Monday, 30 September 2013

The destruction of the NHS and a complicit media

Only a little local affair
You might have missed it yesterday, but some 50,000 people took to the streets to protest about something.

If you did miss it, you can hardly be blamed: it might sound like a newsworthy matter to you, but to the BBC and others, it was – at most – just a little local affair.

The demonstration itself – which the local police force involved went to some bother on social media of pointing out was the biggest it had ever had to deal with and was entirely peaceful – was about what’s happening to the National Health Service (NHS).

The protestors included not just patients, but those working in the health service itself, from doctors and nurses to cleaners and porters.

In a nutshell, the protestors believe that it is being deprived of funds and privatised by stealth using the inevitable consequences of that reduction in funds as the excuse to bring in private companies to make private profit from the service.

The process has been ongoing since the government came to office in 2010. Before the election that year, the leader of the Conservative Party, now Prime Minister David Cameron, sought to quash fears by stating both that: “there will be no more top-down reorganisations of the NHS” and “I will cut the deficit, not the NHS”.

On the former, this would have been welcome, after some years of changes that seemed to come on a weekly basis and left staff reeling. Unfortunately, it was a lie, since his government has subsequently been involved in the biggest top-down “reorganisation” of the service ever.

On the latter, policies have seen him wrong on both counts.

Austerity has helped worsen matters – including the deficit – to the extent that even the International Monetary Fund (IMF), hardly a bastion of anything that could be remotely described as socialist, has criticised the government for its approach.

So you could be forgiven for imagining that the reality behind such electioneering statements would be picked up by a conscientious media: that a prime minister who made them would be help to at least some account.

But no: no more than the reality of statements by secretary of state for work and pensions, Iain Duncan Smith, who has been caught out by the Office for National Statistics – more than once – playing fast and loose with figures of those claiming benefits or those on benefits for lengthy periods of time.

Indeed, when once challenged over this, IDS retorted that he “believed” the figures to be correct – ergot they must be correct.

Thus we now know that only a belief in it is required for a politician’s statement to be true.

But back to yesterday’s protest.

It took place in Manchester – a sunny Manchester, so presumably God was smiling on the demonstrators and the cause.

It took place there because the annual Conservative Party conference has just opened at a conference centre there. It was organised under the auspices of the Trades Union Congress (TUC) and was attended from people from across the UK.

Both the Conservative Party and the TUC are national bodies. The conference in question is for the national Conservative Party, and the NHS is a national health service.

Yet the BBC decided to relegate reports of those 50,000 to regional news pages.

On the other hand, a report of a man being ill after swallowing drugs during a drugs bust – also in Manchester – was linked to from the front page of the website. That, in other words, was decreed editorially to be of national interest.

The Conservative Party conference is being reported as national, headline news – as it should be: it’s a national story.

But mass opposition to government isn’t?

Much of the media will avoid the story altogether for entirely political reasons. Much of the media now works on the basis simply of promoting the core political-economic agenda of its proprietors. It has long since given up any idea of being a fourth estate that holds the other three to accountability.

The BBC should, theoretically, be above this, but it has, over the last 30 years, allowed itself – under pain of losing the licence fee and charter, presumably – to dance to the tune of whomsoever is holding the reins of political power at the time.

It has been dismal on reporting the NHS since 2010, except where there are negative stories.

Now I dislike conspiracy theories, but one does ask whether it is entirely a matter of coincidence that the ultimate head of the Beeb, Chris Patten, has had anything to do with this.

In which case, it is worth noting that Lord Patten seems to have a conflict of interest on the matter.

Not that he is alone: Social Investigations has also pulled together information showing that over 70 MPs – and that’s without mentioning the peers – have similar potential conflicts of interest.

Wouldn’t you also wonder about this too?

There have been a number of situations that have occurred in the last few years where hospitals have seriously erred and patients have seriously suffered.

But staffing levels have been reduced and it’s hardly rocket science to say that in health care, there will be safe levels of staffing and unsafe ones. In the last few years, the posts of more than 5,000 nursing staff alone have disappeared. That is not conducive to safety.

