Campaigner's Diary

Articles from John Lister's regular column in the Morning Star, plus other articles for publication.

Select an article from the list below

Campaigning can make a difference.

April 2013

The storm of anger against the government's attempts to push through a major additional set of measures to toughen up section 75 of the Health & Social Care Act without debate or vote in Parliament succeeded, against the odds, in forcing a delay and a redraft.

The regulations would effectively require Clinical Commissioning Groups to put more and more NHS services out to tender, or open them up to the hazards of "any qualified provider".

The decisive factor in the first round of the campaign to block them seems to have been when even the normally aloof Academy of Medical Royal Colleges joined in the chorus of criticism.

Before that, trade unions, Labour MPs, some Lib Dems and even a Tory or two had also expressed alarm at the wording of the regulations that would bring EU competition law into play, and create an EU-style "right to provide" for businesses wanting to carve out a slice of the NHS budget.

Indeed it is a striking irony that David Cameron has at the same time been fighting furiously within the EU to prevent its rules imposing any restriction on bankers' bonuses - while his ministers have laboured away to force through legislation that would open up the NHS to EU competition law.

The reason for this is clear: EU competition law (strongly influenced by British and other neoliberal governments) - is a one-way valve to permit the privatisation and tendering of services, but preventing any measures to bring services back into the public sector. Once it's gone, it's gone.

On this occasion the opposition was strong, and the coalition was potentially divided on the Section 75 regulations. So, under fire, and with their sneak attack trying to smuggle in proposals through parliamentary procedure well and truly blown, ministers opted to withdraw the regulations and redraft them.

However the redraft has proved to be little better, if at all, than the original, so the fight has to begin again to block their passage through the Commons and Lords.

The health unions, the BMA's GP Committee, and the House of Lords Scrutiny Committee have all declared their concern that the new regulations depart from the explicit commitments made by ministers as they struggled to get the Act through parliament, and Labour's Andy Burnham and Ed Miliband are now also on the case.

Sadly it seems that 38 Degrees, the online campaigning body which helped build the broader public opposition the first time around, with a massive online petition, seems to have swallowed the porkies offered up by junior minister Norman Lamb and decided not to join the renewed campaign to kill off the "new" regulations.

The bizarre timetable of the parliamentary procedures means that there is still time to build a head of steam against this further effort to undermine and break up the NHS - watch out for appeals for support and fresh online petitions before the debate on April 24.

Mean times from the nasty party

But while the government's false assurances over the Health & Social Care Act are coming unravelled, so too are the worthless promises from Cameron and Andrew Lansley before and after the election that the Tories would increase spending on the NHS year by year in real terms.

New figures from the NHS Confederation confirm that the four years 2011-2015 are set to be the meanest-ever years for funding since the NHS was established in 1948.

Spending is set to rise by just 0.1% over the 4-year period, far short of the increase in demand for health care from the aging population, inflation in the costs of goods and services required by the NHS, and the pressures of new technology and new drugs raising public expectations.

That's bad enough: but add to this the fact that some of this money allegedly allocated to the NHS is not being spent, and then returned to the Treasury, and - far from any increase - we have a real terms year by year cut to NHS spending since the coalition took over.

Health Service Journal columnist Noel Plumridge has exposed the shocking extent of this clawback of "surpluses" in the last few years: in 2010-11 the underspend was £1.4 billion, in 2011-12 it was £1.6 billion - and almost all of that was clawed back to the Treasury. 2011-12 seems set to deliver another £2.1 billion surplus, most if not all of which will again be siphoned off into government coffers, while front-line trusts face a year by year demand for 4 percent "efficiency" savings which trusts have to absorb themselves - there is nowhere left to pass them on to.

They face a yearly 1.3 percent reduction in the "tariff" of payments for each treatment they deliver, and get penalised with a 30% reduction in payments for every additional emergency patient they treat above the contracted level - even while emergency numbers continue to increase, and promised improvements in community health and primary care remain simply promises.

Meanwhile most Primary Care Trusts (replaced by clinical Commissioning Groups from April 1) are holding surpluses of unspent cash: Plumridge points out that commissioners "managing risk" now seems to take the form of commissioners "sitting on large piles of money" - equivalent to 3.5 percent of the money they are allocated for patient care.

So big are these reserves that the CCGs "won't get the extra money" for 2013-14: "In all probability the cash will never leave the Treasury".

In other words an already microscopic increase in spending will disappear altogether, and leave a real terms reduction in resources for health care - driving further cuts and rationalisation of front line services up and down the country.

And all of the money saved through relentless "efficiency savings," far from being reinvested in the NHS as promised, is being sucked into George Osborne's slush fund to pay for tax cuts for the rich and big business.

Only following orders

We might have expected the NHS employers' body to be at least mildly put out by this deception and the way their efforts have been cynically exploited by ministers: but the NHS Confederation appears to be unswervingly subservient to the government, and determined to avoid the political reality of the current situation.

Their document Tough Times, Tough Choices manages time and again to avoid taking a position on anything, offering "options, not solutions".

Yet their only 'unthinkable' thoughts all veer towards right wing and neoliberal solutions such as charges for health care, and "raising revenues through private spending," rather than make any attempt to imagine ways in which the progressive character of the NHS could be preserved and restored.

It begins by declaring that "many NHS leaders have indicated that these are the worst times they have ever experienced" - but never even hints that this misery is the result of political decisions taken by government rather than external circumstances or an act of god.

With more and more trusts being driven into deficit by this combination of policies, NHS bosses have a choice between accepting more cuts or shouting out loudly that more money is needed to maintain adequate levels and standards of patient care. This is what they were urged to do in the recent Francis Report on the fiasco at Mid Staffordshire Hospitals Foundation Trust - in which managers were castigated for keeping quiet and implementing cuts with no assessment of their impact on patients.

But the NHS Confed has clearly dismissed any possibility of challenging the status quo, preferring to follow orders, however unacceptable.

Instead they discuss decommissioning services, rationing services, and even charging for services - either to see a GP, or charging patients for 'hotel services' while they are in hospital. They discuss raising income from increased levels of private medicine, exploiting the new provisions of the Health & Social Care Act.

None of these is endorsed as a policy - but all are weighed as options, whereas the possibility of a concerted campaign for improved NHS funding is not even discussed.

The document goes on to gloss over the scandal of the special administrator's cuts in South East London, where Lewisham Hospital has been chosen to take the fall to keep PFI schemes afloat in the neighbouring trust, and suggest more "reconfiguration" despite the obvious lack of resources for new and expanded community health and primary care services - without which "reconfigurations" are simply cuts and closures.

The NHS Confed do reluctantly concede that such policies are "often controversial with the public", implying that communities' "loyalty" to local services and unwillingness to see them closed in the absence of any replacement is somehow irrational.

But with management attitudes like this, the most sensible course for local communities, elected politicians and health unions is to rally in defence of existing services until there is evidence that something tangible and better is on offer.

Resistance makes sense - and campaigning can make a difference. Don't follow the NHS Confed's feeble approach: keep fighting for our NHS. Once it's gone, it's gone!

BCM London Health Emergency • London WC1N 3XX • Copyright © 2013 London Health Emergency