaningless soundbites you wish to put there.

The next election will require meaningful offerings from the main political parties.

There might be a temptation to implement ‘less is more’, and this is not altogether a foolish approach so as to allow greater definition to fall into place at a later date.

On the other hand, vacuous phrases run the danger of making Labour look as if it doesn’t know what it’s talking about, and, instead of talking in socialist language, is simply triangulating itself out of meaningful existence.

Here are some recent phrases which have been offered. They all sound perfectly sensible, and possibly are very attractive to those people who’ve not been following the detailed narrative of the NHS. But other parties are working on their offerings too.

 

1. “The private sector will only be allowed to offer patient services if the NHS cannot improve or they can show genuine innovation.”

It is hard to put down a definition of ‘innovation’, let alone how to measure the success of the application of innovation, commercial or otherwise. That said, the concept of who is better at competition, the private sector or the public sector, is an odd one, as current innovation theory converges on the need to collaborate beyond boundaries to generate innovative ideas.

 

2. “Whistleblowers will be protected.”

This is the ultimate motherhood and apple pie offering. For somebody who has just experienced a truly awful experience, such as Raj Mattu, this will mean very little.

Nobody can disagree with the statement. In fact, to suggest that ‘whistleblowers won’t be protected’ would be truly eyecatching. The real beef is how whistleblowers can be protected. It is extremely difficult to ‘legislate’ in response to a toxic culture, although it can be done.

Take for example, the Sarbanes-Oxley Act legislated in response to the financial misfeasance (understatement) in ENRON. But a good starting point perhaps would be repeal the Public Interest Disclosure Act (1998), enacted very early on in New Labour’s life, which virtually all people agree is not a statutory instrument which is fit for purpose.

 

3. “Intelligent targets will remain where appropriate.”

This is the ultimate in having your cake and eating it. This is Labour getting high on triangulation again – saying we believe in targets but not of the kind that may have contributed to Mid Staffs.

The idea that nobody can disagree with realistic aspirations on ‘waiting lists’ etc. but the phrase above fails the basic assessment device of legal drafting ‘who? what? when? where? how?’.

The extent to which you can encourage policy a certain way, or have to introduce incentives such as for collaborative behaviour, is an important one. More important than incentivising collaboration through financial incentives is getting rid of the effect of legislation which is unlawful due to a collaborative or anti-competitive effect.

Collaboration is not necessarily anti-competitive, hence the discussion of co-epetition, but this is an area which requires a lot of work (such as how to implement incentives which promote integrated care in general.)

 

4. “The NHS will no longer have either an internal nor external market. The NHS will be the preferred provider. Renegotiate PFIs where necessary.”

These statements are inherently internally contradictory. How is it possible to abolish the market and still have the NHS the ‘preferred provider’ simultaneously in a market? This simply does make sense.

This is clearly manna to Labour’s critics who argue that Labour doesn’t really mean it when it criticises the ‘tidal wave’ of marketisation.

The actual truth is that people in the City are currently trading on shares in PFI, and building up portfolios of shares. If you ‘renegotiate’ PFIs, this market for PFI shares will still exist. If you abolish PFI, it won’t.

A reluctance to abolish any PFI ultimately, ahead of payments coming to an end otherwise in the early 2020s, speaks volumes to many.

And this all feeds into the narrative that Labour has no sense of running the economy. For example, would you rather pay for your TV set over hire purchase for the next twenty years, or would you like to pay for it now if you could?

With interest rates set to go up from the Bank of England after the next election, as the recovery gathers speed in the UK, these are important questions, but the question over PFI arguably is as much for the Shadow Chancellor of Exchequer as much as the Shadow Secretary of State for Health.

 

 

 

So it is all very well to supply bland phrases.

Such phrases are either well meant and designed to say little to be non-committal, or are designed to be deceptive so that Labour can simply do ‘business as usual’.