Waiting times have increased; accident and emergency units are being strained to the limit – not least after the axing of the NHS Direct service and the 111 debacle that has followed.

Entire units are being downgraded or threatened with closure: the scheme, earlier this year, to close the A&E and maternity units to Lewisham Hospital in London, on the grounds that an entirely different hospital in a neighbouring borough was struggling financially, is just one illustration of the state of the fiddling that’s taking place.

In that case, when you add in the information that Lewisham is a Labour stronghold and the neighbouring borough is a Conservative one, it’s hard to escape the sense of a nasty smell in the air.

We seem to be headed back to the halcyon days of the last Conservative government, when elderly people were dying on trolleys in hospital corridors.

That’s not to pretend that the Labour governments under Tony Blair and Gordon Brown do not have much to answer for.

The eager adoption of the PFI schemes first imagined by John Major’s government was always a recipe for disaster, based on short-termism and an apparent lack of any comprehension of the financial implications of what was being signed up to.

And Labour also continued and expanded the initial privatisation of the health service that had begun under Margaret Thatcher, when ‘soft services’ were put up for sale.

The result of that should have stood as a lesson for all: perhaps it is a coincidence, but after the numbers of hospital cleaners were halved in order for private companies to make any money from the service, there was a concomitant rise in the number of hospital-acquired infections such as c-diff and MRSA.

Which is a perfect illustration of the operational problems that privatisation and fragmentation of the service and workforce produces. If cleaners, for instance, are employed by a company that is outside of the health service itself, who do the staff answer to?

If the nurses on the ward want to call in a cleaner and have a job done – and done now – who do the cleaners answer to?

For some years, the trade union UNISON, which organises in the sector, has been calling for cleaning services to be brought back in house – and for a restoration of ward sisters who had both the responsibility for and the authority to organise cleaning as and when it was actually required on the basis of medical judgement.

Indeed, a few years ago, the union funded research, in a Glasgow hospital, to see what happened if a ward was returned to such a system, with proper numbers of cleaning staff. Rates of infection declined and costs went down at the same time. Report here.

Yet Labour continued down the same privatisation road, selling off the likes of NHS Logistics to parcel company DHL in 2006.

That was an award-winning arm of the health service that delivered everything from beds to bedpans. There was no business case and none was ever given - in spite of demands for one from unions and other campaigners.

None of this is to say that the NHS had or has no problems. It's a vast organisation, so of course it will.

But much of the media has been complicit in spreading the lie that it is failing on most counts, and failing to challenge the other lie that a privatised system such as that of the US is better.

Indeed, the US spends more per person on healthcare than the UK and has worse outcomes. And the reality of private health insurance there, where small-print - or even downright invisible print - can see people consigned, in effect, to poverty and/or death when serious conditions emerge, should warn anyone against following such a path.

But 30 years have seen the UK electorate sold the lie that private is always better than public – and even as we see fuel poverty rising, in part because of the massive rises charged for costs of domestic fuel by highly profitable private companies – the privatisation goes on, even without any massive debate over what it will offer the country as a whole and whether it will actually benefit the national economy.

And nor is it just the likes of the Royal Mail.

In Cambridgeshire, Hinchingbrooke Hospital was handed over to Circle, a private company, which has already had to go, cap in hand, to government for a loan of £3.5 million. Since when did private companies in a market economy get to beg government to bail them out if private is so much better than public?

Yet further hospitals could be headed in the same direction, including George Eliot in Nuneaton.

So yesterday’s protest, which passed outside the Conservative Party conference, was hardly a local story.

A BBC correspondent claimed, via social media, that it had been stopped from filming the demonstration outside the conference centre by security.

Conference security is being provided by G4S, which cocked up mightily last year when it was supposed to provide security for the Olympics, and the state had to sort out the mess, with soldiers drafted in at the last minute – in many cases, straight after tours of duty in places such as Afghanistan.

It’s also the same company that has, since then, been found (along with Serco) to have been overcharging the government (ie the taxpayer) for services in the justice sector.

