Will the Lib Dems halt Hunt's backdoor NHS privatisation?

Health secretary promises to address "concerns" over Section 75 of the NHS bill after pressure from Lib Dems and Labour.

When the government's Health and Social Care Bill was finally passed by Parliament last year it was on the condition that GPs would not be forced to open up NHS services to private competition.

Andrew Lansley, the-then Health Secretary, told the Commons: "There is absolutely nothing in the Bill that promotes or permits the transfer of NHS activities to the private sector". In a letter to Clinical Commissioning Groups, he wrote:

I know many of you have read that you will be forced to fragment services, or put them out to tender. This is absolutely not the case. It is a fundamental principle of the Bill that you as commissioners, not the Secretary of State and not regulators – should decide when and how competition should be used to serve your patients interests. 

Having accepted Lansley's assurances, the Lib Dems granted the bill their support. But new regulations published under Section 75 of the act flatly contradict the government's promises. The guidelines state that commissioners may only award a contract without competition if they are "satisfied that the services to which the contract relates are capable of being provided only by that provider". In practice, then, GPs will be forced to open up all NHS services to private companies, regardless of the wishes of local people, with the healthcare regulator Monitor granted the power to block any "unnecessary" restriction of competition. 

Secondary legislation like this is normally nodded through parliament without debate but Labour, smelling a rat, warned that the regulations amounted to an attempt at backdoor privatisation. Jeremy Hunt, Lansley's replacment as health secretary, initially sought to dismiss the opposition's concerns. In response to a question from Jamie Reed, the shadow health minister, he declared: "Who exactly are the section-75 bogeymen [he] hates: Whizz-Kidz, who are supplying services to disabled children in Tower Hamlets? Or Mind, which is supplying psychological therapy to people in Middlesbrough?"

But after the Lib Dems joined Labour in raising concerns, Hunt has been forced to think again. Norman Lamb, the Lib Dem health minister, told his party colleague Andrew George, one of those opposed to the regulations, "We are looking at this extremely seriously. Clear assurances were given in the other place during the passage of the legislation, and it is important that they are complied with in the regulations."

In reponse, as today's Guardian reports, Hunt has made it clear that he is prepared to rewrite the new guidelines. A source tells the paper: "We are aware that there are concerns over the wording and the way it may be interpreted. We are speaking to the Lib Dem peers to make sure they are happy. We want to make sure everyone is happy."

The shadow health secretary, Andy Burnham, said in response: "The government has been caught out trying to force through privatisation of the NHS by the back door.

"This is another humiliating U-turn to add to the government list, but we believe ministers will stop at nothing to drive through their plans to put the NHS up for sale to the highest bidder."

But will this be anything other than a comestic rewrite? Ahead of the Lib Dems' spring conference next month, this is a key test of the party's nerve. 

Health Secretary Jeremy Hunt speaks at the Conservative conference in Manchester last year. Photograph: Getty Images.

George Eaton is political editor of the New Statesman.

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From Netflix to rented homes, why are we less interested in ownership?

Instead of owning things, we are renting experiences.

In 2008 the anthropologist Daniel Miller published a book based on an intimate study of 30 households on a single street in south London. The Comfort of Things ­explored the different kinds of relationships people have with what they own.

Miller described a retired couple’s house, cluttered with furniture, framed photographs and knick-knacks accumulated over decades. Down the road, a self-employed man called Malcolm had rented a flat. Malcolm preferred a spartan existence: he kept his belongings in storage, the better to travel at short notice, and conducted as much as possible of his life online. His home was his email address. His central material possession was his laptop.

Today, we are living more like the laptop warrior than the retired couple. Increasingly, our possessions are stored in the cloud or on a distant server. Just as we had grown accustomed to the idea of owning music in the form of data, we are now getting used to not owning it at all. In television, too, we stream instead of buy the latest drama series; when people use the term “box set” they are rarely referring to a box of discs on a shelf in the living room. Everything solid is melting into wifi.

Instead of owning things, we are renting experiences. The proliferation of mobile apps enables us to source or supply whatever we want, for short periods, more easily than ever before. The “sharing economy” is not about sharing, however. I encourage my three-year-old daughter to share her toys with her little brother; I don’t suggest that she charge him an hourly fee for doing so. A better name for it is the Paygo (pay-as-you-go) economy.

