When Tony Blair’s government took office in 1997, every one of the newly-appointed health ministers who had worked with campaigners for the previous decade and more, abruptly cut off all contact with them, and found themselves new, more conservative allies and advisors.
Keir Starmer’s government is different: the front bench team has never worked with campaigners or union activists defending the NHS: there were no links to break.
Instead, taking over what he now insists is a “broken” NHS, but with a Chancellor insisting that no more money can be found to repair it, Labour’s new Health and Social Care Secretary Wes Streeting has begun by rounding up the ‘usual suspects’ who designed or implemented the costly market-style “reforms” under Tony Blair, and have strong links with the private sector or right wing junk tanks.
Two of them have already been publicly wheeled out and found posts. The first was Lord Ara Darzi, a leading specialist surgeon and academic, who does lots of private work, and who was given a peerage and made a health minister under Gordon Brown’s government. Streeting has given him (no doubt backed up by management consultants) the task of drawing up yet another review of the state of the NHS – this time by September.
Polyclinics
Darzi will be most remembered for his intervention – before he was brought into the government – as the author in 2007 of the plan to uproot local GP surgeries in London and concentrate them into 150 centralised (and costly) “polyclinics” (not too far different from Wes Streeting’s proposal for “Neighbourhood Health Hubs”). The irony of a top specialist surgeon designing primary care services was starkly visible from the outset: GPs and their patients hated the idea.
A deeply-flawed supplementary “Technical Paper” – which claimed to show how Polyclinics would improve care and save money – was researched with support from leading McKinsey bosses Penny Dash and Nicholaus Henke. A further report later sought to spread the same ideas across England.
Campaigners took issue with the Technical Paper, and warned that building new polyclinics was linked with plans to replace London’s network of district general hospitals with a combination of (a few) centres of specialist excellence, coupled with an undefined number of ‘major acute’ hospitals, ‘local hospitals’ (with minimal services) and ‘elective centres’. No details were given on how many, or which hospitals would be downgraded, or how the remaining major hospitals would be expanded to meet demand.
Some feared the polyclinics (which on the Darzi costings would have cost £3.1bn per year to run 150 in London alone) would be financed or perhaps run by the private sector, although this was not stated in the proposals, and the few partial projects that ever opened were funded by the NHS.
The scheme was opposed by a lively BMA “save our surgeries” campaign, which secured 1 million signatures on its petition, in stark contrast to the ludicrous £15m charade of a “consultation” on the Darzi report by NHS London, which led to just 932 people in the capital registering support for the idea that “almost all GP practices in London should be part of a polyclinic, either networked or same-site”.
This endorsement from a thumping 0.033893% (3 in 10,000) of the Greater London electorate, dressed up by NHS London as 51% of the 3,760 responses which answered the question, was trumpeted in the Guardian with the headline “Public in favour of polyclinic scheme for London, says NHS”. By contrast the Health Service Journal more prudently headlined “Polyclinics ‘pie in the sky,’ finds capital consultation.”
Darzi’s more positive contribution, as a minister, was to outline a series of pledges to reassure anxious patients and public threatened by hospital closures. These promised to “ensure that change is transparent and driven by the best evidence”, that “Change will always be to the benefit of patients,” and “clinically driven”. Also “All change will be locally led,” “You will be involved,” and perhaps most important of all when cash-saving cuts were being proposed: “You will see the difference first.” The pledges, near impossible to deliver, effectively stymied many of the efforts at ‘reconfiguration’ of hospital services.
Ten point plan
In 2018, the 70th birthday year of the NHS, Darzi (with statistics and work from management consultants Carnall Farrar) chaired an IPPR inquiry into the NHS. Its report’s ten-point plan, with some notable exceptions, effectively sum up Wes Streeting’s policy speeches so far. They include “‘Tilt towards tech’ to create a digital first health and care system;” “Unlock the potential of health as a driver of wealth,” and “shifting power and funding away from the acute sector.”
However Darzi’s report makes no mention of Streeting’s preferred plan of bringing in the private sector: and it focuses strongly on the taboo question today – the need for increased funding –“a fully funded transformation fund for health and care” –along with
“a long term funding settlement for health and care … returning the NHS to its long run growth trajectory and ‘ringfencing’ National Insurance (NI) increases to pay for it.”
