The American threat
During his recent visit to Britain the US President Donald Trump caused widespread horror in the bourgeois press when he stated that, in negotiations for any post-Brexit US-UK trade agreement, everything, including the NHS, would be on the table. Within a very short time, however, the President seemed to have backtracked on that remark. Mr Trump’s apparent U-turn followed a huge and well reported backlash from trade unions, Conservative leadership candidates and opposition politicians. Trump in a later interview, referring to the question of the NHS and his earlier comment, said “I don’t see it [the NHS] being on the table” adding: “Somebody asked me a question today, and I say, ‘Everything’s up for negotiation’ because everything is, but I don’t see that being – that’s something that I would not consider part of trade.” The main media responses following the second statement seem to go from ‘Trump having been soundly put in his place’ up to ‘he is now telling lies to appease us and that post-Brexit the US health giants will still want our NHS’.
We must repeat what we have been saying repeatedly for quite some time now: “There is very little of the real NHS left!”, so much is now owned or serviced by the private sector, and US firms are well represented among the private players that stick an NHS label on themselves in order to rip money from the ailing NHS cash cow. It seems much more likely that someone has taken President Trump to one side and pointed out that the US companies are already here pre-Brexit and that in Britain politicians don’t state the obvious, especially where healthcare is concerned, for fear of a public backlash. The British bourgeois way is to keep the door open for the privateers while referring to the NHS as one publicly owned and accountable organisation which every bourgeois political party swears to defend, while claiming all the others want to privatise it.
It is in this light that we must view statements like; “The NHS is not for sale” issuing forth from the Health Secretary, Matt Hancock, in response to an earlier utterance from the US Ambassador that the NHS must be open to US firms post-Brexit, and “The NHS as a publicly run, publicly owned institution is part of our DNA”, coming from Jeremy Hunt, the Foreign Secretary (and now contender for the office of Prime Minister), who previously served as the Health Secretary. These two Tory ministers were, of course, at the time that these statements were made, rivals for the leadership of their party and, as both have very obvious and public links to the NHS, both obviously felt they had to be seen to be defending it. The Labour Party can play this game equally well. Jon Ashworth, the Shadow Secretary of State for Health was not to be left out, saying: “Though Trump may have later reneged on his original comments, no amount of rowing back should be enough to dismantle the seed of doubt that has now been planted by the president. I want to send a clear message to Donald Trump: our NHS absolutely must not be for sale, and with a Labour government it certainly would not be.”
Mr Ashworth’s little party political broadcast does not stop at pretending all the private schemes brought in to rob and ruin the NHS under Labour governments did not happen. Hoisting the mantle of sole NHS protector onto his party, he continues to attack both Trump and Brexit as the villains in his dream saga: “…if we have a trade deal with the United States, that could genuinely mean Trump’s America, with its huge private healthcare corporations, could get their hands on NHS contracts that I believe would severely undermine our free at the point of use universal and public NHS. I don’t remember seeing that on the side of any Brexit bus.” Of course, Mr Ashworth would have been quite happy doing that very same deal if in power and especially if it could have been with that nice Mr Obama through the good offices of the EU, as was originally mooted, but such is the two-faced reality of bourgeois politics, the ‘Punch and Judy’ show for adults with imperialism hiding behind the screen, doing all the voices and with its blood-soaked hands stuck up all the glove-puppets! That won’t appear on the side of any buses either, will it Mr Ashworth!
Acadia is a Tennessee healthcare firm that paid £1.3 billion on buying the Priory Group, which, through its contracts in the NHS, relieves the British taxpayers of around £720 million annually.
