Health Secretary Jeremy Hunt delivers a speech during his visit to the Evelina London Children's Hospital on July 5, 2013. Photograph: Getty Images.
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NHS privatisation isn't working, it’s time for a more mutual solution

Mutuals are best placed to initiate a system of healthcare that delivers personalised, holistic care in a cost-effective manner.

As much as many of us would like to ignore the fact, our National Health Service is at the most critical juncture in its long history. An ever-ageing population, together with the stark rise in prevalence of those suffering from lifestyle diseases, both place our healthcare system on a financially unsustainable footing. Indeed, long-term conditions, such as obesity and diabetes, will alone bankrupt the NHS within a decade, with a £19bn funding gap expected if these conditions are not managed properly.

Yet from government there seems to be a lack of good ideas on how to ensure that NHS remains viable as an institution free at the point of use. Many of the arguments surrounding health reform suggest that the solution to this financial crisis is a laughably simple one – more liberalisation. The trend towards NHS liberalisation, which started with Margaret Thatcher and continued with the Health and Social Care Bill, has been at the heart of health reform over recent decades. This trend is based upon the proposition that is all that is needed to improve NHS services is to open up the system to private sector providers. Then competitive forces will, as if by magic, improve patient quality whilst making the necessary savings.

But although competition in certain cases is to be welcomed, it is alone insufficient to tackle the health systems incoming problems. The complex conditions of the future will require a different type of healthcare, delivered by a different healthcare system. The NHS of the past, which was designed to combat acute diseases like polio and tuberculosis, is simply not configured to treat the chronic diseases associated with ageing and flawed lifestyle choices. These conditions require more integrated forms of service delivery that provide holistic, whole-person care.

It has long been known that integrated care is the holy grail of NHS reform. Yet the coalition government has failed to make this a top priority, and the cancellation of the £3.8bn Better Care Fund is clear evidence of this. In fact, instead of choosing the harder path towards better healthcare integration, the government has opted for and prioritised yet more liberalisation in the form of the Any Qualified Provider programme.

This initiative is intended to open up services and improve patient choice. Under this scheme, private providers are allowed to deliver basic NHS services. At a first glance, by the government’s standards the programme seems to have been a success, with 105 firms singed up to the scheme. But instead of opening up the service to smaller providers, as was first intended, the process has been criticised for prioritising the larger providers. A study of AQP found that 24 of the 105 firms were large companies with at least 250 members of full-time staff.

AQP is not the answer to integrated care, as it merely atomises and fragments care by multiplying the number of bodies delivering healthcare. In this way, it simply destabilises existing services and damages care pathways. It cannot, therefore, deliver the whole-person care we need. Because of this, we at ResPublica ask that the government seriously consider scrapping the Any Qualified Provider scheme. Competition and choice are to be welcomed, but they should not come at the price of collaboration and holistic care. We would instead argue for a different approach.

In our latest report, Power to the People: The mutual future of our National Health Service, we argue that mutuals are best placed to initiate a system of healthcare that delivers personalised, holistic care in a cost-effective manner. Mutual organisations are, by their very nature, democratic and benevolent institutions. As such, they are perfectly placed to integrate the needs of patients with the capabilities of clinicians in an inclusive fashion.

Such a proposal is not an odd suggestion. Mutuals already have a firm foothold in the NHS. Foundation Trusts, which operate on a mutual model, are now the standard composition for hospitals, and mutual NHS spin-outs are raising standards across the sector. One type of mutual organisation that has often been ignored, but could perhaps perform such a vital role, is the friendly society.

Before the advent of the NHS, most healthcare was provided through friendly societies. Just before the onset of the Great War, there were 26,877 friendly societies operating in England and six million members. The democratic and inclusive characteristics of these organisations would make them ideal candidates for performing an integrator role that would connect disparate elements of the NHS to deliver the holistic care our older people need.

As the report makes clear, the financial benefits of this model could be vast. By integrating care, we estimate that the NHS could save £4.5bn by 2020. Embracing mutualism would not only integrate care and deliver better outcomes, it would have significant financial benefits as well. Clearly, if we are to have the integrated care that so many of us need, then policy makers will have to ditch their fixation with ever increasing liberalisation and assess the benefits more mutualism could bring to the NHS.

Adam Wildman is research manager at ResPublica 

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In the 1980s, I went to a rally where Labour Party speakers shared the stage with men in balaclavas

The links between the Labour left and Irish republicanism are worth investigating.

