The return of the Blairite outriders!

I didn’t bother posting on this weekend’s stories concerning Milibliar’s nudge-nudge-wink-wink leadership challenge.

Suffice to say that the internal conflicts within the PLP are not about bread and butter issues like the rising cost of living for working people, the housing crisis, youth crime, pensioner poverty, etc.

Rather the wrangling is over just how neoliberal New Labour will be in future.

There was something rather comical about the way in which the BBC reported that it had learned of an alternative policy programme that was being put to Brown by “a group of ex-ministers”. As if we would have trouble working out who these people were…

Step forward Stephen Byers, Charles Clarke, and Alan Milburn. Too gutless to stand against Brown last year, this clique of embittered crypto-Conservatives aren’t content with their corporate sinecures, they want New Labour to serve their masters with even greater alacrity and more privatisation. They are joined by current ministers such as James Purnell and John Hutton, so it should not be too difficult for Brown to shuffle them back into ministerial positions.

The WRP’s News Line editorial explains in a characteristically OTT style:

THE ‘DUPLICITOUS TRAITOR’ STRIKES AGAIN

LABOUR MP Bob Marshall Andrews, recently called the Labour Foreign Secretary David Miliband a ‘duplicitous traitor’, after Miliband published an article in the Guardian about the next election, without mentioning the Prime Minister Gordon Brown, making it clear that Miliband was in favour of ditching Brown.

Marshall Andrews called for Miliband to be sacked.

Gordon Brown reportedly told his supporters to ease off on the treacherous opportunist and set about to let it be known that ultra-right Thatcherites such as Milburn, the ex-Health Secretary, who wants to see the NHS replaced by health insurance as in the US, were under consideration to be brought back into his cabinet in a September reshuffle.

Now it turns out that the ‘duplicitous traitor’ was much more than one step ahead of the Prime Minister. He has already made a deal with Milburn that he is going to be the next Chancellor of the Exchequer in a Miliband government, after a September coup that will send Brown into political retirement.

Milburn resigned as health secretary in 1993 in anger at the way he said that Brown was holding back his attempts to privatise the NHS.

In his ‘retirement’ he gained lucrative employment with a private equity company and a number of private companies looking to make profits out of NHS contracts.

No doubt that, with Milburn would return all of the previously dumped discredited and hated Blairites, Byers, Charles Clarke, Blunkett, and Reid, to join ‘new men’ such as James Purnell, the anti-working class Work and Pensions Secretary, to launch a new offensive against the working class to end the Welfare State.

Such a gang would carry out any and every vicious measure against the working class that was required by the bosses.

The message to be drawn from this mess of right-wing opportunist policies and careerist intrigue is clear.

The Labour Party was set up by the trade unions as its representative in parliament to give legal support to the gains that the trade unions made.

The trade unions still finance the Labour Party with millions of pounds from their members’ subscriptions.

Now the trade unions must act to use all of their power to purge the Labour Party of the different gangs of opportunist politicians.

The first thing that they must do is to halt all financial payments to the Labour party. The membership of Unite must force its leaders to rip up their letter of assurance to the Labour Party that they will continue to finance the party into the future.

The next thing is that the unions must call national strike action against the government’s policies of three-year wage cutting deals, while tens of billions of pounds are being handed over to the banks.

The only way to clean up this mess is through indefinite industrial action to bring the Brown government down and to go forward to a workers government that will carry out socialist policies.

A workers government will slash the cost of living through nationalising the gas and oil companies, and slashing the government duty on petrol.

It will ban the repossession of homes by the banks, penalising workers who have either lost their jobs or because of massive inflation cannot service their mortgage debts.

It will solve the housing crisis by organising a national plan to build millions of council homes at minimal rents and to provide millions of youth with jobs and training at trade union rates of pay.

Such a government will resolve the crisis of capitalism by getting rid of it and by going forward to socialism.

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Will an NHS doctor become as rare as an NHS dentist?

Don’t worry, says Ben Bradshaw, these new reforms won’t lead to GP surgeries closing.

Now, since the “reforms” to NHS dentistry resulted in it becoming harder to see an NHS dentist…

Given that Bradshaw has threatened “failing” hospitals with closure or privatisation…. (Just as Education minister Balls has threatened “failing” schools – his list included schools that the inspectors had given good marks.