Universal Health Services (UHS) is another US firm filling its pockets indirectly from the Treasury through the NHS. UHS have recently bought up a lot of psychiatric services in Britain including Danshell which is the proud owner of a Durham hospital that has featured in a Panorama exposé of abuse towards patients. The UK operations of UHS are run by ‘Cygnet Health Care’ (CHC), which, in between public crocodile tears regarding that exposé of their ‘care’, claimed that it was genuinely “shocked and deeply saddened by the allegations.” The latest accounts of CHC shows the company receiving revenues from some 220 NHS purchasing bodies and reveals their profits from the NHS rising to a staggering £40.4 million. Scores of other American firms have joined the current feeding frenzy of private companies in ‘so-called’ NHS psychiatric care; and so secretively are many of the ‘care’ units being operated that many patients are being subjected to solitary confinement, violent restraint, hatch feeding and forced sedation with little chance of investigation or proof-gathering being afforded to relatives except by the expensive methods of programme makers like Panorama who cannot be everywhere. It would be nice to blame solely the financial speculators and funding grabbers that are the private sector, American or otherwise, but the truth was, is and remains that without the willing cooperation of law-makers in Parliament generally and the government of the day specifically (whichever bourgeois party is the government at any given time), the abuses of psychiatric patients and the abuse of the public purse could not take place.
It’s not just the Americans!
The NHS was cracked-open a long time ago to allow private firms the legal right to bid for the care and treatment contracts alongside any ‘in-house’ bids, and if these privateers should occasionally lose out to an in-house bid, they often drag the whole thing through the courts costing the NHS million of pounds until the privateers get their own way.
One British private healthcare company (Circle) has for 11 years been running the Nottingham NHS Treatment Centre, which provides 240,000 operations and check-ups a year, but Nottingham University Hospitals NHS trust (NUH) put in a better bid and won the contract. Circle immediately called its law team and, following a bitter and costly legal battle between Circle the NHS, the NUH were confirmed as the better bid and they were handed the £320m contract to run the centre for the next five years.
Circle had run the Nottingham ‘Independent Treatment Centre’ (ISTC) since it opened in 2008. Which bourgeois party was in government then we have to ask? Oh yes, it was the Labour Party which, according to Mr Ashworth the Shadow Health Minister, would not allow, if they were put back into power, “our NHS” to be for sale!
Circle was one of a large number of private companies that were given charge of ISTCs around the country to use for the manufacture of fabulous profits for themselves. Other private companies that won this particular NHS lottery to enrich themselves from the public funding given to the NHS included Care UK and Ramsay Health Care both of which are still running other ISTCs and making a lot of profit from them.
The Nottingham Treatment Centre is in for a rocky handover, however, as the Rushcliffe NHS clinical commissioning group (CCG), which awarded the contract to the NUH, envisaged a transition time of seven months to make sure that the treatments and running of the centre remained smooth during the takeover by NUH from Circle. That time is now being chopped down to eight weeks as Circle are trying to cause mayhem in a bid to prove their claim that NUH cannot run the centre. This nasty tactic by the ousted private company could spell delays and possibly disaster for the thousands of people who are waiting for treatment at the Nottingham centre, including many cancer patients, as it faces possible delays once NUH takes over the contract on 29 July because it will not be in a position to take on the full range of services immediately.
Jonathan Ashworth MP, has surfaced again to attack the private sector that threatens our wonderful NHS, saying he was pleased Circle had lost the contract and has criticised the firm for using solicitors to try to thwart the contract decision. “It’s hugely welcome this service is returning to our public NHS and out of the hands of Circle” he stated, seemingly forgetting who gave them the contract in the first place – or perhaps hoping that we will forget! “Patients well remember Circle’s chaotic handling of the Hitchingbrooke hospital contract” he added in a reference to another victim of the Circle fund-sucking ‘care’.
It was in 2012 that Circle became the first profit-driven health firm to be put in total charge of an NHS hospital as it took over the running of Hinchingbrooke hospital in Cambridgeshire. Just three years later it gave the contract back to the NHS following ‘financial problems’ stating that it could not keep up with rising demand. The investigators rated the hospital’s care during Circle’s time at the helm as inadequate.
