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peter-pannier · 10 years ago

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"A patchwork quilt of local paternalisms”: the Labour Party's vision for the NHS?

Introduction

Tomorrow, Members of Parliament in the UK have the chance to vote on a Private Members Bill submitted by Labour MP Clive Efford. The full title of the ‘Efford Bill’ is the “National Health Service (Amended Duties and Powers) Bill”, and it provides not only an opportunity to challenge the government on their NHS policy but an insight into any future government where Labour are the majority or lead party.

As the fullest parliamentary response to the disastrous Health & Social Care Act 2012, this is a significant moment for NHS campaigners, and I urge anyone with an interest in healthcare in the UK, and/or public/private provision of healthcare in Europe, to read it (link is to the parliament.uk page containing a downloadable pdf of full Bill text).

It does contain technical language that is challenging to the non-specialist, but it is not too long and I believe anyone with healthy curiosity and well-developed internet-search skills should be able to comprehend it. If you have time, there are also some largely helpful notes produced by the Commons Library here (again, a link to the parliament.uk page containing a downloadable pdf). The Commons Library briefing paper notes among other things that a wide variety of groups are supporting the Bill, including the Labour Front Bench, the Royal College of Nursing and trade unions representing NHS staff - see press releases from Unison, Unite, GMB, and the TUC (latter is a direct PDF link). Others have offered qualified support (such as the BMA), while some have raised critical questions (such as the Green Party PPC for Calder Valley Jenny Shepherd). You can read a good review of the responses on the excellent OurNHS section of the Open Democracy website by Caroline Molloy here.

I agree with the position adopted by Allyson Pollock and campaigners working on the 'NHS Bill 2015' (twitter account) or NHS Reinstatement Bill (article including link to PDF of full bill). Their suggestion is to encourage MPs to vote in favour of the Efford Bill in the hope it will pass its Second Reading in the Commons and move on to ‘Committee Stage’ where critical questions can be explored in detail.

I also feel it is crucial to ask those critical questions as soon as possible (the campaign for an NHS Reinstatement Bill have done, arguing that 'major ammendments' are required). There is nothing to gain from sacrificing critical thought in order to support one’s chosen team or political party. As I have written elsewhere, now is not the time for NHS campaigners to make compromises.

There is one section of the Bill which I believe is receiving insufficient attention, which has particular relevance for me, and which I find deeply concerning. Hence this short blog. I make no apology for exploring only this section – please read the links above for fuller explorations.

Preferred Providers? The NHS, the EU, and #socent

Part 1 of the Bill is about “Amendments to Sections within Part 1 of the National Health Service Act 2006, as amended by the Health and Social Care Act 2012”. The 2012 Act has, after all, proven to be every bit as bad as campaigners feared.

Section 6 of Part 1 of the Efford Bill is about ‘NHS Contracts’, and substitutes Section 9 of the Health and Social Care Act. A minor terminological criticism should be raised immediately. As the Efford Bill itself states:

“(6) Whether or not an arrangement which constitutes an NHS contract would apart from this subsection be a contract in law, it must not be regarded for any purpose as giving rise to contractual rights or liabilities”.

In other words, an ‘NHS contract’ is not a contract. It really would have clarified things for everyone if the Efford bill had instead referred to, say, ‘NHS arrangements’ or 'NHS agreements'. Nonetheless, the intent of this clause should be welcomed: it forms part of the legal changes contained in the Efford Bill that reduce the role of competition in the NHS, reducing the threat of legal action by private providers demanding competitive tenders for health services. The following quote explains how this is possible:

“(15) Payments made for the purposes of this Act by a commissioner to a provider may be designated as being a grant made by the commissioner to the provider for the purposes of the European Directive 2014/24/EU of the European Parliament and the Council.”

The relevant section of European Directive 2014/24/EU (direct link to PDF of the Directive) essentially allows governments to avoid other EU procurement/competition law with regard to public services. Here’s the relevant quote from the EU directive:

“the mere financing, in particular through grants, of an activity, which is frequently linked to the obligation to reimburse the amounts received where they are not used for the purposes intended, does not usually fall within the scope of the public procurement rules. Similarly, situations where all operators fulfilling certain conditions are entitled to perform a given task, without any selectivity, such as customer choice and service voucher systems, should not be understood as being procurement but simple authorisation schemes (for instance licenses for medicines or medical services)”.

So, what parts of the health service does the Efford Bill exempt from EU procurement/competition law?

(1) In this Act, an NHS contract is an arrangement under which one health service body (“the commissioner“) arranges for the provision to it by another health service body (“the provider“) of goods or services which it reasonably requires for the purposes of its functions.

This earlier sentence explains what an NHS contract/arrangement is. It reveals that the Efford Bill does nothing to remove the purchaser/provider split (the removal of which was once Labour policy, and indeed practice between 1997-2000), and implies that under any future Labour(-led) government, the NHS will still be organised to at least some extent via a process of commissioning. At present this process is undertaken by Clinical Commissioning Groups (CCGs), until recently by Primary Care Trusts (PCTs). CCGs are increasingly reliant on support and advice from Commissioning Support Units (CSUs) and even more nefarious characters. At present this regularly involves competitive tenders, which have been widely criticised for a variety of reasons, including wasting the time of clinicians and the money of taxpayers. The Efford Bill attempts to reduce the role for competitive tendering, even as it retains the commissioning system (charitably, we can assume this is in order to avoid a further ‘top down re-organisation’).

At first, the Efford Bill defines a “health service body” fairly restrictively - see picture below. Essentially, Secretaries of State and Ministers, Departments of Health and Local Authorities, NHS Trusts and CCGs, plus a variety of specialist public (or quasi-public) bodies commissioning or providing NHS services. The list does not include private companies that provide public services such as Serco, Virgin or Care UK, nor CSUs or private consultancy firms such as KPMG or McKinsey.

However and crucially, it does not appear that bodies such as these are excluded from the provision of NHS services. The following paragraph of the Bill allows for any “arrangement for the provision of goods or services by a health service body with a person who is not a health service body” to “take effect as an NHS contract”. Charitably, this could refer to GPs – but if so why not spell this out in either the Bill or the guidance notes? To the sceptical eye, this appears to be a measure designed to allow any contract between, say, a CCG and Virgin, to be as protected from EU procurement law as a contract between a PCT and your local NHS Trust once was. Why would the Labour Party want to do that?

