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Britain: Con-Dem government to roll back social gains won since WWII

Greens MP Caroline Lucas addresses the October 20, 2010, protest against the cuts in London, organised by the Coalition of Resistance.

By Raphie de Santos

October 21, 2010 – Socialist Resistance – The Conservative Party-Liberal Democrat Party (Con-Dem) coalition government has announced the most severe cuts in public spending since the great depression of the 1930s. The £81 billion (bn) of announced cuts and the £30 bn of tax increases for the next four fiscal years starting in April 2011 are on top of the already announced £8bn cuts for this fiscal year. Add in the hidden cuts (the National Health Service) and it all amounts to a rolling back of a large part of the gains that people have fought to establish since the end of the second world war.

Scotland has fared slightly worse than the UK, where a pro-rated cut on devolved spending would come in at £875 million (m) – instead £900 m has been chopped off the budget for 2011/2012. Local spending and the poor on welfare will bear the brunt of the cuts with the National Health Service (NHS) under attack through efficiency savings..

We will lose services, see wages frozen and our pensions come under attack by increasing the retirement age, increasing contributions to public pensions with no guaranteed pay out in the end. Pensions and benefits, as well as being cut, will be linked to the less generous consumer price index instead of the retail price index, meaning further real cuts in our living standards. In addition public sector workers face a pay freeze.

The 30% cuts in local council grants will be devastating – this is what they mean by the big society with care and services being carried out voluntarily by the community. Extra cuts from the department of work and pensions are required above those detailed in the budget.

The most savage cut was an extra £7bn on welfare spending on top of the £11bn announced in June’s emergency budget.

The cuts outlined in comprehensive spending review are summarises as follows.

Capital spending: all in real terms over five years with the ring fencing of grants lifted.

Health: Reorganised with tens of thousands of redundancies, outsourcing of services to private sector and £20bn of efficiency savings by 2014, in addition £1bn taken per year to be given to shortfall in local councils’ social care budget; budget growth, before efficiency savings, increased by less than rate of inflation.

Pensions: State and public sector retirement ages to be raised, the state to 66 in 2020 for all – four years stated earlier phased in from 2018; larger contributions (£1.8 bn cut) to public sector pensions and no guaranteed final income; linked to less generous consumer price index.

Welfare: An extra £7 bn of cuts on top of £11bn announced in the emergency budget by more severe means testing; incapacity benefits and housing benefit cut; scrapping of some tax credits; all linked to less generous consumer price index; the extra £2bn promised for social care taken will be outstripped by inflation and an ageing population.

Communities & local government: Discretionary charges for swimming pools libraries etc, overall 7.1% to local councils per year totalling a near 30% cut over four years; squeeze on statutory services that have to be provided by local councils, eligibility to services tightened.

Public transport: Rises in fares no longer tied to inflation; no new rolling stock;

Home Office: Likely 10,000 jobs losses in police departments through a cut of 16% of the budget over four years.

Justice: Legal aid bill cut and prison building programme curtailed, 14,000 jobs to go;

Schools: Cuts in sixth-form education and curtailment of capital spending.

Universities: 80% reduction in teaching funds and cuts to research; students to pay for increased fees through higher interest charges.

Housing: End of tenancy for life, pushing people into private sector; 270,000 fewer houses not built because of cuts leaving 1.8 million on waiting lists for social housing.

Defence: 8% budget cut by 2015 with 42,000 jobs lost.

The coalitions’ spending review was accompanied by a corresponding comprehensive set of lies. Lie number one: the NHS will be ring fenced. Lie number two: the cuts are not ideologically based. Lie number three: the previous Labour government is solely to blame. Lie number four: the cuts will be made fairly. Lie number five:  the cuts will lay the foundation for economic growth. And finally, lie number six: there is no alternative.

Ring fencing the NHS

The NHS will not be protected. The coalition’s white paper, “Liberating the NHS”, clearly points out that the NHS will be fragmented and privatised by the outsourcing of services to private providers and that the NHS will have to achieve £20 billion in “efficiency savings” by 2014. These cuts will be reflected in a reduction in the Scottish central grant as Scotland will be expected to make similar savings and provide the same services.

Ideology

These cuts, the coalition claims, are being made to repair the public debt. But even by the government’s own estimates the debt will grow by £540 billion, to £1.5 trillion over the next five years, within the same period £305 billion of existing debt having to be renewed and £250 billion of interest payments made. The cuts will only save £5bn in interest payments over the four years, while seeing them rise from £44bn to £60bn a year.