One wonders why the Tories want such a dodgy company guarding them in the first place. But if the claim of that BBC correspondent is correct, and a private firm that has been awarded millions of pounds worth of contracts (in spite of dodgy or inadequate behaviour), and is unelected and unaccountable, is getting to help censor the news, then that causes another nasty smell to impinge on the nostrils.

Not that this excuses the BBC. G4S couldn’t stop them filming other parts of the demonstration or the rally that followed. And frankly, they should have tried to find some balls and film anyway – the roads around the conference centre are not private property – and see what G4S was going to try to do about it.

Because it would raise further points if a private company tried to start invoking anti-terrorism legislation to stop the filming of an entirely legal demonstration that was following its entirely legal and agreed route.

All of this is a mess – and not least because of the mess that is the UK’s mainstream news media at present, where any belief in the role of informing the populace has been subsumed by an agenda of pouring out uncritical propaganda for, by and large, the neo-liberal agenda.

And that in turn is why the present abject, cowering behaviour of the BBC is of equal concern.

Further reading


  1. Amanda, you argue against private involvement in the health service. Are you aware that in France, a country with strong employment laws and a 75% higher tax rate, 30% of state funded operations are performed by private hospitals? In France the state pays a fixed fee for the treatment whether the patient chooses a public sector or private sector run hospital, and he or she pays the same (i.e. nothing or the nominal co-payments demanded for some treatments). The French patients seem pretty happy with their (free) treatment at the private hospitals.

    The same is true in Sweden, often put forward as a model of benevolent state intervention.

    The best example is Germany, the land where trade unions are given a seat on company boards, where there is deep suspicion of stock markets. Germany is totally different from the UK in that they have overcapacity in hospitals. The UK has under-capacity, so the NHS is forced to ration care, hence the waiting lists. In Germany, due to overcapacity, the hospitals run with low utilisation rates. Many only survived due to high prices. When the government cut prices per operation, many public or charity operated hospitals went bust. These hospitals were acquired by private sector hospital operators, two of which are quoted on the stock market.

    As in France and Sweden, the patient pays the same (often nothing) at both the private or the public run hospital. In both cases the government picks up the tab, so the private run hospital can only make money if it has lower costs. The typical parochial reaction in the UK is to fear that this will be at the expense of patient treatment. The savings which give the private operators their profit will be at the expense of the quality of care, say critics.

    But because there is still overcapacity in Germany, the patients have a variety of hospitals, both public and private, in close proximity. If the profits made by the private operators resulted in worse standards of care, patients would vote with their feet.

    In practice, private hospitals have been GAINING market share. The patients are choosing them over the public or charitable hospitals. The reason is that the efficiencies free up enough cash to give investors their profit and invest in better equipment which attracts the best physicians, which in turn provides patients with better standards of care.

    The reason that healthcare is expensive in the US is mainly litigation. No GP will see a patient in the US without having two clerical staff present, in case they get sued. Imagine what that does to costs.

    1. Hi Eric. Thanks for the comment.

      I think that in many ways you're absolutely spot on when it comes to litigation.

      My essential problems is that we seem hellbent on going down the US-style route. For instance, a few years ago, there were plans afoot to privatise and then offshore the work of medical secretaries at a hospital in north London.

      This has actually been done in the US, with dismal consequences – wrong drugs prescribed when notes came back wrongly typed up etc, and leading to some very substantial lawsuits. In the UK, the plans would have meant that the NHS itself (so in other words, the taxpayer) would be the one to pick up the bill when things went wrong, even if the problem was caused by a private company.

      I mentioned Hinchingbrooke Hospital, where you see the taxpayer having to step in when something goes wrong with a hospital that has been privatised and where the company has then got in a mess.

      The question of the cleaners that I mentioned is similar, in that the NHS itself has picked up the bill on hospital-acquired infections, while the private companies that cut the number of cleaners in order to make it a profitable business have been let off from paying the costs when that causes problems.

      So in essence we seem to be looking at a situation where everything is being geared to the profits of big private businesses, and not to the patient.

      I think you've highlighted that there is a philosophical difference in countries such as Germany, and I do think that's crucial. But then, we're currently at a point where, as you, in effect, point out, trade unions (the workforce) are very rarely involved in any decisions.

      Would that it was more like Germany!