Why I am sceptical, and cautious about supporting the Efford Bill

At this point you may be inclined to take the charitable view, and approach people like myself describing themselves as sceptical in the same way I treat those who use that word with regard to climate science. Here’s why I’m sceptical:

Since November 2010 I’ve been involved in Stroud Against the Cuts, a local group containing members of a variety of political persuasions. At a meeting in 2011 a NHS worker mentioned that the NHS Trust she worked for would soon be becoming a ‘social enterprise’, taking management of local hospitals, health clinics and other services out of the public sector. At an anti-cuts protest in Gloucester in November 2010, placards from Unison denounced the move - and similar transfers across the South West.

As the Scottish group “Labour for Independence” explain:

“New Labour introduced the “Right to Request” in June 2008 and “Transforming Community Services” in July 2008. The National Audit Office June 2011 Report summarised these developments in Establishing Social Enterprises under the Right to Request Programme:

“It (Transforming Communities) required that PCTs should no longer deliver services and should separate their delivery arm from their commissioning function with delivery being provided under contract to the PCT by other bodies such as Social Enterprises or Foundation Trusts” (p5) “… for the ﬁrst time, that the health sector will be subject to competition law under planned changes in the legislation. The role of Monitor, which currently regulates Foundation Trusts, will change and it will become the regulator of the NHS, including having responsibility for applying competition law and acting against anti-competitive behaviour by providers or commissioners” (p27)

When NHS campaigners say that it was Labour who laid the groundwork for the recent rise of competition and privatisation in the NHS, this is a key part of what they are referring to. The transfer of Gloucestershire’s community health services took place before the passage of the Health & Social Care Act, under legislation and guidance issued by the Labour Party.

However, in Gloucestershire there was a successful fight-back (youtube playlist of campaign videos). Elsewhere, consultations were conducted with workers on the question of moves from the NHS into a social enterprise and roundly rejected. In Gloucestershire there was no such consultation until it was forced upon NHS bosses by legal action (finding 96% of staff and 91% of the public respondents wanted services to stay in the NHS). The Gloucestershire legal action was not based on the lack of a consultation, however.

Instead, the court case, taken by then 76-year old Stroud- resident Michael Lloyd, supported by Leigh Day and Co solicitors and David Locke QC, focused on EU procurement law. I attended court to watch David Locke QC make his case, and gave press interviews when the case collapsed as NHS Gloucestershire reached an out of court settlement. As David Locke QC explained immediately after the case:

“the real lesson from the case is that there is almost certainly a stage for NHS bodies to consider before they decide if they want to undertake a tender process. PCTs are (almost certainly) entitled to conclude arrangements with an NHS trust to deliver services without a tender because such a process is arguably entirely outside EU procurement law. The Secretary of State controls both bodies and these arrangements do not give rise to legally binding contracts, and so there is no “contract” on which the procurement process can bite. There are accordingly strong arguments that it is perfectly lawful for a PCT to make an arrangement with a local NHS Trust for the delivery of NHS services without a tender, and without procurement obligations impacting on the process. This is the first step that the PCT agreed to explore as part of the settlement in the Lloyd case.”

Since the passage of the Health & Social Care Act 2012 the position has changed: the 2013 'section 75 regulations' push tendering, competition, privatisation. The Efford Bill appears to attempt to bring us back to a situation like that pre-2012, where commissioners and providers could conclude arrangements to deliver NHS services without a tender, outside EU procurement law – where such arrangements were with NHS bodies (as eventually happened in Gloucestershire).

My question is whether the Efford Bill alters that prior situation in order to extend this exemption to non-NHS bodies, such as so-called ‘social enterprises’, ‘mutuals’, or indeed other private companies.

It is worth returning to the Gloucestershire case, and again David Locke QC explains the situation concisely:

“Gloucestershire PCT decided to separate its community services from its commissioning function in accordance with Transforming Community Services policy which commenced under the last [Labour] government and was continued under the present [Coalition] government. The PCT Board's favoured model was the creation of a Community Interest Company (“CIC”) to take over the services. This proposal received, at best, a lukewarm reaction from the staff because it would mean that they ceased to be NHS employees. Nonetheless the PCT pressed ahead with the proposal and prepared to enter into a contract with the CIC to a value of approximately £80 million per year.

Mr Lloyd challenged the lawfulness of the decision to enter into a contract with a company outside the NHS without any competitive process. He wanted other NHS organisations to be given the opportunity of expressing an interest in the provision of the services so that the services would remain provided by NHS staff. He also pointed out that the decision to create the CIC would result in a substantial VAT liability, owing by the CIC to HMRC, of around £1 million per year which would denude the resources available to fund services. Finally he was concerned that staff joining the CIC would not be entitled to be members of the NHS pension scheme and that accordingly, in the competition for the best staff, the CIC would be in a significantly worse position. The essential issues in the case were whether an NHS organisation could enter into a contract with a CIC without a competitive process.”

As the above begins to hint, ‘Mutuals’ and ‘social enterprises’ delivering NHS services, despite sounding fluffy and attractive to those disinclined to support the state or centralisation, amount to privatisation and are bad news.

Labour's vision - no longer that of Aneurin Bevan

It is unclear whether Labour still value the ‘Right to Request’ (which saw managers, rather than staff, ‘requesting’ their organisation leave the public sector). Does the Labour Party still value the Transforming Community Services policy? Do they still think ‘social enterprises’, ‘mutuals’ and other private companies are effective ways to deliver public services in some instances? The Labour Party's railways policy provides a hint at an answer. A further hint is provided by the lack of noisy opposition to Francis Maude’s proposals to ‘mutualise’ hospitals (‘technically privatisation’ according to the man himself, and beginning to take effect now). But the clearest indication is given by Labour’s most prominent health ministers, Liz Kendall MP and Andy Burnham MP, and by chair of Labour’s policy review, Jon Cruddas. In October 2013 Civitas published a blog on these issues which reported:

“At a Progress event on public services in April, Labour’s Shadow Care Minister Liz Kendall spoke positively about mutuals and social enterprises in the NHS, describing them as “where Labour came from” in reference to the Labour movement’s early civil society origins. Shadow Secretary Andy Burnham once argued that while he supported the establishment of the theoretically cooperative-run Foundation Trusts, “too many trusts paid lip service to true community involvement”, a sentiment [Liberal Democrat Care Minister Norman] Lamb has perhaps echoed by mooting fully mutualised FTs. Moreover, in a speech yesterday to Civitas, Labour policy review chair Jon Cruddas pledged to “devolve power to encourage and free local and combined authorities to innovate [and] reform public services”.

