On 28 July, it was announced that Amanda Pritchard will be the new head of the NHS in England. She has in fact been its chief operating officer under Sir (now Lord) Simon Stevens, the infamous chief executive who occupied the role for the last decade (although keeping a low profile during the Covid pandemic) and has failed to take any accountability for its gross mishandling – including burying the findings of the 2016 pandemic planning exercise Operation Cygnus, which highlighted our health service’s lack of preparedness for a serious respiratory viral pandemic.
Amanda Pritchard, the ‘continuity’ candidate for privatisation
The press were unanimous – perhaps predictably – in hailing her appointment as a groundbreaking move for increased equality: “It will go down in history as it is the first time a woman has been given the title after the role of chief executive in the NHS in England was first created in 1985,” opined the Evening Standard’s Lily Waddell breathlessly. (28 July 2021)
The Telegraph described Ms Pritchard is the ‘continuity’ candidate, pointing out that she has worked closely with outgoing and former leaders including Sir Simon Stevens, prime ministers David Cameron and Boris Johnson, health secretaries Jeremy Hunt and Matt Hancock, and infamous profiteer Dido Harding.
“Sajid Javid, the health secretary, said Ms Pritchard would bring a ‘steady hand’ to the NHS. And health service managers described Ms Pritchard as ‘the continuity candidate’ who would hit the ground running.”
It was, of course, Sir Simon who led the massive expansion of the Private Finance Initiative (PFI) under Tony Blair – the policy that introduced the largest debt burden into the NHS, now parcelled up into separate ‘trusts’, each working on a business model, and that debt in turn used to leverage further restructuring and ‘reform’.
Sir Simon then took the ‘revolving door’ – also championed by Blair’s ‘new’ Labour – into the private sector, leaving to work for the largest US health insurance firm in the USA, latterly as president of its global health division, which has the stated aim of opening up international markets and particularly of targeting the public health sector in Europe. This behemoth private health insurance firm had an annual turnover in 2020 of $257.1bn – more than twice the budget of the NHS.
US-based health insurance firms receive huge funding streams from governments, and also dominate the provision of private insurance-based medical care, often linked in the US to employment status. The ‘health management organisation’ (HMO) system introduced by President Richard Nixon’s administration in the 1970s introduced a perverse incentive into the heart of its system: the less healthcare is delivered, the greater the profits of the company.
Bringing ‘HMO’ organisations to Britain on behalf of US capital
Today in the US, fully one-third of all health spending goes directly to creating corporate profits. That is why the US health system is the most expensive and the least effective in the world – delivering poorer health outcomes than its tiny Caribbean neighbour Cuba.
“Once you’ve paid your monthly fee, zero medical care provides the HMO with the maximum profit,” remarked Dr David Gans, an internist in Beverly Hills, California. “’To enroll with a HMO, you have to believe that everyone in it is so noble that all they care about is wonderful healthcare. If you’ve given up believing in that and the Easter bunny, you have to believe that a HMO has an incentive not to provide healthcare.”
Conversely, the purely private health system finds that maximisation of profit pushes in another direction: “A doctor in private practice is like a toll booth operator. Every time you enter his office, you toss in more coins. His incentive is to overtreat a patient, since the more he does the more he earns. But for now most people, it seems, would rather live with too much care than too little.” (The king of the HMO mountain by NR Kleinfield, New York Times, 31 July 1983)
Both tendencies have been exhibiting their vile forms in the USA, with lawsuits for unnecessary heart operations on the one hand, and 70 million denied any meaningful access to care during the Covid pandemic on the other. The fact that the USA had some of the worst pandemic health outcomes, with 36 million proven cases and more than 630,000 deaths is itself indicative of the inequality and chaos that reigns in the US health sector.
But the enormous profits generated by the system have their own logic and never cease to push towards expansion. Such corporations have the ability to draw the brightest Oxford graduates into their orbit and manipulate the democratic process in order to achieve their ends. So what better way for Sir Simon, close personal friend of key figures in Britain’s government, to achieve United Health’s expansionist goal – to introduce the HMO organisation into Britain – than to return and ‘serve’ for a further decade as the chief executive of ‘NHS England’, the Quango that now directs an enormous £159bn budget?
Ms Pritchard herself said in a statement: “I am honoured to lead the NHS, particularly as the first woman chief executive of an organisation whose staff are more than three-quarters female.
