I attended a session of the Swindon & Marlborough NHS Foundation Trust AGM last night. The FT was launched at the end of last year as part of the government “health market” in which “independent” Trusts compete with each other, and private companies, for patients. The Chair of the Trust and the Chief Executive spoke of “difficult times ahead”, expecting cutbacks in funding. They thought, however, that there were advantages in FT status, the most important of which, they said, is that they are accountable to us as members rather than to NHS bureaucrats. “Difficult decisions” would have to be made, but would be done “in consultation with our governors and our members”.

One of the consequences of “independence” as a FT was that they would not be able to turn to the government for money if they got into difficulties. The Trust had, therefore, to set up an overdraft facility in case they did.

The Financial Director reported on the fact that 90% of bills were paid within 90 days, and said that there was a move towards payment within 10 days, a directive from the Department of Health. In the discussion which followed the presentations a member commented that paying the bills in 10 days “doesn’t make business sense”. They should keep it to 30.

Picking up on this, I made the observation that that this raised the fundamental contradiction at the heart of the government’s system, with its ‘health market’, and trusts “competing for patients”. Was it to act in its own interests, regardless of the consequences for other organisations, or should it act as “part of the NHS family” (in the words of the Chair). Would competition over-ride cooperation? The Trust would have to struggle with this contradiction over the next period. I said I hoped that acting as part of “the NHS family” would dominate over the drive for surpluses.

In responding to my comments (and a question about the arrangements for the overdraft facility) the Financial Director informed us that they had a 2 year deal with a bank which cost £100,000. For this they would have available for use an overdraft facility of £13 million. Should they have to draw on it the rate of interest would be slightly below the LIBOR(inter-bank lending rate).

Of course, if they did not need to draw on it then they would have spent £100,000 for nothing (my words, not hers); money which would have otherwise been available for services.

The Chair expressed his view that their first responsibility was to the patients. So long as this Board remained in place then that would remain the case. He compared the position of an FT with that of a Co-op; the “dividend” was the service to the patients. An FT was a “public benefit corporation” which could only use the surplus for improving services, though he thought that “the discipline of being more business-like” was probably to our advantage.

The chief executive expressed her concern about the future of the NHS. She said she thought we were going to face very difficult times in the next six years. She thought that the only way “we are going to survive” is working together with other NHS providers. “We want to work in the spirit of the NHS.”

The Great Western Hospital in Swindon is probably in a better position than hospitals in metropolitan areas where there is a greater chance of losing work because there are more hospitals to compete. Even so, we were informed that the trust would lose around £2 million of work diverted to an ISTC.

So far as accountability is concerned, the fact is that neither members nor governors have real power. We were told that the governors and the Board had developed a good working relationship. Yet it is a fact that constitutionally and practically executive power rests with the Board. The real test of accountability will come if and when there is a significant disagreement between the Board and the governors. So far as accountability to the members is concerned the current structures are inadequate. A 2 hour AGM in which presentations last more than an hour provides insufficient time for a serious discussion as opposed to questions from the members and answers from the top table.

Likewise the members’ meetings – at least the one I have attended – took up too much time with presentations and too little for discussion. There were plenty of critical comments, but the whole affair was too rushed.

I don’t say that this has been done by design. But the test of accountability lies in the ability to stop a decision before it has been taken, rather than to criticise after the event. The structures set up in promise of accountability will be severely tested in the face of a financial crisis and “difficult choices” which may impact on the service provided.

On Monday I attended an event organised by LINKS, the Local Involvement Network which the government says have been launched “to give communities a stronger voice in how their health and social care services are delivered”. The subject of the meeting was ‘The Big Care Debate’, a government consultation on the future of social care. The consultation is premised on the idea that given the rising age profile of the population ’something must be done’ or else ‘we’ won’t be able to afford to provide it.

We are told there will be a projected 8.6 million disabled people (the older the population the greater the numbers disabled) in 2041 as compared with 2.9 million in 2007.

The government is proposing three ‘options’:

1) ‘Partnership’ – the government will share the cost with us. They will pay 25-33% of the cost of care (but not accommodation) and we would pay the rest.