Even further out of line for a Starmer-Reeves government was Darzi’s 2018 call to:
“Make social care free at the point of need. This means extending the NHS’s ‘need, not ability to pay’ principle to social care and fully funding the service as part of ‘new social contract’ between the citizen and the state.”
Blair ally
The second ‘usual suspect’ chosen by Streeting is Paul Corrigan, a 76-year old academic who has claimed to be a marxist, but fitted right in with New Labour under Blair, and has published pamphlets for right wing junk tank Reform (not the political party of the same name).
Corrigan was therefore involved in shaping policy in perhaps the most disastrous period of New Labour extravagance, as costs of PFI hospitals soared, and as more and more costly new deals were done with the private sector.
In 2001 Corrigan was appointed as a special adviser to the Secretary of State for Health, Alan Milburn and continued as an adviser under his successor John Reid. At the end of 2005 he became the senior health policy adviser to the Prime Minister Tony Blair. Between June 2007 and March 2009 he was the director of strategy and commissioning at the London Strategic Health Authority.
But by 2012 Corrigan was clearly in the camp of the Cameron coalition government, urging ‘reforms’ even more radical than Andrew Lansley’s health and Social Care Act. Corrigan’s idea, eagerly promoted by Reform just as the disastrous experiment with private sector management of Hinchingbrooke Hospital took off, was to let the private sector take over failing hospitals.
And now as he is invited back he is again urging radical policies. He warns that pumping more money into the NHS is “not feasible” while it fails to improve productivity. But he does not explain how productivity can be improved without investment, and indeed while real terms funding is reduced this year and next.
The Times notes that “During the previous Labour government, Corrigan was at the heart of successful efforts to bring down waiting lists,” as if there is any sensible comparison between the 2000s, in which New Labour increased spending well above inflation each year, and the current situation after 14 years of austerity and frozen or falling funding.
Corrigan may have been there at the time, but the waiting lists would not have been reduced without substantial extra funding. The tens of millions squandered on private sector providers would have done much more visible damage to the fabric of the NHS if these policies had not been in the context of a rising budget – and an expansion of the core NHS services.
Corrigan’s answer on the funding issue now is vague in the extreme, and takes no account of the scale of the financial crisis that is already upon us. His Baldrick-style cunning plan is to devise:
“some innovation about how we work the money through the system, so that, for example, the extra money that goes into either primary care or domiciliary care to keep frail older people out of hospital is in some way paid back by the savings that are made in that entirely different stream, in emergency care in the hospital.”
If this could be done it would be lovely. But of course there is no direct or immediate correlation between improving primary care (and wider public health measures) and reducing costs in A&E. Expanding out of hospital services will not instantly improve the health of millions of older people, or reduce the need for cancer treatment.
Taking resources away from already struggling hospital trusts, and giving them to primary care may mean more patients can be seen more quickly by GPs – but it will slow or halt efforts to reduce waiting lists, creating other pressures on the hospitals.
Millionaire
But harsh facts like these don’t deter Corrigan, and won’t deter a third familiar name from the Blair years, Alan Milburn, who stepped down as Health Secretary in June 2003 and has since coined in millions from the private sector.
He chairs PricewaterhouseCooper’s ‘health industries oversight’ board, which was set up to expand the accountancy firm’s business in healthcare, and is also a senior advisor to private equity group Bridgepoint Capital, which owns Care UK, one of England’s largest external providers of NHS services and a large care home chain.
Milburn has also been chair of Ribera Salud, then a Spanish subsidiary of US private healthcare giant Centene, but has also served Tory governments as chair of the Social Mobility Commission. And he is chancellor of Lancaster University.
So far no official announcement has been made on how Mr Milburn, another one-time left-winger, might be slotted in to Wes Streeting’s apparatus, but there is no doubt at all what Milburn will be arguing for: more of what he did over 20 years ago.
A Labour source told the Telegraph: “In opposition, he has been incredibly helpful to Wes and his team. Particularly in the last six weeks, he has been working really closely with the team on a daily basis to make sure we have the plans in place to hit the ground running…
“Alan brings the insight and the knowledge of what made the biggest difference last time Labour was in office… It was the reforms on transparency, choice, and use of the private sector that delivered the goods on cutting waiting lists and making the NHS sustainable for the long term.”
Of course that’s what Milburn has told them, and nobody will have disputed his claims. It’s true that he was the government minister most involved in bigging up PFI and increasing reliance on private sector providers. He collaborated with Corrigan, Simon Stevens and other advisors in drawing up the NHS Plan in June 2000 which came alongside the decision for a decade of increasing investment in the NHS.
