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THERE ARE growing demands for bipartisan approaches to the NHS — a cross-party review perhaps or maybe a Royal Commission.
But the NHS has been hacked by the “sensible centre” for years, that centre being where Tony Blair, David Cameron and Nick Clegg agree. For the NHS that means privatisation, fees and even dismantling the whole thing.
Ninety MPs, led by Liz Kendall, Sarah Wollaston and Norman Lamb, wrote a letter to Theresa May asking for a Royal Commission into the “structure, funding and sustainability of the NHS in England as a whole” last November.
That doesn’t just mean more money. It means that a commission could decide, for example, that the NHS is currently unsustainable and should charge fees.
That’s not some random worry. The Centre For Policy Studies (CPS), the entirely Thatcherite think tank, is campaigning hard for this Royal Commission.
In their call for one, led by Tory ad man Maurice Saatchi, they say that the commission should consider “revenue sources beyond taxation,” including “patient co-payment,” — charges, in other words.
If you think that the CPS is just the fringe, consider George Freeman. A “one-nation” Tory, he is what the New Statesman call “one of the most intellectually energetic Tory MP” and he's on Theresa May’s advisory board of backbench MPs
In January, Freeman wrote that this could be “an electrifying moment for renewing the NHS.” He made the case that, “for too long the politicisation of the NHS has held back the debate we need to have about how to fund European standards of health and care in 21st century Britain.”
He thought that it would be easy to reach a deal with Liz Kendall in a cross-party commission, writing: “I believe there are a number of people like the Lib Dems’ Norman Lamb, Labour’s Liz Kendall, a number of distinguished peers and myself who could happily and effectively work together to frame a non-partisan model for a 21st century health and care system.”
And what would that commission produce? According to Freeman's vision, it would be like “the vast majority of European countries run on the basis of national and corporate insurance-based payments, co-payment and companies and users who can afford it being obliged to contribute to their health costs.”
So, again, the “non-partisan,” “non-political” plan means moving away from the NHS to a patient-pays and insurance model.
“We have to end the idea that co-payments, top-ups, are somehow antithetical to an NHS,” Freeman added. That’s the sensible centre — overturning the fundamental principles of the NHS and calling it reform.
What of the LibDems ? Where do they stand in this cross-party cabal? The LibDems are mostly led by the Orange Book tendency, promulgated in 2004 by financier and LibDem donor Paul Marshall and David Laws who put out the book to “reclaim liberalism” from what they called the “soggy socialism” it had drifted into.
In the Orange Book, David Laws asked if the “cumbersome, centrally directed monopoly that is the NHS is really the best way to deliver health services in the NHS.” He argued that it should be replaced with a “national health insurance scheme” with people “choosing either the NHS or an alternative insurance provider.”
The NHS, according to Laws, is a “second-rate, centralised, state monopoly service” and the LibDems should back putting more “competition” into “public services such as health.” Private-sector providers are more efficient than the NHS, Laws stated, and he called for “more competition within the NHS and more provision from the private and not-for-profit sectors”
Vince Cable was a bit more moderate in his Orange Book chapter. He acknowledged that there had been some problems with “outsourcing, PFI/PPP contracts,” but this should not mean LibDems “surrendering to the idea that a public service involves a monopoly of public-sector provision.”
Cable said that “the one area of plurality of provision that is being most strenuously resisted is the NHS” and argued that this was a bad thing. For Cable, the public and private sectors should “compete to provide mainstream services” like the NHS. He also asked for “regional pay” in public services to cut the pay bill.
The Orange Book tendency helped ease the LibDems into coalition with Cameron. Laws and Cable became ministers in the Coalition, as did LibDem MP Danny Alexander. He put some NHS “reforms” into practice and, along with Tory Oliver Letwin, struck the deal in 2010 that would underpin the Lansley reforms, in which all NHS commissioning would go to GP commissioning groups who would award contracts to “any willing provider.”
The result has been disruption and privatisation.
What of Labour? Blair’s original model was “reform and invest,” which meant extra money but also more internal markets and privatisation. Slowly the Labour “centre” drifted away from the extra money to just the privatisation.
Andy Burnham, a straight new Labour minister, began to have doubts about privatisation. In 2010, he proposed, modestly, that the NHS itself should be the “preferred provider” of NHS services. This would mean rowing back on, though not stopping, privatisation.
Progress, the main “moderate” organisation in the Labour Party were enraged. They saw Burnham as a traitor and launched a campaign against his decision. They wrote to him, protesting at his “restricting the use of the private” sector in the NHS. “The pro-market principles espoused by Andrew Lansley are the right ones,” Progress magazine said and the organisation attacked Burnham for his “preferred provider” announcement, stating: “With an election approaching, Labour has regrettably adopted anti-market rhetoric on health.”
The bit of the Labour Party closest to the Tories and LibDems backed Lansley and privatisation over even a middle-ground MP like Burnham.
This is why a “cross party” commission on the NHS is a terrible idea. It brings together all the worst people in each party, the ones who believe in top-up fees, vouchers, privatisation and turning the NHS into an insurance scheme.
It will stop the NHS being treated like a political football — but only by puncturing the ball and cutting it into pieces.
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