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

 

Photo: Getty
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The rise of the green mayor – Sadiq Khan and the politics of clean energy

At an event at Tate Modern, Sadiq Khan pledged to clean up London's act.

On Thursday night, deep in the bowls of Tate Modern’s turbine hall, London Mayor Sadiq Khan renewed his promise to make the capital a world leader in clean energy and air. Yet his focus was as much on people as power plants – in particular, the need for local authorities to lead where central governments will not.

Khan was there to introduce the screening of a new documentary, From the Ashes, about the demise of the American coal industry. As he noted, Britain continues to battle against the legacy of fossil fuels: “In London today we burn very little coal but we are facing new air pollution challenges brought about for different reasons." 

At a time when the world's leaders are struggling to keep international agreements on climate change afloat, what can mayors do? Khan has pledged to buy only hybrid and zero-emissions buses from next year, and is working towards London becoming a zero carbon city.

Khan has, of course, also gained heroic status for being a bête noire of climate-change-denier-in-chief Donald Trump. On the US president's withdrawal from the Paris Agreement, Khan quipped: “If only he had withdrawn from Twitter.” He had more favourable things to say about the former mayor of New York and climate change activist Michael Bloomberg, who Khan said hailed from “the second greatest city in the world.”

Yet behind his humour was a serious point. Local authorities are having to pick up where both countries' central governments are leaving a void – in improving our air and supporting renewable technology and jobs. Most concerning of all, perhaps, is the way that interest groups representing business are slashing away at the regulations which protect public health, and claiming it as a virtue.

In the UK, documents leaked to Greenpeace’s energy desk show that a government-backed initiative considered proposals for reducing EU rules on fire-safety on the very day of the Grenfell Tower fire. The director of this Red Tape Initiative, Nick Tyrone, told the Guardian that these proposals were rejected. Yet government attempts to water down other EU regulations, such as the energy efficiency directive, still stand.

In America, this blame-game is even more highly charged. Republicans have sworn to replace what they describe as Obama’s “war on coal” with a war on regulation. “I am taking historic steps to lift the restrictions on American energy, to reverse government intrusion, and to cancel job-killing regulations,” Trump announced in March. While he has vowed “to promote clean air and clear water,” he has almost simultaneously signed an order to unravel the Clean Water Rule.

This rhetoric is hurting the very people it claims to protect: miners. From the Ashes shows the many ways that the industry harms wider public health, from water contamination, to air pollution. It also makes a strong case that the American coal industry is in terminal decline, regardless of possibile interventions from government or carbon capture.

Charities like Bloomberg can only do so much to pick up the pieces. The foundation, which helped fund the film, now not only helps support job training programs in coal communities after the Trump administration pulled their funding, but in recent weeks it also promised $15m to UN efforts to tackle climate change – again to help cover Trump's withdrawal from Paris Agreement. “I'm a bit worried about how many cards we're going to have to keep adding to the end of the film”, joked Antha Williams, a Bloomberg representative at the screening, with gallows humour.

Hope also lies with local governments and mayors. The publication of the mayor’s own environment strategy is coming “soon”. Speaking in panel discussion after the film, his deputy mayor for environment and energy, Shirley Rodrigues, described the move to a cleaner future as "an inevitable transition".

Confronting the troubled legacies of our fossil fuel past will not be easy. "We have our own experiences here of our coal mining communities being devastated by the closure of their mines," said Khan. But clean air begins with clean politics; maintaining old ways at the price of health is not one any government must pay. 

'From The Ashes' will premiere on National Geograhpic in the United Kingdom at 9pm on Tuesday, June 27th.

India Bourke is an environment writer and editorial assistant at the New Statesman.

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