“I have always been incredibly proud to work in the health service but never more so than over the last 18 months as nurses, doctors, therapists, paramedics, pharmacists, porters, cleaners and other staff have responded so magnificently to the Covid pandemic.” (Evening Standard, op cit)
Starving the workforce to feed the profiteers
All of which stands in glaring contradiction to the headlines that followed the 21 July announcement that public sector workers – with the exception of those in the health service – would receive a pay freeze this year, effectively pushing their wages down in real terms. NHS workers are now being offered a 3 percent rise, after an initial offer of 1 percent was roundly rejected, but this itself remains frankly insulting, given that inflation currently sits around 2.5 percent and is set to keep rising.
We are being told that there is a shortage of public funds owing to the immense costs arising from the Covid-19 pandemic. Nurses have been campaigning for a 15 percent pay rise, with even the conservative Royal College of Nursing demanding 12.5 percent so as to bring them back to the kind of living wage the profession commanded before a decade of austerity cuts.
The fury at the derisory offer was further compounded by the realisation that the government proposed to fund the pay offer out of the existing NHS budget. The Times, meanwhile, claims to have been informed that much of the extra 2 percent “is likely to be funded from an increase in national insurance that was intended to pay for overhauling social care”. (22 July 2021)
“Jenny McGee, one of the nurses who looked after Johnson when he was hospitalised with Covid soon after the pandemic struck in March last year, resigned in May, citing the 1 percent offer as a key factor. ‘We’re not getting the respect, and now pay, that we deserve. I’m just sick of it. So I’ve handed in my resignation,’ said McGee.
“An official at one health union said that a 3 percent award would be ‘difficult’ for unions such as the British Medical Association, Royal College of Nursing (RCN) and Unison, which have been pressing for a bigger rise, adding: ‘Three percent may be high enough to dissuade unions from taking industrial action, because enough of their members might accept it, especially with the law now requiring unions to get at least a 50 percent turnout in any ballot for industrial action, and 40 percent of members to agree to take action.’
“The RCN looks likely to reject 3 percent as too little. Its branch in Scotland has already turned down the 4 percent pay rise offered by the Scottish government and last month triggered the first stage of a disputes process which could see nurses going on strike.” (NHS staff in England could be offered 3 percent pay rise by Denis Campbell, The Guardian, 20 July 2021)
Of course, a modest one-off wealth tax of Britain’s super-rich could more than cover such necessary costs without pauperising a soul, but capitalism would not be capitalism if such solutions were applied. No, the ‘solution’ will, as ever, be sought by piling the debt onto the backs of workers.
Looting of the Treasury goes hand in hand with starving our services of resources
Much of the debt accrued under emergency Covid legislation has been awarded in a highly corrupt and totally ineffectual manner. The disorganised farce of so-called ‘track and trace’, for example, will forever be remembered not for its effectiveness in containing the virus but for its speedy transfer of vast quantities of public money into the hands of pharmaceutical companies, management consultants, logistics companies and other government cronies.
And let’s not forget Matt Hancock (and his publican, his sister and his brother-in-law), the efforts of David Cameron on behalf of Lex Greensill, or the billions entrusted to Oxford hedge fund manager chums like Dido Harding and Kate Bingham to splash on their corporate friends.
Besides this lavish spending, the pay rises needed to support those who actually deliver our care pale into insignificance: “Siva Anandaciva, chief analyst at the King’s Fund, said that every 1 percent rise would cost the Treasury between £340m and £500m a year.” (The Guardian, ibid)
Meanwhile, the nauseating beatification of NHS workers as ‘heroes’, of leading the nation in applause for their efforts, and finally of awarding the entire NHS the George Cross, is just so much sand to throw in the eyes of a public who are blissfully unaware of the abuse being heaped on the health service’s staff.
“Cate Mimi wrote: ‘As an NHS nurse, I do not want to be clapped for. All I want is for people to stick to the guidelines and for the government to raise the wages for nurses.’ …
“A number of people who commented described the clapping as a ‘hollow gesture’ and, instead, called on the public to campaign for fair pay for nurses.
“In addition, several people raised concern about the use of the term ‘hero’.
“Vicky Bintley wrote: ‘We aren’t heroes, or brave. We are educated professionals with careers in nursing.’
