Few campaigners or union activists appear to have noticed or commented upon Labour’s Manifesto commitment to roll back privatisation in public services. Some of Labour’s manifesto promises go further than many union activists and campaigners have realised.

The Manifesto promises (under ‘Kick start economic growth’) to “introduce legislation within 100 days to implement in full” Labour’s ‘Delivering a New Deal for Working People’. This specifically includes steps to:

end the Tories’ ideological drive to privatise our public services, extend the Freedom of Information Act to apply to private companies that hold contracts to provide public services, exclusively with regard to information relevant to those contracts, to ensure any outsourced contracts are transparent and accountable  …

“The next Labour government will also examine public services that have been outsourced as part of our drive to improve quality, design better services to meet changing needs, ensure greater stability and longer-term investment in the workforce, and deliver better value for money. …

“In most cases, the best time to achieve value for money for publicly run provision will be when existing contracts expire or are broken through a failure to deliver. Before any service is contracted out, public bodies must carry out a quick and proportionate public interest test, to understand whether that work could not be more effectively done in-house. The test will evaluate value for money, impact on service quality and economic and social value goals holistically.

“We will also reinstate and strengthen the last Labour government’s two-tier code to end unfair two-tiered workforces. The scope of the two-tier code and the public interest test will apply to wholly owned subsidiary companies.”

This should mean Wes Streeting – directly or indirectly – stepping in to halt moves by trusts like East Suffolk and North Essex FT to outsource cleaning catering and other non-clinical support services, or further moves to outsource clinical care and diagnostic services.

It also means all NHS Trust bosses should also be instructed to review all existing contracts as they come up for renewal, and required to prove they could not be more effectively done in-house before they even consider outsourcing services to private contractors.

However there are strong reasons for believing that Streeting’s instincts, reinforced by the advisors he has surrounded himself with, are in the opposite direction. Many, including the Lowdown, have criticised Wes Streeting’s repeated ill-judged commitments to use “spare capacity” in the private sector to reduce waiting times.

However there are strong rumours in the right wing press that among the Blairite figures from the New Labour government that are being drawn back in as advisors to Starmer’s new cabinet, former Health Secretary Alan Milburn, now a multi-millionaire after prolonged lucrative involvement with the private sector is expected to play a leading role.

Milburn, who served as Health Secretary from 1999-2003, worked with Tony Blair’s advisor Simon Stevens to develop the notion of creating a competitive market in clinical care. In 2000 as health minister Milburn signed the Concordat with private hospitals to treat NHS-funded elective patients (at much higher than NHS prices).

Under his watch the first APMS contracts opened up primary care to commercial takeover; the basis was established for the first for-profit “independent sector treatment centres” to treat NHS elective patients – with guaranteed volumes of patients and payment some 15 per cent above NHS tariff costs. Milburn also pushed through the creation of foundation trusts with maximum autonomy from the NHS, including the freedom to make up to half their income from private medicine and commercial activity.

Milburn also drove an expansion of the building of hospitals through the Private Finance Initiative (PFI), vastly increasing the size (and cost) of projects and saddling many of today’s NHS trusts with hefty and still rising annual payments.

With Tony Blair himself also still pressing from the sidelines for greater reliance on the private sector as the way forward for the NHS, and apparently advising Streeting, there are real dangers that instead of implementing the progressive elements of their Manifesto, the Starmer government could again be side-tracked into even more new, costly and wasteful experiments with privatisation that delivered such wretchedly poor results in the 2000s.

With these advisors in the wings, the lack of NHS capital to tackle the maintenance backlog or build the promised new hospitals also creates new fears that a version of PFI (which collapsed with the bankruptcy of Carillion, one of its major corporate players in early 2018, leaving hospitals half-built in Liverpool and Birmingham) could be in the offing.

In 2018 Tory Chancellor Phillip Hammond announced that the Conservatives would not sign any more PFI deals: and under Jeremy Corbyn the policy was clearly rejected, with plans put forward to stem the flow of PFI profits into private, often off-shore, coffers.

But six years later, would Starmer’s government really want to risk a stand-up fight with the unions to give PFI – and extensive use of the private sector – a new lease of life?

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