Richard Horton, editor of the Lancet: Cowards, betrayers and appeasers have destroyed the NHS

All three parties have colluded in the creation of ideal conditions for an unprecedented colonisation of the NHS by an aggressive, profit-seeking private sector. NHS SOS, a new book edited by Jacky Davis and Raymond Tallis, explains how it was done.

NHS SOS: How the NHS Was Betrayed and How We Can Save It
Edited by Jacky Davis and Raymond Tallis
Oneworld, 288pp, £8.99

Andy Burnham, the shadow secretary of state for health, tells a revealing story about his last days in the Department of Health, back in May 2010. As Burnham was saying his goodbyes to civil servants in Richmond House, David Nicholson, the fierce chief executive of the National Health Service, warned that if he returned after the election, his priority would have to be efficiency – achieving a better NHS with less money. A financially fragile health service could tolerate no more reorganisations.

When, just two months after the election, Burnham read Andrew Lansley’s extra - ordinary white paper Equity and Excellence: Liberating the NHS, he was dumbstruck. A huge top-down reorganisation was being proposed, despite what he knew to be the department’s view that such changes were unwanted and unsustainable. Something seemed to have gone very wrong at the heart of government.

What we now know – and what Jacky Davis’s and Raymond Tallis’s new book, NHS SOS, so lucidly describes – is that a very British coup had taken place. During the run-up to the election, the Conservative Party had claimed that there would be “no more top-down reorganisations of the NHS”. Despite this, Lansley soon infiltrated the Department of Health, ignored the advice of his most senior civil servants and implanted his carefully constructed plan to end more than 60 years of consensus that it was the duty of the secretary of state to provide a comprehensive, continuous and equitable health service that was free at the point of use.

Lansley set about a major – indeed, revolutionary – reversal. Like many coups, this did not result in immediate victory but it started a civil war within the NHS that today threatens to create further crises, providing justi - fication for even more destructive reforms in the future.

Conservatives have an honourable philosophy that unites them and that seems to make some intuitive sense. They argue that competition is by far the best way to solve society’s ailments. Competition certainly works in sorting out the best football teams from the worst. In business, competitive instincts can sharpen minds to create new products that transform important aspects of our lives. It would be entirely natural to think that competition among health providers would enhance the quality of our NHS. The problem for the Conservatives is that there is not one shred of reliable evidence to prove that competition improves health. On the contrary, we know only too well that creating competitive markets in health is extremely harmful.

The US has the most advanced marketbased health system in the world. There, competition has driven up costs, created enormous variations in the quality of services available and fuelled distortions and disparities that make the idea of equity a pipe dream. Despite this, Conservatives, ably and surprisingly supported by their Liberal Democrat partners, have succeeded in creating conditions for the unprecedented colonisation of the NHS by an aggressive, profitseeking private sector. For these reasons, it is a simple, although appalling, truth that the Health and Social Care Act 2012 marked the end of the NHS.

NHS SOS explains how it was lost. It is a painful story and one that we must confront if we are to have any hope of reclaiming what was once ours. There were three catastrophic failures. The first great error was made by the Labour Party. As Tallis argues, “Labour was most culpable.” It was a suc - cession of Labour ministers, led by Alan Milburn and Patricia Hewitt, who prepared the NHS for privatisation. Having betrayed their visionary Labour forebears, many of them went on to line their pockets with well-paid consultancies in the private sector that they had done so much to foster.

The second failure lay with the media and especially with the BBC. Journalists consistently failed to ask questions about who would profit from Lansley’s reforms. They failed to explain the conflicts of interest staining so many of those designing his plans (from management consultants such as McKinsey to “think tanks” such as the King’s Fund). And they failed to point out that Lansley’s bill would dissolve the vital link between the secretary of state and his duty to provide care.

Perhaps the most atrocious betrayal of all came from an unexpected quarter – the medical profession. The British Medical Association pursued a policy of appeasement, which rendered it guilty of a crime of quite astonishing proportions: the death of a health system that had led the world in proving that a universal right to health could also be a universal symbol of our respect – and responsibility – for one another.

The Royal Colleges preferred to fight their own internecine wars rather than unite in opposition to a government that they each privately detested. The most senior medical leaders within government – notably the chief medical officer – chose to remain silent. The authors of NHS SOS use words such as “feeble” and “dismal” to describe their medical colleagues. They are too kind.

Tallis writes, “There is room for hope.” Maybe. Labour must unequivocally commit to repealing the Health and Social Care Act 2012. Campaigns must be launched, political pressure applied, evidence of harm gathered, so-called leaders held to account. Most of all, we need “an urgent inquest into the abysmal failure of professional leadership” within medicine.

What we have learned from the past decade is this: Labour, yes Labour, initiated a process that eventually erased an institution that had become a beacon of advanced democracy. The Conservatives happily used Labour’s perversions to accelerate this destruction. And the Liberal Democrats? They colluded and connived. If there is a hell, I look forward to the day when I meet these cowards, betrayers and appeasers – burning in obloquy.

