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Medical politics in 2014

2014 was a busy year for me….

Right at the end of 2013 I started covering medical politics, for various publications including the New Statesman and Open Demoncracy. Over the next 12 months I wrote extensively on the Coalition’s reforms of the NHS as they took place, covering everything from the progress of legislation through parliament, the effects of reforms on the front-line, the growing activist movement against these changes, and the gradual morphing, as I see it, from the public system into a private one.

The articles I wrote in this 12 month period were shared over 10,000 times on Facebook and Twitter. But the only reason my writing has had any success is that it’s so closely connected to the movement on the ground. As a freelance journalist all of this work has been produced with my own time, energy and organisation. I have spent the last year marching with protestors, attending committees of parliament, building and maintaining relationships with doctors, nurses, politicians, academics, union members and activists.

Below is a summary of these article. The work goes on


THE NHS is in a critical condition. Sixty-six years after it was introduced as a socialised system to, in the words of the leaflet that was sent out to every household in Britain back in the summer of 1948, “ease your money worries in time of illness”, the whole concept and ideology of its founding is being dismantled.

Over the past 25 years the NHS has been subtly mutated from within. Marketisation, the admittance of private financing, imposed performance standards, increased regulatory burdens, the ascendance of special administrators and, most recently and most crucially, the enforcement of competitive tendering for all healthcare contracts, have steadily undermined the NHS’ existence as a public service.

The public is largely unaware of the changes that have been made because care is still free at the point of delivery. But with an increasing ‘Americanisation’ of the NHS, envisioning a future in which the powerful trans-national health insurance industry finally gets its way in Britain should be simple to even the humblest student of medical politics.

The campaign I have been fighting over the past 12 months is not for an individual facing human rights violations, nor an oppressed minority. It is for a concept, an ideal that affects every British citizen. There are plenty out there fighting; in demonstrations, rallies, petitions, the march from Jarrow to London which took place this summer, and on the forums, pages and newsfeeds of social media.

Every lead, every issue, every off-the-record briefing, has come out of this body of activists spread around the country. They have rewarded me with totally up-to-date information about what’s happening out there on the front line of healthcare campaigning. (see ‘”NHS principles aren’t intact“: how the public is trying to protect its health service’; New Statesman, October 2014).

The turning point in so many ways was the Health and Social Care Act 2012. This has forced NHS trusts to compete with private sector providers over every care contract that comes onto the market. This is a hugely expensive process, and can be an abject waste of limited resources given that a trust might simply be bidding to run a service it already provides which has come up for renewal (seeNHS reform and the hollow marketisation myth’; New Statesman, October 2014).

Estimates for the total annual cost of competing in the market vary, but the most conservative figure out there is £4.5bn (others put it at £10bn), all of which could be spent on frontline healthcare.

This issue couldn’t be more current. On November 21st 2014 a debate will take place in the Commons over Labour MP Clive Efford’s private members’ bill, which calls for the reversal of marketisation through the repealing of the ‘section 75’ regulations of the Health and Social Care Act, and exemption for the NHS from the Trans-Atlantic Trade and Investment Partnership (TTIP) – (see How the EU is making NHS privatisation permanent’; New Statesman, December 2013).

Labour has pledged to make this a prominent issue in the Rochester and Strood by-election, taking place the night before, and will press the other parties on whether their candidate would vote to have the NHS exempted from TTIP in the vote the next day. This will put both the Conservative Party and the Lib Dems in a difficult position, given the Coalition’s support for the trade agreement and unwillingness to protect the NHS from it (seeGovernment brushes aside NHS Free Trade Treaty Concerns’; Open Democracy/Our NHS, February 2014).

The Labour Party has also pledged to repeal the Health and Social Care Act altogether if it is elected next year, and is likely to make the NHS a key issue in the election. The Conservative party is deeply unwilling to let this happen, and with the uncomfortable rise of UKIP there is a danger that health could be eclipsed by immigration unless public interest can be raised now. These are precarious times.

Another contentious piece of legislation, the Care Bill, was enacted this year. The key issue in this was the tightening up and expanding of the powers of Trust Special Administrators (TSA) in enforcing closures of services, wards or hospitals on financial grounds. This all hinged on Clause 119 (previously Clause 118) of the Care Bill, aka the ‘Hospital Closure Clause’ (seeClause 118 would leave no hospital in England safe’; New Statesman, January 2014).

The clause was hastily added to the bill after the government’s attempts to close the A&E department at Lewisham Hospital in South London were met with fierce local resistance and then deemed illegal in the courts. The ‘Hospital Closure Clause’ was intended to make sure the government’s TSAs would succeed in future. It went through parliament, despite the efforts of the Labour Party to stop it, and I reported on the build up to the vote (seeLabour’s Andy Burnham moves to strike out “Hospital Closure Clause“; Open Democracy/Our NHS, March 2014).

But this isn’t a party-political campaign; the Labour Party must face its own share of the responsibility. One of the most damaging legacies of New Labour to the NHS was a huge long-term financial burden on hospitals and trusts locked into private finance initiatives. PFI agreements were behind some 97% of the new hospitals built under Tony Blair and Gordon Brown, and now trusts find themselves forking out hundreds of millions just to repay the interest on these loans (see To save the NHS, Labour must face the ugly truth of PFI debts’; New Statesman, July 2014).

In 1948 Aneurin Bevan, the founding father of the NHS, said that the service will last “as long as there are folk left with the faith to fight for it”. There are folk still fighting, but they are granted far too little attention. The mainstream media has been as equally beguiled by UKIP as large sections of the public, and I fear that the immigration agenda, not the secretive reform of the NHS, will dominate next spring. More than ever, the plight of the NHS, and those fighting to save it, needs to be covered.

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