The NHS, the Covid pandemic and the private insurance takeover

Resolution passed unanimously by the Congress of the Communist Party of Great Britain (ML) meeting on 8-10 October 2021.

This Congress notes that the Covid-19 pandemic has laid bare the fundamental crisis that has been engineered within our beloved but much abused National Health Service over a 40-year period, by successive Labour, Conservative and LibDem ministers and administrations. The Covid pandemic (2020-21) has been used, under cover of the fraudulent slogan ‘Stay at home, save lives, protect the NHS!’, issued by the kleptocratic Johnson administration, to channel hundreds of billions of pounds to finance capital, bailing out the latter in the context of the 2020 global economic depression, while compounding attacks upon the National Health Service.

Congress further notes that Britain’s health crisis is a crisis of under-provision of beds, hospitals, clinics, services, doctors, nurses and other staff. The acute bed-base of the NHS over the past 30 years has fallen from 240,000 to 100,000 beds (with a corresponding reduction in nurses and other medical staff). No wonder, then, that the NHS is struggling to cope with the health needs of the population.

Congress fully realises that under ‘emergency’ Covid legislation, without even the pretence of scrutiny or competitive bidding, tens of billions of pounds were handed out to private companies (Deloitte, Serco, KPMG, Group 4 Security, Lighthouse Laboratories, etc.) in the form of multimillion and multibillion-pound contracts to deliver ‘health services’ entirely outside the framework of the NHS. This was another way of entrenching under-capacity and underfunding in the NHS, with a view to ushering in outright privatisation. This Congress understands that the true motivation behind the British state’s entire Covid response was outlined by the government in statements such as Boris Johnson’s, made to Conservative MPs, that “The reason we have the vaccine success is because of capitalism, because of greed, my friends,” and his former advisor Dominic Cummings’ strategic summary that the government’s plan was: “Herd immunity, protect the economy, and if a few pensioners die, so be it.”

Congress considers that the evidence shows that the NHS was overwhelmed not because of Covid per se, but by its downsizing and privatisation. The 2016 Operation Cygnus, an exercise presided over by Jeremy Hunt, to trial the resilience of the NHS in the face of a respiratory pandemic, demonstrated quite clearly that “the NHS would fall over” owing to a “lack of beds, lack of staff, lack of PPE and lack of ventilators.” The fact that this entirely accurate prediction led to that report being buried, rather than acted upon, was further confirmation of the true long-term ruling-class agenda: to downsize, incapacitate and then privatise healthcare in Britain – to serve the interests of “capitalism and greed”.

This Congress agrees with Professor Allyson Pollock that “The NHS, which established healthcare as a right, has been progressively dismantled and privatised by successive governments over the past [40 years].”

Congress notes that the steps taken to attack the principle of a health service, funded by taxation, that is free at the point of use, from the cradle to the grave, have not been taken accidentally or unconsciously. Rather, those steps were clearly laid out in the period of the Thatcher administration, particularly by Tory ministers Oliver Letwin and John Redwood, both former highly-paid bankers, in their notorious free-market fundamentalist document Britain’s Biggest Enterprise – Ideas for Radical Reform of the NHS. ‘Reform’ on the lips of the servants of finance capital, was a euphemism meaning ‘dismantle, privatise, and maximise corporate profit’. Their ‘realistic and revolutionary ideas’ for ‘radical reform’ were the penetration of the market into every aspect of healthcare delivery. They justified such a ‘vision’, by pointing to the 700,000 patients then waiting for treatment – some of whom waited as long as “two [yes, just two] months”. Redwood and Letwin explicitly stated that the NHS could be compared to the Soviet Union, where demand outstripped supply, and contrasted that to Britain in which “our shops are full of the things that people want to buy … and everywhere supply meets demand ... [but] the same is not true where the NHS is concerned”. The document is a panegyric to the great invisible hand of the capitalist ‘free market’.

This Congress fully appreciates the significance of this libertarian sleight of hand (legerdemain): in the capitalist world, supply meets (indeed outstrips) demand, the shops are full of “the things people want to buy“, in Britain and even more elsewhere, because such a large proportion of the population have been so impoverished that they cannot afford to buy them. Marketised health will of course reproduce those effects, whose disastrous and sickening results can be witnessed in the USA and India, amongst others.

Congress is fully aware that over a million of Britain’s children are undernourished. Yet there is ‘oversupply’ of food in Britain’s supermarkets, despite epidemic levels of hunger and malnourishment in wider society. Each night our monopoly supermarkets discard tons of unsold produce and go the lengths of guarding their bins to prevent the still edible waste food being ‘stolen’ and eaten by the poor. Supermarkets have even taken the hungry poor who attempt to eat their wasted food to court – all in the interests of “capitalism and greed“.

Congress understands that privatising the NHS – reintroducing the market into healthcare –has not and will not ‘solve the problem of supply and demand’, and is not solving the problems of access to medical care for Britain’s working class. It simply, as in other fields, prevents the poorest, and even the relatively better-off workers, from having timely access to high quality healthcare, while giving abundance and oversupply to the rich. In medicine, as with food and housing, the effects are particularly egregious and detrimental to the health and wellbeing of our entire society.