Janice Tate, a GP, writes in Tribune that NHS doctors may become as rare as NHS dentists:

FIRST, let me declare my prejudice: I’m a GP. Second, let me set out my ambition: to warn you of the delicate health of the NHS. Scaremongering? Well, once upon a time you saw an NHS dentist; perhaps, in the not-too-distant future, you’ll recall the days when you saw an NHS GP.

Let’s start with some pertinent history. The NHS was established in 1948. At that time, hospital consultants became public sector employees, but the Government of the day could not afford to buy out GPs and so they remained self-employed practitioners. This continued to the present day and until recently GP partners retained a monopoly of primary healthcare, because their practices provided cover 24 hours a day, 352 days a year. In the beginning, this wasn’t too onerous, because calls were infrequent and often tea and sympathy were all that could be prescribed.

However, half a century later things had changed. Mobile phones and the internet had transformed the temporal landscape. Sunday was no longer a day of rest and the worker rats were running faster and further on their spinning wheels. Medicine did not miss the beat. Clinical possibilities increased, patient expectations rose and politicians promised more and more. By the 21st millennium, GPs were suffering from chronic fatigue. And so, in 2003, we reached a watershed.

That watershed was called the New Contract and, as some would argue, it transformed exhausted GPs into rich, lazy millionaires. In return for giving up out-of-hours care, they were rewarded with performance-related pay in the form of the Quality and Outcomes Framework. All they had to do was focus on new targets, code the information for audit and Bob was your uncle. No one mentioned that those unlucky enough to be ill with unfashionable diseases might lose out.

Given the constraints of 10-minute consultations, software was developed to flash up warnings regarding QOF-related omissions as a patient approached the consulting room door, thereby enabling health professionals to juggle QOF requirements with the patient’s own wayward agenda.

For a few months, all seemed well and GPs lived in paradise. Then they began to wake up to the fact that the New Contract was more akin to a Faustian pact with the devil. The Government had driven a wedge into the provision of primary healthcare from which GPs were unlikely to recover. The monopoly was lost forever and the door had been flung wide open for alternative, competing providers. Choice became the watchword, the be all and end all of the Government’s policy-making machine, and patients benefited enormously – or so ministers wanted them to believe. But the problem with the choice agenda, identified by those with more discernment, was that it seemed to bear little relation to equity of provision or improved health outcomes. In fact, it seemed to be driven by economic imperatives (reduce public spending), ideology (individual rights are more important than social imperatives) and political expediency (politicians thinking they are more likely to get re-elected if people believe they have given them want they want, even if it’s not necessarily what they need).

The problem is that “alternative providers” actually means creeping privatisation. This was introduced by Margaret Thatcher in the 1980s. Gone are the long-stay hospitals for the frail and elderly. These have been replaced by private residential homes. Access to NHS dentistry and optical services also declined under the Conservatives. What is new and shocking about the current scramble for alternative provision is that it has been zealously pursued by the present Labour Government. This means that neither of the two main political parties in Britain is prepared to champion a publicly-funded, equitably-distributed NHS. So why has there been no rumpus?

Labour has been cunning. So far, the Government has only allowed healthcare commissioners to contract for-profit companies to provide NHS services. In other words, patients don’t pay directly from their own pockets – yet. But that squeaky clean new treatment centre round the corner owned by South Africans and serviced by professionals from eastern Europe is funded by British taxpayers. A Trojan horse has arrived and healthcare is being outsourced to private companies from across the globe.

Does it matter? If we’re happy getting gas from Russia, nuclear fuel from France and cars from India, then buying healthcare from China may not be such a big deal. Except there’s a hitch. By definition, for-profit organisations need to make a profit, so their service provision is more expensive than that of the not-for-profit public sector.

The Government does not agree with this simple arithmetic. It insists that public service is stuffed with dead wood and that consequently it is inefficient and extravagant with funds.

But can we afford to be persuaded by this assumption? Consider the privatisation of the railways. Think Northern Rock. Private companies fail regularly and, when the stakes are high enough, politicians readily forget their scruples and plunge their hands into the public purse. When the alternative healthcare providers fail, the British taxpayer will be expected to bail them out.

