Category Archives: Politics

Do you want a Capitalist Run Health Service?

hospital

A Capitalist National Health Service.

The NHS has been discussed in this election in terms of chronic underfunding, but not much in terms of its continuing privatisation. National Health Action, one of the smaller parties, has raised the issue and aims to repeal the 2012 Health and Social Care Bill. It sees the scale of the problem. Labour aim to do something similar, but the issue of the emergence of a capitalist health service deserves more thought from all voters. It is key. The process will soon be irreversible. Capitalism puts those who are selfish in control. For decades the NHS has been marked by service, care and concern for patients. Soon it will be a question of what profit can be made out of patients and sickness. Voters need to think what they are losing. This short paper provides some background and warnings.

Capitalist Privatisation of the NHS.

You are aware that the NHS is being privatised. Nurses are being provided by agencies. Operation systems are set up by private companies. Hospital trusts can and do undertake commercial activities on a large scale. Hinchingbrooke Trust Hospital was taken over by a private company, Circle, in 2012. Private patient care is mixed up in the working of Hospital Trusts. GP Surgeries are being run by private companies; one has 3 million patients in its network. The Private Finance Initiative has been building hospitals through financial corsortia, and vast pharmaceutical companies put acute pressure on the NHS and NICE to use its products. It is difficult, deliberately so, to work out the proportion of the NHS which is now funding private and corporate agencies, but it is approaching 10% on the most limited calculation, and if PFI and other elements are included it could be twice that. Given the weight of ordinary staff wages, that is very high.

Structural Privatisation.

But the situation is worse than this. The structure of the NHS was changed drastically by the 2012 Health and Social Care Act. (Notice the Conservatives had an opportunity to address Care in this Act, but did not.) This Act created a capitalist structure to the NHS which embeds and encourages a private enterprise NHS. Contracts have to be put out to private tender and Foundation Trusts are expected to act like large private companies. There are all kinds of ways in which capitalism is embedded. The NHS logo, for example, covers a lot of private companies acting commercially. There is a company, NHS Property Services, which has shares and a commercial structure to handle NHS property. There are Commissioning Support Units which have a list of “preferred providers” dominated by private multinational companies. In the Budget of March 2017 the Chancellor Phillip Hammond provided £325 million for Sustainability and Transformation Plans, another privatisation move. There are now enough highly paid posts, with executives are in favour of the system that pays them, for privatisation to roll on.

So What?

So the structure for full privatisation is in place and quasi- privatisation has already occurred. But so what? Many people are not worried as long as they get NHS services free at the point of delivery. It is like receiving a free ice cream – Why worry who provided it? But here we must do a little analysis.

Waste and Inefficiency.

First, we look at the waste of money. One example was the contract to put out to CSC and BT to computerize all NHS records. It started in 2011, cost £10.1bn, was axed in 2011 without any records being delivered. Only a few hundred million were recovered from the companies concerned, a vast loss to the NHS. The cost of hospital PFI is similar. The contracts meant that repayments were three to seven times the physical cost of building the hospitals and repayments of £10bn a year are being paid (Guardian estimate) this fiscal year when, with QE, the Bank of England borrows at an almost zero rate. We hear the vast cost of agency nurses, drugs, private contracts and many other NHS contracts emerging month by month.

Quasi-Monopoly Private Control – Why it costs a lot more.

But the examples are merely that, examples. Far more important is the economic weakness in these privatisation contracts. Contracts are put out to competitive tender, but what does this mean? Say a cleaning contract is awarded for several hospitals. Employees, expertise, equipment is gathered by the company concerned and it does the job, well or badly (and remember G4S, that flawed company, “provides services to around 200 hospitals and healthcare centres in the UK alone”). Once these contracts are in place, the firms have an effective monopoly, because the cost of matching a contract in that area is beyond most other bidders. It is wrong to call it an internal-market system within the NHS, because monopolies are not markets; they kill competitors. It is an oligopoly, a club for favoured contractors. These are state favoured corporations. More than this, because if any one of these services stopped, a hospital or service would be in crisis, these firms have a power akin to the old union strike power. Usually, there is not any available way to withdraw from a contract when there is failure. No-one is going to rock the boat.