The Paygo economy combines two intertwined phenomena: the rise of renting and the decline of stuff. If you are in your twenties and unburdened by wealth you may already have accepted that you will always be in hock to a landlord. If you are in the market for a car, you will probably be thinking about leasing it, or joining a car club, or waiting until Google makes car ownership obsolete. There are even apps that allow you to rent a dog rather than take on the responsibility of owning one.

A world in which we own less and rent more is not necessarily one in which consumers are empowered. You never really own the electronic versions of a book or a film – you can’t lend them to a friend or sell them on – because the publisher retains its rights over them. Even our photos aren’t ours any longer: they are owned by corporations that scrape them for data that can be sold. In a recent article, the Financial Times journalist Izabella Kaminska argued that “ownership of nothing and the rental of everything represents . . . the return of an authoritarian and feudalistic society”.

The Paygo economy is changing our relationships with each other and with ourselves. Possessions form part of what the marketing academic Russell Belk calls “the extended self”. In Daniel Miller’s book, he describes how objects, however trivial, can embody relationships. Each household’s collection of stuff – tacky souvenirs, CDs we borrowed and never gave back – forms a constellation of personal significance. Post-materialism does not equate with spiritual enrichment. “Usually the closer our relationships with objects,” Miller writes, “the closer our relationships are with people.”

Human beings have a deep-seated tendency to imbue physical items with the ­essence of their owner. Hence the market for rock-star memorabilia: an old guitar that has been played by John Lennon is more valuable, and more revered, than a new replica that has not.

We apply this intuition even to money, the units of which are, by definition, interchangeable. Psychologists who study “essentialism” have found that people are less likely to recommend that stolen or lost cash be returned when it has subsequently been deposited in a bank account, as opposed to remaining in paper notes.

When things evaporate, so does ­meaning. A fetish for owning things connects to a yearning to retain a distinct identity in the face of change. Japan has been economically stagnant for decades and, as a result (and perhaps a cause), has preserved a set of idiosyncratic social norms, at odds with the rest of the developed world. One of these is a strong preference for owning music in a physical form: 85 per cent of the music bought in this technologically advanced society is on CD or vinyl. Japan is also the last developed country to rely on fax machines. A fax, unlike an email or the past, is something you can hold on to.

One way of framing the central arguments of British politics is that they are about the rights of owners versus renters – and not just in the sense of home ownership. Long-standing Labour members believe they own the party, and are outraged both by Momentum clicktivists and £3 voters. What appals many who voted Leave in the EU referendum is the thought that migrants can, in effect, rent a livelihood from the UK, treating the country as a giant Airbnb host. They want to know if this is still their country, or if they are now merely tenants of it.

Most younger voters chose Remain, but relatively few of them voted. That was a function of their lack of home ownership as much as age: millennials who rent are nearly half as likely to vote in elections as their peers who have managed to get on to the property ladder. This is partly a product of the mundane business of spending enough time in one place to get on the electoral roll, but it nonetheless suggests that renters form weaker bonds with the society in which they live.

For centuries, what we own has been an important way of placing ourselves in relation to those around us. The 18th-century curiosity cabinet was a collection of objects used to display the erudition and refinement of its owner. In the 20th century, houses became showcases. Your curtains, your car and your choice of decor said who you were or wanted to be. This was the era of what Thorstein Veblen called “conspicuous consumption”. In the Paygo economy, we will have fewer things of our own to ­display, as our possessions dematerialise and we rent more of what we need.

Despite all this, human nature has not changed: we are still apes with status anxiety, endlessly preoccupied by our position in any given hierarchy, eager for ways to convey our aspirations and allegiances. So we find other ways to signal. Rather than deploy what we own to say who we are, we use our photo streams and status updates to show it, even going so far as to arrange our meals and holidays with the aim of generating impressive on-brand content.

The vacuum of meaning opened up by the disappearance of stuff may even have increased the stridency of our political debate. One way I can let people know who I am is by loudly asserting my membership of a political tribe.

If I can’t show off my possessions, I will show off my beliefs.

Ian Leslie is the author of “Curious: the Desire to Know and Why Your Future Depends on It” (Quercus)

Ian Leslie is a writer, author of CURIOUS: The Desire to Know and Why Your Future Depends On It, and writer/presenter of BBC R4's Before They Were Famous.

This article first appeared in the 16 February 2017 issue of the New Statesman, The New Times