"The NHS is being hollowed out from within; that's not efficiency." Photo: Getty
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NHS reform and the hollow marketisation myth

A metamorphosis is taking place; a mutation of the NHS from a public service into a lucrative marketplace.

When the chief executive of NHS England produces a 39-page, 15,000-word rescue plan for the health service that, a senior doctor later told me, “doesn’t even mention the real problem in the system”, you know something is up.

Not that it’s any great surprise. Simon Stevens isn’t likely to agree with my source that the real problem in the NHS is a prevailing ideological dogma that “private is good and public is bad” among top brass, nor that the aggressive marketisation programme currently underway is all based on a myth. The private healthcare man turned NHS-saviour has only been in his post for seven months after 10 years at global giant United Health Group, and old habits die hard.

But the real paradox at the heart of Stevens’ five-year plan is that he calls for ruthless efficiencies and then turns a blind eye to the sort of “grotesque financial waste” that consultant clinical oncologist and National Health Action Party (NHAP) co-leader Clive Peedell says is crippling the system.

Peedell says: “Wasteful internal markets, commissioning support units, management consultancy fees, the cost of procurement of clinical services, profit-taking by private providers, the cost of fragmenting pathways due to outsourcing components to private contractors, and PFI deals bankrupting our hospitals; they are draining billions from frontline care in our NHS”.

A metamorphosis is taking place; a mutation of the NHS from a public service into a lucrative marketplace. None of this is particularly new – but since the Health and Social Care Act kicked in two years ago, trusts have been legally obliged to compete with private providers over contracts, and take on the extra administrative costs of doing so. Allyson Pollock, professor of public health research at Queen Mary University of London, says: “It’s quite clear that the government wants to contract out as much as it can before the general election, but there’s no data about the costs for trusts such as lawyers and management consultants in doing this”.

And after a slow start, the scrum has really kicked in now. Campaign group NHS Support Federation has recorded five times more contracts coming onto the market between July and September this year, a cool £2bn’s worth, than in the first three months of life under the Health and Social Care Act when only £266m was up for grabs. Bound by competition laws, NHS trusts find themselves in the position of having to spend tens, maybe hundreds of thousands bidding to carry on running services they already deliver, or, even worse, to then lose out to private providers that have cherry-picked the contracts and put all of their corporate weight behind winning them.

Take Cambridgeshire and Peterborough for example, where a million pounds of taxpayer money was wasted on the procurement process of older people’s healthcare and adult community health services before the CCG finally decided that Cambridgeshire and Peterborough NHS Foundation Trust should carry on running the service.

Why are such tremendous burdens being overlooked by Stevens? Or the hideous levels repayments for the same PFI loans he advocated when he had Tony Blair’s ear back in the noughties? Why no mention of the £4.5bn a year that Calum Paton, Professor of Public Policy at Keele University, conservatively estimates is the cost of administering an internal market he describes as “costly and of dubious effectiveness”, or the extortionate legal fees just being in that market forces trusts to stump up?

GP and anti-privatisation campaigner Dr Bob Gill says: “A market doesn’t work in healthcare; the administration of it just drives up costs. The NHS is being hollowed out from within, assisted by people from banking and the private sector who are dumbing down the service and delivering everything as cheaply as possible. That’s not efficiency”.

Neither is, Gill argues, a system in which a hollowed-out NHS has to pay when those private companies fail in their duty. Private companies like Vanguard Healthcare, which had its contract with Musgrove Park Hospital in Taunton terminated after a series of post-surgery complications, leaving Musgrove medical director Dr Colin Close admitting, “any financial responsibility would rest with us”.

How is all this playing out? Kathryn Anderson is a nurse at the Royal Free Hospital and NHAP general election candidate – in Iain Duncan Smith’s constituency. She says that far from bringing in greater efficiency or care, these new wasteful costs are having the opposite effect in the wards. “All that money comes from the frontline,” she says. “It comes from nurses and HCAs and doctors’ pay, and from drugs that don’t get purchased. You can’t run the NHS and expect it to perform if you flush the money out of the system, it just doesn’t work. We see this every day and it’s getting worse”.

The Conservatives are keeping very quiet about all this, perhaps wisely. With one hand Lansley and Hunt have enforced pay freezes on frontline staff claiming the pot is empty, and with the other, enforced an extortionate tendering process that has wasted vital funds. Just the cost of the top-down reorganisation alone, which a senior Tory MP recently described as the party’s “biggest mistake” in government, is estimated at £3bn.

On the pretext that the NHS is an egregious waste of public money – despite the fact that in 2012 the UK spent less on healthcare as a percentage of GDP than any other G7 country – the system has been altered from within. The result is a conduit to a £100bn-a-year pot with an NHS stamp on the side, which through some alchemy turns taxpayer money into private profits.

Stevens’ five-year plan is full of hope and some entirely sensible ideas to improve the system. But with no mention of any of the debilitating costs of running the new marketised system, which Unite head of health Rachael Maskell says could be as high as £1bn by the time of the election, nor the outcry from the profession about marketisation which the BMA itself is campaigning to see reversed in law, it seems a little hollow to say the least.

Benedict Cooper is a freelance journalist who covers medical politics and the NHS. He tweets @Ben_JS_Cooper.

