Thursday, 21 November 2019

How Boris Johnson will dismantle the NHS in all but name

Back in June, when Boris was merely a candidate for the Conservative Leadership, I published a blog detailing how one of his team had explained how Boris will deliver #Brexit by holding an autumn general election. Re-reading this is fascinating, as it more or less spells out everything Boris has done. Huge fiscal giveaways, a divorce from the Maybot Tory years and a general election as soon as possible. At the time of writing, I wasn't convinced, but I am now. So imagine my delight when the chap who gave me the information it was based on asked if I fancied meeting for a pint in town.

I love a bit of good political intrigue, so I was well up for a chat. You may wonder why anyone would want to speak to me. Well there is a perception that I have my ear to the ground and the Tories are quite intrigued to know what is going on in the Barnet constituencies. I could tell them that in my conversations, I've not spoken to anyone over 30, apart from committed, die hard Labour supporters who are voting Labour. I suspect that the core Labour vote will hold up well and it is possible that the 18-30 vote may swing it for them, but I consider it to be extremely unlikely. Many Labour voters have said they will be voting Lib Dem and there are quite a few Tory #Remainers who are also tilting towards the Lib Dems. I can't really say too much about Chipping, as I've not been out and about there, but in Hendon and FGG I genuinely believe that the Lib Dems will come first or a close second. In Hendon particularly, the hard #Brexit stand of Matthew Offord and his opposition to equal marriage has made a huge dent in his natural support. There is also a trust issue for many with Boris. I felt comfortable sharing these insights as this is what I am happy to say on my blog. My friend looked rather glum and asked about the Jewish vote. For me this has been especially interesting. Generally this has been rock solid for Offord in previous campaigns. This time it is less so. Whilst it is still overwhelmingly Tory, quite a few people have told me that if they thought Labour had zero chance, they might, just might vote Lib Dem. As it appears this is the case in Hendon we may well see some surprises. As for FGG, many people within the community would love to see Luciana Berger elected to stick two fingers up to Corbyn and her treatment of her. As a candidate, she is certainly a game changer. This news was met with a degree of agreement.

So I asked, what juicy plums of blogging info can I get in return? I was shocked at the response. What is your view of the NHS and how efficient it is? I am a big fan of the NHS. As a cancer sufferer, I am at the coalface. But I noticed the nuance in the question. How efficient do I think the NHS is? There are three ways to answer that. Firstly, it delivers universal health care at a far cheaper price than a non universal system in the USA, so it is clearly pretty efficient. That was my first response. But the question was then asked "You are a business owner, when you go for treatment, do you ever see examples of where it could be more efficient?". The answer to that is, yes all of the time. This is not a criticism of the NHS, but I spend my life walking around with bits of paper in my hand, which is clearly a pretty bad way for such an organisation to manage itself. So, yes there is clearly lots of scope for money savings and efficiency. The third question, the lynchpin was "Do you think the Private sector could deliver the services more efficiently then?". That is a really interesting question. Lets look at the evidence, as best we have. I live in the London Borough of Barnet, which signed an enormous deal with Capita, on this very basis. Has it delivered savings and better services? The answer to me is clear, no, it has been a disaster and even the Tories know it. Or there is the privatisation of the Railways. To get into town, I took a Thameslink train. Has privatisation delivered a better service than British Rail? Anyone who has seen the complete farce of Thameslink over the last few years, would be hard pressed to claim it has worked better than BR. The public subsidy paid to the railways is six times higher than in BR days. Of course we've seen a completely new fleet of trains on Thameslink and the service, when it works is good, but it just doesn't work on far too frequent a basis. So the answer has to be "Not based on the evidence I've seen". My friend was a tad disappointed "But what about BT, surely you can't support Jeremy Corbyn's plan for a nationalised Broadband service".  I had to concede that of all the privatisations, the BT one was the most successful. I worked for BT shortly after it was privatised and it was still hugely bureaucratic, but the liberalisation of Telecoms services has, I believe, delivered a better service, but this is the exception and not the rule.

I asked "So are you saying that a BT style privatisation of the NHS, with everyone getting a few free shares is part of your plans?". My friend laughed and said "no, of course not, that would never be politically achievable". So I asked "What do you think would?". He said "There are many companies in the Private Sector that do things the NHS do, but far better and cheaper. For instance, it is cheaper to buy incontenance pads from Boots than it is through the NHS, surely you can't argue that hospitals are spending money wisely buying these through the NHS, when the savings could be spent on cancer care". This is where running a business is useful. I understand the economics of this "Yes, but if every hospital has to manage its own supply chain, the pads may be cheaper, but they will have to have a whole department to manage the purchasing, gobbling up any savings". So my friend said "well that is just one example that is easy to explain to the man in the street". I replied "But it is incorrect isn't it". So my friend explained "What people care about is getting treated, not the ownership of the hospital they are treated in. If you needed further treatment for cancer to save your life, and the NHS sent you to a private clinic, as they are the only people who have the equipment, wouldn't you be happy?".  Now this is a difficult question as if that was the only option, I can't say I'd be happy but it would be foolish and churlish to complain. Then he asked "There are many failing hospitals in the UK, don't you think it would be wise to let the private sector turn them around, if the treatment was still paid for by the NHS".Again, this is, on the face of it a fairly simple question to answer. If a hospital is failing, surely it should be fixed and if the Private Sector can do it and give better patient outcomes, who would object?  It is an appealing argument. However I live in the London Borough of Barnet. We have an administration who believed that privatisation and outsourcing was the cure to all of the issues within the public sector and it has gone spectacularly pear shaped. If there are failing hospitals, we need to look at why? There are also outstanding hospitals as well. Generally the ones that are failing are in trouble as they are not properly funded. There has been chronic underfunding of the NHS and the stress and strain of this causes things to go wrong. Brexit has seen a huge loss of migrant specialists in the system and the rules around nurse tuition fees have driven away many potential recruits. So what I would like to see, before anything is privatised, is a proper audit of such failing hospitals and an understanding of why the situation was allowed to develop. We've had nine years of Conservative government and I can't help but think that the starvation of funds has been a deliberate policy to soften us up for a change in the way the NHS is run, with private companies becoming the core providers of service.

I asked whether Boris really would sign a trade deal with Donald Trump that would allow US companies to run hospitals and other medical services. The answer was instructive "There's no reason why he wouldn't if it provided better services at a lower price to the taxpayer". At that, our pints were finished and we said our goodbye's.

I have been thinking about this conversation all day. It is clear to me that Boris wants the NHS to be run on the Barnet Council model, with there being a small commissioning division, with private companies delivering all of the services. It seems that the lessons of British Rail have not been learned. There were no savings for the taxpayer and can anyone honestly say that the system is more reliable? It is pretty clear to me that the Tories have plans for the NHS. In the forthcoming weeks, the opposition really needs to nail him down on this. When he says he won't "sell off the NHS" what he means is that he's quite happy for it to be run by private companies, but the government won't be getting a lump sum payment. What they will be doing is giving private companies lucrative contracts to manage it and deliver services, in the hope that they'll do a better job of it than Capita have done with Barnet Council. What could possibly go wrong?

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