Congress notes that the Redwood / Letwin plan has largely been implemented and is now entering its final stages. Of the ‘radical and realistic reforms’ (capitalist market privatisation) introduced by successive Labour and Conservative administrations, those asterisked were explicitly mooted in their 21-page document.

1. Make the NHS an independent trust (or series of trusts).*

2. Remove governmental control / responsibility for the overall running of the NHS.*

3. Introduce corporate management (the revolving door between private business and NHS management) and decrease the role of healthcare professionals in administering the NHS.*

4. Introduce market mechanisms into the NHS (the internal market; the purchaser/provider split; clinical commissioning groups, etc).*

5. Reduce the ability of the NHS to plan its service (national planning body removed, regional planning implemented and then disbanded in favour of CCGs).*

6. Increase ‘public-private partnership’ or PFI.*

7. Introduce means-testing (implemented first in social care, then through the re-merging of social care and the NHS, introducing self-pay mechanisms throughout the NHS, by degree).*

8. Downgrade pay and conditions of NHS staff, making the running of private sector health services potentially more profitable (implied in 1, 2 and 3).*

9. Privatise services (management of grounds, buildings, cleaning, catering and portering, then expanding to include core medical services, starting with radiology and expanding to embrace the entire clinical activity or ‘network’).*

10. Sell off NHS assets (particularly land and cottage hospitals).

11. Decrease capacity (at every stage of PFI rebuild, fewer beds were built in the new hospitals, hospitals were ‘merged’ with fewer beds, and cottage and district hospitals were closed) and thus increase rationing.

12. Decrease access to GP care (sold as ‘convenient’ virtual appointments for the busy well, such as Babylon Health, then generalised during the Covid pandemic).

13. Encourage the growth of parallel private healthcare groups, and self-paying access to private care and private insurance. (Around 8 million people, 13 percent of Britain’s population now have private medical insurance in the UK, and 53 percent state that, given difficulties in accessing care, they would like to invest in some sort of scheme. The average policy cost is currently £1,500 annually.)*

14. Pay the private sector to make good the loss of capacity in the NHS sector. (The government announced a further £10bn contract to buy private health capacity to ‘deal with the NHS waiting list’, allegedly due to Covid.)*

15. Stipulate that increasing proportions of the health budget must be spent on the private sector.*

16. Finally, as a last step, introduce a health credit scheme (‘patient choice’: the ability to be treated upon request at any centre, including in the private sector, and to take a certain portion of government / NHS funding with you).*

17. ‘National’ private health insurance.* This is the effective takeover of funding and administration of the NHS by the insurance / banking sector, with the funds being levied from the individual. A ‘no-claims bonus’ could be paid for the well.*

This Congress believes that the true significance of the 2021 Health and Care Bill, introduced by Health Minister Matt Hancock and continued by his successor Sajid Javid, is the final step of this long process of capital penetration and the takeover of the NHS by private health insurance finance capitalists.

Under the provisions of the Bill, benign sounding ‘strategic clinical networks’ will replace the 2012 Health and Social Care Act clinical commissioning groups of GP consortia. The latter currently administer 70 percent of the £140bn NHS budget, so that overarching control of some £90bn annual budget will pass to these networks, where a dominant role will be played by US health insurance giants United Health, operating in Britain under the name Optum, and Centene operating in the UK as Operose. The former are already actively engaged in the UK insurance market and in the formation and administration of clinical networks. The latter have recently taken over a string of GP practices, including AT Medics. These ‘health networks’ will effectively reproduce in Britain the US system of ‘health management organisations’, with their perverse incentives to maximise profit by denying care to their policy holders, and their consequent failure to deliver healthcare to tens of millions of citizens.

Congress realises that this list does not exhaust the influence of the private sector, but these corporate giants represent its apogee and triumph. Large corporate interests will thus cement their control of the finances and delivery of health services within and outside of the state sector. Much of this has been implemented under the direction of Sir Simon Stevens, Chief executive of NHS England since its inception until this year, who was formerly the PFI advisor to Tony Blair’s Labour government and then president of global expansion for United Health. His successor and former deputy, Amanda Pritchard, is fully committed to continuing these policies.

This Congress notes that, far from ‘eliminating waiting lists’, these successive and relentless measures taken to privatise the NHS have seen waiting lists expand exponentially. The NHS has an unprecedented waiting list of five million patients (eight percent of the population) and is widely expected to grow to 13 million (more than 20 percent of the population). What’s more, in a feat of Goebbelsian propaganda, the waiting lists generated by privatisation measures (all covertly and fraudulently implemented, against the will of the British working people) are again being used to justify the last step of the further ‘radical reforms’ that amount to implementing outright privatisation. It is not an exaggeration to say that the Health and Care Bill’s measures will be nails in the coffin of the NHS, which was inspired by Soviet socialist healthcare provision for the working people. It was that example which led British workers to demand similar measures for a decent life and many of the best features of Britain’s post-war NHS.