A brief scan of Twitter any day will prove to anyone that business as usual from Labour for the NHS is no longer an option.

Burnham goes from strength to strength as ‘striker’, but who’s the David Moyes?

There’s no doubt Andy Burnham MP drives the Conservatives potty.

Despite the Conservatives’ best attempts to annihilate Burnham MP, Burnham keeps on scoring goals.

Meanwhile Jeremy Hunt continues to score blanks, apart from where profits from ‘Hot Courses’ are concerned.

But Burnham is more concerned about the day job, and that is running the NHS to a level of some degree of competence.

Hunt meanwhile continues to run his NHS into the ground, paying for costly advice on the managerial implementation of compassion, when he could be paying nurses to do the professional job they’re trained to do.

So Burnham can certainly hold his head up high as chief striker or scorer for Labour United.

As the Conservatives spit out the oranges from their half-time pep talk, as the oranges were in fact horsemeat due to the abolished Food Safety Agency, it’s time to recapitulate.

Clive Peedell kindly tweeted the other day points on which he would like Labour to play ball.

@legalaware @andyburnhammp 1. Fill £30bn funding gap by abolishing PFI & cracking down on tax avoidance 2. Get NHS exempted from TTIP

— Clive Peedell (@cpeedell) April 22, 2014

//platform.twitter.com/widgets.jsBefore the 2010 election, Liberal Democrat leader Nick Clegg indeed condemned PFI as “a bit of dodgy accounting – a way in which the government can pretend they’re not borrowing when they are, and we’ll all be picking up the tab in 30 years”. It’s well known that PFI is a relic of the John Major government from 1995 (predating New Labour in fact). In opposition, Osborne pledged that the Conservatives would stop using PFI and denounced Labour for relying so much on a source of finance that he said was “totally discredited”. “We need to find new ways to leverage private-sector investment. Labour’s PFI model is flawed and must be replaced,” Osborne muttered in November 2009. Indeed Margaret Hodge, chair of the powerful Commons public accounts committee, said the coalition had failed to come up with the promised alternative since coming to power.  The facts speak for themselves.

And Burnham is handicapped by not being the actual Secretary of State for Health at this crucial time for the NHS.

He nonetheless did go to Strasbourg last month to try to explain the case:

(This is a video recording I took of Andy’s talk at the Southwark Labour meeting recently.)

Labour will need to abolish PFI contracts or renegotiate them or both. But Ed Balls will need to be on the wing to help Burnham shoot. And it’s hoped the football manager is not asleep on the job. Labour has indeed proposed a five point plan to tackle ‘tax avoidance’. Labour supports a form of country-by-country reporting. It would extend the Disclosure of Tax Avoidance Schemes regime, which Labour introduced, to global transactions. It would open, further, open up tax havens, with requirements to pass on information about money which is hidden behind front companies or trusts. Crucially, Labour also wants to see fundamental reform of the corporate tax system. But Peedell’s work is not done.

@legalaware @andyburnhammp 3. Abolish purchaser provider split 4. Improve NHS accountability with transparency & openness — Clive Peedell (@cpeedell) April 22, 2014

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The abolition of the purchaser-provider split remains one of the totemic political decisions to be made, as is not a ‘deal maker’ for many grassroots voters.

In fact, the whole issue of whether the general public is interested by public health or competition remains uncertain.

Nonetheless, a pioneering integrated healthcare scheme in New Zealand has improved the care of patients while reducing demand on hospital services.

On the contracting side, the report said that the abolition of the purchaser-provider split in the health system was important as it gave boards the autonomy to decide how to fund their hospitals.

The project was launched in 2007 in response to rising hospital admissions and waiting times and to a population that was ageing more rapidly than in other parts of New Zealand and other developed countries.

Similar to the drive towards whole person care in this jurisdiction, is aim was to create a “one system, one budget” approach to health and social care, together with various aspects as centrepieces: sustained investment in training, support for staff to innovate, and new forms of contracting, including abolition of the split between healthcare service purchasers and providers.