And it’s worse. In its haste to limit spending from the public purse and dodge its social responsibilities, this Government has offered private sector providers more favourable contracts than those enforced in the NHS. Combine this with the fact that private companies do business first and healthcare second and you’ll understand why they have rapidly cherry-picked the more lucrative services. If you have a chronic or relapsing condition or you’re on the far side of your date of birth, start to fret. In the future, you may be dumped into what’s left of the NHS with the intractable, high-risk, challenging stuff that doesn’t make a profit – unless you’ve got health insurance. But beware: insurance is slippery stuff. You’re never quite sure what you’ve got until you actually claim. Did you forget to read the small print? Did you understand the small print? Did you realise that the more you need it, the more it costs? So don’t get ill or relapse and don’t get depressed or stressed. It’ll be like trying to get house insurance after flooding.

Which brings us back to those rich lazy millionaire GPs. They’re feeling as if they’ve been zapped with a Taser. For the first time in half a century, they understand what it means to be self-employed in a competitive market. And they’re on the back foot. Most GPs are just clinicians. In the past, this has not really mattered. But now they have businesses to run, too, and they’re not sure how that works. And they don’t have the time. So now they employ business managers instead of practice managers and clinical meetings have been abandoned in favour of updates on QOF and the provision of time for the administration required for the new forensic audits. Many GP partners, while retaining their NHS status, have also started joining private companies. They’re not quite sure what joining a private company means, but they’re fearful for the future so they’ve started diversifying.

From the outset, “new” Labour – bent on the transformation of social healthcare into a market – dispensed with intelligent or philosophical discussion. Instead the Government used carrots and sticks. The carrots for GPs included reprieve from punitive 24-hour care. The sticks were mainly in the form of threats to livelihoods: “Do this or someone else will”. More recently, the sticks have become batons. Earlier this year, GPs were required to vote for a continuation of their current practice for less pay or extended and less desirable hours for less pay. There was no third choice and the first option was strongly discouraged by the threat of alternative provision. GPs are beginning to feel like dentists.

But forget for a moment the possibility that your NHS GP will become as rare as a dodo. The transformation of healthcare means a heavier price will be paid – by patients. In its eagerness to open up the market and provide choice, the Government has progressively and systematically fragmented primary healthcare.

Once, the grand symphony was conducted from general practice. Although there were a few fluffed notes, everyone knew which part of the score to play. District nurses and pharmacists had solos, but there was an attempt at harmonisation. Now the score has been shredded. Now we have a plethora of uncoordinated overlapping services, a multiplication of opinions and confusion regarding responsibilities. Throw alternative providers waiting for your custom on railway stations and in high street stores into the mix and you’ve got a great big noise. And noise is wasted energy and expensive. So we’ll all pay – even if we get to pay less in tax and more directly from our own pockets.

Interestingly, there is a model for this transformation of our healthcare system. It’s in the developing world where there is a panacea of possibilities on the pavement alongside spiritual healers and shamans. Multiple opinions will lead to multiple diagnoses and multiple prescriptions and this could be dangerous.

The Government thinks it will overcome this with a national medical database. It has already spent a lot of money trying to get this up and running, but so far there hasn’t been a lot to show for it. Sadly, even if it ever works (and it isn’t stolen or left on a train,) the database won’t prevent the multiplication of diagnoses and prescriptions. There’s only so much that one human being can process in 600 seconds.

So it’s back to the future with the commodification of healthcare, abandonment of continuity of care and dawn of the age of choice. Tomorrow you may be able to hobnob with the community pharmacist, take tea with the community matron, pop into the treatment centre or take out some health insurance. Confused? Beginning to wonder if Jamie Oliver is responsible for your healthcare? So is your GP.

We’re Sicko choice

Too cowardly to attack doctors in person, Ben Bradshaw has attacked them in print – suggesting that they are putting their own interests before those of their patients by resisting the government’s plans for the English NHS.