2) ‘Insurance’ – the government would pay 25-33% of the cost and ‘make it easier’ for people to take out insurance to cover the rest.

3) ‘Comprehensive’ – everybody would get ‘free’ cares in return for a state insurance scheme ‘if people can afford it’.

In the manner of government consultations you are supposed to express your support for the best (or the least worse) of the options the government has chosen. What if you don’t agree with the options? What about progressive taxation and an end to means testing? The government has ruled out paying through the tax system.

On a show of hands the audience ‘voted’:

• 4 for option 1

• 1 for option 2

• 26 for option 3

Twelve of us were counted as ‘abstaining’ or opposed to all three options.

I could not say for sure but I would guess that the majority who put their hand up for option 3 shows that the idea of a comprehensive service open to all (free at the point of use) still has wide support. Although it would only be free for the poor. But it also reflects the idea that the country is short of money, an idea which, excuse the pun, has much currency.

Jo Osario, introducing the opening session inadvertently put his finger on a key problem with this sector. He realised what he had said when he referred to “the market” (assisted by a scowl from me), saying he had slipped into ‘the Martin Wicks trap’. Jokes aside the key question in relation to Health and Social Services is precisely whether it is a public service or a commodity. Since ‘Care in The Community’ was introduced social care has to a large degree been commodified, with the privatisation of much provision and the growth of a low paid and exploited workforce. In the first 10 years of the Tory government Councils’ bill for private residential care rose from £10 million a year to £1 billion.

The “Third Sector”

One of the dangers in the current government policy in regards to the so-called “Third Sector” is that it will be used as a means of providing care service on the cheap. One of the people present told me that they could use the “Third Sector” more – it would be cheaper and some of them would not even want to be paid!

Another issue which was discussed was the question of Personal Budgets and ‘personalised care’. If my memory serves me well the justification for Personal Budgets was that it ‘empowered’ people. These budgets can be used for a range of purposes but these include employing your own carer. This gives power to the individual over their employee but disempowers the latter who is reduced to an isolated individual worker with all the potential consequences. I was told that the holder of the budget was given the necessary ‘management training’ but it is not clear if the situation is policed so that there is no abuse of the employee.

I wasn’t aware that this facility had been available for the last 12 years. Yet the take-up has been minuscule. There are only 200 budget holders in Swindon, half of whom apparently use care agency staff. The Borough Council has employed a Director of ‘Personalisation’. It would be interesting to know how much the Council paid for this resource to concentrate on such a small group of people.

“Choice”

In this field as in others the government mantra is ‘choice’, as if service users were taking advantage of choice in the marketplace. In the Health Service there has been a positive change from the situation where consultants used to rule the roost and tell patients what was best for them (those of a certain age may remember the picture of James Robertson Justice, the autocratic consultant in Carry on Doctor). Today, most often you will be told what options you have in terms of treatment and the choice will be yours, if you want it. They call this ‘co-production’ of health. Instead of a patient being a passive recipient of treatment determined by a doctor, it’s a relationship in which the diagnosis is dependent on what the patient tells the doctor and the responsibility for determining what to do rests with the patient (obviously they will depend on the advice and expertise of the doctor).

The same should apply to social care. But the concept of choice as applied by this government is based on ‘competition’ between different providers. In the NHS most people do not want the choice of travelling to a hospital miles away. They want to be treated in their local hospital, if possible, or the nearest one in which a particular treatment is available.

Disabled or frail ageing people should have the choice of ‘independent living’ (of being able to stay in their home) if they prefer it to sheltered accommodation or a care home. But this should be provided as a public service rather than a commodity (an opportunity for a private company to make a profit) which they might not in any case be able to afford.

Personal Budgets are a gimmick. The overwhelming majority of people would like some choice in relation to the services available to them but they will not want to become employers of their carers, as the figures after 12 years show. So long as care is a commodity then those who cannot afford it will not receive it.

Postscript

Today’s Guardian reports on the ‘Big Care Debate’. Those of us at the above session were not told what the cost of insurance was likely to be. According to the Guardian the ‘insurance model’ would involve a one-off payment of £20-25,000. The one-off payment for the ‘comprehensive’ model is likely to be £17-20,000. I suspect that if we had been told that then the numbers supporting option 3 would have fallen considerably.