In his September 2014 Labour Conference speech, Andy Burnham said “the NHS won’t be able to do it all”. What did he mean? In March 2014 Burnham gave a keynote speech to the Association of Chief Executives of Voluntary Organisations (ACEVO), saying: ‘The demands of the 21st century mean that the NHS will not succeed if it tries to go it alone. … In the voluntary sector, it has a partner that shares its people-not-profits ethos.’

Back in 2010, the Chief Executive of ACEVO blogged proudly that his organisation had:

“achieved a neutering of Burnham's "preferred provider" policy. Guidance for commissioners published today makes clear that competition has won the day over discrimination against third sector providers.”

Do you remember Sir Stephen Bubb? You should do. From March 2011 to June 2011 Bubb was seconded to the Department of Health, as part of the team leading Andrew Lansley's National Health Service (NHS) "listening exercise". ACEVO will shortly publish their Manifesto for the next election, with Sir Bubb seemingly pleased with Labour’s current “preferred provider” policy. I’m sure he is a very busy lobbyist at the moment.

Insufficiently scary? Try this from Frank Field (via Labour Uncut):

“Welfare and health bills will increase. Taxpayers are rightly wary of government taking even more of their earnings and spending the results as it wishes. Hence the need for a new tax contract… establishing a NHS mutual. The mutual would … introduce what is clearly lacking at the moment, namely, a clear link between services provided and level of contributions required"

Jonathan Todd, Deputy Editor of Labour Uncut, seems enthusiastic:

"Could Field facilitate a grand bargain between Balls and Burnham? Could Burnham have his health and social care integration if Balls’ demand for affordability is secured by Field’s NHS mutualisation?

Such a grand bargain on this policy specific is illustrative of that which might be made more generally. It achieves the bigness and boldness of health and social care integration, while retaining the fiscal credibility prized by those who wish to “shrink the offer”.

I'm frankly baffled by this. The contributory principle is a pretty stupid way of looking at a social security/welfare system that should be universal, but when you attempt to introduce it to the NHS it makes no sense whatsoever. How does an unborn foetus "contribute financially" to support the midwives that will bring it into the world? Will a 5-year-old who breaks his arm learning to ride a bike be denied an NHS plaster cast because they haven't built up enough National Insurance payments?

By now I hope you're wondering what Clive Efford MP thinks of the contributory principle. Wonder no more:

.@KarenBuckMP says "people coming to live in the UK must contribute before they can access to Jobseekers' benefits" http://t.co/VRX2AKxwrQ

— Clive Efford (@CliveEfford)

November 19, 2014

All this, of course, is a long way from Bevan, who wrote of the mutual societies and voluntary organisations that existed before the NHS in In Place of Fear: “Without rational planning … we are left with a patchwork quilt of local paternalisms”

Extra Extra

There is much much more to say about the Efford Bill. One additional issue left untouched is the pressure for all NHS Trusts to become Foundation Trusts (not to mention the existence of these quas-private organisations) and the failure to specify a lower than 49% cap on the income such Trusts can earn from private. Another issue to explore is the question over the extent to which allowing non-NHS contracts to continue would entail the application of EU procurement law. Another blog, another day.

#nhs #backthebill #ournhs #saveournhs #savethenhs #Labour #ukpolitics #NHSbill2015 #privatisation #socent

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peter-pannier · 10 years ago

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Healthy Scepticism: thoughts on Andy Burnham's #lab14 speech, Labour and the NHS

Labour are going to make the 2015 General Election as much about the NHS as they can. They say they intend to make the election effectively a referendum on which party should manage the NHS, even a 'Day of Reckoning'.

Retweet if u agree with Andy Burnham that Election Day will be a day of reckoning for Cameron for privatising our NHS pic.twitter.com/s2xa03Y2wQ

— Dr Éoin Clarke (@LabourEoin)

September 24, 2014

As is obvious from the above tweet, one reason for this is it enables them to connect with their base and soft supporters far better than Ed Ball's economic policy of a "root and branch review of every pound the government spends from the bottom up" aka austerity-max.

I'll leave it to others to critique Labour's austerity economics, but it is worth raising them early, as they do of course have implications for the party's NHS policy. Here, I offer a strong dose of scepticism to anyone inclined to listen to Labour's words on the NHS.

Until recently, Labour have been criticised for not really having any policies. A criticism that retains some validity. But Andy Burnham's speech to the 2014 Labour Party Conference (#lab14) does flesh out a few things, so it's worth dissecting.

The speech begins with Burnham requesting delegates to "please show your appreciation for the Darlo mums and the People’s March for the NHS". Burnham has been attempting to align himself with the extra-parliamentary movement to defend the NHS for some time. I'll note two examples here - first, I reacted grumpily to the way he presented the campaign to Save Lewisham Hospital. That campaign was dealing with problems arising from PFI contracts expanded massively under the previously Labour government, of which Burnham was not only a part but at one point Health Minister. At no point, to my knowledge, has Burnham apologised for the past government's obsession with PFI, the best he could do being to describe the £300bn+ cost as 'poor value for money'.

Closer to my personal experience, Andy Burham and Diane Abbott were invited by my local Labour Party to join a public meeting Stroud Against the Cuts had organised in the aftermath of a settlement in the High Court. The settlement was between a local patient and Gloucestershire PCT (precursor of CCGs) and it proved to be crucial in our ultimately successful campaign to stop Gloucestershire Community health services being privatised - giving us the staff and public consultation that had previously been avoided - and the time to mobilise a preference of 91% of the public and 96% of staff to remain in the NHS). No doubt Burnham wanted to turn up at what at a point could be mistaken for being the end of the campaign and soak up some positive vibes for the Labour Party, at at time when the Health & Social Care Act was going through parliament, as he was later to do with the Lewisham campaign (in neither case did he stick around when it became clear it wasn't the end of the campaign).

