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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Should feminists talk about “pregnant people”?

Two writers present the arguments for and against.

NO

“I’m not sure what the public health issue is that would require a focus only on those who become pregnant, as opposed to any of those involved in pregnancy, either becoming pregnant or causing someone else to become pregnant,” Dr Elizabeth Saewyc, a Canadian professor in nursing and adolescent medicine at the University of British Columbia, recently told journalist Jesse Singal when he asked her for clarification on a study she conducted into trans youth and pregnancy.

Her statement is, on the face of it, extraordinary: unlike those who “cause someone else to become pregnant” (males), those who “become pregnant” (females) actually, well, become pregnant, with everything that entails from the risk of varicose veins and pre-eclampsia, to having an abortion or being denied abortion, to miscarriage or giving birth and living with the economic strain and social discrimination that come with motherhood.

As absurd as Saewyc sounded, her position is the logical endpoint of “gender neutral” language about pregnancy. Pressure on reproductive rights groups – especially those in the US – to drop references to “women” and instead address themselves to “people” have been growing over the last few years, and the American body Planned Parenthood now regularly mentions “pregnant people” in its communications. In theory, this is supposed to help transmen and non-binary-identified females who need reproductive health services. In practice, it creates a political void into which the female body, and the way pregnancy specifically affects women, simply disappears.

The obscuring of the female body beneath obscenity and taboo has always been one of the ways patriarchal society controls women. In 2012, Michigan Democratic representative Lisa Brown was prevented from speaking in a debate about abortion after she used the word “vagina”, which Republicans decided “violated the decorum of the house”. Now, that oppressive decorum is maintained in the name of trans inclusion: in 2014, the pro-choice organisation A is For was attacked for “genital policing” and being “exclusionary and harmful” over a fundraiser named Night of a Thousand Vaginas.

Funnily enough, trans inclusion doesn’t require the elimination of the word vagina entirely – only when it’s used in reference to women. A leaflet on safe sex for trans people published by the Human Rights Campaign decrees that “vagina” refers to “the genitals of trans women who have had bottom surgery”; in contrast, unaltered female genitals are designated the “front hole”. And it’s doubtful that any of this careful negation of the female body helps to protect transmen, given the regular occurrence of stories about transmen getting “unexpectedly” pregnant through having penis-in-vagina sex. Such pregnancies are entirely unsurprising to anyone who knows that gender identity is not a contraceptive.

It does, however, protect from scrutiny the entire network of coercion that is cast over the female body: the denial of abortion rights in the Republic of Ireland, for example, affects the same class of people who were subjected to the medical violence of symphysiotomy — a brutal alternative to cesarean, which involves slicing through the cartilage and ligaments of a pelvic joint to widen it and allow a baby to be delivered — the same class of people who were brutalised by Magdalen Laundries (institutions established to house “fallen women” which operated from the late 18th to the 20th centuries), the same class of people who are subject to rape and sexual harassment. That class of people is women. If we give up the right to name ourselves in the service of “inclusion”, we permit the erosion of all our hard-won boundaries.

Sarah Ditum is a journalist who focuses on feminism.

YES

No matter who you are and how straightforwardly things go, pregnancy is never an easy process. It might be a joyous one in many ways, but it’s never comfortable having to lie on your back in a brightly lit room with your legs hitched in stirrups and strangers staring at parts of your anatomy some of them hesitate to name. Then there are the blood tests, the scans, the constant scrutiny of diet and behaviour – it may be good practice for coping with a child, but the invasion of privacy that takes place at this time can have a dehumanising effect. And that’s without having your gender denied in the process.

If you’ve never experienced that denial, it might be difficult to relate to — but many women have, at one time or another, received letters addressing them as “Mr” or turned up at meetings only to discover they were expected to be men. It’s a minor irritation until it happens to you every day. Until people refuse to believe you are who you say you are; until it happens in situations where you’re already vulnerable, and you’re made to feel as if your failure to conform to expectations means you don’t really deserve the same help and respect as everyone else.

There is very little support available for non-binary people and trans men who are happily pregnant, trying to become pregnant or trying to cope with unplanned pregnancies. With everything geared around women, accessing services can be a struggle, and encountering prejudice is not uncommon. We may not even have the option of keeping our heads down and trying to “pass” as female for the duration. Sometimes our bodies are visibly different.

It’s easy for those opposed to trans inclusion to quote selectively from materials making language recommendations that are, or appear to be, extreme – but what they miss is that most trans people going through pregnancy are not asking for anything drastic. We simply want reassurance that the people who are supposed to be helping us recognise that we exist. When that’s achievable simply by using a neutral word like people, does it really hurt to do so? I was always advised that manners cost nothing.

Referring to “people” being pregnant does not mean that we can’t also talk about women’s experiences. It doesn’t require the negation of femaleness – it simply means accepting that women’s rights need not be won at the expense of other people’s. We are stronger when we stand together, whether pushing for better sex education or challenging sexual violence (to which trans men are particularly vulnerable).

When men criticise feminism and complain that it’s eroding their rights, this is usually countered with the argument that it’s better for everyone – that it’s about breaking down barriers and giving people more options. Feminism that is focused on a narrow approach to reproductive biology excludes many women who will never share the experience of pregnancy, and not necessarily through choice. When women set themselves against trans men and non-binary people, it produces a perfect divide and conquer scenario that shores up cis male privilege. There’s no need for any of that. We can respect one another, allow for difference and support the growth of a bigger feminist movement that is truly liberating.

Jennie Kermode is the chair of the charity Trans Media Watch.