The religious right and Republican opposition to health care reform in the USA has used propaganda which has little traction with reality. One of their assertions has been that health-care reform would mean ‘death panels’ deciding on whether old people can live. The irony is lost on them since the current system, dominated by the insurance companies does operate a sort of death panel, although one without any discussion.

As people who have seen the Michael Moore film ‘Sicko’ (see http://martinwicks.wordpress.com/2007/11/11/a-killing-machine/ ) will recall from the film much of the business of insurance companies was comprised of trying to find a reason for not paying for treatment that sick people needed, even if it meant that they were destined to die. Moore concentrated on those people who were lucky enough to have health insurance rather than the tens of millions who don’t.

In the context of the current debate over health reform in the USA, the California Nurses Association has investigated the level of refusal to pay for treatment by these companies, in California. They discovered that 21% of claims were denied on average. In the first six months of 2009 denial rates were:

PacifiCare — 39.6 percent

Cigna — 32.7 percent

HealthNet — 30 percent

Kaiser Permanente — 28.3 percent

Blue Cross — 27.9 percent

Aetna — 6.4 percent

The figures in absolute terms are staggering. The six top insurers in California rejected 47.7 million claims.  Each one is a potentially harrowing personal story. PacifiCare, with the worst of the refusal rates, denied a special procedure for treatment of bone cancer for Nick Colombo, a 17-year-old from Placentia. After protests organized by Nick’s family and friends, CNA/NNOC, and local activists, PacifiCare reversed its decision. But the delay resulted in critical time lost, and Nick ultimately died.

“This was his last effort and the procedure had worked before with people in Nick’s situation,” said his older brother Ricky.

Cigna, second in the list, gained notoriety two years ago for denying a liver transplant to 17 year old Nataline Sarkisyan of Northridge, and then reversing itself, tragically too late to save her life.

The top 18 insurance companies in the US racked up over $15 dollars of profit last year.

“The United States remains the only country in the industrialized world where human lives are sacrificed for private profit, a national disgrace that seems on the verge of perpetuation,” said Deborah Burger CNA leader.

“The routine denial of care by private insurers is like the elephant in the room no one in the present national healthcare debate seems to want to talk about,” Burger said.

“Nothing in any of the major bills advancing in the Senate or House or proposed by the administration would challenge this practice.”

CNA/NNOC supports an alternative approach, expanding Medicare to cover all Americans.

Data released in late August by the Organization for Economic Co-operation and Development, which tracks developed nations, found that among 30 industrial nations, the U.S. ranks last in life expectancy at birth for men, and 24th for women.

These hardy souls above braved heavy downpours to lobby the Swindon Council in opposition to transfer of our Council houses to a Housing Association. There is another row at the back of shy and retiring types not visible owing to the angle of the shot and their flagrant refusal of the photographer’s instructions to move forward.

The good news was that the Council’s ruling Tory group agreed to withdraw their motion (to ballot tenants for transfer of the town’s Council Housing) until they can examine the details of the government’s consultation on a new Housing system. For analysis of this see Swindon TUC’s website at:

http://swindontuc.wordpress.com/2009/07/11/swindon-tuc-breifing-government-consultation-on-new-housing-finance-system/

Iran is a country in which the USA and Britain have a history of interference. It’s history was shaped by the overthrow of the Mossadeq government which had the audacity to nationalise Iranian oil. He was removed in a coup in 1953 supported and funded by the US and British governments. The price of this coup was paid by the Iranian people with the brutal regime of the Shah. One of the consequences of this dictatorial regime, with a complete absence of any freedom to organise, was the use of the mosque as a focus and a cover for opposition in the absence of any democratic framework for the struggle for democratic rights. In that sense Britain and the US share responsibility for the fact that Khomeini and the clerical regime emerged from the revolution of 1979 as a ruling elite.