The trouble was, the privatisation of local NHS services we were fighting was the result of policy introduced as part of the previous Labour government's privatisation of the NHS (specifically, the 'right to request' transfer of services to social enterprise - which was a) nothing but 'friendlier' privatisation through 'social enterprises' and b) routinely abused by management, resulting in what were effectively management buy-outs, rather than the 'staff takeovers' the rhetoric implied. More on this later)

As a result, a fraught SATC meeting left local Labour Party members frustrated at the attitude of others to Mr Burnham, who cancelled (it was claimed he was busy working on opposition to the H&SC Act, but it is widely assumed he was warned of a negative reception and stayed away). The local parliamentary candidate and Chair of the local Constituency Labour Party, left SATC following the public meeting, citing the attention on the non-appearance of Mr Burnham and the possible reasons for this as their reasons for leaving (it was probably more to do with the obvious drift of the Labour Party away from an anti-austerity position).

Why does this anecdote matter? Well, for all that the Labour Party is banging on about how they are bravely standing up to fight for the NHS, they certainly pick and choose the battles they want to join (or, less charitably, they're interested in co-option for their own ends).

I'm also convinced that the Labour Party's policy on privatisation/competition within the NHS remains not dissimilar to that under the previous Labour government - ie, there will be some, though it will often be dressed up as 'social enterprise' or 'mutual' or 'staff-led'.

Let's have a look at what Burnham says in the speech to indicate this:

"People look to Labour to change these things and that is what we will do. You know the Tories will never do it. They put profits before people - always - it’s in their DNA.

Their answer is to let the market that has ripped through social care carry on ripping through the NHS.

Conference, we will do the precise opposite.

I am clearer about this than anything in my life - the market is not the answer to 21st century health and care."

So - Burnham sets up the Tories as privatisers par excellence (which is basically fair) and then claims Labour are the opposite. The last part of his quote is, to anyone with either an understanding of health as a public good or an anti-capitalist approach, a welcome statement:

"the market is not the answer to 21st century health and care."

It's troubling then, that 5 sentences later, Burnham is spelling out what the Labour Party policy actually is:

"We will ask hospitals to collaborate once again and reinstate the NHS as our preferred provider."

Look at these words carefully. First, "ask"-ing hospitals to collaborate is different to "enabling" this. More importantly, a "preferred provider" implies continuing the system of commissioning (competition between different providers to be selected to provide services, through winning eg. 5-year contracts), and in turn a commitment to retain the fragmented, marketised system we in the UK now have (thanks to both the current govt and the previous Labour one).

This is not surprising. It's what Burnham has been saying for some time, and plenty of people have been calling him out on it. Indeed, he was heckled just before the conference on this very issue.

You may also notice a similarity with other Labour Party policies - "An incomprehensible policy on our fragmented, rip-off, publicly subsidised privatised railway is offered, even though a clear-cut commitment to renationalisation is backed by a large majority" (as Owen Jones has it). Their education policy, as I noted last year, is similar too. "The comprehensive ideal, within a mixed economy of schools", said Stephen Twigg, then Shadow Education Minister. "There will be no bias for or against a school type"... "A school should not have to change its status to earn the permission to innovate…if a freedom is afforded to an academy and it drives up standards, that freedom should be available to all schools"..."Academies can choose to buy in tailored support that better meets their needs, so should maintained schools…We’ll give all schools, not just some, the option to shop around"..."I pay tribute to the excellent work of many chains, like ARK and United Learning".

Burnham might not be saying things quite so explicitly, perhaps because he's smarter, but probably just because it would be spotted by Labour's core support as unacceptable in a way that isn't quite as true for education, and (adopting the very charitable view those on the Labour Left take) because he may disagree with these elements of the policy himself. But the implication of the preferred provider policy is that Labour will continue to treat the market as part of the answer to 21st century health and social care.

My hunch is that the preferred provider policy is also loose and that, as with rail, Labour will make 'social enterprises' and 'mutuals' preferred providers, as well as publicly owned NHS Trusts (to be fair, by 2015, most NHS Trusts will be Foundation Trusts / 'Mutuals', which are effectively private companies anyway). Why do I suspect this? Because they've said next to nothing about the utter sham that is Francis Maude's plan to mutualise the NHS, and because they say they will "legislate to make private and third sector providers subject to the Freedom Of Information Act". While it's good to do this, I suspect it implies less opposition to those private and 'third sector' providers currently delivering NHS services (it's worth stating unequivocally here to a naive anarchists, that 'mutualising the NHS' is not a great working class gain even if it superficially looks a bit like 'anarcho-sydicalisation of the NHS'. While were living within capitalism, taking apart the welfare state just makes it harder for us all to survive - harder for us to undertake activity).

Finally on the preferred provider policy, and as the Tory Health twitter account wasted no time in pointing out, Burnham's preferred provider policy is probably illegal:

Official guidance issued by the Labour govt to NHS commissioners stated that Burnham’s preferred provider policy was illegal. What’s changed

— ToryHealth (@Toryhealth)

September 24, 2014

This of course gives any future Labour government a handy post-election get out clause. EU competition law prevents services where commissioning takes place from favouring particular companies. It was by utilising this that SATC was able to stop Gloucestershire PCT handing Gloucestershire's community health services to it's 'preferred provider', a 'social enterprise'. There hadn't been a tender. There - at that point at least - was only one way to hand services to a chosen provider without a tender and that was to give them to an NHS Trust (a process at that time exempted from competition law because of health's status as a public good, essentially. The H&SC Act has changed this).

The Labour Party is not offering renationalisation of the NHS, despite the impression it is attempting to give to supporters and activists.

This is as true of funding/cuts as it is of privatisation. Miliband made much out of finding £2.5bn for the NHS from a Mansion Tax and a Tobacco levy, but a) the details are unclear (whether this is a one-off or annual increase), b) it's not the sensible option of using higher income taxes for higher earners and c) it's not actually that much money (like Miliband's derisory £8/ph National Minimum Wage policy).

[I'll hyperlink the following up a little, but basically, health spending as a proportion of GDP is well below what it is in other countries in the UK. This is partly because the NHS is more efficient than other, more marketised/privatised systems - achieving the same or better outcomes for less money - but partly because it has been massively underfunded for decades. While the Tories crow about increasing NHS spending since 2010, it has basically flatlined - they're increasing it just enough to claim it's rising - and is falling per person, as a percentage of GDP, and - particularly when combined with the social care budget (which is s sensible way to look at things because people not treated by social care end up being treated by the NHS) is unable to cope with demand. What Labour is offering is insufficient to meet the ~£30-60bn gap that's been identified. Sometimes this gap is exaggerated to make the case for payments - beloved of both the Kings Fund and Reform, for example,, but it's certainly bigger than Miliband's £2.5bn]

Speaking of the links between health and social care, let's come to what Burnham considers his key task as future Health Minister:

"Just as Nye Bevan wrote to every household to introduce his new NHS, so I will write again in 2015 to explain what people can expect from our national health and care service."

