This article was recently written by Dr Julian Tudor Hart.

NHS Wales and Scotland: money-changers dismissed from the temple

Here are some quotes from One Wales, the policy statement agreed
by Wales Labour and Plaid Cymru in the new government of the
Wales Assembly:

“We firmly reject the privatisation of NHS services or the
organisation of such services on market models. We will
guarantee public ownership, public funding and public control
…We are resolved to keeping the NHS publicly owned, funded and
managed… We will move purposefully to end the internal market…We
will eliminate the use of private sector hospitals by the NHS in
Wales by 2011…We will rule out the use of Private Finance
Initiative in the Welsh health service...We will end competitive
tendering for NHS cleaning contracts…We will maintain free
prescriptions…We will build on existing workforce plans to
include all care staff, with a strong emphasis on work-based
training to enable individuals to gain qualifications on the
basis of their practical skills and to develop those skills
further… “

And so on. If Rhodri Morgan had gone into the recent Wales
Assembly elections with this programme, and if Tony Blair had
not invited himself to come and blight its campaign in the eyes
of Welsh voters, Labour might still have a majority. But then
we wouldn’t have entered this exciting period of new
opportunity, bringing together the real socialists to be found
both in both parties, Labour and Plaid. This has thrown some of
their more fossilised members and more lickspittle MPs into
confusion.

Something similar is happening in Scotland, where the SNP’s new
health minister Nicola Sturgeon told the NHS Confederation
annual conference:

“Before the election, a poll showed that voters’ top concern was
of creeping privatisation of schools and hospitals. The
Scottish public expects public money to support public services
rather than the private sector. They believe that public
services should be delivered by public servants…We reject the
very idea that markets in healthcare are the route to
improvement. We believe, instead, that it comes through the
collective energy and ideas of committed staff, working with
patients, and the communities they serve.”

The Labour-Liberal Democrat government in Scotland had already
ended the purchaser-provider split, the foundation on which all
plans for NHS privatisation rest, but still loudly proclaiming
loyalty to Blair and all his works. So, as in Wales, Labour’s
traditional voters were determined to teach its representatives
a lesson. Proportional representation helped them to do so
without handing power to their oldest enemy, the Conservative
Party. One party rule is finished in Celtic Britain, and good
riddance to it.

Meanwhile, the NHS in England is falling apart. The promise of
greater efficiency has not been delivered. The profitable
procedures contracted out to private companies have not been
profitable enough to satisfy investors, and even after trebling
NHS spending, there’s not enough left to pay for the
unprofitable emergency and chronic care which the NHS will never
be able to evade. A new study by the NHS Commercial Directorate
shows that private sector hopes are receding. For the NHS to
attract the big multinational corporations Blair wanted, between
450,000 and 500,000 procedures needed to be contracted out from
the NHS each year. Even if contracts still under negotiation
are included, this figure now seems unlikely to reach even
300,000. This is because most doctors and most patients want to
use the local NHS hospitals they know and which operate as
public services, not what many see as slick new operators
working for profit.

New Labour’s electorally disastrous policy of privatising public
services won’t go away by itself. Desperately trying to hang on
to private investors with growing doubts about quick profit from
this field, government is now subsidising bidders. A
disappointed bidder for a Private Finance Initiative contract
for work on two hospitals for the North Bristol Trust complained
the company would lose millions already spent in preparing its
bid. Interviewed by the journal Health Matters, a spokesperson
for the Trust said compensation around £6m was being considered
to offset this loss. Interest in PFI has been declining
steadily over the past three years for similar reasons. To
maintain this originally Conservative policy, government must
steadily shift the financial risks of competitive investment
away from investors back to the taxpayer. This will continue
until the policy itself is abandoned.

Wales and Scotland are showing that marketisation of health care
and education was not just unprincipled, for leaders who claimed
to be socialists, but grossly inefficient, because it assumes
that the only reason anyone does anything is to make more money
for themselves. This is insulting and demoralising to health
workers and teachers. At its worst, it becomes a
self-fulfilling prophecy. Above all, it ignores the huge, still
largely unused, contributions to health and education which can
be made by patients and students themselves, once they feel that
these services belong to us all, rather than to remote officials
from some other planet. We know this is true, because we see it
every day, in the NHS and in schools and universities still
struggling to uphold the spirit of public service. In this
respect, Wales and Scotland, with their loosened-up parties and
politics, promise to become liberated areas. When will England
follow?

Dr Julian Tudor Hart, Swansea