This background of interference and the “anti-imperialist” language of the Iranian leaders has led some people on the left to see the current regime as an ally in the struggle against US imperialism. For instance, the Ministry of “Popular Power for Foreign Affairs” of Venezuela has issued a communique in relation to the crisis in Iran. It “expresses its firm opposition to the vicious and unfounded campaign to discredit the institutions of the Islamic Republic of Iran” which apparently has been “unleashed from outside”, designed “to roil the political climate of our brother country”. The statement denounces “these acts of interference” in the internal affairs of the “Islamic Republic of Iran”, while demanding an immediate halt to the manoeuvres to threaten and destabilise the “Islamic Revolution”. The people and government of Venezuela are “certain that the Iranian people will find how to solve its internal affairs “and will continue the path of the Islamic Revolution”.

Speaking to supporters Hugo Chavez called Mahmoud Ahmadinejad ”a courageous fighter for the Islamic Revolution, the defence of the Third World, and in the struggle against imperialism”. The Venezuelan government, “in the name of the people,” hailed the “extraordinary democratic development” that resulted in Ahmadinejad’s victory according to a foreign ministry statement.

These staggering statements by the Venezuelan government appear to be based on the delusion that Ahmadinejad is some sort of anti-imperialist because of his denunciations of US imperialism. My enemy’s enemy is my friend, seems to be the guiding light of Chavez and the Venezuelan state. It would be perfectly correct to demand that the US government keep its nose out of the Iranian political crisis, but offering political support for the Iranian regime is choosing the wrong friend and can only compromise the Venezuelan government in the eyes of an Iranian democratic and workers’ movement, and other workers around the world.

Continuing the path of the “Islamic Revolution” means in practice the imposition of repression of independent workers’ organisations, of women and of youth, whose freedom is drastically curtailed by all sorts of moral police and religious thugs on a daily basis. Iran is a clerical dictatorship in which working class and socialist forces have no freedom to operate, never mind participate in the elections.

Following the election, Chavez was quick to telephone Ahmadinejad to congratulate him, saying the victory “represents the feeling and commitment of the Iranian people to building a new world.” What sort of world is that? One in which gays are hung, that women are denied the freedom to dress and carry out their lives as they are pleased, that raped women are seen as sinners, that workers leaders’ are imprisoned for striking? Even a cursory examination of the reality of life in the “Islamic Republic” contrasts absolutely to the world that Chavez says he wants to build.

Rigged election?

According to the Guardian report on the election results there were at least some curious results when you compare them with the 2005 election. For instance in Lorestan, in 2005 Ahmadinajad received 9% of the vote, compared with 55% for Karroubi (also a candidate in 2009). Miraculously after 4 years in power Ahmadinajad increased his vote eightfold. Obviously a popular man. Karroubi’s vote dropped to 5% this time, despite the fact that his campaigned appeared to be going well. In Khuzestan the President increased his vote from 16% in 2005 to nearly 65% this time. In East Azerbaijan his vote increased slightly from 10% last time to nearly 57% in 2009. In Ardabil, a province of which he had been governor, and was not exactly popular, he won 7% last time and 51% today.

Elections in Iran, of course, are not free because no opponents of the “Islamic Revolution” are allowed to stand (unlike in Venezuela, of course, where opponents of Chavez could even collect signatures for a referendum to have him removed from office). Real power rests with the Council of Guardians which is a 12 man body made up of six high ranking Islamic clerics and six Islamic lawyers, selected by the Leader (currently Khamenei). It stands above the ‘parliament’ and can dismiss laws passed by it on the basis that they are unIslamic or against the Constitution of the Islamic Republic. Of the 400 people who put their names forward only four were accepted. Needless to say the 42 women candidates were rejected.

These results appear highly questionable, but even if the 64% vote were accurate, it would do nothing to alter the fact that the elections are not democratic in any acceptable sense of the term. It has been clear for a number of years now that young people in particular have been chafing at the petty restrictions imposed upon them by a state which imposes its religion and mores on them.

For the Venezuelan authorities to describe Ahmadinejad’s declared victory as “an extraordinary democratic development”, in an election in which any individual or organisation that had, for instance, the politics of Chavez would be barred from standing, is itself extraordinary for its lack of contact with reality.