Many people might consider it arrogant to try to align yourself so blatantly with Nye Bevan (who actually had some rarely publicised views on housing crises not dissimilar to Newham's shitweasel Mayor Robin Wales and his fellow councillors), but Burnham knows this will go down well with Labour's core vote. And to most people, it sounds great. It's been dissected well elsewhere, however. The key issues are:

1) You know how they means-test access to social care? Not something we want in the NHS, is it?

2) ‘Merging two bankrupt outfits – the NHS and social care – will not magic up one solvent service.’ (as even Polly Toynbee is capable of noticing)

3) There's loads of guff about people being treated 'at home' or 'in the community' which is really just coded language for 'we can save money by closing hospitals'. This gets dressed up as being very modern (hospitals being very 20th century, dontchaknow) but is basically a load of fatuous bollocks designed to appeal to private companies who like avoiding the expense of buildings and prefer you to work from your car (externalisation of costs, basically). There's no reason why we can't maximise the benefits of a network of hospitals in a thoroughly 'modern' way, given sufficient funding. This guff often overlaps even more fatuous bollocks about extending 'choice' by giving people 'Personal Health Budgets' or, as Thatcher had it, 'vouchers', so you have to do all the work of deciding how your healthcare should be delivered (more externalisation of costs) and conveniently can also be blamed for not spending your vouchers on the right types of healthcare. Personal Health Budgets also rather conveniently make it easier to cut budgets without people noticing, and with fewer opportunities for collective action by either patients or workers. At it's extreme, the two piece of fatuous bollocks combine to create policy so utterly idiotic the swearwords necessary to introduce it just don't exist, like Essex Council's 'Treat your own Dementia'.

The best bit of Andy Burnham's speech, for me, is the bit where he says:

"will we have mental health nurses and therapists at the heart of this team, no longer the poor relation on the fringes of the system but making parity a reality."

Anyone who has experienced mental health provision will know how desperately this is needed. Even those with relatively minor issues face interminable delays, limited options (a heavy preference for drugs - which are easy, or CBT - which is cheap), and a woeful lack of provision (the services are underfunded, fragmented, and suffering from the privatisation and marketisation that has occurred already, basically - we should demand more, but I think these things can be done better within the NHS framework than by expanding privatisation).

HOWEVER, as it stands "The only 'parity' for mental health is that it is being cut and privatised as well". Based on the above comments regarding Labour's actual policies on funding and privatisation, I'm not inclined to give them the benefit of the doubt.

The worst bit of Andy Burnham's speech is probably his failure to mention the Transatlantic Trade and Investment Treaty. Well, that or his failure to apologise for PFI and make clear they'll be none of it in the future. Perhaps he just "forgot to mention it", eh? More likely that's because Labour don't have a decent policy on TTIP, and are bound to use PFI (or variants of it like Social Impact Bonds) to keep borrowing off central government books again.

Running these sins of omission a close second is this sin of comission:

"But, with the best will in the world, the NHS won’t be able to do it all."

This, I'm sure, is coded language for "all that stuff I said about a National Health & Care Service. Doesn't mean what you think it does. I reserve the right to ration and exclude in accordance with what Mr Balls will let me pay for. Which is not much"

There are two more quotes I want to mention from Burnham's speech:

"Help the party that founded the NHS give it a new beginning."

The Labour Party will make hay with this slogan, and they have some excuse. But this version of events neglects to mention the fact that Nye Bevan resigned over the Labour Party's 1951 decision to limit free prescriptions and spend the money on war instead (his resignation speech is well worth a read. It includes the suggestion to "Take economic planning away from the Treasury. They know nothing about it").(1) Here's the key quote from Bevan:

"The Chancellor of the Exchequer in this year’s Budget proposes to reduce the Health expenditure by £13 million—only £13 million out of £4,000 million... If he finds it necessary to mutilate, or begin to mutilate, the Health Services for £13 million out of £4,000 million, what will he do next year? Or are you next year going to take your stand on the upper denture? The lower half apparently does not matter, but the top half is sacrosanct. Is that right? ...

The Chancellor of the Exchequer is putting a financial ceiling on the Health Service. With rising prices the Health Service is squeezed between that artificial figure and rising prices. What is to be squeezed out next year? Is it the upper half? When that has been squeezed out and the same principle holds good, what do you squeeze out the year after? Prescriptions? Hospital charges? Where do you stop? ... The Health Service will be like Lavinia—all the limbs cut off and eventually her tongue cut out, too."

I don't doubt that Bevan would like to be making the same speech today. I suspect that were he elected as a backbench MP for Labour in 2015, he'd be saying much the same thing in 2016.

Burnham closes his speech with a rousing section to inspire the Labour faithful. It includes the following:

"Make no mistake - this coming election is a battle for the soul of the NHS. The fight of our lives."

I agree with Burnham that defending the NHS is (one of) the fight(s) of our lives. I agree that the coming general election will feature it as a key issue - hence giving us an opportunity to intervene in this debate. I do not believe that voting Labour, still less campaigning for them on the basis of their NHS policies, is the best way to defend the NHS. Indeed, supporting Labour is not only a misdirection of effort, but a tacit approval of their shitty offer (it will only encourage them to think they can get away with even more egregious bullshit). There are plenty of alternatives - you might pick another party (the Green Party and National Health Action Party certainly have better policies on the NHS) - or you might choose to support the upcoming strike action by 500,000 NHS workers (not mutually exclusive, obviously).

Personally, I consider the NHS a key concession that followed collective action and class struggle undertaken in the first half of the 20th Century (though it should also be seen as part of a range of reforms motivated more by the desire to keep workers healthy enough to maintain capitalist profitability). Though the NHS is now a shadow of what was an imperfect system even when it was founded (from an anarcho-syndicalist point of view), it remains worth defending. It is collective action and class struggle that will be most effective in defending it. I am opposed to working through political parties not only as a matter of 'ends', but because I believe that even in the most pragmatic sense, a more effective 'means' to pressure the parties of government is determined action which terrifies them from outside, rather than pleading for compromises on the inside.

