Note: there is a live link to a pdf of the book at the bottom of this page.
When I try to explain to people that highly controversial NHS reforms, such as the imposition of the new Junior Doctors’ contract, are part of a much wider plan to destabilise and deconstruct the NHS, I am quite often accused of being a conspiracy theorist. Amongst my front-line NHS co-workers, there is a widespread agreement that the government is pushing the health service towards privatisation. But amongst those not directly involved with the NHS, the perceptions are quite different. Many people believe that the NHS is too precious an institution for the Conservatives to destroy without risking political suicide. To justify this position, people will often point to the fact that no-where in any of the Conservative rhetoric or party political literature are there direct references to a desire to privatise the NHS. Well, this is not strictly true.
‘DIRECT DEMOCRACY’ by Jeremy Hunt et al.
Back in 2005 when the Conservative Party was undergoing a prolonged period of navel-gazing after having been out of power for 8 years, a group of ambitious MPs co-authored a book called ‘DIRECT DEMOCRACY – An Agenda for a New Model Party’. Contributors include: Douglass Carswell (of recent UKIP defection fame), Michael Gove and most importantly, Jeremy Hunt. There was some muted reference to the contents of the work in the national media prior to the 2010 election but since then it has fallen off the radar and is in fact notoriously difficult to find. It would appear there is a very good reason for the books’ disappearance – and that is, in part, because it quite explicitly lays outs the desire of the authors, including Jeremy Hunt himself, to privatise the NHS.
From a review of ‘Direct Democracy’ in The Spectator –
“One of the founding texts for the new, revitalised Toryism….written by some of the brightest young Conservative thinkers”.
Here is a summary of some of the key statements.
The problem with the NHS is not one of resources. Rather, it is that it is a centrally run, state monopoly designed over half a century ago.
This highly pejorative description of the NHS might explain the paltry and grossly insufficient 0.8% increase in funding that constitutes David Cameron’s promised sustained increase. This is a fifth of the average percentage rise that has been seen year on year since 1948 (it has previously been 4% on average).
A recent independent study of national health care systems placed the UK’s 18th out of 19 countries.
There is no reference to the actual study so no actual analysis of the figures can be made. However, in 2014 The Commonwealth Fund – an Independent US Foundation mandated with analysing Health Policy and Systems from the point of view of providing high quality, efficient care, especially to the most vulnerable in society, assessed 11 Healthcare systems using detailed data from patients and clinicians, supplemented with outcomes data from the WHO. The United Kingdom was ranked first overall, scoring highest on: quality, access, affordability, effectiveness, safety, co-ordinated care and patient-centred care. The US Health Service, upon whose structures many of the surreptitious NHS privatisation reforms are based, scored worst overall in spite of having per-head health expenditure of more than double that of the UK ( £5017 Vs £1876).
Professor Julian Le Grand, Policy Adviser to the Prime Minister and Professor of Social Policy at the London School of Economics has consistently emphasised the inequalities in the current health system. In an academic lecture in 2004 he said, “Unemployed people and individuals with low income and poor educational qualifications use health services less relative to need than the employed, the rich and the better educated.”
This is a simple re-statement of the Inverse Care Law, proposed by Julian Tudor Hart in 1971. It is a strange statement to quote as criticism of a nationalised health service because vast bodies of international evidence suggest that health inequality in relation to the healthcare system is most adversely affected in countries where there is poorly regulated private care as the predominant provider. In fact, the full expression of the Inverse Care Law reads:
“The availability of good medical care tends to vary inversely with the needs of the population served. This operates more completely where medical care is exposed to market forces, and less so where such exposure is reduced.”
A centrally funded health service has, in fact, been a major contributor to reducing health inequality by allowing healthcare practitioners and policy makers to design services and deliver care based on need, not profitability. The biggest contributor to health inequality is in fact social inequality, a problem that has deteriorated significantly in the wake of the Conservative agenda of combined economic austerity and welfare reform.
Our ambition should be to break down the barriers between private and public provision, in effect DENATIONALISING the provision of health care in Britain, so extending to all the choices currently available only to the minority who opt for private provision.
