Well, there is another narrative, this one stemming from the heart of the Labour Party, that the Tories are hell bent on privatising the NHS. The motivation for maintaining this narrative is, of course, to make the voters distrust the Tories on this policy issue and to persuade them to vote Labour instead. After all, as the founders of the NHS only Labour can be trusted to keep it in state hands, can’t they? If they were really the founders of the NHS that might be true, but I get ahead of myself.
Do you remember the famous 1997 Tony Blair speech in which he declared that “we have 24 hours to save the NHS”? The only way to save the NHS was to vote Labour, which some people duly did. Well, he failed to deliver. Over the next three years standards continued to decline. The Labour government threw money at the problem, which is what Labour usually does. They imposed targets that led to a culture that ended up with people in a hospital in Staffordshire dying of neglect, and of course they started the introduction of private medical companies to provide services to the NHS.
Don’t expect Ed Miliband or Andy Burnham to remind you on any of this. They’re trying to bury it. But we wouldn’t want a few basic facts to ruin a good narrative, would we? Besides, there is no value in looking backwards, we have to keep looking forwards. Unless you are a Labour supporter in which case everything is Margaret Thatcher's fault.
But that doesn’t mean we have to ignore history either. Let me ask you a question. Who founded the NHS?
If you just answered ‘Labour’ then deduct 10 points. It wasn’t.
The NHS was founded by the Tories and the Liberals. I now hear Socialists across the country howling with rage and baying for my blood, but it’s true. Labour Party revisionists have certainly worked hard to make us believe that it isn’t true and they seem to have succeeded. Labour claimed in their 1997 manifesto that they founded it, but I say it again: The NHS was founded by the Liberals and Conservatives.
It was a Liberal idea stemming from the Beveredge Report of 1942. Beveredge was a Liberal Peer. The White Paper that paved the way for the foundation of an NHS was published by the Conservative Minister for Health, Henry Willink in 1944. All the necessary legislation required to permit the founding of the NHS, except for the final Bill, was passed before the Tories left office on 5th July 1945.
While the final Bill that created a National Health Service was put before Parliament by Aneurin Bevan in 1946 all the spade work had already been done. The NHS was already on its way when Labour took office in 1945.
To say that Labour ‘created’ or ‘founded’ the NHS is like saying that the man who put the frame on the Mona Lisa is also responsible for painting it. At best the founding of the NHS was a team effort and it is always distasteful when one person or group takes the credit for the efforts of the whole team.
The NHS is only a state institution because Labour won the first post-war general election. Had Churchill won then the NHS would still have been created but would undoubtedly have been structured differently. At the time the Labour government was busily nationalising everything from coal production to water supplies, so the idea that they would establish a privately owned NHS would be unthinkable to them, but that is down to an election result, not to a rational decision or a national debate about the right way to manage the NHS. By the time Labour left power on 25th October 1951 the NHS was too well established as a state organ for the new government to try to dismantle it and start again.
With regard to privatisation, a significant part of the NHS has been delivered by private businesses since Day 1. Surprised? You shouldn’t be, but Labour also tries to keep this quiet.
Every time we enter a GP's practice we are participating in a privatised medical service. The NHS doesn’t employ GPs. GP practices are private businesses, usually partnerships, who have a contract with the NHS to provide GP services in a specified area. In return no other practice is allowed to compete in that area.
The GP service had to be structured this way because many GPs opposed the setting up of the NHS because they had so much to lose, or at least they perceived that they did.
The NHS can’t sack a GP. They have to be voted out of their practice by their fellow partners or they have to lose their licence to practise. The NHS doesn’t even control those licences. The practice is paid a set amount for each patient on its books. It is also paid extra for doing some things, such as implementing specific immunisation programmes in their area. Some things you can’t even get for free, such as life insurance or HGV driver’s medicals and inoculations for holiday travel.
