David Owen's NHS bill offers a final chance to save our health service

Labour and the Lib Dems must support a bill that restores the right of all citizens to comprehensive care.

David Owen has today published in full a bill in the House of Lords to reinstate the NHS and the secretary of state’s legal duty to provide a national health service throughout England. This duty has been in force since 1948 and is the legal foundation of the NHS and our rights and entitlements to health care, a duty the coalition’s Health and Social Care Act 2012 is abolishing.

Owen’s 'reinstatement' bill puts into reverse the monstrous 473 H&SC Act, which from April this year abolishes the NHS throughout England, reducing it to a stream of taxpayer funds and a brand or logo for the public bodies and private companies which will receive them. The bill does not entail yet more disruptive reorganisation, it simply restores the democratic basis of the NHS and the rights and entitlements of all citizens to comprehensive care; rights which were shredded by the 2012 Act.

As Owen has warned: "the NHS has remained by far and away the most popular public service because people sense rationing and restrictions are inevitable, and resources limited but that they value and recognise the fairness of those decisions being taken not by market forces or quangos but by some overall democratic, open, transparent decision-making."

This bill comes at an important moment. Next week, Health Secretary, Jeremy Hunt will determine the fate of Lewisham hospital and very soon the fate of many more hospitals as cuts and shareholders' profits bite deep into NHS budgets. By putting power into the hands of quangos, the government hopes to protect itself from the full force of public anger at the implementation of a four-year 'efficiency' plan expected to generate £20bn savings by 2014.

The plan, drawn up by US management consultants McKinsey on PowerPoint slides, the electronic equivalent of the back of a cigarette packet, has already led to the sacking of thousands of nurses and loss of services.

David Nicholson, the chief executive of the new NHS Commissioning Board, who appeared before the public accounts committee last week, warned of worse to come: "We are just going into a phase now where quite a lot of fairly contentious service change issues are surfacing." "Fairly contentious" makes a mockery of the scale of proposed losses and closures.

In north west London the government plans to cut 25 per cent of beds, and throughout London at least seven accident and emergency departments will close; 5,600 jobs in North West London will be lost by 2015, 4,000 in Merseyside, and thousands more in Rotherham, Devon and Cornwall, Bolton, and Portsmouth. Hospital closure and downgrading will take place in several major cities. Meanwhile, payments to private contactors continue to escalate, from those to management consultancies that have taken over from public officials, through expensive PFI deals involving payments that are contracted to rise each year, to outsourced services from which shareholders are seeking returns ranging from 15-25 per cent.

And yet the NHS returned over £2bn to the Treasury last year. Hospitals have deficits because the government chooses to load them with these costs, not because they are badly run. The government is manufacturing a financial crisis which is not of hospitals' own making.

The Health and Social Care Act legalises the break-up of the NHS under the efficiency plan. Some services will become the responsibility of local authorities and others will be the responsibility of private, for-profit firms; many services may no longer be provided free. For instance, mental health, immunisation and sexual health are being transferred to local authorities. Services for pregnant or breast-feeding women, for younger and older children, for the prevention of illness, even for the care of persons suffering from illness or needing after-care may no longer be mandatory parts of the free health service. In fact, pretty much everything is up for grabs.

MPs and the public have yet to realise that the Act will abolish the NHS by splitting up services in this way and removing the secretary of state’s control over provision. Unfairness has already been creeping in under existing rules. Two weeks ago the medical director of the NHS, Sir Bruce Keogh, admitted to the public accounts committee that for the last two years he has been "deluged by letters from people saying, 'This PCT isn’t paying for that', or that one PCT takes a different view on (entitlement of patients to) hip surgery or cataracts to another." We are outraged by the unnecessary pain this causes and authorities must be held to account for the denial of care. After April, when the Act is implemented, that will no longer be possible. Instead, a range of bodies not accountable to parliament, including for-profit companies, will decide which services will be freely available and who will receive them. That is no longer a national health service and people must understand that.

The coalition has deceived the public over the NHS. The Health and Social Care Act is not about making the service GP or patient-led, it is about abolishing the national service and transferring public funds and services to the private sector through a process of closure and the manufacture of a financial crisis. Loss of services coupled with new discretionary powers mean that people will be forced to pay out of their own pocket for more of their care. Owen’s bill exposes the truth behind the Act. For sixty years, the public , unlike their US cousins, had no fear of health care bills; this freedom from fear and commitment to the NHS model has stood the test of time. Will Labour and the Liberal Democrats support a Bill that restores the democratic and legal basis of the NHS and the principle of health care for all on the basis of need and not ability to pay?