This is the key statement – the open, unambiguous admission that the aim of the Conservative Party’s health policy should be the dismantling of the NHS. The inference from the complete statement is that allowing the private sector to provide services would drive efficiency to such an extent that the government / employers would be able to pay for everyone to have the higher levels of care. Without rehashing the whole public-private debate, one of the main problems with this assertion is that when private providers are introduced, any costs savings generated through efficiency can easily be offset by the need to turn a profit. Regulation of profit margins and service delivery by insurance providers and private healthcare companies is notoriously difficult. For evidence of this you can read about the very recent difficulties that the Democratic administration in the USA have had in trying to regulate insurers and achieve universal access to care with their Patient Protection and Affordable Care Act. A second, huge problem is that many important, complex health interventions are just not profitable. How do you demonstrate profitability in the management of complex, chronic diseases such as Diabetes, Obesity and Heart Disease when they interact with complex social factors that require very long-term involvement from multiple disciplines? When there is difficulty in demonstrating profitability, private enterprises are very unlikely to make investments in developing high quality, innovative services. As a result, there is no equivalent system in countries with predominantly private healthcare that can match the diverse, prolific and highly inclusive primary health system of the UK.
Those of us that oppose the widespread privatisation of NHS services do not do so for ideological reasons. The two-tier system that is proposed in Hunt’s book, where people who can afford high quality care access the private sector and the rest access whatever rudimentary level of care the government decide to provide is exactly the situation that Aneurin Bevan feared would emerge if he chose any system other than a nationalised service. A cynic could argue of course, that using evidence to highlight the benefits of a nationalised system of healthcare is in fact pointless because Conservative opposition to the NHS is ideological, not pragmatic. That is to stay, that it is a central tenet of the right that health should be treated no differently to chocolate, cars or flat-screen TVs because it is a commodity, that like everything else should only be purchased by those that can afford to pay for it.
Instead of Tinkering with a fundamentally broken machine [the Conservative Party] should offer to update the model, setting out in warm optimistic tones, its vision for a healthier Britain.
All of the recent NHS reforms have been presented in warm optimistic tones – very much in the tradition of a siren-song luring the good ship NHS towards destruction. With regards to the vision for a healthier Britain – see the discussion above.
So there it is, the rumours are true. Jeremy Hunt co-authored a book in which he openly professed a desire to privatise the NHS.
In the next volume Mr Hunt could quite easily outline a Dummie’s guide for Privatising a Public Service……
- Slowly run the service into the ground.
- Facilitate a media onslaught so that that public believe that the system and the workers within are failing them.
- Gradually usher in private enterprise in the name of ‘efficiency and safety’.
Perusing the national press this past week has been like watching such a story unfold in real time. In addition to the government’s farcical behaviour over Junior Doctors’ contracts, the events at Addenbrooke’s Hospital can be seen as a microcosm of the upheavals occurring throughout the NHS. Two hundred of Addenbrooke’s beds are blocked as a result of cuts in council social care and people subsequently being unable to access care at home. The Hospital is spending 1.2million per week above its income to cover the staff shortages arising due to patient overload, a lack of trained nursing staff and an inability to recruit from abroad due to blocks on Visas for non-EU nurses. As a result, citing serious staff shortages as the reason, the Care Quality Commission has downgraded Addenbrooke’s performance assessment to “inadequate” from the “top ranking” assessment that it was given just over a year ago. The decapitated Head of Cambridge University Hospitals Foundation Trust, Keith McNeil, perfectly summarised the impossible position faced by many NHS Chief Executives in the context of this chronic government neglect and under-funding. He observed, that when forced to choose between debt and risking quality, front-line NHS leaders will choose quality every time.
Even from this brief description, it is easy to see how Addenbrooke’s problems stem in large part from the indirect constraints placed upon it by various incrementally damaging government policies. Sadly, their situation is far from unique. Addenbrookes is but one front in a war of attrition being waged against the NHS . It is a war that is 50 years in the making, and it is a war that without our collective resistance, the Conservative government is going to win.
A heartfelt thanks to publishers Lulu.com for being the only people to still sell Direct Democracy. If you would like to thank them by buying a copy (it’s only £1) – you can do so here. Otherwise, here’s a link to a pdf copy: