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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