Firms have an interest in colluding in these kinds of markets. I’ll bid high on this contract if you bid high on that. Further still, bribery is also likely. If doctors have been bribed to prescribe certain drugs through receiving favours, how much more likely are bribes when billion pound contracts are involved. When a commissioning executive moves to one of the companies he has previously given big contracts to, that is bribery in my book, a reward for services given. So these monopolies can, and do, milk the system. Meanwhile the NHS employs 25,000 people to commission and administer these contracts, when they could be directly running the services concerned.

The other key point is that the costs for private companies are costs plus profits, while the direct running of the tasks would involve no profits. Since profits may be 10-20% of operating costs, this pushes up the NHS budget by billions.

But there is another structural problem with these privatisation moves. If the NHS is operating under a tight Budget, as it is, partly because of the privatisation which has already occurred, then private firms are in a stronger position to come in and pick up contracts. So the private companies benefit when the NHS is underfunded. Far from being efficient, this all reeks of waste on a large scale.

Andrew Lansley, the 2012 Health and Social Care Act and Care UK.

My interest is in the strange career of Andrew Lansley, my MP. Just before the 2010 Election the wife of John Nash, founder and then Chairman of Care UK was reported to have donated £21,000 to the private office of Andrew Lansley, then the Shadow Secretary of Health. Aside the issue of whether John Nash and his wife spoke to one another about donations, the £21,000 was effectively a bribe to Lansley, who anyway was planned to change the NHS. However, in the election Lansley said repeatedly that there was to be no “top-down” reorganisation of the NHS. Immediately after it, he opened the door to privatisation and within two months a white paper, undiscussed in the election or manifesto, was published. The Health and Social Care Act was being formulated. I was incensed at the donation. It was immoral, even if it could not be nailed as such. But my moral indignation was partly wrongly directed. Lansley became Secretary of State for Health, gave the green light to Care UK and other private companies who had effectively written the 2012 Health and Social Care Act for themselves and private health care was set to explode. Care UK has NHS Budgets of around £350 million a year. That makes £21,000 look small. Lansley proved an ineffective Secretary of State and has disappeared from politics. Care UK committed a number of gross failures in their contracts, operated off-shore to avoid taxes and were then partly taken over by a bigger capitalist, but is a big NHS private provider. Branson and othe capitalists with no Health expertise are looking to move in on these lucrative contracts..

Continued privatisation.

The privatisation continues. Jeremy Hunt, the present Health Secretary, has declared himself in favour of NHS privatisation. The question is merely when and how fast. Service is gradually being crushed under the capitalist commitment to selfish profit. Of course, within these organisations there are many who serve, care and work hard. There are many more who work hard on low pay so that the owners can reap their profits. Many contracts allow space for profits. A £1.2 bn contract in Staffordshire may well reap a minimum of £100mn “fees” which could have gone to the NHS.

This election.

If the Conservatives are returned this election, this privatisation with its waste, falling levels of care, entrenchment of selfishness, inefficiency and escalating costs will continue. We should be grateful to the National Health Action Party for the stand they have taken, and for the Labour Party’s commitments, and see how dangerous the situation is to Health Care. Underfunding is partly a problem, but it has also been partly caused by the privatisation and profiteering that has already occurred. We should be warned.