Please support the upcoming strikes for pay increases. If you want to do more, assist health workers in acting collectively across union and workplace boundaries and with patients and other members of the public. Time your use of different campaigning tools (including the use legal cases where it buys you time to organise) is, to my mind, better than restricting yourself dogmatically to particular forms of action. More important still is designing campaigns to leave room to escalate. This is how I believe we can defend the NHS. It's also how I believe we can build a basis on which to demand provision of health and care on the basis of need, not profit. Both things, I think, will contribute to our ability to prefigure a future society that enables us to live the longest and highest quality lives possible.

Footnotes:

1) Anyone with a genuine interest in the record of the halcyon 1945-51 Labour Government (and certainly those with either a a healthy scepticism or Loach-level of enthusiasm) really ought to read "How Labour Governed 1945-51" (link is to a pdf) - a pamphlet produced by an earlier incarnation of the Solidarity Federation.

#nhs #labour #labourparty #lab14

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peter-pannier · 11 years ago

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(Don't) Join a Political Party!

Or: Stop joining political parties and do something more useful instead.

This is an archive of some quick thoughts on twitter in response to an article I found interesting but nonetheless disagreed with, which also functions as another test of Tweetdeck's 'custom timelines' feature. I intend to write these thoughts up (along with others on the broader appeal to engage with various aspects of the current UK political system; from voting in elections to participating in Healthwatch groups) soon. Please reply to tweets/tweet me peterpannier if you have thoughts, so when I do get around to writing something it is as good as can be... (I'll embed tweets I find useful, or reference them somehow)

(Don't) Join A Pol Party

// <![CDATA[ !function(d,s,id){var js,fjs=d.getElementsByTagName(s)[0],p=/^http:/.test(d.location)?'http':'https';if(!d.getElementById(id)){js=d.createElement(s);js.id=id;js.src=p+"://platform.twitter.com/widgets.js";fjs.parentNode.insertBefore(js,fjs);}}(document,"script","twitter-wjs"); // ]]>

(readers may also be interested in: Vote Labour in 2015: Going Forward with Tough Decisions in Performance Management)

#political parties #organisation #2015 Elections #community organising

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peter-pannier · 11 years ago

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"Why does no-one protest anymore?"

I'm utterly sick of hearing this question of variations of it, so I put a few thoughts and references out on twitter. People seemed to have appreciate them, there were a fair few RTs and favourites, and Terry Christian of all people suggested I turn it into a blog. Which I will do properly as soon as possible (which may be some time, sadly).

In the meantime, the wonderful latentexistence has done a grand job in putting the tweets together in an easily to embed form, and introduced me to the idea of twitter 'timelines' in the process:

Why don't people protest?

The missing Answer 13 is

A bigger answer to this Q is about whether/how/in what form(s) 'protest' can impinge on C21st capitalism+the authoritarianism it relies upon

— Peter Pannier (@PeterPannier)

November 15, 2013

#protest #acab

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peter-pannier · 11 years ago

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Profit maximisation and profit dependency

"profit maximisation is not the priority of the Savings Banks; yet they are entirely dependent on profit to support their balance sheets, raise equity and thus provide the necessary loan funds for their local community."

This is as good an example as any of the way in which certain people are trying to posit "profit maximisation" rather than "profit" alone as a problem. It makes very little sense to do so, as is - to my mind - evident in the above quotation.

(this was inspired by a tweet from Blue Labour, by the way. The quote is from (page 20 of) the 2013 Civitas report: "The German Sparkassen (Savings Banks): A commentary and case study", written by Christopher Simpson, managing Director of Simpson Associates, an international engineering consultancy they cited to defend it)

@PeterPannier a lot of birds to kill with 1 stone! Poor lending decisions - driven by profit maximisation but German local banks are not.

�� Blue Labour (@blue_labour) October 23, 2013

#profit #Blue Labour

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peter-pannier · 11 years ago

Photo

Photos of the tree-sit protest at the Abercairn development, Belle Vue Rd., Stroud, Gloucestershire, UK - taken by several anonymous protestors.

The tree-sit is over, the ~100 year-old apple tree felled, following 3 arrests (2 for 'breach of the peace' de-arrested immediately after the tree felled) on 09/10/2013.

The battle against Walsh Homes, and the war against destructive development, continue.

#abercairn stroud gloucestershire directaction trees

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peter-pannier · 11 years ago

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Walsh Homes:

Life becomes capital.

Community becomes empty speculation

Mr Walsh's first name is Gerrard.

Winstanley is spinning in his grave, perhaps preparing to arise?

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peter-pannier · 11 years ago

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If we are to discuss alternatives to capitalism, we must define what 'capitalism' refers to

In which I try to respond thoughtfully rather than with angry frustration to the failure to define capitalism in this piece which asks the question "Can co-operatives provide an alternative to capitalism?" (it is all about this Ethical Consumer project, which is culminating in a conference and book launch under the same name.

I intended to enter the essay prize, but felt I didn't have the energy, knowledge or hours in the day to write something at the time. Having read a few entries and seen the coverage-and announcement of a book-I wish I had. Perhaps articles I have not read deal appropriately with the question of what capitalism actually is before discussing alternatives, but I am yet to see evidence for this.

In preparation for a full length blog, here are some tweets I sent out as a first draft yesterday. Before those, here are a couple from the ever enlightening Joseph Kay:

If mode of production is to be used as a general abstraction, i.e. one applicable across the epochs it seeks to periodise, it needs to be

— Joseph (@JosephKay76)

September 12, 2013

broader than property relations alone. It's only in capitalism that property and kinship, politics and economics have really separated out.

— Joseph (@JosephKay76)

September 12, 2013

So a rich conception of the mode of production needs to include social reproduction.

— Joseph (@JosephKay76)

September 12, 2013

Maybe mode of production = social property relations + kinship relations + relations of domination/politics + forms of technology

— Joseph (@JosephKay76)

September 12, 2013

Or maybe Graeber's general abstractions are useful here: hierarchy, exchange and baseline communism (i.e. mutual aid).

— Joseph (@JosephKay76)

September 12, 2013

A mode of production would be a specific, relatively stable configuration of hierarchy, exchange and mutual aid. Too vague?

