NHS Targets; Another Dodgy Cold War Weapon for Jeremy Hunt To Use

aabdeAlthough Jeremy Hunt can be accused of many things, dissembling, incompetence and duplicity amongst them, it is my opinion that he actually works very hard.  Unfortunately for us the aim of his efforts have not been improving the National Health Service but in managing the news to deflect the justified criticism of his actions and instead place the whole blame on the staff of the NHS or, incredibly, on us the users of the service  Hunt is not looking for solutions to deep seated NHS difficulties, but rather to make HNS itself look unsalvageable. Here is how he is achieving this goal.

Missed targets are nothing new

This winter the NHS, especially its Accident and Emergency Departments are rarely out of the news. The main focus for the media has been the increasing inability to meet the target to treat 95% of A&E patients within 4 hours.  The scale of the problem was leaked to the BBC last month.  As a result Health Secretary Jeremy Hunt suggested that he may consider relaxing the four hour target.

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Are all UK Republicans Lefties?

It is a frequently held view that, in the UK at least, Republicanism is a concern of socialists and communists. ‘You’re just a bunch of ‘loony lefties’ is an occasional accusation, though I’m never sure whether the accuser is claiming that all ‘lefties’ are ‘loony’ or that only some ‘lefties’ are ‘loony’! Setting that aside, is the accusation correct?

Republicanism Predates Modern Political Notions of  Left and Right

A brief look at the roots of modern Republicanism reveals that this cannot be the case. Influential early Republican thinkers such as Macchiavelli and his colleagues in Renaissance Florence lived during the Fifteenth and Sixteenth centuries well before the concepts of ‘left’ and ‘right’ were conceived. Later, during the English Civil War of the 1640s many of the Parliamentary forces which opposed the king, Charles Stuart, were led by aristocrats such as the Earls of Manchester and Essex who had no interest whatsoever in sharing either their lands or wealth very widely. Similarly, the aristocrats were joined by the wealthy traders and merchants who viewed the fact that the King possessed the rights to extensive natural resources such as minerals as an obstacle to the development of free trade. Interestingly the modern-day rivalry between the north-east cities of Newcastle and Sunderland dates to this era when miners of the Tyne were given the coal trading franchise by the King at the expense of their Wearside competitors. So at the outbreak of the Civil War, Newcastle was a Royalist stronghold and Sunderland fought for Parliament. It has been argued by CB MacPherson and others that the emergence of Britain as a modern free enterprise mercantile nation could not have occurred without a successful opposition to the monarchy. This was reinforced by the fact that the King claimed the power to raise taxes under certain circumstances independently of Parliament, such as for purposes of warfare.

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Bombay 1668; Autocratic Corporatism Then and Now

On March 27th 1668 an event took place which has an important lesson for us today with the possibility of a free Trade Agreement between the United States and the UK replicating parts of the stalled Transatlantic Trade and Investment Partnership agreement making democratically elected Governments subject to Corporate interests. I have written a post about how TTIP would work in practice. Back in March 1668, the restored British monarch Charles II leased Bombay (now called Mumbai) to the East India Company (EIC) for £10 a year. Charles acquired the Bombay islands from the Portuguese as part of a dowry payment when he married Catherine of Braganza. This was all part of a strategy to give extensive autocratic powers to the EIC and over the next couple of years Charles issued five Charters allowing the company rights to autonomous territorial acquisitions; to mint money; to command fortresses and troops and form alliances; to make war and peace, and to exercise both civil and criminal jurisdiction over the acquired areas. The Bombay islands was just one event in a series of significant events over the next 100 years which led to the EIC virtually monopolizing India (except for some minor areas of local control in the South) and becoming so powerful as to rival the British Government itself. This led to a series of Parliamentary Acts during the 1770s and 1780s which separated the commercial and administrative/political functions of the EIC and reasserted the supremacy of Parliament over the corporation. Apologists of the British Empire will point to the economic and administrative benefits of the EIC while avoiding the awkward facts of endemic corruption; massacres; looting of Indian treasures resulting in poverty; numerous famines including the Great Bengal of 1770; and exploitative systems of agriculture including the forced cultivation of opium in place of foodstuffs.

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The NHS Internal Market: A Flawed Ideology

In February 2016, NHS whistleblower Sarah Hayes revealed the chaotic state of the NHS 111 service in the South West of England. The story, picked up by the Daily Mail in a series of articles including this one , was associated with a scandal involving the death of baby William Mead in Cornwall. Hayes told of exhausted staff sleeping on the job and calls being handled by teenagers who had just finished their GCSEs with no medical training.  Understandably, defenders of the NHS were quick to criticise the newspaper’s angle of the story, claiming the unacceptable level of service to be a consequence of privatisation.  But the situation complicated by the fact that the NHS 111 service in the area in question was contracted by the local Care Commissioning Group  and being run by a public organisation, the South West Ambulance Foundation Trust (SWAFT). Rather than being a straightforward case of the dangers of external privatisation the story tells us something more general about the market model in large organisations, private as well as public.

Leaving aside the whole issue of external privatisation, we have lived with an internal NHS market in some form or another for 25 years. We have been told so often that the way to promote service innovation and drive down costs is via competition that many people accept it uncritically. But does it work?  It is interesting to start by looking at the private sector where, surprisingly, internal markets are not popular. This 2013 article by Steve Denning outlines the problems. Denning’s article is focussed on innovation rather than service provision but the principles are the same since the whole point about delivering more medical services for less cost relies on creating or adopting innovative ideas. Denning mentions the case of retailer Sears whose chairman Eddy Lampert is an enthusiastic proponent of internal business units for driving innovation. As Denning says,

An outspoken advocate of free-market economics and fan of the novelist Ayn Rand, [Lampert] created the [business unit] model because he expected the invisible hand of the market to drive better results. If the company’s leaders were told to act selfishly, he argued, they would run their divisions in a rational manner, boosting overall performance.

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