The outgoing NHS England chief executive Sir David Nicholson last year told HSJ his organisation was looking at “whether the straightforward commissioner-provider split is the right thing for all communities”.

Hospitals wish to focus on delivering better services to patients and often get frustrated by the amount of time they have to spend negotiating contracts with commissioners with the legal shutgun pointing in the direction of their necks.

And there’s no doubt there’s a steady stream of whistleblower tragedies, with Raj Mattu the latest in the long line of casualties.

People still struggle to think of a NHS whistleblower who has had a good outcome.

The Nursing Times ‘Speak Out Safely’ has only so far succeeded in signing up 30% of NHS Trusts.

Most people accept that the whole system is rotten, not least in how clinical regulators appear to pass the buck or even worse target whistleblowers.

Many do not think the Public Interest Disclosure Act, enacted by New Labour is 1998, is fit for purpose either.

So Clive Peedell is right, but Andy Burnham may have trouble in shooting goals on target with nobody on wing or a manager more concerned about ‘One Nation’.

Moyes, sacked by United on Tuesday after the 2-0 defeat at former club Everton on Sunday confirmed their failure to secure Champions League qualification, oversaw just 51 games in charge of the team after succeeding Sir Alex Ferguson last summer.

Moyes, like Ed Miliband, though had his army of people who thought he was doing a good job.

But Burnham like many, although focused on sorting out the undeniable problems of the NHS, is avoiding relegation for his team too.

I certainly don’t want to ask who the Ryan Giggs is. That certainly would be tempting fate.

How did a hardworking nurse, Gerry, become a top social media influencer in the NHS?

Many of us take, of course, Top 10s with a pinch of salt!

Many of us have had chatted with Gerry about the NHS.

Gerry’s Twitter account is @archangelolill.

Gerry’s profile is self explanatory.

As a hardworking frontline nurse, Gerry’s views are very interesting.

One of the onrunning themes in this unique Twitter thread is how unfair it is for hardworking nurses, who don’t even get time to make a cup of tea as a break, get harpooned in the political discourse.

While people who have no clinical training, but have a management background, offer “advice” on compassion – and sell their ‘knowledge’ to the NHS – nurses like Gerry end up picking the pieces.

Gerry has often spoken about being demoralised through well rehearsed NHS scandals, which were very difficult for the nursing profession to cope with.

The hurt is that £20bn ‘efficiency savings’ are currently being delivered across all the main political parties. None of these ‘savings’ have been pumped back into frontline care, it is widely reported.

And many of these savings have been achieved by making draconian staff cuts, while balancing the budgets to negotiate crippling PFI loan repayments.

Now it turns out that Gerry is having the last laugh, in the face of her views about protecting the NHS which many find passionate.

Sometimes Gerry has been difficult to argue with, on grounds of the feelings whipped up, but Gerry freely admits this and means no offence at all it appears.

Gerry has recently come very high up in an impact poll published recently.

And guess who came last!

 

 

 

The LibDems are spoilt goods and they have nothing to contribute to the NHS

One good thing that David Cameron did in this parliament was to strangle at birth the electoral prospects of the Liberal Democrat Party through the boundary changes.

Nick Clegg is a spoilt product. His politics are not only unfit for purpose. They defy the Trade Descriptions Act.

The shameless motto of the LibDem Party is ‘fairer society, strong economy.”

Nick Clegg, Simon Hughes and Danny Alexander all shamelessly lied about how Labour had caused the global financial crisis singlehandedly.

In the name of austerity, they led disabled citizens to an edge of the precipice. Some didn’t return.

The welfare benefits saga has an unmitigated catastrophe.

Even if you wish to question your welfare benefits, TOUGH. Your local law centre has shut down.

Some banks are booming but not the ones St Vince The Privatiser is thinking of.

Food banks have never been busier.