In his Friday speech after the elections Khamenei said:

“These elections showed our religious democracy to the entire world. All those people who are ill-wishers towards the system witnessed what religious democracy really is.

This is a third way different from dictatorships and tyrannical systems on the one hand and democracies removed from spirituality and religion on the other. This is religious democracy. This is what attracts the hearts of people and brings them to the centre of the arena, and it just passed its test.”

So a “religious democracy” is one in which anybody who does not agree with the system has no right to stand in elections, no freedom of expression. According to Khamenei, every last one of the 40 million people who voted in the election voted for “the path of the revolution”. And the mass of demonstrators, what are they?

“They are the ill-wishers, mercenaries and agents of the Western intelligence services and the Zionists.”

Alas the size of the demonstrations does somewhat contradicted his assertion that “the people live in an atmosphere of trust, hope, and enthusiasm in this country”. How could it be otherwise when “the Islamic Republic system is one of the healthiest political and social systems in the world today.”

“21^st Century Socialism”?

The mass movement in Latin America against the impact of neo-liberalism, which was first tested out on the continent, has created a series of radical government which have, to one degree or another broken with neo-liberalism. Venezuela, which has resisted attempts to derail it, for instance by the US supported coup in 2002, has been an inspiration to many people around the world for whom socialism has been put back on the agenda.

Hugo Chavez has spoken of building a “21^st Century Socialism”. Venezuela has been seen as a beacon of hope for millions of people around the world. Yet support for the Iranian regime, can only undermine its standing amongst workers around the world and discredit the name of socialism. How can Venezuela support a regime which oppresses attempts of Iranian workers to form independent trades unions, and demands of all its citizens that they accept a state based on religious fundamentalism and in which 12 men can even overrule decisions of the Parliament (such as it is)?

If Hugo Chavez wants allies to “build a new world” then he should support the Iranian workers struggling for their independent trades unions and not a state apparatus which oppresses them and denies them their right to freely organisation.

In writing this piece, I have searched the web in vain for comment of Venezuela’s support for Ahmadinejad. Whether it is an embarrassed silence amongst supporters of Venezuela’s struggle I can only guess. However, it is surely the responsibility of the labour movement, and especially those who campaign for solidarity with Venezuela, to challenge this profound mistake of the Venezuelan government. They should call for an end to this support for Ahmadinejad, and an “Islamic Revolution” which denies democratic and trade union rights of its citizens.

The “anti-imperialism” of the Iranian regime rests upon the historical hostility of the Iranian masses for the US and British powers who were responsible for the downfall of Mossadeq, and the imposition of the bloody regime of the Shah. But it is a fake, designed to bind the Iranian population to the “Islamic Republic”. It is a Republic which has no place for socialism or socialists, be it of the 21^st Century variety or any other. Hoe can it be an ally of such a struggle?

And what of Mousavi?

Does any of this mean that Mousavi deserves our support. Of course not. He has been very much part of the Islamic regime for many years. No doubt many Iranians place their hopes in him, essentially because they hope that their lives will be a little freer, if he had won. He appeals to this sentiment. For instance, interviewed by Al Jazeera he responded to a question of the policing of women’s dress in the streets, that there should be no interference by the police into people’s personal lives.

Writing on behalf of Mousavi in the Guardian an Iranian writer explained the aims of the struggle. It was not very radical. If he was elected President then this would be a counterweight to the ‘Supreme Leader”.

Khamenei, in his speech pointed to the fact that the ‘dispute’ was between four candidates who were part of the system. That is true, but any mass movement struggling for freedom takes advantage of openings created by people who do not necessarily share their aims. Such was the vote and movement behind Mousavi.

Iranian workers

Socialists or consistent democrats cannot accept a state based on religion, of any sort. Of course, the Iranian people should determine their own future, but it is our responsibility to support those struggling for democratic and workers rights. To paint up this reactionary clerical regime as an ally of Venezuelan or any other workers is a grave error.

The Tehran bus workers have been at the forefront of the struggle for freedom of trade union organisation. Their leaders have been jailed, many activists sacked. They have been supported by an international trade union campaign. It is therefore interesting to hear what they say about the elections.