India Bourke
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Pegida UK: the new face of Britain’s far-right movement, and how to challenge it

“Let them drink tea,” Birmingham tells Islamophobes.

“Spooky,” is how Pegida UK – the latest branch of a global, anti-Islam, protest group  chooses to describe its silent march on the outskirts of Birmingham. 

“Islam is Nazism incarnate,” announces its new leader, Paul Weston, to a few hundred soggy, sober, brolly-clad protesters waving “Trump is Right” placards. 


Pegida UK protestors march through the rain. Photos: India Bourke

Such numbers are a far cry from the tens of thousands who attended the movement’s inaugural rallies in Germany in 2014, in response to the perceived “Islamisation” of Europe. And they would be derisory if the cheers Weston receives from his supporters weren’t quite so chilling, nor echoed so far.

For Pegida UK is not alone. From Calais to Canberra, thousands marched in the name of the movement’s toxic platform of anti-immigration and anti-Islam last weekend. I went to see the Birmingham rally to find out why such a protest is taking place in Britain.

***

"Today is the first of many European wide demonstrations that will bring people together like never before,” Tommy Robinson, UK founder and ex-EDL leader, tells the assembled crowd. “It's planting the seed of something huge.”

Robinson hopes to exploit a gap within Britain’s far-right. Traditional groups are fractured: the British National Party was decimated at the last election, standing just eight of a previous 338 candidates. In its place, a swell of smaller, extremist bodies – from the Sigurd Legion to National Action – are pressing an ever more militant agenda. Pegida hopes to scale back the hooliganism in order to garner a wider appeal, but it shares these groups’ confrontation with Islam, and each may spur the other on.

“With Pegida we’re seeing the rise of a seminal new threat,” says Birmingham MP Liam Byrne. “In the rise of Isis and politicians like Donald Trump, you have forces determined to promote a clash of civilisations between Islam and the West. Pegida is trying to surf that wave and make sure it crashes on our shores.

Opponents hope the movement will suffer the same implosion that felled the BNP and EDL, with both leaning  too much on their leaders’ personal brands. Robinson certainly seems as adolescent as ever: laughing as he swipes away a photo of a scantily-clad blonde on his iPhone screen to show me the international Pegida leadership’s “hidden” Facebook group.

Their new apparently "suited and booted" middle-class following is also less than wholehearted. One pin-striped IT executive I speak to seems embarrassed by the whole affair: “I’m just a cowardly family man who can’t see a solution being offered by mainstream politicians. I’d be sacked if they knew I was here,” he says, declining to give his name. 


A Pegida protestor poses in front of the main stage.

As long as such hesitation prevails, Pegida UK will struggle. Still, there’s a sense more needs to be done to ensure its demise.

Matching protest with counter-protest is the traditional leftwing response, and this weekend saw thousands of Pegida opponents take to the streets across Europe. Yet, in some cases, direct confrontation can risk drowning out – even alienating – the very voices it seeks to win over.

“Smash the facists into the sea,” instructed the Twitter account of the North London Antifa group ahead of last weekend’s far-right, anti-immigration protest in Dover, where injuries were sustained by demonstrators on both sides.

***

Instead, many now believe a better answer begins with that most British of pastimes: tea and a chat.

On the day before the Birmingam march, hundreds of the city’s cross-party leaders, religious figures and citizens gathered together at Birmingham Central Mosque to share their concerns over shortcake and jalebi.

“Groups like Pegida are parasites on the real concerns people have,” says John Page from the anti-extremism group Hope not Hate. “So we have to listen to these issues to close the cracks.

Initiatives around the city will attempt to take this approach, which sets a welcome lead not just for the UK, but Europe too.

The blanket smearing by groups like Pegida of Islam as a religion of sexist, homophobic Jihadi Johns places the burden of action disproportionately on the city’s Muslims. “It is our turn now to suffer these attacks,” says Mr Ali, Birmingham Central Mosque’s 42-year-old administrator. “It was the Irish, then the Jews, and now it is the time for us. But we are proud to be British Muslims and we will do what we can to defend this country.” 

A permanent visitors gallery, Visit-my-Mosque events, and publications that condemn Isis, are just some of the ways the community is challenging demonisation. It is even hosting a documentary crew from Channel 4 – a bold move in a city still reeling from Benefits Street.


Birmingham resident, Luke Holland, at a peaceful counter-protest in the city centre.

Mr Ali says: “The extreme right know nothing about Islam, but neither do many Muslim extremists.” The mosque is therefore in the process of formulating a “code of conduct”, making clear that hate speech of any kind is unacceptable.

"We have to help young people become the next Chamberlains and Cadburys and Lucases of this city," regardless of background, says Labour councillor Habib Rehman. Instead of letting them slip into despair and extremism of any kind, "we have to tell them: 'Yes You Khan!’”

Tea and talk is not the most dramatic response to Pegida’s claim it will have “100,000 decent people on the street” by the end of the year. But, in Birmingham at least – the city of Typhoo, where bhangra is as familiar as Bournville, and “No dogs, no Irish!” still sits heavy on the collective mind – tea, for now, means hope.

India Bourke is the New Statesman's editorial assistant.