The LibDems killed off employment support allowance.

They also breathed new life into the drastic hospital closure clause.

With friends in high places, they turned competition law into a lifestyle choice, and they made compulsory commissioning by competition into the private sector “living the dream”.

The LibDems get high on neoliberal politics.

But nobody gives a monkeys what they have to say.

How tragic.

TTIP and free movement of capital are supreme.

May 7th 2015, and the forthcoming European elections, should be a time when they are consigned to history.

I can’t wait.

I agree. The effects of the free market on the NHS are indeed terrifying.

Tony Benn said famously, of Tony Blair, “It’s not up to Mr Blair to rename my party. I haven’t suddenly become a member of New Labour. I was never a member of Old Labour.”

There is a therefore a strange cognitive dissonance in this picture to come out of the Spectator factory.

It mixes a parody of the famous Tony Blair ‘evil stare’ with the letters ‘Old Labour’.

Presumably the overall message, unsubtle though it is, is that a vote for Ed Miliband is a vote for socialism.

And the advertising shill in this is that socialism represents a ‘danger’.

No.

Let’s get this clear.

The private finance initiatives led to some investors in the private sector making very good deals on the financing of hospitals and associated services, often with exorbitant profit.

Andy Burnham’s message of letting the market creep in too far is understating the severity of the problem.

There is a plethora of NHS trusts which have been crippled by PFI loan repayment debts.

These loan repayments possibly represent the biggest single threat to the financial stability of the NHS in the forthcoming decades, not the ageing population.

The PFI situation has gone beyond farcicle. An instrument first developed in John Major’s government in 1995, later welcomed with open arms by Tony Blair’s governments and beyond, has clearly been an abuse of power.

Not only can NHS entities conceal their staffing data under freedom of information, but PFI shares in hospitals which may ultimately shut down may be freely traded like carbon credits on the stock market.

That’s what letting the market has become.

You can now hire consultants who are experts and could make you millions on predicting whether your local hospital will shut.

There is no doubt that these market considerations have impacted on the provision of care, which should be made on clinical conditions. And yet the current regulatory set up, which gives a lot of power to Monitor’s elbow, is clearly unable to cope.

It is now widely recognised that the NHS has lacked both the expertise and the resources to cope with the aggressive pimping of services into the private sector.

And private investors are now lining up to provide financing for social value impact bonds, which could help to sustain multinational corporates to enter markets they otherwise would have dreamt of.

This further leads to leeching out of resources away from the NHS to the private sector.

So long as senior leaders in the NHS say technology and innovation need to drive the NHS, you will see further leeching of money into the private markets.

This shift on emphasis, to people ‘finding opportunities in the NHS’, is by far the biggest danger in the NHS. And the political dynamite question is to what extent does Ed Miliband produce a killer stroke?

Everyone concedes the PFI situation is a mess, but should Miliband simply buy back these hospitals into the public sector?

After all buying back shares is common currency currently in corporate land, pardon the pun.

And there is never any shortage of money for illegal wars.

That would be quite a break from New Labour, but the public, and the Spectator know this, might actually welcome a return to state ownership. This is borne out by all the polling evidence in fact.

Despite the undeniable popularity of issues such as immigration considered to be “right wing”, the Spectator might have done Labour a favour – in telling Labour that the Tories are in fact terrified of Miliband and Burnham.

 

Will Clive Peedell reply to Andy Burnham’s tweet?

It’s fairly well known that Ed Miliband is firmly fixed on the general election in the UK, to be held on May 7th 2015.

But, of course, he is aware of the impact that the European Elections can have, which can act as a useful barometer of the level of unpopularity at the current political incumbents.

On 29 December 2013, Andy Burnham MP tweeted at the NHA Party to ‘RT if you agree‘ if there needed to be a “broad campaign against market forces”:

It received 454 RTs.

But it did come across Clive Peedell’s RADAR. Clive is the co-chair of the National Health Action Party.

