Labour’s front-bench health spokesperson, Andy Burnham made a pledge at the TUC rally in March this year that if he is health secretary when Labour are next in power he will repeal the Tories’ Health and Social Care Act, which became law in March 2012 and vastly increases privatisation and marketisation of the Health Service.
But the pledge is full of loopholes.
Most of the current cuts in the NHS were planned by Andy Burnham while he was Health Secretary. Burnham started off as Shadow Health Secretary by criticising Tory health minister Andrew Lansley for planning to increase health spending!
Lansley has cut spending in two successive years (£766 million 2010-11, £26 million 2011-12). But in his first debate as shadow Health Secretary Burnham situated himself to the right of the Tories.
During his time in office Burnham backed the recommendations of Sir David Nicholson, the chief executive of the NHS, to make £20 billion “efficiency savings” by 2015. Nicholson pointed out that rising demand due to the ageing population and new technologies cost the taxpayer an extra £20 billion by 2015. He advised the government to halt extra funding and attempt to find the extra cash by shutting down hospitals and moving care to the community. Burnham concurred.
Burnham has done his best to expose the fact that the Tories are trying to privatise both commissioning and NHS provision.
But here again, he struggles because his own policies are mere watered down versions of Lansley’s. As Unison general secretary Dave Prentis put it, “The Tories are marching over the bridge that Labour built”.
Burnham opposes Lansley’s plans “to let market forces rip right through the system with no checks or balances”, but he is at pains to stress that “without the contribution of private providers, we would never have delivered NHS waiting lists and times at historically low levels”.
He claims that the Tories want “unchecked privatisation” whereas he wants “the private sector working at the margins providing innovation and support.” The problem with this line is that market forces tend to take on a dynamic of their own.
That is seen in Labour’s own manifesto pledge to “[give] Foundation Trusts…the freedom to expand their provision into primary and community care, and to increase their private services — where these are consistent with NHS values, and provided they generate surpluses that are invested directly into the NHS.” Market pressures from Foundation Trusts to expand their private work led Labour to accept proposals to raise the private patient income caps.
Burnham has since claimed that he was only planning a “modest loosening” of the cap. But it is difficult to oppose the Tories plan to give over up to 49% of NHS beds to private patients when the Labour policy is nothing but a smaller step in the same direction.
Burnham has qualified his basic promise to repeal the Health and Social Care Act, he has since qualified this with a promise to avoid any “top-down reorganisations”. Ed Miliband has approved “clinician-led commissioning”, the core idea of the Act.
Cut through the bluster and Andy Burnham’s vision is basically Tory policy minus the Maoist execution and with a bit more regulation — HSCA-lite.
Miliband and Burnham have both stressed that much of Lansley’s programme could have been executed without new legislation.
If Burnham is the next Labour Health Secretary then his promise to repeal the Bill without any top-down reorganisation will probably leave much of the new infrastructure in place.
Entirely missing from this debate is a rational evaluation of the pre-Thatcher NHS. The Tories drove through this policy arguing that the NHS was bureaucratic and wasteful. Nobody from the Labour benches raised the obvious objection.
The waste and inefficiencies of the NHS bureaucracy are the result of Tory and New Labour attempts to introduce market mechanisms and PFI. For much of its history the NHS was a state-planned organisation run on the basis of block grants and risk-sharing. It was occasionally a bit clunky, and it was chronically underfunded, but from 1948-1980 the bureaucracy accounted for just 6% of health expenditure.
With the introduction of the Tory “internal market” and the continuation of this policy with New Labour’s “purchaser-provider split” the bureaucracy swelled to around 14% health funding. Health economist Allyson Pollock estimates that in the new system “billing, invoicing, marketing and advertising will add between 30% and 50% to costs”.
In the USA, with a fully privatised system, administration costs account for a third of all health spending. 50 million are without health insurance, yet the USA spends nearly 17.4% of GDP on healthcare, compared with 9.8% in UK.
The labour movement must imagine the possibilities for an NHS run on the founding principles of collaboration, risk-sharing and democratic planning. The labour movement must fight for such a policy and fight for leaders willing to argue it and implement it.