The choice is between US-style private health insurance under a Theresa May dystopia, and a public NHS under Jeremy Corbyn’s progressive vision

It’s a brutally simple question: does Britain still want a national health service? On Thursday you decide, says GP Youssef El-Gingihy

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The Independent Online

The general election provides us with a real choice for the first time in a generation. Jeremy Corbyn’s progressive, anti-austerity vision breaks with the consensus of decades of neoliberal policies. The ideological gulf with the Tories is evident in the manifestos, particularly on the question of the future of the NHS.

There have been some murmurings from the commentariat as to the nature of Theresa May’s NHS policy. This is rather strange because we know exactly what it is as laid out in the Five Year Forward View and the sustainability and transformation plans (STPs), which explicitly state that the NHS should move towards an accountable care model.

Accountable, also known as integrated or managed care, sounds persuasive. After all, who could argue with the concept of integration of care? Unfortunately this is not on the table. Accountable/integrated care is an American model of healthcare associated with organisations such as Kaiser Permanente. In fact, Jeremy Hunt has informed Parliament that the NHS should learn from Kaiser even though it became infamous for dumping patients on the streets of Los Angeles.

Accountable care cuts healthcare costs by restricting access to hospital care and specialists as these are both expensive. It purports to deliver this care in the community, although in reality it often withholds care even for life-saving treatments as portrayed in Michael Moore’s devastating, must-see documentary Sicko.

In case all of that is insufficient, NHS England chief executive Simon Stevens has informed Parliament twice this year that the STPs will be used as the vehicle for the implementation of accountable care. Unsurprising as Stevens was one of the architects of privatisation in the Noughties before swishing thorough the revolving door to work for the best part of a decade as an executive at UnitedHealth – the largest healthcare insurance provider in the US and one of the biggest corporations in the world. David Cameron propositioned Stevens with the top NHS job in the last parliament.

How does all of this translate into concrete reality? NHS England proposes to reduce the total number of major A&Es in England down to between 40 and 70. NHS bed numbers have already been reduced by half since the 1980s with the result that bed-to-population ratios are lower than certain Eastern European countries.

The STPs propose £22bn in efficiency savings (cuts) by 2020, taking the total amount of cuts for the NHS to around £40bn by the end of this decade. The catastrophic effects of this were apparent in the new year when the British Red Cross declared a humanitarian crisis in the NHS.

Furthermore, tens of billions of the annual NHS budget are already siphoned off to corporations. The Department of Health’s own figures reveal that private sector outsourcing has reached nearly £9bn, or 8 per cent of the budget, having doubled from 2010 when it was around £4bn (or 4 per cent). The Centre for Health and the Public Interest (CHPI) states that the true figure is over £20bn as the official figures exclude general practice, dentistry and pharmacies.

Add to this a massive programme of hospital closures with over 60 NHS trusts facing downgrades, closures and mergers. The Conservatives claim that this care will be delivered in the community. Yet hundreds of GP surgeries have closed since 2010. The Royal College of General Practitioners warns of up to 600 more closing by 2020. In fact, the number of GP surgeries will be reduced from 7,500 to 1,500 super hubs.

At the same time, there have been massive cuts to social care and welfare budgets. The idea that care will be delivered in the community is a smokescreen, with the real intention being to shrink the public NHS infrastructure and ramp up private infrastructure. George Osborne brought in PFI2 and current reforms propose private financing of new GP and community models of care.

We have been here before with mental health from the 1980s onwards when the closure of psychiatric asylums and hospitals was justified on the grounds of humane care with the promise of care in the community. The reality left patients with serious illness stranded and unsupported in the community. Patients, including children, now have to travel hundreds of miles to access inpatient beds. Remarkably, Conservative plans would extend this to physical health.

Patients, including children, now have to travel hundreds of miles to access inpatient beds. Remarkably, Conservative plans would extend this to physical health

Theresa May also told Andrew Neil that the Conservatives are committed to the proposals of the Naylor Report. This sounds innocuous enough until you realise that this report recommends selling off billions of pounds of NHS estate, land and assets.

Most of this is openly discussed in the health trades press. The driver for this is quite simply that the US healthcare market is saturated, hence the need for American healthcare and insurance corporations to expand into the UK, Europe and Asia. Furthermore, the opening up of NHS contracts resulting from the Health and Social Care Act 2012 was simply not as lucrative as envisioned for the likes of Virgin, Serco and Circle.

Hence the restructuring of the NHS to close down district general hospitals and smaller GP surgeries based on the traditional model of the family doctor in order to create chains of super hospitals (as per the Dalton review) and networks of GP surgeries. These economies of scale are much more attractive to corporates, multinationals and private equity. One only has to look across the pond to gauge the extent of public services run by private equity in the US.

Similarly, the redesign of the NHS workforce (the biggest overhead for any organisation) is part and parcel of privatisation. Simply put, privatised healthcare does not require over 1 million NHS workers. This was the real justification behind the new junior doctor contract and the axing of the student nursing bursary with similar contracts, offering worse pay and conditions, likely to follow for all NHS staff.