“During these past years the workers have been told to make sacrifices and to accept their hardship and their lack of rights. While the workers can neither go to work with security or hope, nor to their homes for rest, thousands of plain-clothes and security force [officers] – forces that perform no productive work and are used everywhere and for any deed that is necessary, with any level of violence and use of force – are kept to deprive and detain workers from a free life. Yet [the candidates] refuse to give up one day to talking about the workers’ demands and needs.”

I leave the last word to them.

“In recent days, we continue witnessing the magnificent demonstration of millions of people from all ages, genders, and national and religious minorities in Iran. They request that their basic human rights, particularly the right to freedom and to choose independently and without deception be recognized. These rights are not only constitutional in most of the countries, but also have been protected against all odds.

Amid such turmoil, one witnesses threats, arrests, murders and brutal suppression that one fears only to escalate on all its aspects, resulting in more innocent bloodshed, more protests, and certainly no retreats. Iranian society is facing a deep political-economical crisis. Million-strong silent protests, ironically loud with unspoken words, have turned into iconic stature and are expanding from all sides. These protests demand reaction from each and every responsible individual and institution.

As previously expressed in a statement published on-line in May of this year, since the Vahed Syndicate does not view any of the candidates support the activities of the workers’ organizations in Iran, it would not endorse any presidential candidate in the election. Vahed members nevertheless have the right to participate or not to participate in the elections and vote for their individually selected candidate.

Moreover, the fact remains that demands of almost an absolute majority of the Iranians go far beyond the demands of a particular group. In the past, we have emphasized that until the freedom of choice and right to organize are not recognized, talk of any social or particular right would be more of a mockery than a reality.

The Syndicate of Workers of Tehran and Suburbs Vahed Bus Company fully supports this movement of Iranian people to build a free and independent civil society and condemns any violence and oppression.

In line with the recognition of the labour rights, the Syndicate requests that June 26 which has been called by the International Trade Unions Organization ‘Day of action’ for justice for Iranian workers to include the human rights of all Iranians who have been deprived of their rights.

With hope for freedom and equality.”

These are the people Hugo Chavez should be supporting, not their oppressors.

Martin Wicks

June 22^nd 2009

]]> http://martinwicks.wordpress.com/2009/06/22/with-friends-like-these/feed/ 2 martinwicks http://martinwicks.wordpress.com/2009/06/08/keep-our-nhs-public-agm/ http://martinwicks.wordpress.com/2009/06/08/keep-our-nhs-public-agm/#comments Mon, 08 Jun 2009 15:56:25 +0000 martinwicks http://martinwicks.wordpress.com/?p=148 ]]>

Saturday I attended the AGM of Keep Our NHS Public. One of the issues which was discussed was the possibility of KONP standing candidates in elections. This debate elicited the response from a representative of UNITE (which is an affiliate and financial supporter of KONP) that if it did take such a step then the union would have to withdraw its support from the campaign. The issue will be discussed by the Steering Committee this week.

My own view is that if such a step were to be proposed then it would have to be the subject of a specially convened meeting of members and affiliates of the campaign. However, launching KONP into the electoral arena would be a mistake, for a number of reasons. Foremost of these is that the withdrawal of the Labour affiliated unions would block the direct involvement of their branches and inhibit the involvement of staff who work in the NHS. A decision to launch into electoral activity would be a gift, in particular to Dave Prentis and the UNISON apparatus which has effectively boycotted KONP, and would immediately move to ban any of its branches from supporting the campaign.

The low turn out at the AGM AGM underlined the need for the campaign to build an active base of support amongst NHS workers, of whom there were very few present. The discussion which took place on how a socialised health service should be organised reinforces the need to involve health service workers in campaigning to end privatisation and the ‘health market’ and to develop practical plans for an NHS from which competition and the profit motive are driven out. Campaigning for a socially owned NHS requires the active involvement of health workers if KONP is to develop beyond the limits of small numbers of health campaigners and health professionals.