Now, this is rich coming as it does from a New Labour minister seeking to get more for-profit corporations involved in the health service…

I don’t suppose the Sicko healthcare companies that blight the Amercian people take an oath, but if they do it’s to their shareholders, not their patients. Their behaviour won’t change

From The Morning Star‘s editorial:

Who asked for choice?
(Thursday 03 July 2008)

IF Health Minister Ben Bradshaw believes that there is political capital to be made by taking on our NHS doctors, he will quickly come unstuck.

People respect their local GPs in a way that new Labour drones such as Mr Bradshaw can only dream of.

When Labour took office in 1997, then health secretary Frank Dobson set about dismantling the internal market that the Tories had set up within the NHS as a means of assisting its privatisation.

Over a decade later, this excuse for a Labour government has adopted the Tory “choice” agenda, with Mr Bradshaw demanding that GPs should compete for patients.

And he has the temerity to invoke the authority of patients, as though there is public acceptance of this capitalist shibboleth of competition.

GPs and people who depend on the NHS for health care know that competition generates winners and losers, which would result in the closure or takeover of supposedly “failing” GP surgeries.

This is precisely the model adopted by the government to foster competition and “raise standards” in state education and it is equally inapplicable.

Whenever people are asked what they want of the NHS, competition and marketisation are never mentioned.

The preference voiced is for local, well-resourced facilities.

But public consultation counts for nothing if it throws up the wrong answer.

This is why the government presses on with its hobby horses, based on Tory dogma that it has picked up along the way and shamelessly passed off as the kind of policies that Nye Bevan would be espousing today.

Only if he had had a mental breakdown that had caused him to kick all his previous principles out of the window and to sign up to private health care.

Mr Bradshaw is singing from the same song sheet as his unelected fellow minister Lord Darzi, who is also obsessed with giving patients greater GP choice that they have never asked for.

Setting up new GP facilities where there is no current paucity is nothing less than an attempt to undermine the existing primary care system.

The government is committed to opening up general practice to US private companies so that private care can achieve the kind of success that it has done across the Atlantic, where 50 million US citizens have no entitlement to health care.

That cannot be acceptable to people working in the NHS, their trade unions or to the vast majority of the people.

Pay fallacy
LABOUR MPs should have told Gordon Brown to stick his meaningless gesture of refusing to accept the pay rise recommended by their pay review board.

But they should also have told him what he could do with his bullying dismissal of the pay board recommendations for other public-service workers.

Health workers, police, prison officers and other public servants are certainly less able to sustain a decline in disposable income than many MPs, especially ministers.

The government gesture is based on the fallacy that inflation is rampant because of excessive pay claims by people such as Tube cleaners rather than by banks and energy company profiteers.

The theory and the gesture are equally worthless.

Defending GP services in England – resistance is fertile

Apologies for the pun in the title, couldn’t resist it.

This is from the online edition of the Socialist Worker:

Preston challenges polyclinics
Central Lancashire Primary Care trust has recently announced plans to open a “primary care assessment centre” – or “polyclinic” – in Preston.

The plans involve opening a large health centre in the city with GPs, dentists and a variety of auxiliary health care providers on site.

The PCT have heralded this as a new dawn for the NHS locally. They have emphasised that services will be available seven days a week from 8am to 8pm. They say that there will be a drop-in service available for city residents to see a health professional at a time that suits them – one that can be structured around work and not involve taking time off for a GP appointment.

But the service represents a significant threat to local health care provision.

First, although initially the number of patients registered in the new polyclinic will be restricted this limit is likely to be removed after the first phase of development. As such this poses a significant threat to locally based GP services.

The pressure will be for the “health care market” to decide where resources are allocated and smaller, local, family orientated GPs are likely to be squeezed. GP practice closures will detrimentally impact on the poor, the disabled, lone parents and the elderly.

Secondly, the polyclinic model also opens up services to private providers of health care. This is another significant step in the privatisation of health care – and is also likely to have an impact on local hospitals and the services they are able to provide.

Lancashire PCT’s plans were announced in March and tenders have already been sent out to interested parties. There has been no formal consultation – perhaps a reflection of the fact that the PCT got a rough time in 2007 when it “consulted” over the introduction of privatised health services in the city.

