Sunday, September 14, 2014

The Herald. Aug 9, 2014.

Has anyone asked Sir Bruce Forsyth for his views on sterlingisation? Has someone persuaded Simon Cowell to name the powers devolved to the Scottish Parliament? How's Sir Mick Jagger coming along with his analysis of, let's say, the relationship between NHS privatisation in England and the Scottish health budget?

As far as I know, there is no collective noun for a group of celebrities. I'm holding out for “a self-congratulation”, but that's neither here nor there. Admirers of the 200 or so notables who have put their names to the Let's Stay Together billet-doux to Scotland would probably say I'm unfair, that their stars glow only with simple affection. They don't pretend to know anything about the place. That would be presumptuous.

Ed Miliband has no such excuse. He was in Glasgow yesterday to explain why “as Prime Minister” - no, really – he could not accede to a post-independence currency union. Judging by what Labour's leader told the BBC, he fears for the working poor and for “stability”.

As Mr Miliband spoke, the Telegraph was reporting that “The soaring pound is savaging corporate Britain, with more than £1.5 billion wiped off the year-to-date profits of a string of top multi-nationals”. Obviously, this is a completely different kind of stability. It helps in such a situation, though, to have your hands on offshore revenues denominated in US dollars, especially when a gigantic new field off Orkney is due to begin producing in 2017.

Like oil pipelines, ideas connect. Mr Miliband did not address the relevance of oil to a currency union. Equally, he did not respond to the goading of Alex Neil, Scottish Health Secretary, on the question Sir Mick Jagger and his friends have, unaccountably, failed to answer. If Scotland remains within the Union, what effect will NHS privatisation in England have on the health service here?

Even by their unambitious standards, Better Together folk have offered some specious – no, make that dishonest – answers on this point. They have responded that Scotland is wonderfully devolved, in full control of the NHS on this side of the Border, and has not a thing to worry about. To hear them talk, the Barnett-Goschen formula and austerity economics have been miraculously abolished. The looting of the NHS in England doesn't matter a bit to us. Honest.

So look, first, at the NHS pillaging to which our English friends have been subjected. It is the result of a generation's worth of cross-party Westminster consensus. The parties have, turn and turn about, fetishised “marketisation”, alleged competition, and the principle (their word) that “any qualified provider” is entitled to profit from a taxpayer-funded system of universal health care. If you happen to run one of the big medical corporates, generally American, it's all going terribly well.

Last year, the bulk of new contracts for the NHS in England went to private firms. In 2013, for the first time, they collected better than £10 billion from the taxpayer. If you believe the Financial Times, a publication never knowingly confused with Socialist Worker, around £5.8 billion worth of English NHS work is being advertised, right now, to the private sector. That's a 14 per cent increase on the previous year.

The Health and Social Care Act 2012, which came properly into force in England last year, saw the Westminster coalition complete Labour's preparatory work. Primary care trusts and strategic health authorities were abolished; something of the order of £60 billion to £80 billion was transferred from the trusts to new “clinical commissioning groups” for the purchase of services; the cap on earnings from “non-NHS sources” was removed. Above all, the Secretary of State for Health was deprived of formal responsibility for the health of the people. That's a fact.

In England, there ceased to be a duty on government to provide a National Health Service. Instead, services were to be “promoted” by a plethora of consortia who would do the commissioning. If that happened to mean a bonanza for the private sector, so be it. The Department of Health will tell you that only 6 per cent of NHS spending in England is going to the private sector, that “groups of GPs” now make most of the funding decisions. The word “liberation” is sometimes used.

What politicians like to call the direction of travel is clear enough, nevertheless. Those doughty, self-employed GPs, the ones who continued as private operators after Nye Bevan brought the NHS into being? The private operators Chilvers MacCrea these days run 40 “GP centres” in England; Virgin Care has fully 31. So it goes on.

At this juncture, elementary points don't go amiss. Why would a private health conglomerate with legal duties to shareholders do the taxpayer a favour? Is there any evidence – any – that privatisation has led to more efficiency? Do private providers ever bid for the least-profitable, or even unprofitable, health contracts? Was any of this mentioned by the Tories during the 2010 election campaign? If you answered No to each question, top marks.

A couple of weeks ago, Labour's Andy Burnham, the shadow Health Secretary, sounded the alarm. Privatisation, he said, was being “forced through at scale and pace”. Mr Burnham added that it was “indefensible for the character of the country's most valued institution to be changed in this way without the public being given a say”. He demanded that privatisation be halted until the next general election was out of the way. Subsequently he said Labour would repeal the act.

The coalition responded by pointing out that “Use of the private sector by the NHS doubled in the last four years of Labour, a far bigger increase than under this government. Andy Burnham himself signed off the privatisation of Hinchingbrooke Hospital during Labour's final year”. All of this happens to be true.

Still, isn't NHS Scotland inviolate? Isn't it the case that if we vote No in September a Scottish government – perhaps even a Scottish Labour government – will learn from Mr Burnham's lesson and shun NHS privatisation? That's not what being Better Together means. Strangely, Simon Cowell hasn't yet got around to explaining Barnett, but the facts aren't too complicated. If spending cuts follow the surrender of England's NHS to privatisation, Scotland's NHS will be pushed down the same road. Money will talk.

Besides, does anyone imagine that a Scottish alternative NHS will be tolerated for long? Why would marketisation be just the thing for England but wrong, morally, socially and economically, when all are better together? Remember, too, that the Transatlantic Trade and Investment Partnership deal being thrashed out between the US and the European Commission will allow American conglomerates to sue any British government or health body if it tears up a privatisation contract.

Voting Yes will spare NHS Scotland these horrors, but it will not solve every problem. Scotland's health, collectively, is not great. That's no secret. Our population is ageing, meanwhile, and immigration might not, of itself, provide us with the resources to foot all the bills. These are our challenges, in short, and they have nothing to do with the madness afoot in England.

 Still, a vote for sanity wouldn't hurt. Think of it as preventative medicine.

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