The Servant Queen and the Whole Earth

The Bible Society, HOPE and the London Institute have just published a lovely book, entitled “The Servant Queen” as a tribute to the Queen on her 90th birthday. It shows Elizabeth’s clear sense of duty and devotion to God, and her conception of being the servant of the state of the United Kingdom and of the Commonwealth. The book shows through what she has said in Christmas broadcasts, but also through decades of service to the State and to the ordinary people whom she serves, how this has worked out. It is built upon the example of Christ and with Jesus as her focus, as she fully acknowledges. She is, simply, another Christian, learning and living the lessons of the Christian faith.
I’m not the kind of person who believes that Britain is Great, or even great, or a monarchist, but Elizabeth’s understanding and practice seems to me to be one of the defining principles of governance throughout the world. She has taken the words of Christ, and lived them. Jesus said, “The kings of the Gentiles lord it over them; and those who exercise authority over them call themselves Benefactors. But you are not to be like that. Instead the greatest among you, should be like the youngest, and the one who rules like the one who serves. For who is greater, the one who is at table, or the one who serves? Is it not the one who is at table? But I am among you as the one who serves.” And that is the kingdom service Christ conferred on his disciples. The ruler is the servant. That is not only the personal commitment of Queen Elizabeth, but also a principle of governance that applies everywhere and throughout history, as Moses also was the servant of the Lord. It is the reversal of state control, self-glorification, conquest, empire, using nations in our self-interest, militarism, ethnic superiority and the attitudes which generate wars and international crises which have dominated much of history.
It is also the deep undergirding of democracy, for democracy is the service of the people by the rulers. Slowly the self-service of the monarchy and the government has dropped away under the influence of Christ’s words. They are for us. They are not the lording people. They are not serving themselves by corruption and manipulating the law, by passing the resources of the state to their cronies, by building themselves big houses, by being like Caesar or Herr Examine My Armpit. They are not masters, but servants. We have Civil, or nearly civil, servants. We have ministers who answer to us. When we call, they should come running. For the least of us, whoever is the least, and in Christ’s kingdom there is no least, because the lepers come first, they are our servants. They are not to get uppity. That is democracy, the normative structure of the state, the service of all the people by the stewards of law, justice and the common good – and we know She knows.
Of course, the British monarchy has the trappings of imperial and national self-glory – palaces, servants, crown jewels, a gold coach, titles, soldiers with furry hats who march up and down, an aristocracy who shoot birds and play silly games on horses and Lords dressed in vermin. The Queen was born into this set-up and it is still substantially intact. The British establishment state has a bloody, “send us victorious, happy and glorious” insufferability, and for some inexplicable reason wants to punch above its weight, but She knows differently. She knows we need to renew ourselves in God’s love and become better people. She knows we need to love our neighbours as ourselves and that what the quiet people do moves the world. She knows that you do not have to be rich or powerful to change things for the better, and the unseen and unrewarded often do the best stuff.
She also has a grasp on peace and reconciliation, and understands the Common Wealth of nations, what they can give to one another, like few others, and her international visits and welcoming of foreign visitors, has given that dimension weight in the life of the nations. She understands “healing old wounds”, and does it well whether in Ireland or elsewhere.
Her governments often do not see things the same way. They are often into winning, self-promotion, and putting down the opposition. They, contrary to Christ’s words, are constantly parading themselves as our Benefactors and telling us how good they are for us. They frequently go out and fight other states, and see them as enemies or threats. They have the power. They govern and shape the laws. But they also fail by their failure to serve. The principle of service rules, even when it is ignored or compromised. In Christ, and by obedience in Elizabeth, it does, and should, rule throughout the earth.

A Biblical Worldview of Government

(A short summary paper of some key principles for discussion)