The money skimmed off by profiteers is urgently needed elsewhere
Meanwhile the storm hovering over us of the near complete breakdown of the system of hospital and GP care in Britain, as reported in Lalkar: March/April 2019 issue, continues to gather. Without staff there can be no healthcare and, unless doctors and nurses can be found very quickly, what is left of the NHS will come crashing around our ears, causing a humanitarian crisis of extreme severity. A report from the Nuffield Trust shows that the number of GPs per 100,000 people has shrunk from nearly 65 in 2014 to 60 last year. Even if these losses in the number of GPs were evenly spread it would be causing great problems, but the lowest number of GPs seems to be concentrated in the poorest (most in need) areas. All these problems could be solved if the NHS funds were directed to the areas of need rather than to the enrichment of parasites.
There are 7,148 surgeries operating in England according to the most recent NHS figures which were released in July 2018. The harsh truth is that some 357 could face closure during the next year and, with each surgery in the country having on its books an average of 8,279 patients, it means that almost 3 million people could be left without a doctor if 350 practices did close next year.
In the year between July 2017 and July 2018 more than 260 GP surgeries closed their doors in England so, unless the trend can be stopped and reversed, that projected 350+ surgery closures is not by any means panic-mongering but a very real prospect.
Incidentally, to the extent that the NHS is still functioning as well as it manages to do, it is understood by most sensible people and even a fair few bigots that without immigrant workers (1st, 2nd and 3rd generation) our NHS cannot exist, and yet there are still people wanting to put greater restrictions on foreign workers entering the country to work in the NHS. Until we are prepared to put serious money into training more doctors and nurses, we cannot hope to see the survival of even the much-reduced level of healthcare that we currently enjoy much longer.
Incredibly, Richard Murray, the Chief Executive of the King’s Fund, is on record as saying that without radical action to expand the NHS workforce, there is “a very real risk that some of the extra funding pledged by the government will go unspent, waiting lists will continue to grow and important improvements to services like mental health and general practice will fail”. Of course, when he says that some funding will go unspent he means only that it will not be spent on “radical action to expand the NHS workforce” but will instead be quietly clawed back by the government on the grounds that the NHS did not have the staff to spend it!
Urgent action needed
We need eradicate all the leeches growing fat from the funding that is supposed to keep our healthcare going, be they the amazingly bloated levels of greedy and bureaucratic managements throughout the system, or their even more parasitic financiers. We need to end the putting of services out to tender which is giving our money straight to people who give nothing back and desire only the maximum profit for themselves.
Moreover, we need to end the private production of drugs that give the pharmaceutical giants the ability to dictate how much the NHS has to pay above the real financial costs of producing any given medicine. We need good quality, properly funded, accountable and publicly owned pharmaceutical enterprises unencumbered by the profit motive but instead powered by the ideals of public service, able to focus far more on research to find definitive cures to various ailments, rather than continuing to rely to such a great extent on lifelong palliatives that generate eternal profits.
Private enterprise, i.e., the creation of the greatest amount of wealth for a small group of individuals by performing the least service possible at the lowest cost to themselves, is not and can never be good for healthcare. The company Interserve was given a huge seven year contract worth £300 million to provide facilities management for hundreds of NHS buildings across Leicestershire, yet that contract had to be ended after only three years following many complaints and reports of patients receiving meals up to three hours late, uncleaned and bloodstained corridors, and various bins overflowing, making even a short trip to hospitals or clinics very hazardous to the health of workers, patients and visitors alike.
Another example would be Coperforma, a patient transport service whose actual service was so shocking in its unreliability that often patients were forced to wait for hours to get to urgent care, and getting home afterwards within two hours of the time you were supposed to was likened to the chances of winning the National Lottery top prize.
Carillion was another cleaning company with a disastrous record. After winning a £200 million five-year estates-and-facilities management contract, they failed to clean any of the hospitals properly to the point where infectious waste was seen overflowing in a children’s ward.
