What does the Labour reshuffle mean for the development of its NHS policy?
For the first time since June the Labour Party has a full Shadow health team for England. Only Justin Madders MP continued in post throughout the chaotic summer period that included a failed coup and a similarly unsuccessful challenge to the leadership of Jeremy Corbyn. Post-reshuffle, and with Diane Abbott promoted to shadow home secretary, what can we expect from the new health team led by Jonathan Ashworth?
Corbyn’s re-election as Labour leader with an increased mandate of almost 62% of those voting, followed an extraordinary window in Labour Party governance. With most of his shadow cabinet resigning en masse, Corbyn was obliged to promote many of his less experienced parliamentary supporters to shadow cabinet roles. The result was both paradoxical and positive – a thinly populated but enthusiastic and very progressive opposition front bench.
The first front bencher to resign in the coup was shadow health secretary Heidi Alexander, who subsequently criticised both Corbyn’s leadership style and also the actions of shadow chancellor John McDonnell.
Alexander’s replacement as shadow health secretary was Corbyn ally Diane Abbott. During the next three months Abbott published a series of speeches, articles and blogs very much more radical and progressive than those of her predecessor, in terms of supporting the NHS workforce and of reinstating a publicly provided, national health service. This culminated in her speech to the Labour Party conference on September 27. Abbott told us that Labour stands with the junior doctors. She said that NHS England’s Sustainability and Transformation Plans (STPs) “seem like a vehicle to drive through cuts and closures” and that “where they are purely about cuts, Labour will fight them.” She pledged that “under Jeremy Corbyn’s leadership the Labour Party will be committed to halting and reversing the tide of privatisation and marketisation of the NHS… Labour in government will repeal the Health and Social Care Act”. And she stated that “The NHS will be returned to a publicly owned, publicly funded, publicly accountable universal service, as outlined in the NHS Reinstatement Bill now being piloted through Parliament by my colleague Margaret Greenwood MP, with the support of the Labour leadership.” Continue reading “After a summer of crisis and opportunity, can Labour’s progressive NHS policies be sustained?”
I want to give a broad political overview of what’s happening in the NHS in England and of the background to the current situation.
As you’ll know, the English NHS is in a bad way, with practically every part of the country in financial deficit. Many hospitals and many services are being closed down, cut back or rationed. At the same time, many long term contracts for the provision of NHS services are being awarded to private sector companies – though often people are unaware of this because the likes of Virgin, Carillion and SpecSavers are allowed to operate under the NHS logo.
By definition, these arrangements are wasteful, because private companies have a duty to make profits and to give those profits to their shareholders. That means that public money is haemorrhaging out of the NHS – whereas when a public provider of NHS services makes a surplus it is reinvested in the NHS.
There is also a substantial legacy of (mainly Labour initiated) private finance initiative (PFI) funded hospitals, whose exorbitant loan interest payments have to be made before NHS funds can be spent on routine services. And it’s no coincidence that people’s inboxes are filling up with adverts for health insurance, with their invitations to jump the NHS queues. Everything I’ve described forms part of what in my view is an intentional strategy by the Conservative government to create financial, managerial, professional and public chaos throughout the NHS, so that private provision of NHS services, alternative private health services, health insurance, and NHS co-payments and ultimately charges will be seen as inevitable.
This ‘cultural revolution’ takes many different and apparently unrelated forms whose destructive nature is denied by the government – which continues to assert that it has the public interest at heart and that it is factors like the ongoing impact of the credit crash, the increasing costs of drugs and medical equipment, the ageing population and our unhealthy lifestyles which are the true problems facing the NHS. The building blocks for privatisation to which I have referred currently include: the aforementioned awarding of NHS contracts to private bidders – often asset strippers who provide poor quality services, fragment and undermine the cohesive public ethos of the NHS; the creation by the Treasury of NHS deficits and of regulations which forbid them; enforced rationing of services to extend waiting lists and encourage patients to seek private alternatives; manufactured confrontations with doctors and other members of the NHS workforce; the imposition of ‘new models of care’ which undermine NHS hospitals and create community based healthcare structures ripe for privatisation; personal health budgets, designed to link with health insurance. There are many more and I can provide documented evidence for all of them. It is a national scandal. Continue reading “NHS – on life support”
While it can be politically expedient for governments to engage with health inequalities, in a neoliberal world they struggle to realistically propose actions which will substantially reduce them – such as tackling power inequalities, patriarchy-sustaining institutions or class inequality. A dominant ‘policy paradigm’ prioritising economic growth restricts even their ability to imagine alternative, equitable scenarios. In this context, politicians, policy makers and some researchers have devised a parallel fantasy world in which proximal, downstream and easily tackled exposures are put forward as viable solutions to health inequalities (and sometimes even positioned as the causes). The consequence of this is a widespread public sector culture in which well-meaning policy-makers, practitioners, researchers and the public collude in sustaining a ‘cargo cult’ around the ‘worship’ of health behaviourism.
It’s now widely accepted that health inequalities – unfair, unjust differences in health determinants and outcomes within and between populations – have serious immediate and long-term negative impacts on individuals and societies. As a result, many governments have at least a rhetorical commitment to reducing of health inequalities. It is rare for national inequality reduction strategies to include any analysis of the causal pathways that result in health inequalities and rarer still for them to suggest interventions that seek to tackle the fundamental causes of health inequalities. Instead, most policy approaches (even the few that acknowledge material and structural causes) put forward lists of ‘downstream’ (proximal) health determinants, such as smoking, unhealthy dietary choices, poor housing conditions, or failure to use contraception, whose social patterning – ie, greater prevalence among working class people – is itself presumed to represent the cause of the relevant inequality. Continue reading “Neoliberal governments and health inequalities: a fantasy paradigm”