UNISONActive is an unofficial blog produced by UNISON activists for UNISON activists. Bringing news, briefings and events from a progressive left perspective.

Wednesday, 30 July 2014

Vintage tables and the NHS

Yesterday Andy Burnham addressed a packed gathering of the Labour faithful at North West UNISON’s office.
   It was a timely speech as part of Labour's summer campaign offensive. Burnham is an articulate and engaging speaker who talks in language that actually speaks to ordinary voters. A rare quality in a shadow cabinet awash with southern policy wonks whose ideas seem to stem from glugging Rioja over an Islington vintage effect kitchen table, complete with Cath Kidston crockery and twins called Cornelius and Cosmo.

The Burnham messages on the NHS will in fact now start to connect with Bill and Jean at the British Legion Club who have long been disaffected Labour supporters. But the message to Bill and Jean can’t be diluted by the misguided few who appear to be punching above their weight (and intellect) at the Labour Party’s National Policy Forum. I refer of course to the continuing prevarication on the role of coops and mutual in public services.

The dilemma for Burnham is this; he is absolutely right to point the finger at the imminent threat facing the NHS through mass marketisation under the guise of the Health and Social Care Act. He is right to explain, as he did, that the evidence that health services improve through competition is not there and that the confusion of multiple providers, contracts for everything and profit motives is acting as a road-block to genuine collaboration and integration of NHS services.

He is right to point to the statistical data that shows the undisputed downward spiral in key performance indicators- from cancer care to A&E waiting times that mirror the cuts, confusion and waste that have stemmed from the cringingly wasteful bureaucracy that market principles, and an unwanted reorganisation, have placed on a treasured public service. But the schism in policy is created by the replication of these problems in alternative models of delivery such as coops and mutual.

Some might argue (as in fact Burnham did in response to a question from the floor) that coops and mutual are ‘not really privatisation’. The answer of course is that coops and mutual are most definitely privatisation and the Labour Policy Forum needs to wake up and smell the coffee on this. Even the Cooperative Party is luke-warm on the idea of coops and mutual as a replacement to public services so why is the Labour Party afraid to take on the minority expansionist in Coops UK who would happily see us return our public services to some form of philanthropic Victoriana vision of public services?

The reasons for the failure of markets apply just as much to coops and mutual as they do to the failure of the model when using the mega outsourcing firms:-

Big firms rely on winning contracts. So do coops and mutuals.

Big firms need people and systems monitoring their contract performance. So do coops and mutuals.

Big firms strive for profit. Coops and mutuals may not always be profit maximising (although A4E clearly was!) but they do need to make a profit to survive.

The NHS relationship with outsourced providers is managed through contracts which increase costs and inflexibility. The NHS relationship with spin-outs, coops, mutuals and other varieties of yoghurt-knitting company forms is managed through contracts which increase cost and inflexibility - if they cut costs it is through pay and pensions being lost (as evidenced in the APSE research study ‘Proof of Delivery’).  

Like academies and free schools it is misguided to suggest that fragmentation to local former NHS staff will keep services local. What has happened with the free school and academy experiment is in fact the initial smaller contracts and providers have been sucked into regional, national and even global conglomerates – it has been a very helpful stepping stone to privatisation to first fragment and then recalibrate the contracts and providers into super providers, making vast profits from the public purse.

There is no one legal form of coop or mutual or social enterprise – just like the Coop Bank which was a PLC wrapped in an coop blanket these public sector spin outs are in the form of a Company Limited by Guarantee, a Company Limited by Shares or other forms of company structures.
Just because new owners of NHS services used to work for the NHS doesn’t make them public servants. The services are owned by a few former workers not the whole collective of the public. It is simply a different (and arguably less sustainable) model of privatisation.

Carpet-bagging is simply wrong. When a service is truly public its value lies in the service – when it is outsourced to a coop or mutual it has a new commercial value. I do not see any moral reason why the general UK taxpayer should gift a service, which the minute it leaves the NHS starts to have commercial value, to a few former employees – if it is a management buy-out put their money on the table for the benefit of the NHS. Anything less is surely poor value if not a corrupt practice? 

So finally back to Mr Burnham. It is simply naïve to be cowed by what is a lobby group acting in the interests of the army of consultants making a fast buck and buying Cath Kidston aprons to go with their crockery; they are now tainting the coop principles and the coop brand.

The coop retail principles are excellent and could and should be a moral voice in retailing but public services from Bevan onwards was about a different settlement than reliance upon charities and social enterprise. We can’t step back to the days philanthropic intent – it was that which thankfully led to the creation of today’s public services but it is not a route-map to where public services lie in the future. It is a regressive and self-interested agenda driven by lobbyists and consultants. It waters down and weakens the NHS message to Bill and Jean at the British Legion. Resist this weakening of policy and stand up and be counted to protect the N in the NHS.

Anna Rose