It was shared by Clive the same day in fact.

It received 20 RTs.

Clive has 12.1K followers.

Andy has 54.9 K followers.

To my knowledge, I don’t think the NHA Party or Clive ever took up Andy on the offer or replied to the tweet (but I could be wrong.)

But here, Louise Irvine, MEP candidate for the European Elections, who was the lead for the Save Lewisham campaign against Jeremy Hunt in the High Court and the Court of Appeal clearly has many of the same reservations as Labour and Andy Burnham.

Irvine is critical of how clause 118 (now clause 119), a legislative step would allow ‘unaccountable bureaucrats’ to make decisions about NHS reconfigurations, and an “acceleration of privatisation”.

She is also highly critical of the EU-US ‘free trade agreement’, which will ‘lock in privatisation, whereby ‘private companies could sue the British government”.

“Labour is in a muddle. It is a partly committed to the NHS, but feels it can flirt with privatisation.”

But Andy Burnham MP, Shadow Secretary of State for Health, recently rocked up at the Bermondsey Village Hall in 12th April 2014.

Burnham argued that “we need MEPs to protect the NHS from the EU-US free trade treaty.”

Burnham made special reference to the Lewisham campaign, mentioning a key campaigner in his speech, calling it a ‘famous victory… which was a message to an arrogant government.”

He also spoke of ‘unprecedented pressure in A&E’ in London, due to “massive cuts in primary care”.

And 8 mins 4 secs in, Burnham began a massive tirade on the aspects of the EU-US free trade treaty which he argued would damage our interests in the NHS:

“I have said that, before, even I think we let the market in too far into the NHS.”

“We can’t carry on letting this happen, or if – we do – it will devour the NHS and everything that is precious about it.”

“That’s why I am absolutely clear that the NHS has to be seen as a ‘preferred provider’. We repeal the Health and Social Care Act (2012).”

“Labour proudly stands for a public NHS again. That’s where we should be, and there’s where I want you to be too, fighting the privatisation.”

“That’s important for the European elections too. If we don’t get the European Parliament with our MEPs in it, the threat goes up to an whole different level.”

“Why? Our ability to protect the NHS moves to fall out of our hands. Why? – it’s because of this trade treaty that is being negotiated in Brussels right now; it’s between the EU and US which has some positive aims but, if it stays at it is, it could have the effect of opening up the NHS to US corporate entities.”

In the second Farage-Clegg debate on the BBC, Farage was vehemently anti-multinational corporations, but Burnham later remarks that UKIP have said previously the NHS should be ‘put out to tender’.

Burnham continues, “The issue – it’s the combination of the two entitires. The Health and Social Care Act having exposed the NHS to the full glare of the EU competition law, and then the US-EU free trade treaty, and then we are in a totally different world, and our ability, as I say, to protect the NHS has gone. It’s that serious.”

Burnham then talks about his ‘good hearing’ to argue for an exemption for the NHS from this legislation.

“They’ve said that the NHS should be in the scope of the EU-US free trade treaty. The LibDems have said nothing.”

The National Health Action Party appears to have blamed Labour too for contributing to the privatisation of the NHS.

However, it is currently unclear whether the Party as a whole is grandstanding as a protest vote in a ‘plague on all your houses’ way, or is offering constructive solutions to move things forward.

Clive Peedell has often spoken about his shared vision of Bevan for a public NHS.

Many of us in Labour like Clive much, so it will be interesting how things progress from here.

Social enterprises and the NHS: who benefits and what’s at stake?

As social enterprises for care get promoted in England, such that they literally get ‘bigger and bigger’, now’s a sensible time to task who exactly benefits and what’s at stake.