Meanwhile, in the United States, where a bank account is checked before a pulse, the pharmaceuticals companies are having great fun at the expense of the poorest and politically weakest sections. The Israeli drugmaker, Teva Pharmaceutical Industries, is one of the world’s largest manufacturers of generic medicines. This rapacious company has already faced criticism in February 2018 for charging $18,375 for a bottle of 100 pills for a rare medical condition known as Wilson disease. Another purveyor of overpriced drugs is Mylan who have also generated outrage for raising the price for a two-injection EpiPen set to over $600 from $100.
These two companies, along with Pfizer, Novartis and others, stand accused in the US courts of conspiracy and price fixing. “Rather than enter a particular generic drug market by competing on price in order to gain market share,” the complaint states, “competitors in the generic drug industry would systematically and routinely communicate with one another directly, divvy up customers to create an artificial equilibrium in the market, and then maintain and increase anticompetitively high prices,” said Gurbir S Grewal, the New Jersey Attorney General in a statement relating to the case. The named companies have, it is claimed by the New Jersey State Prosecutor, in some cases raised prices together by 1,000%.
The NHS and Brexit
These companies and/or their subsidiaries also operate in Europe and, as readers of Lalkar and Proletarian know from past articles, Britain’s toothless health watchdog has in the past allowed these very methods to be practised by drug companies here. In short, there is little that is done in America that isn’t also done here to some extent. The point is to remove all, not just US, private firms from the NHS. But that will not happen while we live under the dictatorship of the bourgeoisie (bourgeois democracy if you prefer). Revolution is the long-term fix for the NHS, and most other real problems, but we will support whatever steps within capitalism that do not go directly against the long-term interests of the working class and the goal of revolution and a proletarian dictatorship that we have. However, there are plans to try to use the NHS as some sort of reason not to support Brexit and that must be combatted.
One of the reasons that so much is being made of US firms grabbing NHS contracts at this moment is to try to create a strong anti-Brexit feeling within the working class. Within the bourgeoisie there is a majority for staying within the EU, but a serious split exists, with quite a vocal minority bourgeois pro-Brexit group very much in evidence as well. Within the petty bourgeoisie, the situation is one of mainly pro-EU Remainers, but the working class can easily outvote them all and it is here that there exists a large pro-Brexit group that is growing in numbers and anger.
If we look at the British lobby group, 38 Degrees, whose members and campaigns usually run along middle class lines, they stayed out of direct participation in the Brexit – Remain argument but now, in the name of saving the NHS, of course, they are firmly weighing in on the remain side. In their latest letter to members and supporters they argue that: “the ‘no-deal’ Brexit some candidates are talking about could mean the NHS as we know it is sold off to American businesses. Donald Trump has already said the NHS will be ‘on the table’ in any trade deal after Brexit.” But what is the no deal Brexit except the absence of a deal? The majority of voters decided that Britain should leave the EU but this idea that you cannot have a no-deal Brexit means that the House of Commons and its overwhelming Remain majority can keep finding ways of not agreeing until everyone forgets what the question was! This is clearly understood by the 38 Degrees leaders as they advise that; “If enough of us come together again, we can show MPs that we are not prepared to tolerate a version of Brexit that risks our NHS.”
Yet it must be obvious to all but the wilfully blind that, Brexit or no Brexit, the NHS is being deliberately dismantled piece by piece to the point that in area after area it risks collapse. To suggest that only a trade deal with America would be the cause of collapse is to whitewash what is already happening, pushed forward by the political representatives of both bourgeois parties that have been in government in the years since the NHS was founded, with a view to cheating the British public of their most cherished institution, the NHS.
Advisors to US President Donald Trump are routinely frustrated by the President’s seemingly limitless ability to play down rising tensions with Iran. Despite mock imperialist media outrage over alleged Iranian attacks on oil tankers, and the shooting down of a US drone in mid-June, President Trump has yet to light the fuse on what would be a cataclysmic intervention in the Middle East.