Sunday 29 November 2015

Increase The Budget, But Slay The Cow?, by Paul Bicknell

An argument in favour of bona-fide public works schemes.

Honest conceptual clarification of the NHS, which few wish to hear on either side of the chamber, will help the public decide on what may be a crisis, but not necessarily one of patient care. Meanwhile, liberated funds could be used to fight child-poverty.

There is a false dichotomy concerning the National Health Service.

Under the aegis of the left, we are led to believe, it is a neo-Keynesian employment racket which telegenic Tory rascal Dan Hannan will tell any voter in earshot (he tells it glibly and inaccurately) employs three times as many managers as medical staff and is the worlds’ third largest employer after the Chinese Red Army and Indian National Railways.

Meanwhile, under the imagined corruption of the right, so the story goes, millions, albeit not billions are wasted on cronyism; the money which is ‘haemorrhaged’ on external consultants either directly, but also indirectly; there are thousands for example of what one candid recruitment consultant said to me recently of private sector recruiters for the NHS regularly taking home six figure salaries (you know, four times that of a junior doctor etc).

There are very laudable, honourable and genuine reasons for those of us on the left to laudably proclaim the virtues of a cradle to the grave, free at point of access (and various other pieces of dogma) public health programme.

What can be more touching a use of income, what could be more apple pie and mother than the public’s health? This hasn’t been a partisan issue, even in the dark days of Thatcherism (who would nevertheless never speak about using the NHS on the record).

John Major, a more benign Tory in his party conference speech in 1991, famously pledged: ‘No privatisation of healthcare, neither piecemeal, nor in part, nor in whole, not today, not tomorrow, not after the next election, not ever while I am prime minister.’

Now what’s the schtick? 

He was required to say this against the ‘better’ instincts of the right hand side of the chamber, because under Neil Kinnock, sensible centrist policy was under threat of stealing the lower middle-class vote and he could not afford to lose the voting block which the NHS represents?

It is a fine example of how the praxis (the mid-point of the dialectic between left and right) has worked in British politics since the people’s budget of Lloyd George and the introduction on these islands of superannuation.

There is a centrist path-dependent dynamism, which sadly exists in the absence of revolution. To put this simply, the would-be revolutionary zeal, the once real possibility of full-structural Marxism, has had the rug pulled out from under it by revolutionary social policy instead.

The radical left-has thus won a great many battles, but sadly few if any in government. Those of us, who in the absence of revolution, wish government to be more left wing, must do so almost playfully with a kind of magnetic inertia which operates around the praxis. Then we can win elections. 

The crisis of NHS funding is one at its heart then which is not about patient care per se, but is about what the NHS is largely in practice once you subtract its MacGuffin, one of the largest scale public works schemes in the western world.

It’s the beastly Hannan postulate again, but I wish to eat the cake and have it. I wish to bite the bullet.

While 98.8% of NHS funding comes from general taxation and National Insurance, with just 1.2% coming from patient charges, amounting to 9.3% of GDP, according to the Kings Fund, under the French system big business pays for peoples’ healthcare, with the tiny percentile coming from general taxation.

Let’s keep the health service for what it was originally intended for, firstly. Secondly, with the liberated funds, let’s create an honest-to-goodness quangocracy which deals with ‘public works’, which would exist at regional levels only (more of which at the end).

There is a unique opportunity for the Corbyn faction of the Labour Party to do this.

It could be a better idea than nationalising the railways and in any case it would be underpinned by sound neo-Keynesian economics and economists such as David Blanchflower as well as the conservative International Monetary Fund.

What would the public works scheme be for the Blairite monkey on my right shoulder is asking me?

Well this misses the point, given the fact that currently the public works scheme is already in existence; it forms a large part of the NHS, and its existence is there merely to propagate itself with ‘wastage’.

The wastage is the creation of millions of upper middle-class non-jobs. University educated ninnies who believe the tradesman of Wychwood Avenue owe him or her a living.

And then call it ‘Left’, or ‘Conservative’ or ‘the common ground’; because one thing is true, on the NHS nothing really substantive seems to change.

In any case, with the issue such as the relative poverty of children at the absolute forefront of our minds, with homelessness at very high levels and with the myriad of worthy causes proclaimed by many of the charities, it should not be beyond the wit of human kind to concoct a package of schemes which could put these very bright and able graduates to better use.

Let’s break the tired narrative of NHS funding, the bloated entity which has grown since inception. It still existed pervasively under New Labour and continues to this day.

Simon Stevens, the chief executive of NHS England appointed last year by the Tories, despite being policy advisor to two separate Labour secretaries of state for health Frank Dobson and Alan Milburn, may be one of the more shrewd moves made by David Cameron since in government.

But he is not committed to coming clean with the public: Telling them honestly what the NHS has come to be about. There are other more minor ideological issues as well.

Over 300m consultations in England and Wales take place each year and more than one billion prescriptions dispensed (albeit three-quarters are free because they go to the elderly and the unemployed), according to the Health and Social Care Information Centre.

So keen are we on the left to hold-truck with dogma and so keen are they on the right to use weasel-words and policy which chimes with the public sector electorate, we refuse to acknowledge the usefulness of a small £5 consultation charge for higher-rate taxpayers which in turn would liberate funds to reduce treatment costs currently paid by the sick and needy poor.

It could be a simple trade-off. Wealthy drunks presenting on Friday and Saturday nights with frivolous and vexatious complaints pay in the stead of a young person needing for the sake of argument, expensive anti-retroviral drugs.

NHS finance announced last week what is needed to keep the unfit for purpose entity running: A £3.8bn increase to the NHS budget next year to cover £2bn on new drugs, 800,000 new operations, 5.5m more outpatient appointments and 2m more diagnostic tests.

Now behind the spin of course we can see while this money is indeed equivalent to these costs, one might just as well argue that the money is being used to fund NHS administration as much as anything else.

Heidi Alexander MP, Labour’s Shadow Health Secretary, barks up the wrong tree slightly then in riposte: “With hospitals facing a £2.2 billion deficit this year, and demand going up, this money will simply be plugging the black hole that has emerged in NHS finances under the Tories.”

This is true and while it is also undoubtedly true that patient care must not be compromised at any cost; it does not follow that cuts will necessarily cause detriment to patient care.

Meaning the statement by Alexander: “While ministers also remain committed to making £22 billion worth of efficiency savings in the NHS by 2020” is spot on. “Everyone in the NHS knows that efficiencies on this scale simply cannot be delivered without harming patient care,” may not be. 

Administrators of the odious new poor law of 1834, in replacing the more generous and fair system of local mandates which existed under the 43rd of Elizabeth, would become well aware of how much more costly it must be to run a centralised and bureaucratic system.

Let’s break the cycle of ‘unintended consequences’ and public dishonesty.

The Tories coalition government was rightly lambasted (though not nearly vocally enough) for removing pivotal components of regional governance, whilst doing little to dismember the centralised cronies; the apparatchiks closer to the heart of government.

We desperately need public works schemes: socially and economically. Let’s have them and be honest about it.

We also desperately need to eliminate wastage in the NHS: Let’s do it; there would be no unemployment consequences provided it could be done in a mature ‘piecemeal’ fashion.


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