Like personal budgets or PFI, a discussion with the public is unlikely to be forthcoming in the near future. Nonetheless, it’s possible to make some inroads into this complicated narrative. At the beginning of this parliament, the Department of Health declared its vision that the NHS should be the “largest social enterprise sector in the world” through the liberation of foundation trusts, and handing over services to NHS staff. Enhancing the role of social enterprises and mutuals in public service provision was right at the heart of the Coalition Government’s vision of the “Big Society”, and part of the aspiration to move one in six public sector jobs into staff-owned companies.

In a somewhat provocatively titled article in the Health Services Journal, “Norman Lamb: Mid Staffs would never have happened at a mutual”, Health minister Norman Lamb suggests that acute trusts could improve staff engagement by becoming social enterprises and argued that the culture problems seen at Mid Staffordshire Foundation Trust would never happen in a mutually-owned company. It is not any surprise to anyone who has worked as a clinician in the last decade in the NHS that understaffed services, perhaps cut back as a result of ‘efficiency savings’ to help address ‘the funding gap’, have been the major threat to patient safety in NHS hospitals and Foundation Trusts.

The Berwick Report discusses safe staffing ratios, and staff engagement is a pervasive theme in the whole analysis. And yet curiously the document “The Care Bill explained: Including a response to consultation and pre-legislative scrutiny on the Draft Care and Support Bill“, which indeed calls Mid Staffs a “watershed moment in care”, does not mention social enterprises or mutuals once.

The famous Norman Lamb/Chris Ham review is due to report imminently.

Meanwhile, the Cabinet Office ‘Mutuals Information Service” has a feeling about it of “Well done on setting up your first mutual!”

As they report,

“Setting up a mutual is a major achievement… However, the transition from the public sector can bring significant challenges… The biggest challenge that comes with leaving the public sector, though, is having to operate as a business. In the first year, you will be focussed on delivering your service and making your mutual work. However, as you build your experience and look to the future, you should start to think about opportunities for expansion and growth.”

All organisations involved in care have have had a tension between board members acting as representatives for particular membership groups and ‘experts’ charged with driving the performance of the organisation forward.

Social enterprises are non-profit ventures designed to achieve both social and commercial objectives. Although trading for a social purpose is hardly a new phenomenon (Hall, 1987), the growth of social enterprise has been a key feature of economic activity in both developed and developing countries.They are hybrid organisations that have mixed characteristics of philanthropic and commercial organisations (Dees, 1998).

According to Alter (2006), social enterprises are driven by two forces:

“first, the nature of the desired social change often benefits from an innovative, entrepreneurial, or enterprise-based solution. Second, the sustainability of the organisation and its services requires diversification of its funding stream, often including the creation of earned income opportunities (p. 205).”

It’s already known the accountability and transparency (corporate governance) mechanisms of social enterprises aren’t always necessarily “fluffy”: see for example this interesting discussion of “asset locks”. Co-operatives have long held to have three groups of participants, according to Johnston Birchall and Richard Simmons (2004). They are: those “true believers” who can be persuaded to train as potential board members, those who can be formed into a kind of club who believe in the aims of the organisation and will participate through voting, attending annual meetings and social events, and supporting campaigns such as fair trade, and a third group which is quite ambivalent.

Birchall and Simmons review that the best way to encourage active participation amongst membership is to reinforce the values of mutuality, engage widely with the community, and to make accountability central to corporate governance and strategy. And “non-uniform engagement” is a well-documented issue with NHS Foundation Trusts (FTs) too.  Nonetheless, managers in FTs have described using members of public to give their governance a sense of legitimacy (Allen et al., 2012):

‘They are seen as a very important strategic weapon . . . the governors and their influence into the community, is really, really key’

Multinational corporations have an interest in working with the community too. The construct of ‘corporate social responsibility is important for such corporations to gain ‘competitive advantage” through “value creation” (Husted and Allen, 2007). The European Commission identifies corporate social responsibility as: “a concept whereby companies integrate social and environmental concerns in their business operations and in their interaction with their stakeholders on a voluntary basis” (Commission of the European Communities 2001).