In comparison, discussion in the mainstream media is largely confusing and does not provide clear analysis of what is happening. Instead we are mired in a bogus debate around unsustainable costs due to ageing populations and new treatments when, in fact, the NHS model is the most cost-efficient. Meanwhile, the bilious tabloids foment about health tourism – accounting for 0.3 per cent of the budget and distracting from over £300bn of UK Private Finance Initiative (PFI) debt being siphoned to corporates and banks.

The Corbyn vision breaks not just with the Conservatives but with New Labour, hence the power struggle with a parliamentary party still very much captive to the influence of Blair, Mandelson and Campbell. The wider Labour Party is very much on the side of the leadership, with a massive surge in membership.

Since the 1980s, successive governments have converted the NHS from a publicly provided and owned healthcare system into a market one, with the direction of travel towards a two-tier system with the expansion of private healthcare. The Thatcher government introduced outsourcing. In the 1990s, the limited internal market was created and then expanded from 2000 into an extensive market with greater outsourcing and PFI.

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The Conservatives are committed to the proposals of the Naylor Report, which recommends selling off billions of pounds of NHS estate, land and assets (Getty)

Since 2010, we have seen an acceleration of privatisation with the opening up of NHS contracts and foundation trust hospitals allowed to make up to half of their income from private patients, thus establishing a two-tier system. There have also been significant increases in rationing and the rolling out of personal health budgets opening the door to top-up insurance co-payments.

This is all ideological rather than evidence based. As we have known for decades, market forces and privatisation in healthcare are extremely problematic – they escalate costs and create fragmentation and chaos, not to mention much greater iniquity. While public healthcare systems are unrivalled at the provision of collaborative, planned, genuinely integrated healthcare for whole populations provided they are not deliberately run into the ground.

This ideological watershed between Labour and the Conservatives extends beyond the NHS. However, the portrayal of Corbyn’s vision as radical is a distorted exaggeration. Polling shows that majority of the public – and even Conservative voters – are in favour of much of what Corbyn is proposing, whether it be renationalisation of railways and public utilities or keeping the NHS in public hands.

Corbyn and McDonnell are pushing an anti-austerity agenda with £500bnn in public investment into the economy. The Conservatives and their allies in the right-wing media are apoplectic; recycling the usual memes on debt as well as tax-and-spend policies. In fact, government spending works the other way round through spend and tax whereby public investment leads to growth and jobs, which can then be taxed. 

Seven years of austerity economics have demonstrated its bankruptcy – investment is required in a climate of recession and stagnation in order to grow the economy and shrink debts. Besides, comparisons with Greece are largely irrelevant when the UK has its own central bank and currency.

The post-Brexit Conservative Global Britain strategy will mean a bonfire of regulations around workers’ rights, health and safety as well as environmental protections

The reality is that the 2008 crash was a banking crisis conveniently converted into a public spending crisis. Labour’s plans for a national investment bank with networks of regional banks (as in Germany) aim to rebalance a financialised, lop-sided economy. Big banks are not facilitating investment in the economy but are merely engaging in enriching a small clique; often through corruption with a raft of scandals, such as PPI and Libor, exposed in the wake of the financial crisis. 

The smear campaign conducted by the mainstream media, as conceded by David Dimbleby recently, is hardly surprising. After all, the vested interests of the corporate and financial elite are under threat from the prospect of a Corbyn premiership. One instantly thinks of Richard Branson and Virgin’s Traingate episode designed to discredit Corbyn.

The Conservative agenda will promote neoliberalism-max with more privatisation, deregulation, austerity and the shrinkage of public sector. Theresa May’s hand-holding with Trump is emblematic. May has refused to rule out the NHS as part of a free trade deal with the US. Meanwhile, Jeremy Hunt tweets that he wants the US and UK health sectors to work together.

The post-Brexit Conservative Global Britain strategy will mean bilateral free trade agreements with bigger markets such as Trump’s America, the EU and China forcing the NHS and public services open to transnational corporations. It will also mean a bonfire of regulations around workers’ rights, health and safety as well as environmental protections.

You cannot say that you have not been warned. So if you vote Conservative then you are voting for a dystopian, cruel and pessimistic vision – a private healthcare insurance system, more inequality and poverty, more wealth siphoned up by the corporate and financial elite, wage stagnation, collapsing living standards, deteriorating public services and greater divisions in society.

If you vote for Corbyn’s Labour then you are voting to restore a public NHS and for a transformative agenda towards an optimistic, positive and green vision of 21st-century Britain. In fact, this progressive vision is the only way forward. The neoliberal orthodoxy of deregulated free markets is economically, socially and ecologically unsustainable. It will lead to widening inequality, ecological catastrophe and the amplification of terrorism and migration crises.

Evidently, a Labour victory would not mean that Corbyn’s proposals will automatically happen. We have seen with Syriza in Greece how a progressive government can be crushed by the weight of transnational capital. The struggle would begin on day one with the corporate and financial elite resisting any change. It is down to all of us to build the mass movements to force power to make the necessary concessions. 

We hear a lot about personal choice in the free market economy. Well, 8 June is a choice; 8 June is a really big choice. Make it count.

Youssef El-Gingihy is the author of How to Dismantle the NHS in 10 Easy Steps, published by Zero books http://www.zero-books.net/books/how-dismantle-nhs-10-easy-steps

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