This is why some GP practices take on far more patients than they can handle then try to weed out the ones that are going to be most expensive to treat: the old, the infirm, those with chronic ailments etc. Not all practices, I hasten to add, but a few. The healthier the patients the more money the practice makes because they don’t have to spend so much of their budget on the expensive business of treating the patients.
Oh dear. Do you think some GP partnerships might be motivated by profit? Get rid of them all today. We can’t have people being treated for profit, can we? Profit, of course, is the ultimate dirty word if you are a Socialist. Dirtier even than “crevice” (General Melchett, Blackadder Goes Fourth).
We have become so used to the narrative that the whole of the NHS is owned by the public that we believe it, though it has been a lie since the day it was set up. Far more people are treated every day by the privately owned GP practices than by the state owned hospitals.
So if private businesses can be trusted to provide GP services why can’t other private companies be trusted to run other parts of the service? The answer is that they can, providing the correct checks and balances are put in place, but there are vested interests that don’t want that to be the case.
This whole argument is deliberately manipulated to make us think that somehow the use of private medical practices to deliver services will result in us having to pay for treatment, which is nonsense. If that were the case we would have to pay to visit our GP, butd we don’t.
The concept is very simple. You decide what treatment you wish to be provided. You employ a company to provide that service, within which the contract defines pricing, quality standards and penalties for failure. The NHS then pays the company for each patient treated to the required quality standards and based on results. Labour didn’t do that, of course. They let contracts that paid suppliers even if they didn’t treat anyone and the Tories then had to withdraw those contracts when they took office, but again Labour won’t tell you about that.
We have to separate the political structures of the NHS from the delivery of services if we are to get to grips with this argument. I defer to no one in my admiration for the clinical treatment that is provided by the NHS. While it isn’t always perfect it is usually good and sometimes outstanding. However, it is when we look behind that treatment that we see the disease and decay that costs us so much money from our tax revenue.
It’s not about whether or not you will get x treatment or y treatment. It’s about the best way to provide that treatment so that the taxpayer gets best value for money. If the best way is to deliver it in state owned hospitals that are staffed by state employed doctors and nurses then fine. Let’s do it that way. But if it’s better to deliver it in a private hospital, or even at home, by a privately employed doctor or nurse, then let’s do it that way.
But of course that isn’t how the argument is phrased. The argument is surrounded by highly emotional words, in which our heart strings are tugged frequently by reference to ‘poor overworked and underpaid nurses’. It’s time to close our ears to those emotional words and start dealing with the realities of what has become the national scared cow. We can’t make those decisions through emotional arguments, we have to get down to the cold hard cash.
The real problem is that the cost of the NHS is now so high that its future is becoming untenable. That’s why Ed Miliband is having to suggest a Mansion Tax to help pay for it. It won’t stop there of course. The NHS is sucking more and more money out of the economy. If things keep going as they are then we will eventually reach a point where every penny we pay in tax will be used to pay for the NHS and nothing will be left to pay for anything else. Do you think that can’t happen? Just look at how NHS spending has escalated, in real terms.
Over 50 years the budget has gone from 3.4% of GDP to 8.2% of GDP. Now, just think about how much richer the country has become in that same period and try to imagine what affect that has had on GDP. By 2061 that spending could increase to 16.5% according to the Office For Budget Responsibility. In 1948, the year the NHS was founded, the budget was £437 million, the equivalent to about £9 billion at today’s values. In 2013/14 the budget was £108.9 billion. The fiscal deficit for this year is entirely accounted for just in that budget! I'm not stating a cause, by the way, just putting the numbers in context.
The NHS employs 1.7 million people, but guess what, less than half of those are clinically qualified. Yes, that does mean that over half the employees of the NHS aren’t involved in delivering medical treatment. There are only 3 bigger employers than the NHS in the whole world: The Chinese People’s Liberation Army, Walmart and Indian Railways. No wonder it is costing us so much money.
In their 1997 manifesto (linked above) Labour promised to cut the number of administrators in the NHS and to reinvest the savings in clinical services. Guess what happened? Yes, the number of non-clinical staff rose steadily between 2001 and 2005, dropped back little in 2006 and 2007 and then again rose steadily until 2010.