Recent examples of the failure of private providers to deliver NHS services, such as Serco with its contract for older people’s services in Cambridgeshire and Peterborough CCG, have led to a greater desire within the NHS to see commissioning in terms of how a provider can deliver a long-term business model with greater social value, going beyond the cost-effectiveness of their work. That’s where social enterprises come in so handy for multi-national companies, and vice versa. And as you progress down the ‘You too can set up a mutual’ aspirational route, you as a member find yourself less interested in real persons and real patients, but get more bogged down with the “bottom line”. Though the field is young, it’s clear private equity want a slice of the action: the “Socially Responsible Investment” is an investment process that integrates social, environmental, and ethical considerations into investment decision-making (Crifo and Forget, 2013).

From a somewhat corporate perspective, Antony Bugg-Levine, Bruce Kogut, and Nalin Kulatilaka gave a neat description of the “social impact bond” in the Harvard Business Review in 2012:

“Another innovation, the social impact bond, deserves special notice for its ability to help governments fund infrastructure and services, especially as public budgets are cut and municipal bond markets are stressed. Launched in the UK in 2010, this type of bond is sold to private investors who are paid a return only if the public project succeeds—if, say, a rehabilitation program lowers the rate of recidivism among newly released prisoners. It allows private investors to do what they do best: take calculated risks in pursuit of profits. The government, for its part, pays fixed return to investors for verifiable results and keeps any additional savings. Because it shifts the risk of program failure from taxpayers to investors, this mechanism has the potential to transform political discussions about expanding social services.”

However, this approach has already been likened to a ‘private finance initiative’ for social enterprises. The critical issue then becomes “he who pays the piper calls the tune”, and membership engagement becomes even more murky. Any steady income source can have its drawbacks. For example, according to the “crowding-out hypothesis”, an increase in one source of revenue, such as a government grant, can lead to a decrease in revenue from other sources, such as private donations (e.g., Weisbrod 1998).

So in answer to my original question, private investors stand to benefit while public sector budgets get cut (which could be easier to hide anyway through integrated care or ‘whole person care’ in the next parliament), and what’s at stake is that membership engagement gets worse as the social enterprises get bigger and bigger. But would this policy plank, in fact, prevent another Mid Staffs as Norman Lamb would perhaps like us to believe?

 

 

Selected readings

Allen, P., Townsend, P., Wright, J., Hutchings, A., Keen, J. (2012) Organizational Form as a Mechanism to Involve Staff, Public and Users in Public Services: A Study of the Governance of NHS Foundation Trusts, Social Policy & Administration, 46(3), June, pp. 239–257.

Alter, S.K. (2006) Social Enterprise Models and Their Mission and Money Relationships. In A. Nicholls (Ed.), Social Entrepreneurship: New Models of Sustainable Social Change: Oxford University Press

Birchall, J, Simmons, R (2004) The Involvement of Members in the Governance of Large-Scale Co-operative and Mutual Businesses: A Formative Evaluation of the Co-operative Group, Review of social economy, LXII, 4.

Bugg-Levine, A., Kogut, B., Kulatilaka, N.  (2012) A New Approach to Funding Social Enterprises,  January–Harvard Business Review, February, pp. 119-123.

Crifo, P, Forget, V.D. (2013) Think Global, Invest Responsible: Why the Private Equity Industry Goes Green, J Bus Ethics, 116, pp. 21–48.

Dees, J. G. (1998). Enterprising nonprofits, Harvard Business Review, pp. 55-67.

Hall, P.D. (1987) A historical overview of the private nonprofit sector, In The Nonprofit Sector: A Research Handbook. Powell WW (ed.). Yale University Press: New Haven, CT; pp. 142–175.

Husted, B.W., Allen, D.B. (2007) Corporate Social Strategy in Multinational Enterprises: Antecedents and Value Creation, Journal of Business Ethics, 74, pp. 345–361

Piercy, N.F., Lane, N. (2009) Corporate social responsibility: impacts on strategic marketing and customer value, The Marketing Review, 9(4), pp. 335-360.