“Kirstie Hill said they believed hero was a ‘dangerous’ term, because it ‘implied invincibility’. ‘We are not invincible and when we do say we’re struggling, we’re not believed,’ added Kirstie. (Clap for Heroes: Nurses say they do not want return of applause by Gemma Mitchell, Nursing Times, 7 January 2021)
The attack on the NHS does not stop at the reduction in pay and conditions of its staff. Nor does it rest with the devastating underfunding and downgrading of the service.
All this is being carried out in conjunction with the new government whitepaper on health, which seeks to merge GP clinical commissioning groups with other health and social care providers, under the leadership of private sector providers. The introduction of these ‘clinical networks’ will entrench Optum (United Health) and Operose (Centene), the giant US for-profit health insurers, at the centre of administering NHS budgets and as the major players in the rollout of NHS planning and clinical delivery.
These are the British versions of the HMO organisation that has been so discredited in the USA. No wonder that the demands of the NHS workers, and British working class are being ignored, for there is a broad and sinister coalition of interests – from huge capitalist firms, their Tory backers, the media, and the Labour shadow cabinet, together even with compliant ‘NHS’ campaign groups that look to the Labour party for direction – ranged against them.
Drs Bob Gill and Ranjeet Brar are two of the few campaigners who have raised their voices in serious and meaningful opposition to cuts and privatisation in the NHS and who have consistently joined the dots between the different strands of policy.
Health secretary Sajid Javid has said that the raising of the government’s initial 1 percent offer to 3 percent was in recognition of NHS workers’ “extraordinary efforts” during the pandemic, but the workers themselves point out that this still represents a real-terms pay cut of £200 pounds per month for an experienced nurse, and their unions are promising a summer of industrial action.
Unfortunately, as is so often the case, some union leaders are already being led to believe that their initial demands are ‘unreasonable’ or ‘unrealistic’. The horse trading is underway, but the argument that is being pushed (as ever) to the fore is: where is any pay increase going to come from?
It is usual for the Treasury to cover the cost of public sector wage deals, but this time the government is putting the squeeze on the NHS to fund the rise out of its already insufficient budget, meaning in effect that any slight pay uplift will in fact constitute a further cut to NHS funding. (Government giving no new money to fund NHS 3 percent pay rise, No 10 confirms by Dan Bloom, Daily Mirror, 22 July 2021)
While the NHS budgets keep increasing, the percentage that goes to frontline care is steadily diminishing, and has been fundamentally compromised by corporate penetration, with the private parasites sucking huge profits from operational budgets, to the serious detriment of patient care across the board.
Does that mean we are faced with choosing between curbing the NHS wage offer or maintaining present funding levels to our struggling services? That is certainly what our rulers would like us to believe. They are doing everything possible to make the public feel resentment at the ‘greed’ of hard-working NHS staff, despite repeatedly praising them as heroes during the last year.
They want us to forget that more than a decade of real-terms pay cuts has left many health workers in real difficulties; that single-parent nurses have been known to struggle so much that they were forced to use food banks.
A question of priorities
A civilised society, one that put the interests of its working people (the real wealth creators), above the interests of the profits of its financial capitalists, would not need to choose between paying people properly and providing decent services. Britain certainly never seems to be short of funds when the super-rich spongers hold out their begging bowls, whether after the banking collapse and bailout of 2008, or the ‘Covid’ stock market collapse and bailout of 2020.
It is not a question of lack of resources, but of priorities. As a society, are we focused on the needs of people or the needs of corporations? Unfortunately, while the capitalist class remains in charge of a capitalist economy and state, the needs of the corporations will always come first.
Campaigns to oppose cuts and austerity generally, to reverse the steady decline in pay and living conditions, and to renationalise our dismembered NHS are desperately needed. While the working class remains fragmented and disorganised, our rulers feel confident in pushing forward their own agenda, safe in the assurance that we can muster no meaningful opposition.
Moreover, the Labour party continues to form a useful safety valve, with MPs who make vague noises about ‘reform’ but who fail concretely to hold our government or the ruling class to account, or educate the workers about the real causes of their poverty. Moreover, their constant drive to take over, divert and stifle meaningful opposition from the working class has prevented any mass popular opposition making its voice heard.
The only way to push back against the drive to maximise corporate profits is for workers to organise themselves in large numbers to resist and fight for their own interests. Following George Galloway’s historic result in Batley and Spen, the Workers Party of Britain offers the opportunity to give a radical voice to the urgent needs of the working class.