Some two billion of the world’s population are Christian. They hold, varyingly, a perspective on politics and government drawn from and shaped by the Bible. It is surprising this perspective is not expressed more systematically, more often, especially in Jesus’ transformation of world politics. This short paper seeks to do it, in a rough fallible way, as a series of notes for your discussion on what seem the generic points.
1. God and humanity. The central, full relationship for all people is with God and not with the state. This rules out totalitarianism, ruler worship and political absolutism.
2. God and creaturehood. People are not self-referencing, autonomous, or merely part of a collective group. They live freely before God, not beholden of the State and are responsible for good living. We are neither individualistic or collectivistic.
3. We are called to good living. Justice, or righteousness, or loving our neighbour as ourselves, is the guiding condition of humankind before God. The law of God expresses this good and right living and we are to seek the law and abide in it, to normatively seek the common good, not just our own.
4. We live in institutions. Areas of life like Marriage, Family, Work and economic stewardship of the creation, Education, Worship, Community, the State and are ordained by God for our good. We live in these plurally, respecting them as areas of life in different spheres.
5. The State is instituted, or constituted, by God for law-abiding justice. It is “constitutional”, involves offices and articulated tasks of government like legislation, judgement, punishment, welfare, common good provision and institutional balance. This has developed since the time of Moses.
6. People are called to submit to the God-ordained state, but on God’s terms, not necessarily those dictated by the ruler. Generally, this leads to a stable state, but democratic and conscientious objection rather than rebellion is the stance taken to unjust rule.
7. Law and justice are the main matters of state formation. They involve just legislation, political understanding, international co-operation, principle, love, fairness, mercy, restitution, impartiality. The State does not own the law, but submits to it and forms it by principle under the rule of law, seeking for the good of the people, with accountability to God.
8. As Jesus taught in the SotM, people are called to be upholders of the law and law-abiding. The attitudes and attitude of ordinary people to the law is crucial for the health of the State.
9. Central to State formation is truthfulness, transparency and honesty. Jesus’ interchange with Pilate staes this centrally. As Jesus said, “There is nothing hidden which will not be revealed.”
10. People and states are sinners. Sin is both personal and corporate. It involves understanding, motivation, action and embedded attitudes. One of the deepest forms is idolatry, where money, military power, control, racial identity or some other human focus dominates life. In the Bible both people and state sins are addressed by the prophets. We should understand sin.
11. Properly understood states are governed through service of the people, as Jesus taught, not by self-promotion, glory or nationalism. The prophets, and Jesus, identified the self-serving ways of the Jewish rulers and the weaknesses of the Jewish state and surrounding empires.
12. The biblical understanding of power is not of control or military conquest, but of the power to do good. Acton: Power seen as control corrupts… Those who take the sword will perish by the sword.
13. The biblical economic understanding is of the goodness of work and stewardship, the lawful distribution of property among families, the wrongness of stealing, fairness and service in exchange – the basis of markets, economic long-sightedness, the absence of predation, of putting righteous living before seeking goods, and generosity to the poor partly through redistribution and forgiveness of debt. These principles have been behind much of the economic development of the west.
14. Political life can be redeemed, centrally through Christ, with peace, truth, justice, forgiveness, reconciliation, redistribution, service, fairness and freedom from state control.
14. Christianity is a faith of peace and peacemaking. Christ is the Lamb on the Throne and the Prince of Peace. Nations can unlearn war and swords become ploughshares. World disarmament is possible. Causing offence can be addressed. Nations can be reconciled in Christ. We can love our enemies.
15. Taxation is for the good of the people, especially for their common good, redistribution and addressing poverty. It is not for the self-aggrandisement of the rulers.
16. Democracy is a combination of Christian principles of the rule of law, impartiality, service of the people, public accountability and the space where truth can be debated. The demos, the people, are not sovereign or necessarily right. It is where truth contends in the market place.
17. Political Parties are expressions of shared faith and the discussion of truth following the calling to state office, not organs of self interest or state control.
18. God’s people are of all races and nations in equal respect. God is no special respecter of states or empires. Nation shall speak peace unto nation.
Alan Storkey October 2015
(Irenaeus, Augustine, Justinian, Wyclif, Erasmus, More, Luther, Melanchthon, Calvin, Knox, Hooker, Althusius, Perkins, Grotius, Cromwell, Putney Debates, Lilburne, Burke, Acton, Papal Encyclicals, Tawney, Kuyper, Dooyeweerd, Maritain, Fogarty, Mouw, Wolterstorff, O’Donovan, Skillen, Chaplin)