Last Thursday Preston City Council passed a motion submitted by Respect/Left List Councillor Michael Lavalette demanding that the PCT appear before a specially convened Council Scrutiny meeting to explain their behaviour and plans. The council meeting will also hear evidence from the BMA and Unison.

While the council initiative is useful it must be combined with local campaigning by those determined to keep the NHS public. The coalition of unions, community activists and councillors who defeated the privatisation plans in 2007 needs to be reinvigorated if the current attack is to be defeated.

PFI + EU = poverty pay for migrant workers

From the Guardian, a story which demonstrates the terrible effect of the expansion of the EU and New Labour’s Private Finance Initiatives on the living standards of construction workers.

This case was uncovered because of the strength of the union and the fact it’s happening on a government project (albeit outsourced & subcontracted) – many similar cases go unreported.

Eastern European migrants working on the construction of a £600m NHS hospital have been taking home as little as £8.80 for a 39-hour week, the Guardian has learned, in what has been described by union bosses as one of the worst instances of employee abuse in the building sector since EU enlargement.

The group of around 12 men, most of whom are Lithuanian, are construction workers on the government-backed PFI project in Nottinghamshire. Though allegations of abuse of migrants’ rights on construction sites are widespread across the country the scale in this instance has shocked unions and politicians.

Michael Clapham, MP for Barnsley West and Penistone, who is due to raise the matter in parliament today, said: “This happened on a government project where there are good rules and a strong union – who knows what is happening on the hundreds of smaller sites around the UK?”

According to industry guidelines and an agreement between unions and the building firm Skanska, which is overseeing the project, workers on the site should have been earning more than £7 an hour. But after deductions for rent, tool hire and utility bills, some of the Lithuanian employees were receiving so little observers say it left them virtually destitute.

Payslips seen by the Guardian show that one man worked a 39-hour week and took home just £8.80 after his entire monthly rent was deducted in one week, in breach of the law. A second worker was paid £79.20 for a 63-hour week and a third worked 70 hours a week for just £66. As they were registered as self-employed they did not receive holiday or sick pay. One man had £228 taken from his pay in one week for tools. The men each had a further £76.80 deducted weekly as their payment to the “construction industry scheme”, which technically registers them as self-employed, meaning their employers have no requirement to pay national insurance.

Employers are allowed to make deductions from their staff’s pay for accommodation, but the amount is limited by law to a maximum of £30.10 a week, or £4.30 a day. According to Ucatt, the building union, this means that an employee working 37 hours at £6 an hour should take home a minimum of £174.14 a week unless they have agreed to any other deductions. The men refused to talk about their experiences when approached by the Guardian. However, a colleague said at least seven of them were sharing a three-bedroom flat and they cycled to work to save money. “We are worried about how they are managing to survive,” he added.

Alan Ritchie, general secretary of Ucatt, said: “This case is the worst we have seen. These workers were virtually destitute.”

The men have been working on the Kings Mill hospital site in Mansfield. They are not employed directly by Skanska, which has subcontracted another firm, which in turn subcontracted a third, responsible for supplying the men. A number of other subcontractors are operating on the site and have no complaints against them.

Last night Skanska, the main contractor on the site, said it had been made aware of the allegations two weeks ago and took “such issues very seriously”. It has since held meetings with the subcontractors and the union. “On June 24 matters were resolved with the parties involved. Skanska understands that all back pay will be paid to the relevant workers on or around July 2.” The Guardian attempted to contact the subcontractor that had directly employed the men at an address it had registered with Companies House but there was no response. Last night Ucatt’s regional secretary, Steve Murphy, said he was confident the men would receive back pay for deductions and missing overtime in the next few days. “We will be able to eventually get a fair resolution for these workers. What is truly frightening is to think what happens on the many unorganised sites in our country.”

The men were building internal walls and some were working up to 70 hours a week without receiving overtime. Clapham said: “Working that long on a building site is hard work. How can we expect to improve safety standards in this industry when employers carry on like this?”

Philip Hyland, partner at the employment law firm PJH Law, based in Stamford, Lincolnshire, said that in his experience excessive deductions from migrant workers’ payslips were widespread, and cited an experiment in which his firm invited local Poles to contact it. Of 80-100 people who got in touch over a month, he said, only one was getting the correct pay.