Andrew Lansley, upon arrival at the Department of Health, ended "more than 60 years of consensus" that secretary of state should keep the NHS "free at the point of use". Photograph: Getty Images.

This article first appeared in the 15 July 2013 issue of the New Statesman, The New Machiavelli

Photo: Getty
Show Hide image

Unite stewards urge members to back Owen Smith

In a letter to Unite members, the officials have called for a vote for the longshot candidate.

29 Unite officials have broken ranks and thrown their weight behind Owen Smith’s longshot bid for the Labour leadership in an open letter to their members.

The officials serve as stewards, conveners and negotiators in Britain’s aerospace and shipbuilding industries, and are believed in part to be driven by Jeremy Corbyn’s longstanding opposition to the nuclear deterrent and defence spending more generally.

In the letter to Unite members, who are believed to have been signed up in large numbers to vote in the Labour leadership race, the stewards highlight Smith’s support for extra funding in the NHS and his vision for an industrial strategy.

Corbyn was endorsed by Unite, Labour's largest affliated union and the largest trades union in the country, following votes by Unite's ruling executive committee and policy conference. 

Although few expect the intervention to have a decisive role in the Labour leadership, regarded as a formality for Corbyn, the opposition of Unite workers in these industries may prove significant in Len McCluskey’s bid to be re-elected as general secretary of Unite.

 

The full letter is below:

Britain needs a Labour Government to defend jobs, industry and skills and to promote strong trade unions. As convenors and shop stewards in the manufacturing, defence, aerospace and energy sectors we believe that Owen Smith is the best candidate to lead the Labour Party in opposition and in government.

Owen has made clear his support for the industries we work in. He has spelt out his vision for an industrial strategy which supports great British businesses: investing in infrastructure, research and development, skills and training. He has set out ways to back British industry with new procurement rules to protect jobs and contracts from being outsourced to the lowest bidder. He has demanded a seat at the table during the Brexit negotiations to defend trade union and workers’ rights. Defending manufacturing jobs threatened by Brexit must be at the forefront of the negotiations. He has called for the final deal to be put to the British people via a second referendum or at a general election.

But Owen has also talked about the issues which affect our families and our communities. Investing £60 billion extra over 5 years in the NHS funded through new taxes on the wealthiest. Building 300,000 new homes a year over 5 years, half of which should be social housing. Investing in Sure Start schemes by scrapping the charitable status of private schools. That’s why we are backing Owen.

The Labour Party is at a crossroads. We cannot ignore reality – we need to be radical but we also need to be credible – capable of winning the support of the British people. We need an effective Opposition and we need a Labour Government to put policies into practice that will defend our members’ and their families’ interests. That’s why we are backing Owen.

Steve Hibbert, Convenor Rolls Royce, Derby
Howard Turner, Senior Steward, Walter Frank & Sons Limited
Danny Coleman, Branch Secretary, GE Aviation, Wales
Karl Daly, Deputy Convenor, Rolls Royce, Derby
Nigel Stott, Convenor, BASSA, British Airways
John Brough, Works Convenor, Rolls Royce, Barnoldswick
John Bennett, Site Convenor, Babcock Marine, Devonport, Plymouth
Kevin Langford, Mechanical Convenor, Babcock, Devonport, Plymouth
John McAllister, Convenor, Vector Aerospace Helicopter Services
Garry Andrews, Works Convenor, Rolls Royce, Sunderland
Steve Froggatt, Deputy Convenor, Rolls Royce, Derby
Jim McGivern, Convenor, Rolls Royce, Derby
Alan Bird, Chairman & Senior Rep, Rolls Royce, Derby
Raymond Duguid, Convenor, Babcock, Rosyth
Steve Duke, Senior Staff Rep, Rolls Royce, Barnoldswick
Paul Welsh, Works Convenor, Brush Electrical Machines, Loughborough
Bob Holmes, Manual Convenor, BAE Systems, Warton, Lancs
Simon Hemmings, Staff Convenor, Rolls Royce, Derby
Mick Forbes, Works Convenor, GKN, Birmingham
Ian Bestwick, Chief Negotiator, Rolls Royce Submarines, Derby
Mark Barron, Senior Staff Rep, Pallion, Sunderland
Ian Hodgkison, Chief Negotiator, PCO, Rolls Royce
Joe O’Gorman, Convenor, BAE Systems, Maritime Services, Portsmouth
Azza Samms, Manual Workers Convenor, BAE Systems Submarines, Barrow
Dave Thompson, Staff Convenor, BAE Systems Submarines, Barrow
Tim Griffiths, Convenor, BAE Systems Submarines, Barrow
Paul Blake, Convenor, Princess Yachts, Plymouth
Steve Jones, Convenor, Rolls Royce, Bristol
Colin Gosling, Senior Rep, Siemens Traffic Solutions, Poole

Stephen Bush is special correspondent at the New Statesman. He usually writes about politics.