— Joseph (@JosephKay76)

September 12, 2013

Capitalism: political state with formal equality, theoretically non-hereditary class hierarchy; generalised commodity exchange;

— Joseph (@JosephKay76)

September 12, 2013

mutual aid organised capitalistically and patriarchally. Feudalism: hierarchic relations of vassalage, hereditary class hierarchy;

— Joseph (@JosephKay76)

September 12, 2013

non-market exchange (tithes, tributes) and localised markets; mutual aid operating at level of village economy.

— Joseph (@JosephKay76)

September 12, 2013

Hunter gatherers: varies but hierarchies of status/presteige; customary exchange of goods and women between extended kin groups;

— Joseph (@JosephKay76)

September 12, 2013

mutual aid/communism as dominant within groups.

— Joseph (@JosephKay76)

September 12, 2013

Kay concludes by saying "I think I am more Marxist than Graeberist". I think I am potentially more Graeberist, but I'd need to finish 'Debt: the first 5000 years' and read a lot more of Marx(ist)'s stuff on modes of production, in the original, to be sure. For now, I like the sound of Graeber's emphasis on mutual aid as being present, but differently organised, under all modes of production. That seems to chime, for me, with the evidence in Kropotkin's 'Mutual Aid: a factor of evolution', and the bits of Graeber and Marx that I have read on similar anthropological evidence. Nonetheless, my own thoughts on capitalism, as presented on twitter, were less directly grounded in any intellectual author or academic perspective and were more off-the-top-of-my-head initial reactions - the influence of others is there, but is unattributed(/able) and subconscious. So, my thoughts. First, on what capitalism is:

I find disappointingly large amount of stuff I see on"alternative to capitalism"is actually "alternative to bits of capitalism I like least"

— Peter Pannier (@PeterPannier)

September 17, 2013

How could we define capitalism when discussing alternatives to it? How do I define it. Here comes a series of tweets:

— Peter Pannier (@PeterPannier)

September 17, 2013

1st:capitalism's an economic system.Even this insuff,cos its also a political/cultural/social(etc)system.But it prioritises the economic, so

— Peter Pannier (@PeterPannier)

September 17, 2013

2nd: capitalism followed (and to some extent incorporates or fails to replace) other economic (/political/cultural/social) systems

— Peter Pannier (@PeterPannier)

September 17, 2013

3rd: to suggest capitalism is merely"the economic system we live under now" is insufficient. it has partic features,as did preceding systems

— Peter Pannier (@PeterPannier)

September 17, 2013

So far, so preamble. What are those features? Starting with the most obvious

— Peter Pannier (@PeterPannier)

September 17, 2013

4th: Private ownership.Goods, services, the end-products of human labour/environmental processes have been(/are) owned differently elsewhere

— Peter Pannier (@PeterPannier)

September 17, 2013

5th: Profit. A driving force for production under capitalism, rather than other goals, which have/do prevail(ed) elsewhere in time+space

— Peter Pannier (@PeterPannier)

September 17, 2013

6th: Exchange via market and price mechanism. connecting previous 2. Private ownership + profit as driver entails monetary valuation+market

— Peter Pannier (@PeterPannier)

September 17, 2013

(again, exchange via the market and price mechanism are special in time and space. They are not immutable features of economic systems)

— Peter Pannier (@PeterPannier)

September 17, 2013

7th: Wage Labour. Rather than holding onto things produced/receiving remuneration/reward in kind/indirectly,monetary payment per time period

— Peter Pannier (@PeterPannier)

September 17, 2013

8th: Capital Accumulation. This is both a longer term version of profit (goal to make more £) + crucial to reproduction of capitalism

— Peter Pannier (@PeterPannier)

September 17, 2013

8 is trickier to explain in a tweet.Basically: in order to keep producing for profit,in markets,etc investments need to be made-from profits

— Peter Pannier (@PeterPannier)

September 17, 2013

So, in those 8 points are 5 important features of capitalism. Most so-called "alternatives" (co-operatives especially) challenge 1, at most.

— Peter Pannier (@PeterPannier)

September 17, 2013

Of those 5 features, I think Co-operatives only really challenge private ownership, replacing it where they can with a form of collective ownership. Some also replace wage labour with degrees of payment in kind, and profit-sharing (especially worker co-ops). But neither of these constitute full alternatives to capitalism, at least until a bunch of co-ops set up a network in which to share goods and services via non-monetary, non-market exchange, and organise labour on the basis of community/societal democratic decision-making rather than the labour market and production in accordance with the whims of competitive markets. By which point this starts looking less like co-operatives as we know them today, and more like a form of anarcho-syndicalism. Which is not to say that the two do/could not shade into one another. I'll post my thoughts on the current strength/prospects of each of the above 5 features, and more on what post-capitalism or 'alternatives to capitalism' might look like if we were to define capitalism in this way, later.

As ever, comment and critique and suggestions for further reading are warmly welcomed. Part of the reason for posting via twitter first, and embedding tweets here rather than copy pasting text - is to enable you, dear reader, to respond to the specific elements you find interesting / share the parts you like (which, to me, is an example of the kind of mutual aid relationships a positive post-capitist sociopolitical economic system would be characterised by).

Now, how much of this can I fit in my Doctorate?

#capitalism #co-operative

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peter-pannier · 11 years ago

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The idea that socialism is synonymous with the nationalization of the means of production plus planning - and that its essential aim is merely an increase of production and consumption - must be pitilessly denounced. The identity of these views with the fundamental objectives of capitalism itself must constantly be shown. Socialism means workers’ management of production and of society. It means popular self-administration through workers’ councils.

Paul Cardan (Cornelius Castoriadis), Modern capitalism and revolution (via probablyasocialecologist)

"workers' councils" is too prescriptive, and I'd use a less workerist phrase ("self-administration through direct democracy"), but otherwise yes.

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peter-pannier · 11 years ago

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Today a "Wealth Manager" posed the following question on twitter:

Purnell in top job at BBC. Newsnight Ed from Guardian. Political Ed - Observer. Flanders. Mason. Just me who sees BBC run by #Marxists?

— Jonathan Davis (@JDWealthManager)

September 10, 2013

Let's just take a look at those people.

James Purnell: In December 2008, Purnell proposed charging up to 26.8% per annum interest on the interest-free crisis loans to the unemployed and pensioners made by the DWP.

Flanders. Worked as a speechwriter for US Secretary of the Treasury Lawrence Summers. A man who was on Reagan's Council of Economic Advisors. Clearly a Marxist.