Weisbrod, B.A. (1998), The Nonprofit Mission and Its Financing: Growing Links Between Nonprofits and the Rest of the Economy, in To Profit or Not to Profit: The Commercial Transformation of the Nonprofit Sector, B. Weisbrod, ed. Cambridge, MA: Cambridge University Press, pp. 1–24.

That you can safely assume the recovery won’t benefit the NHS speaks volumes

 

Chancellor George Osborne is hailing the UK’s economic recovery in a keynote speech in Washington DC as we speak.

Mr Osborne said has critics of the government’s economic plan have been proved “comprehensively wrong”.

His chest-beating lap of honour after the International Monetary Fund said Mr Osborne’s austerity policies were “playing with fire”.

Speaking while in the US capital for the spring meetings of the IMF and World Bank, the chancellor said that cutting deficits and controlling spending had “laid the foundations for sustainable growth”.

There is still a prevailing view by certain politicians that running up a deficit in a NHS trust is simply due to inefficiency. This is to some extent, but ignores the considerable impact of the loan interest repayments in PFI hospitals.

I have often thought about whether the State should pay off its debts in one foul swoop, after all it had managed to bail the bankers by a tune of about £1 trillion?

Then my mind invariably turns to ‘credit’ and ‘blame’.

I think of how the last Labour government bit the bullet for this bank re-capitalism. They received no credit for it, and took the blame from David Cameron and Nick Clegg for ‘crashing the car’.

Except… Gordon Brown didn’t singlehandedly crash any car.

Chris Leslie MP, I suppose, has got completely fed up of touring the TV studios to explain it was a global recession, and not simply Gordon Brown’s fault.

Whenever a Coalition MP says the economy’s in a mess due to Labour, audible groans are now heard.

And yet people don’t especially trust Ed Balls MP or Labour “on the economy”.

For this to work, the general public has to separate away the abuse of employment rights and the cost of living through inflated privatised utility bills as separate from “the economy”.

And yet this Government is still borrowing like no tomorrow.

Whatever the explanation is, voters tend to prefer the Conservatives on the economy.

And the NHS likewise, under the mandates from all three political parties, has been pursuing ‘efficiency savings’. The money thus far has been returned to the Treasury, and where it went thereafter is far from clear.

So that is exactly the point.

The crashing of the economy by investment bankers has had many ordinary people taking the bullet, and yet, as the economy recovers, you can expect there to be no ‘let up’ on the tightening of the belt of the NHS finances.

And it’s been demonstrated time and time again that NHS funding has been falling in real terms in recent years.

For all the ‘thinking’ by think tanks, the methods for funding the NHS have become increasingly convoluted, when the vast majority of the general public wish for a NHS funded wholly out of general taxation, and wish to maintain a NHS which is comprehensive, universal and free at the point of need.

That you can also assume that disabled citizens won’t benefit from the recovery is a safe bet. Disabled citizens have become an invisible demographic for Labour, to the point that the Labour Party are embarrassed to soil their lips with their name.

I still believe any party which can show a clear vision for the NHS, in the week that has showed that the English NHS has fared the worst through full-frontal implementation of an internal market compared to other devolved regions, will ultimately succeed.

There was not a single clause in the Health and Social Care Act (2012) devoted to patient safety, together with its £3bn ‘top down reorganisation’.

I, in fact, tell a lie.

There is a clause abolishing the National Patient Safety Agency, supported vocally by some prominent patient campaigners for reasons best known to themselves.

All the experience is that understaffed NHS institutions are unsafe.

If Labour can’t capture the public mood over rejecting the current government’s approach to the NHS, it is in serious trouble. There’s only a year left for the Labour Party to get its ducks in line, and if it is unable to do so, it won’t win the General Election in 2015 regardless of Farage’s landslide in the European elections.