A spat between Jeremy Corbyn’s henchfolk and Conor McGinn, the MP for St Helens North, caught my ear the other evening. McGinn was a guest on BBC Radio 4’s Westminster Hour, and he obligingly revisited the brouhaha for the listeners at home. Apparently, following an interview in May, in which McGinn called for Corbyn to “reach out beyond his comfort zone”, he was first threatened obliquely with the sack, then asked for a retraction (which he refused to give) and finally learned – from someone in the whips’ office – that his party leader was considering phoning up McGinn’s father to whip the errant whipper-in into line. On the programme, McGinn said: “The modus operandi that he [Corbyn] and the people around him were trying to do [sic], involving my family, was to isolate and ostracise me from them and from the community I am very proud to come from – which is an Irish nationalist community in south Armagh.”

Needless to say, the Labour leader’s office has continued to deny any such thing, but while we may nurture some suspicions about his behaviour, McGinn was also indulging in a little airbrushing when he described south Armagh as an “Irish ­nationalist community”. In the most recent elections, Newry and Armagh returned three Sinn Fein members to the Northern Ireland Assembly (as against one Social Democratic and Labour Party member) and one Sinn Fein MP to Westminster. When I last looked, Sinn Fein was still a republican, rather than a nationalist, party – something that McGinn should only be too well aware of, as the paternal hand that was putatively to have been lain on him belongs to Pat McGinn, the former Sinn Fein mayor of Newry and Armagh.

According to the Irish News, a “close friend” of the McGinns poured this cold water on the mini-conflagration: “Anybody who knows the McGinn family knows that Pat is very proud of Conor and that they remain very close.” The friend went on to opine: “He [Pat McGinn] found the whole notion of Corbyn phoning him totally ridiculous – as if Pat is going to criticise his son to save Jeremy Corbyn’s face. They would laugh about it were it not so sinister.”

“Sinister” does seem the mot juste. McGinn, Jr grew up in Bessbrook during the Troubles. I visited the village in the early 1990s on assignment. The skies were full of the chattering of British army Chinooks, and there were fake road signs in the hedgerows bearing pictograms of rifles and captioned: “Sniper at work”. South Armagh had been known for years as “bandit country”. There were army watchtowers standing sentinel in the dinky, green fields and checkpoints everywhere, manned by some of the thousands of the troops who had been deployed to fight what was, in effect, a low-level counter-insurgency war. Nationalist community, my foot.

What lies beneath the Corbyn-McGinn spat is the queered problematics of the ­relationship between the far left wing of the Labour Party and physical-force Irish republicanism. I also recall, during the hunger strikes of the early 1980s, going to a “Smash the H-Blocks” rally in Kilburn, north London, at which Labour Party speakers shared the stage with representatives from Sinn Fein, some of whom wore balaclavas and dark glasses to evade the telephoto lenses of the Met’s anti-terrorist squad.

The shape-shifting relationship between the “political wing” of the IRA and the men with sniper rifles in the south Armagh bocage was always of the essence of the conflict, allowing both sides a convenient fiction around which to posture publicly and privately negotiate. In choosing to appear on platforms with people who might or might not be terrorists, Labour leftists also sprinkled a little of their stardust on themselves: the “stardust” being the implication that they, too, under the right circumstances, might be capable of violence in pursuit of their political ends.

On the far right of British politics, Her Majesty’s Government and its apparatus are referred to derisively as “state”. There were various attempts in the 1970s and 1980s by far-right groupuscules to link up with the Ulster Freedom Fighters and other loyalist paramilitary organisations in their battle against “state”. All foundered on the obvious incompetence of the fascists. The situation on the far left was different. The socialist credentials of Sinn Fein/IRA were too threadbare for genuine expressions of solidarity, but there was a sort of tacit confidence-and-supply arrangement between these factions. The Labour far left provided the republicans with the confidence that, should an appropriately radical government be elected to Westminster, “state” would withdraw from Northern Ireland. What the republicans did for the mainland militants was to cloak them in their penumbra of darkness: without needing to call down on themselves the armed might of “state”, they could imply that they were willing to take it on, should the opportunity arise.

I don’t for a second believe that Corbyn was summoning up these ghosts of the insurrectionary dead when he either did or did not threaten to phone McGinn, Sr. But his supporters need to ask themselves what they’re getting into. Their leader, if he was to have remained true to the positions that he has espoused over many years, should have refused to sit as privy counsellor upon assuming his party office, and refused all the other mummery associated with the monarchical “state”. That he didn’t do so was surely a strategic decision. Such a position would make him utterly unelectable.

The snipers may not be at work in south Armagh just now – but there are rifles out there that could yet be dug up. I wouldn’t be surprised if some in Sinn Fein knew where they are, but one thing’s for certain: Corbyn hasn’t got a clue, bloody or otherwise. 

Will Self is an author and journalist. His books include Umbrella, Shark, The Book of Dave and The Butt. He writes the Madness of Crowds and Real Meals columns for the New Statesman.

This article first appeared in the 25 August 2016 issue of the New Statesman, Cameron: the legacy of a loser