Ucatt is campaigning to have the Gangmasters Licensing Act extended to cover the construction industry, which would mean that employment agencies and subcontractors have to pass minimum standards before they can supply labour.

A spokesman for the department for business said that the construction industry was covered by the Employment Agency Standards Inspectorate. “The reason we have not extended the GLA into construction is because there has been no consensus to do so and we have felt there are more effective ways to tackle abuses in the sector.”

Case studies
After a 39-hour week, one man took home £8.80 when his monthly rent of £155 was deducted in one week. Another man worked a 70-hour week, earning £420, but was not paid overtime and after having £228 deducted for repayment on tools was left with £66. A third man worked a 40-hour week but was left with £13 after paying £155 for a month’s rent. As self-employed workers they received no holiday pay.

John Lister on the English NHS at 60

John Lister, director of London Health Emergency, details the history of the NHS, New Labour’s privatisation plans, and the advantages of devolved control of healthcare.

Labour losing support amongst public sector workers

From Unison, the biggest public sector union in the UK:

Labour’s traditional supporters look to be deserting the Party in their droves, according to an Ipsos MORI poll commissioned by UNISON. Almost half (47%) of those who have regularly voted Labour at past elections now say they are less likely to vote Labour than they were in 2005. In addition, 51% of the public generally say they are less likely to vote Labour than they were at the last General Election. The exodus among public sector workers is equally bad, with 49% saying they are now less likely to vote Labour than in 2005.

The poll also found that the Conservatives are closing in on Labour’s territory, such as education and managing the economy. Both of these have traditionally been Labour strongholds so it is very worrying for us all that the Tories are now seen to have the better policies on these issues. Labour is still just hanging on to its lead in healthcare by 5 points (with 34% thinking Labour has the best policies on healthcare, and 29% thinking the Conservatives do).

And a potential vote-winner in the next election for the general public is Government policy on running public services, with more than 7 in 10 (71%) saying that Government policy on running public services will be important to them when they decide how to vote at the next election.

Public sector workers are beginning to see the Tories as better at getting good value for public money (28% think the Conservatives have the best policy on this, compared to 19% who think Labour do) and managing the economy (30% Con vs. 24% Lab). And more than 8 in 10 (81%) public sector workers say that Government policy on running public services will be important in deciding how they vote at the next election.

UNISON General Secretary, Dave Prentis, said:

“It’s clear that the Tories are closing in on Labour’s natural territory. Gordon Brown must wake up and smell the coffee. Improve your game; heed this warning shot. If you get the public services right, you can start to win back voters. A massive 79% of people believe that public services should be run by the Government or local authorities, rather than by private companies. So it’s time to end the affair with big business and recapture traditional ground. Public sector workers – Labour’s natural supporters – are deserting the Party in their droves. Without their votes, Labour will lose the next election”.

Key Findings

In terms of which issues are most important for the Government to improve on, public sector workers’ are more likely to focus on education (29% compared to 24% general public) and the NHS (32% compared to 25% of the general public).

85% of public sector workers (compared to 79% of the general public) agree that public services should be run by the Government or local authorities, rather than by private companies.

More than eight in ten public sector workers (82%, compared to 77% among the general public) agree that people who provide public services should be employed by the Government or local authorities.

Public sector workers are more likely to say that Government policy on running public services will be important in deciding how they vote in the next election – 81% of public sector workers say its important (compared to 71% of the general public – and 42% of these say it will be ‘very important’ to them (compared to 36% of the general public who say it will be ‘very important’).

Amongst the general public, Labour is still seen as having the best policies on healthcare compared to Conservatives (34% vs. 29%). However the Conservatives lead over Labour on protecting the rights of individual citizens (31% vs. 20%), though Labour are seen as having the best policies on keeping Britain safe from terrorism (32% vs. 28%).

TECHNICAL DETAILS:

Ipsos MORI interviewed a representative quota sample of 1,012 adults in Great Britain aged 18 and over. Interviews were conducted by telephone between 13th and 15th June 2008.

Data are weighted to match the profile of the population by gender, age, working status (including public vs. private sector workers), region, housing tenure, social class and car ownership.