This was followed by moves to use some of the extra spending to intensify the competitive market in health care, and New Labour became the first government to begin the outsourcing (privatisation) of clinical care, which Thatcher never even attempted.
Concordat
In November 2000 Milburn signed the Concordat, an agreement with private hospitals to take NHS-funded elective patients at peak periods (and at eye-watering cost).
Soon New Labour was increasing the use of private companies to deliver diagnostics and scans rather than investing in expanding NHS capacity, and then sponsoring a new expansion of the private sector with the creation of Independent Sector Treatment Centres (ISTCs).
All of these “innovations” had very substantial problems, not least the two waves of ISTCs: a 2006 report by the Commons Health Committee dismissed the claim that these had been the key to reducing waiting lists, as Streeting now seems to believe. The Committee:
“concluded that ISTCs had not made a major direct contribution to increasing capacity. The Department of Health has admitted that the number of procedures performed by ISTCs is a tiny fraction of the NHS’s total capacity. …
“Waiting lists have declined since the introduction of ISTCs, but it is unclear how far this has happened because the NHS has changed in response to the ISTCs or because of additional NHS spending and the intense focus placed on waiting list targets over this period. …
“A number of concerns were raised about the ISTC programme by the professional medical bodies and others. There were concerns that ISTCs were poorly integrated into the NHS and that they were not training doctors. These concerns are well-founded.”
Perhaps it was this criticism that led then Health Secretary Alan Johnson to tell MPs in July 2007 that there would be no third wave of ISTCs.
More recently, a new Nuffield Trust report also warns more generally: “there are questions as to the extent to which spending a higher proportion of an already very tight budget on providers outside the NHS will lead to a further deterioration in the quality and sustainability of NHS-run services.”
Shaky foundations
Milburn was also the architect of foundation trusts (FTs), initially an attempt to give the most wealthy and powerful NHS trusts complete autonomy from the rest of the NHS and the freedom to operate as private businesses. He initially wanted no limit on the amount of income FTs could make from private medicine. However he was eventually reined in by his fellow Labour MPs, including former health secretary Frank Dobson who forced through amendments, including preventing FTs’ from increasing the proportion of their total income coming from private sources. This meant private income could only grow if the trust also grew its NHS income.
Ten years later FTs were assessed as a failure, and 20 years on the years of austerity have stripped away most of the veneer of autonomy and freedoms, while the latest reorganisation of the NHS dismantled much of the competitive market, leaving most Foundation Trusts just as dependent on NHS financial bail-outs as the remaining NHS Trusts.
Unpleasant memories
Bringing back Mr Milburn will bring back unpleasant memories to many Labour activists and trade unionists: bringing back his ideas in a drastically under-funded NHS would be even worse, and could deepen rather than address the crisis left behind by the Tories.
With several hospitals literally in danger of falling down, and half of all trusts hampered by years of neglect of basic maintenance, an older and sicker population than the 2000s and cash pressures weighing down on primary care, mental health and social care as well as the acute sector, the Starmer government does not have much time to play with.
The best result for Streeting would be for Darzi’s inquiry to conclude, as the BMJ Commission and the RCN have done that the NHS faces a ‘national emergency’ and requires an urgent injection of revenue and capital to get it back on its feet. Neither Corrigan nor Milburn will be any help at all on this.
But another question needs to be posed: why has Streeting’s review been entrusted to a 60-year old specialist surgeon, and why is he seeking advice from these figures who have got things so wrong before?
Why is he not involving the trade unions and NHS patient groups in these discussions? Unions can supply valuable expertise and resources to commission serious research if needed. Patient groups and campaigners can give dry statistics a local and a human feel, and help press the case for the funding that the NHS vitally needs.
When push comes to shove these are the people who will stand up and fight for the NHS, not millionaire Milburn, Corrigan or Darzi.
Dear Reader,
If you like our content please support our campaigning journalism to protect health care for all.
Our goal is to inform people, hold our politicians to account and help to build change through evidence based ideas.
Everyone should have access to comprehensive healthcare, but our NHS needs support. You can help us to continue to counter bad policy, battle neglect of the NHS and correct dangerous mis-infomation.
Supporters of the NHS are crucial in sustaining our health service and with your help we will be able to engage more people in securing its future.
Please donate to help support our campaigning NHS research and journalism.
Comments are closed.