Bear in mind that during this period many support tasks, such as catering and maintenance, went out to private contract, so the employee numbers should have been going down. Instead they went up. Why would Labour promise one thing and then do another? Could it be the vested interests?
Who are the vested interests? Well the clue to one of them lies in that 50% that don’t provide clinical services. Many of those posts are administrative and managerial. The NHS is a vast bureaucracy. It’s also why attempt after attempt to reform the NHS has failed, because the reforms are placed in the hands of those same managers and administrators. Pretty much every time any government has attempted to reform the NHS they have ended up with more bureaucrats, not fewer.
The clue to the second vested interest is also lies in those employment figures, because many of those 850,000 non clinical personnel are members of a trades union. Guess who the trades unions fund. Yes, Labour. Could the privatisation narrative be a sign that the unions don’t want to see reform in the NHS? Could pig products be involved in making bacon sandwiches?
With the threat of Labour Party funding being removed or reduced there is no way that Labour will try to make any meaningful reforms to the NHS. This is why they started to use privatised medical services between 1997 and 2010. It seems that the only way to reform the NHS is to bypass the managers and unions and contract medical services out to the private sector. It was easier than tackling the unions. Its why the Tories are doing the same. They don’t want to see picket lines outside hospitals protesting against the job cuts that would result from real reform. It loses votes. Unfortunately that is exactly what they are seeing, but that is all part of the narrative.
The Tories claim that since 2010 they have got rid of 19,000 managers. Good. Keep up the good work. They claim that they have employed 8,000 new doctors and 5,600 new nurses. Also good. Note the similarity in the two sets of figures. Two thirds of the managerial jobs lost have been matched by an additional doctor or nurse post. It should be one for one, but of course doctors and nurses cost more than administrators.
Only 6p of every pound spent in the NHS is spent with a private medical company. That doesn’t include GP practices. Their budgets are counted as being spent within the NHS, even though they aren’t. The new Bill put through Parliament by the Tories doesn’t aim to change that. Neither does it aim to change any other part of the NHS other than to make things more efficient. But you won’t hear that from Ed Miliband or Andy Burnham. What you will hear from them is the privatisation narrative because they want to scare the public into voting for them. However, you don't have to believe me or the Tories or the Labour Party. Here's the analysis done by the BBC
What you are getting from Ed and Andy is scaremongering aimed at making you vote for them to save the NHS. It’s a repeat of the “24 hours to save the NHS” lie of 1997. Can you trust a party that says one thing in its manifesto and then does the opposite, as it did for 13 years?
But the NHS doesn’t need saving, at least not in the way they are trying to tell you. It needs to become more efficient, but that is the love that dare not speak its name. What we as voters should be telling our MPs is that we love the NHS, we want it and we need it, but we’re not prepared to pay for 850,000 non clinical personnel to be employed by it, so get reforming!
So what will you read about this in the press? Well, pick your paper and you’ll get the narrative that they have always supported. The Guardian and the Mirror will tell you that the Tories are going to privatise the NHS. The Telegraph and the Times will tell you that they’re not. The Daily Mail will tell you that it’s going to be sold to immigrants which will lower the value of your house and the Sun will show you a photo of Nurse Mindy who has 34B breasts (apologies to any nurses called Mindy that don’t have 34B breasts).
Personally I don’t think the Tories have the bottle to carry out real reform any more than Labour has, Their Act was another exercise in re-arranging the deck chairs on the Titanic, but I’m not going to vote for a party that has proved itself liars and who are trying to scare me into voting for them.
In the meantime two years’ worth of my own work comes to fruition on Sunday 7th December and I’m finally delivering on a promise I made (to myself). My latest book “The Girl I Left Behind Me” goes on sale. Go to the books page on this website to place your order. I hope that you enjoy it, and if you do then please place a review on Amazon or on https://www.goodreads.com/