The contempt which supporters of the NHS hold for New Labour is entirely understandable given the dire impact of its health service ‘reforms’. Whilst there is a great deal of frustration with the Labour affiliated unions amongst campaigners (for instance, they will have seen the spectacle of a UNISON delegate telling the last Labour conference that the NHS was ‘safe in the government’s hands) a decision to turn KONP into a ‘political party’ – it would have to formerly register as such to stand candidates in its name – would offer a gift to those union leaders who would like to isolate KONP and stop their members being involved in it.

There is nothing to stop campaigners within KONP organising electoral campaigns where this is agreed locally, but they should not use the KONP name. A decision to do so would probably also lead to the departure of some of the people who are currently involved in the campaign.

Surely what is essential about the campaign is that it aims to mobilise all those who are opposed to privatisation and marketisation irrespective of their party or political affiliations. Instead of uniting people to defend the NHS and reverse the government’s ‘reforms’ if KONP itself enters into the electoral fray it would narrow the base of support of the campaign at a time when we desperately need to widen it.

The Health Service Journal reports that the first independent treatment centre to complete a five year contract will have delivered about 20 per cent less work than it was paid for. South African company Netcare’s contract to provide mobile cataract surgery ends on 31 May and is not being renewed.

The £42m contract was for 44,735 procedures. By the end of May Netcare expects to have done just over 36,000 – or just 81 per cent. The NHS will be paying them around £8 million for work not done.

It’s difficult to know whether such a contract is the result of incompetence or the government’s desire to encourage private companies into the “health market”. In contrast NHS organisations have been penalised for carrying out “too much” work, being paid less money for each activity. This reflects the fact that the new “health market” is designed as if they were producing commodities. However, patients do not chose to become ill.

The national MRI scanning contract also comes to an end in July. The Department of Health says more than 431,000 scans have been performed under the contract. HSJ calculates this will mean around 100,000 scans will have been paid for and not used by the end of the contract, which is thought to have cost around £95m for 560,000 scans over five years.

For all the talk of the government abandoning neo-liberalism, it has not shown any sign of moving away from privatisation. Indeed, the DoH has recently produced a document which sets out “a new commercial operating model”. To drive this and increase competition “regional commercial support units” will be set up to “stimulate the market”. They “wish to maximise the contribution of third and private sector organisations”.

Everybody is aware of the a steep rise in unemployment. The latest figure shows 2.2 million out of work; 7.1% of the workforce. However, the TUC has highlighted what might be described as under-employment: people who want full-time employment being forced to take part-time work because that is all they can get.

It appears that one in nine people in part-time work are in this situation (11.2%). There are 829,000 ‘involuntary part-timers’. One in five men working part-time are doing so because they cannot get a full-time job; double the level for women. Twenty seven percent of vacancies in job centers are for 16 hours or less.

The recession if hitting young people particularly hard. The unemployment rate for 18-24 year olds has now reached 15.1%. There are 438,000 young people claiming job seekers allowance.

In January 2008, vacancies were 43% of the number of unemployed (ILO unemployed). This has now fallen so that in January 2009, vacancies were 24% of the unemployed and in March.

The latest issue of ‘Pulse’ magazine reports that NHS hospitals have cut acute beds by 10% in just three years “as managers pile pressure on GPs to manage complex cases in the community”. The figures have been released in response to a Parliamentary question.

Minister Ben Bradshaw said that the decrease in beds was the result of “dealing with patients more efficiently” and more people being treated in primary care. However, despite promises from the Department of Health “there has been no accompanying shift in funding from secondary to primary care”.National Audit Office figures show that the value of healthcare services commissioned by PCT’s has risen by 11% since 2005 for secondary care but by only 6% for primary care.

In contrast with Bradshaw, the Chair of Camden and Islington LMC accused PCT’s of cutting costs and leaving GPs to pick up the pieces. “It’s a rolling door. Every single day GPs have to see patient who have been hurtled out of hospital too quickly. Every single Friday the local hospital is on an emergency beds system and we are fighting to get our patients accepted. We are under pressure continually to manage patients at home”.

Dr Jonathan Fielden, chair of the BMA consultants’ committee, said funding cuts meant specialists were relying on already stretched GPs to pick up the slack.