Mason - no longer at the BBC, moved to Channel 4.

Not content, when challenged he continued:

@PeterPannier Patten is a EUcentric, one world govt Marxist. Robinson and Davies? That's a laugh.

— Jonathan Davis (@JDWealthManager)

September 11, 2013

Chris Patten, Chair of the BBC Trust, was previously Conservative party chairman. He is credited with orchestrating the Conservatives' electoral victory in 199 (though he lost his seat as a Tory MP, arguably - like others at the time - because of his role in the poll tax, that famously Marxist policy initiative).

Nick Robinson was President of the Conservative Association at the University of Oxford, and then of the national President of the Conservative Party youth group. He was "not ashamed" to grab, stamp and throw a "Cut the War not the Poor" sign belonging to a protestor live on TV. Clearly a Marxist.

Evan Davies worked, like Chris Patten, on the 'Community Charge' (Poll Tax), though in his case through the think-tank that promoted the idea, the Institute for Fiscal Studies. He wrote a book, Public Spending, published in 1998, which calls for privatisation of UK public services. Clearly a Marxist.

All eerily reminiscent of the below. Have some people been reading it as fact? It is all too easy to believe, I suppose:

Wealth Management

EXCLUSIVE - ROBERT PESTON AND EVAN DAVIS FOUND TO BE MEMBERS OF ‘ACCELERATIONIST' ANARCHIST FEDERATION SLEEPER CELL AT HEART OF BBC

(Accelerationism) … refers to the idea that capitalist processes should not be resisted but accelerated and that capitalism is both the most destructive and productive moment in history at the same time. Draws from Deleuze’s and Guattari’s conception of capitalism as unleashing massive processes of decoding and deterritorialization (productive), but simultaneously blocking these same forces with immediate compensatory recoding and reterritorialization (destructive). Subsequently accelerationists believe that the proper form of resistance is not withdrawal or a sought ‘exit’ from capitalism, but rather accelerating capitalistic decoding and deterritorialization in order to turn them against themselves. As this quotation from Anti-Oedipus suggests: '….But which is the revolutionary path? Is there one? – To withdraw from the world market, as Samir Amin advises Third World Countries to do, in a curious revival of the fascist “economic solution”? Or might it be to go in the opposite direction? To go further still, that is, in the movement of the market, of decoding and deterritorialization? For perhaps the flows are not yet deterritorialized enough, not decoded enough, from the viewpoint of a theory and practice of a highly schizophrenic character. Not to withdraw from the process, but to go further, to “accelerate the process,” as Nietzsche put it: in this matter, the truth is that we haven’t seen anything yet.

Accelerationism is a strategy that has been hitherto only adopted (rather unsuccessfully) by those at ‘Spiked’ under the guise of Brendan O’Neill. It seems however that elements within the anarchist left may have taken the strategy to another level in an exclusive that will shake the much venerated British Broadcasting Corporation (BBC) to its very core.

While details remain sketchy it now seems clear that the ‘AFED’ (Anarchist Federation) have maintained a sizeable ‘sleeper cell’ within the BBC for the best part of the last decade. This cell was operationalized, not in order to actively sabotage the organisation in the traditional sense but in the hope that agents could actively facilitate an accelerationist strategy.

PESTON - in what seems like a precision-engineered plan Peston catalysed the run on Northern Rock and precipitated its demise and consequent nationalisation. In the words of Mervyn King, ‘the actions of one arse have brought this crisis six months forward’. Except Peston was no arse - this was the greatest AFED action yet - a run on a bank started by a single individual and the hijacking of a whole national media network by one haugty anarchist infiltrator. The years of handing out AFEDs publication ‘Catalyst’ suddenly seemed ridiculous, ‘This is how industrial sabotge operates in the Network Society’, he was overheard saying to another AFED comrade that worked behind the bar at Shoreditch House ‘….and this is only the beginning’ he ominously added. Later Peston made AFED millions (and in the process rendered them one of most capitalised Anarchist organisation in Europe since the Spanish CNT of the early 1930’s) when in September 2008 in the fraught atmosphere of the global financial crisis he ‘revealed’ that merger talks between HBOS and Lloyds TSB were at an advanced stage. In the minutes before the broadcast, AFED purchased thousands of HBOS shares at the deflated price of 96p, in the hour following it, they were sold at 215p. It is believed that Peston maintains a good working relationship with Russian FSB agent and fellow ‘market provocateur' Max Keiser.

DAVIS. While Peston hit the markets hard his AFED comrade, Evan Davis was the ‘ideology’ man, suffusing popular ‘common sense’ with an accelerated and increasingly hegemonic belief in the entrepreneur, post-fordism and the ridiculous belief in a ‘knowledge economy’. The two great examples of this are of course the hilarious ‘Dragons Den' and the almost obvious 'Made in Britain' (which nearly gave Davis away to M15 in championing a 'knowledge economy' three years after the global financial crisis). This was in retrospect an effective, and at times, comical strategy that took the degenerate ideology of Thatcherism to such an extreme that people simply believed they no longer had to 'work' to live - innovation and speculation were sufficient. The simulacrum of work replaced work itself. This was an act of supreme genius and a strategic innovation that sought to build on the Italian autonomist ideas of the 'refusal of work' and the 'strategy of refusal’. By way of explanation Davis was overheard paraphrasing Mario Tronti in a South Kensington ‘Footlocker' while trying on some Nike 'AirForce Ones',

"…while capital dictates the conditions of labour, it is labour which dictates the conditions of capital - by convincing labour that it need only be enterprising and innovative we can create the conditions whereby capital can no longer reproduce itself in the West. By inculcating a sense of entitlement and saying ‘anyone can be a billionaire’, we create the perfect conditions for a revolutionary mass when it all goes tits up after Sub-Prime collapses. We will abolish the one thing capital needs in the West to reproduce itself, ‘the worker’ - by rendering the ‘entrepreneur’ as the hegemonic mobilizing identity to individuals, primarily young adults. Amid a collapse of credit this is to initiate the beginnings of a truly revolutionray class”.

It is believed that ‘Dragons Den' was operationalized in collaboration with another Anarchist tendency 'the Mervyn King Collective’ who were behind the production team that gave us 'The Apprentice'.

Details of this sleeper cell have been passed on to senior management at the BBC and Scotland Yard. Solidarity is extended to comrogues Davis and Peston in their hour of need.

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