Congress agrees with Allyson Pollock, that: “The story is of course not unique to Britain. Universal healthcare systems are being dismantled and privatised across the world. Making healthcare once again a commodity to be bought, rather than a right, has become the standard prescription of the World Bank, the International Monetary Fund, the World Trade Organisation, and even the World Health Organisation …

“The dismantling process and its consequences are profoundly anti-democratic and opaque. The catchphrases of ‘public-private partnership’, ‘modernisation’, ‘value for money’, ‘local ownership’ and the rest conceal the extent and real nature of what is happening; moreover the complexity of healthcare allows the reality of its transformation into a market to be buried under a thousand half-truths.”

This Congress is fully aware that the theft of the NHS from British workers has been made possible by the cooperation of Labour Party social democrats, who continue, perversely, to claim in election campaign material and speeches that Labour ‘gave’ the NHS to Britain and who are in total denial about the extent of their party’s collaboration in its privatisation and dismantling.

Congress condemns the particularly pernicious role that the Labour Party has played in disarming the working class ideologically and organisationally. It is the domination and subversion of real grassroots campaigns and of the trade union movement by the Labour Party that has led to the neutralising of effective campaigning against the serial attacks on the NHS. This phenomenon can be seen again and again, from the struggles of the Hillingdon hospital workers to keep their NHS contracts, through hospital campaign groups such as those in Lewisham, Leicester, St Helier and Epsom, to the campaign to protect the student nurse bursary and the junior doctors’ pay dispute, the NHSPay15 campaign and more.

In light of this knowledge, this Congress reaffirms our Party’s strategy to raise awareness amongst British workers, whose love for the NHS as an institution remains second to none and is in fact a true barometer of their desire for a just and equitable society, that capitalism is the agent of the attacks upon the NHS and that the NHS can never be fully secure, any more than any other aspect of workers’ lives, while capitalism continues.

This Congress therefore resolves:

1. To fully support the demand of nurses and NHS health workers to a 15 percent pay rise. Our frontline health workers must have a living wage if we are to protect our health service. We will oppose pay freezes and ‘restraint’, and the movement of foundation trusts to disband national employment contracts and frameworks.

2. To campaign against the (corrupt) granting of multimillion and multibillion-pound contracts to the private sector instead of channelling adequate funds to NHS services.

3. To campaign for the expansion of state-funded NHS services: for more NHS beds, more NHS hospitals, more NHS clinics, more NHS GP surgeries, more NHS nurses, more NHS doctors, more NHS dentists, etc, to meet the health needs of the British people.

4. To campaign against the health insurance industry’s takeover of the NHS by means of the health boards being set up to administer ‘strategic clinical network’ funds.

5. To campaign for the reintroduction of integrated health planning, commissioning and provision on a national and regional level, by the NHS itself.

6. To campaign for the scrapping of all PFI debt, without compensation.

7. To oppose the internal market, and all privatisation of services, whether ‘core’ or ‘peripheral’.

8. To campaign for the renationalisation of all privatised aspects of NHS provision, including pharmacy services, dental services, physiotherapy and support services, management, service provision (core and peripheral), etc. to establish a health service that provides nationally funded, universal and comprehensive care, free at the point of use, in fulfilment of the NHS’s original charter.

9. To demand the scrapping of Foundation Trusts, which act as businesses first and health providers second, and the financial targets that have driven those trusts into debt, which in turn is used to force a rationing of services. To campaign instead for the reintegration of all trusts into a single health service, run nationally, and the reintroduction of government responsibility for the provision of healthcare to the British people.

10. To demand the nationalisation of all pharmaceutical and medical technology companies. It has long been the case that while public debt is social, profitable enterprises are private. We must demand that the government finances the wellbeing of the working people, not the corporate profit of the financial capitalist elite.

11. To seek out and engage with all individuals and campaigns that fight sincerely to defend the NHS, while pointing out the pitfalls of accepting guidance from the mainstream political parties, particularly Labour, but also others who are committed to capitalism and have consequently led the attacks on the NHS.

12. To expose the media campaign of lies about how privatisation will bring ‘efficiency’ and ‘reduce waiting lists’ and show that that NHS cuts and privatisation are being smuggled in under the banners of ‘choice’, ‘efficiency’ and ‘excellence’. We are heading toward the dystopian US model of ‘health management organisations’ under their protective propaganda blanket.

13. To educate British workers so that they refuse to accept the legitimacy or necessity of cuts to the NHS and social provision. If these cuts are a result of the direction of the state by the capitalist class, and the economic and financial crisis that is of their system’s making, then they prove themselves bankrupt and unable to rule in the interests of the vast majority. That is an argument for socialism – not for the strangulation of the NHS or the working class.

14. To fearlessly expose the pernicious role played by the Labour Party, which has done as much as Tory and ConDem administrations to privatise and destroy the NHS. Our Party must use this fact to demonstrate that capitalism seeks nothing other than maximum profit –which means privatisation of healthcare and decreased provision to the mass of the working class.

15. When the opportunity presents itself, we must not fail to make the connection between the campaign to defend the NHS, with its immediate impact upon the lives, health and wellbeing of British workers, and the broader fact that the welfare of workers cannot be achieved and maintained without putting in place a socialist system of planned economy, administered by the working people themselves.

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