Allyson Pollock is professor of public health policy and research at Queen Mary, University of London, and the author of NHS PLC

David Price is a senior research fellow at Queen Mary, University of London

Demonstrators protest against the proposed closure of the Accident and Emergency and maternity units at Lewisham hospital. Photograph: Getty Images.

 

Allyson Pollock is professor of public health policy and research at Queen Mary, University of London, and author of NHS PLC

David Price is a senior research fellow at Queen Mary, University of London

 

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Leader: Against neverendums

At present, we are experiencing a fetishisation of referendums. But we must remember that Britain is a representative democracy.

Imagine a Britain where the death penalty was restored, where immigration quotas were determined on ethnicity and where some communities were forcibly repatriated to countries that they never called home. This is not some dystopia led by a British Donald Trump. It is what the UK could have looked like had the proponents of direct democracy – referendums – had their way.

Britain is a representative democracy. We elect 650 MPs and we entrust them with the power to make and scrutinise legislation on our behalf. This simple method of central government (we also have devolved institutions) has done much to ensure our stability where more fragile democracies, or illiberal ones, have succumbed to disorder or fascism.

At present, we are experiencing a fetishisation of referendums: we argue this having supported the Scottish referendum in 2014, for which the SNP had an unequivocal mandate. Yet, broadly, referendums are not a uniquely democratic way to arrive at a decision of national moment but a crude majoritarian tool. The deliberative nature of a parliament, with its built-in checks and balances, safeguards it against blindness to the interests of minority groups and views and allows compromises to evolve. Referendums can too easily allow the dominant moral panic of the time to be translated into immediate action. Had they been called on the progressive social advances of the 20th century, we would now be a far less open and tolerant society.

Referendums can also undermine the basis of representative democracy. Our parliament works, on the whole, because we trust its supreme authority to make decisions. As one concedes that there are some issues that are only legitimately settled by a referendum, the question immediately arises: which ones? If the UK’s continued membership of the European Union falls into this category, why not the Budget? If the Alternative Vote does, why not the issue of military intervention in Iraq or Libya? Yet the ultimate threat to our form of democracy is not referendums but those who have instigated them. The EU referendum on 23 June was dreamed up by the Prime Minister for no better reason than that he was pressured by recalcitrant right-wingers in the Tory party, as well as the UK Independence Party and the press.

Referendums seldom settle difficult questions, as events in Scotland have demonstrated. There, a “once in a generation” vote turned out to be no such thing: rarely does a week pass without Nicola Sturgeon making vague threats about a “second” independence referendum. Moreover, Ukip’s Nigel Farage is already talking about the need for a second EU referendum before the first has even happened.

When confused voters say that they want an objective list of the pros and cons of Brexit before they can make up their minds, what they mean is that they want their representatives to regain the courage to make difficult decisions on their behalf. Britain needs a frank reminder that politics is complicated and its practitioners are often skilled and conscientious.

It would be a folly to leave the EU but it was a folly enough to call this referendum during a period of multiple crises in Europe. It is time to speak up for representative democracy.

The rise of the nativist right

Had 31,000 Austrians voted differently, Europe would now have its first far-right president since 1945. The narrow defeat of the Freedom Party’s Norbert Hofer is emblematic of the xenophobic nativism that has spread across the continent. Mr Hofer’s softly spoken, telegenic manner belied his extreme views. He has declared that “Islam has no place in Austria”, wears a blue cornflower (the historic symbol of pan-Germanism) and is an honorary member of the student fraternity Marko-Germania zu Pinkafeld, which rejects the “fiction of an ‘Austrian nation’”.

Yet far from being an outlier, Hofer has many allies. Marine Le Pen’s Front National, Frauke Petry of Alternative für Deutschland and Geert Wilders of the Dutch Party for Freedom all rallied to his cause. In Hungary, Poland and Finland, the far right holds office.

The rise of these atavistic forces is an indictment of Europe’s mainstream, most notably its becalmed centre-left. As in the 1930s, nationalists have skilfully exploited cultural and economic alienation. History provides ample warning of the consequences of allowing such extremists into power. It is a lesson that Europe should not be forced to learn again. 

This article first appeared in the 26 May 2016 issue of the New Statesman, The Brexit odd squad