“While we have hospitals with this limited capacity – as we saw this winter – we will have more delays in getting patients in and we will be much more reliant on our GP colleagues to look after patients a bit longer and take them that little bit earlier,” he said.

Pulse reported in October last year there had been a rise in emergency readmissions as hospitals sought to decrease bed-days and follow-up appointments and shift work to GPs. Figures showed a 12% leap in emergency readmissions over the first three quarters of 2007.

GP’s have been offered financial incentives to cut referral rates of patients to hospitals. Pulse reported: “Take GPs in Torbay, where the PCT is offering practices payments of around £8,000 per thousand patients, if they meet its targets to reduce spiralling hospital activity. Practices can earn maximum points if they achieve an 8% reduction in GP referrals, bring down the number of emergency bed days by 4% and pull off a 10% reduction in admissions for a huge array of acute and chronic conditions, ranging from COPD, heart failure and diabetes complications via dental problems through to influenza and ENT infection. The coup de grace though is the unfortunately worded section which offers GPs top points for ‘increasing the proportion of all deaths that occur at home by 4%’.”

When the NHS is more and more being operated on a commercial basis, with the obligation to break even every year, then it is no surprise that trusts are cutting costs, and that includes bed numbers.

Swindon is undergoing an ‘options appraisal’ of its Council housing. This is the charade that offers ‘choice’ to tenants to stay with their Council or to transfer to a Housing Association or some other body. From a high of 18,000 homes, since the ‘Right to Buy’ was introduced by Thatcher, the Council stock has declined to around 10,500. With the New Labour government maintaining the ‘Right to Buy’ (albeit it with less of a reduced price) and the effective ban on new Council house building, the housing waiting list in Swindon has trebled since Blair came to office. This is despite the fact that many people do not even bother to put their name on the list since they know they have no chance of getting a house.

Yesterday, following up contacts for the campaign against transfer, I visited a bloke who had contacted us by email. Steve is 83, an ex-AEU convenor of a local factory, and as he told me, “a Labour man all my life”. When he retired at 65 he had a goodly lump sum with his pension; enough to be able to buy his Council house and leave him with a few thousand pounds left over.

However, being a trade unionist with some sense of the collective interests of working people, he refused to buy it as a matter of principle, despite pressure from some of his family. One of them told him he was “mad” not to buy it. “No”, he said, “you’re mad. These houses are meant for people without homes. If they are sold off we’ll end up with a shortage of them for younger people.” He was right, of course. That is why Council housing waiting lists on the national level have 1.7 million families on them.

One of the successes of Thatcher was getting a fairly substantial group of working class people to put self-interest above collective interests. A minority of tenants adopted the principled stance of Steve. For many people, in the early days, paying the mortgage was cheaper than paying the rent, since Thatcher gave them away at a massive reduction from their actual worth. But as Steve pointed out to me, some of the people who bought them didn’t think it through. They could not afford the cost of maintaining them. Some of them ending up losing their homes. Wander round our estate and you will see some of the worst houses are those bought by former tenants who have not had the money to modernise them.

Steve, like many others, is bemused by the fact that Labour under Blair and Brown has continued Thatcher’s policy. We are paying the price for their discrimination against Council tenants. For the most part, tenants today are too impoverished to be able to buy their homes. Last year in Swindon a paltry 15 were bought. Before the ‘Right to Buy’ our estates were ‘mixed communities’ (a cross section of working class people) in which by and large people treated their neighbours with respect. Not so today. Council estates are treated as objects of contempt. And the current government set out in 1997 to put an end to Council housing at the same time as it began its crusade for home ownership (at the cost of burying the country under a mountain of debt).

Steve, and others, put their principles above self-interest, despite living in a period in which self-interest was encouraged and revered. With the collapse of the neo-liberal system which Thatcher developed and Blair/Brown supported, the ‘excesses’ of that system have been widely recognised. The madness which Steve was accused of now looks more like sanity. One of the Gods of New Labour was ‘aspiration’ – personal aspiration; people ‘getting on’ in the war of one against all. But it is the collective aspiration which was expressed in Steve’s refusal to buy his Council house which has to be revived and rebuilt by the labour movement.