The cuts are being carried out because the coalition does not believe in public services being in public hands and providing a safety net for the poor and vulnerable. These cuts will not be restored even if there is an economic recovery. The Con-Dems want a leaner state run by the private sector so that they can reduce the tax burden on big business and pay the rich and wealthy more. As one Whitehall source said in the Financial Times, there is no rationale to the planned cuts – they are simply taking a salami slice off each department’s budget.

Blame

They lay the blame on the previous Labour Party government for the debt and the deficit. We do not have a structural deficit; the debt and deficit have arisen out of bailing out the banking system and the recession that the credit crunch induced. It was a crisis of the economic system based on a private housing market bubble, consumer credit based on this bubble and a deregulated financial sector. This economy was given birth by Thatcher’s Tories as a replacement for our manufacturing economy, which is almost destroyed. It was this model that was repeated in many major economies to varying degrees, from the USA, to Ireland, to Spain, Greece and Iceland. All these bubble-driven economies have collapsed and have had to be bailed out by the majority of working people through deep budget cuts.

Fairness

Under the cover of taking child benefits from some middle- and upper-class families – also setting the doors open for means testing – the government is saying the cuts will be shared equally. But, as the Institute of Fiscal Studies and the Financial Times have shown, it is the poorest with families who will suffer most from the cuts. The Financial Times estimates that poorest 10% of families will see a 6% reduction their living standards, while at the other end the richest 10% of families will only see their living standards cut by just over 1%.

Foundation for growth?

The coalition government says that the cuts will lay the foundations for economic growth. But all the economic numbers are indicating that the global economy is slowing down rapidly, with unemployment starting to grow and the housing market beginning to fall again in most developed countries. Growth estimates are being revised down by governments and financial bodies worldwide. The Centre for Economics and Business Research is estimating that the UK economy will grow only by 0.1% in the first quarter of 2011. There is a 50% chance of a second recession even before the cuts have started to be implemented.

The estimates for the number of job losses in the public sector as a result of the budget cuts range from the government’s 490,000 to research bodies' 1,000,000. PriceWaterhouseCoppers estimates that 500,000 to 650,000 job will be lost in the private sector, due to loss of contracts from the public sector, and reduced spending power in the economy from public sector workers who lose their jobs.

As the cuts start to bite in the second half of 2011 the economy will be stagnant or go into a mild recession. Four years of cuts will drive the economy into a slump like, as they did in the 1930s. The idea that a structurally weak UK economy – with a burst housing sector, consumer credit and financial sector – with some of the lowest rates of profit in the developed world will attract investment and pull the UK into growth creating millions of jobs is dangerous fantasy.

There is an alternative

The Con-Dem government claims there is no alternative to the budget cuts. The opposition Labour Party can only advocate slightly smaller cuts and tax rises, implemented more slowly. The Scottish National Party can only offer a wage and council tax freeze and wait for fiscal autonomy.

Socialist Resistance says there are alternatives to all these parties’ policies that can reduce the debt immediately, reducing the interest we are paying annually, which is set to rise to £60bn annually by 2015 – 10% of annual government revenues:

  • We would take the banks under full social ownership and control – they have £560 billion in liquid cash and £5 trillion of assets. This would not only allow us to recoup the £375 billion (£175bn indirect investment and £200bn through quantitative easing) that we have ploughed into them during the financial crisis and allow us to pay down a major part of our debt and fund socially useful projects. An example of this would be a renewable energy program. The design, administration, construction, maintenance, running, assembly, commissioning and servicing of the program would create hundreds of thousands of jobs and apprenticeships for our young and old.
  • Rather than spend £4.5 billion on two socially useless aircraft carriers, build new rolling stock for an integrated public transport system.
  • We would introduce a progressive local income tax to replace the council tax; this would raise another £20bn across the UK and £1.5bn in Scotland.
  • We would reduce spending on defence by half and withdraw from the Afghanistan and Iraq, saving up to £20bn per year to spend on socially useful projects with no loss of jobs.
  • Instead of raising indirect taxes or widening their scope, we would raise taxes on corporations. Corporate tax rates have been halved under successive Conservative and Labour governments, and a further 4% cut is planned in the next budget. This could raise an additional £30 billion a year in revenue.
  • Instead of the cuts in services, we would close the loopholes in tax avoidance schemes – this would save £20 billion a year.
  • We would tax the rich and wealthy. A one-off 10% tax on Britain’s richest people would raise £35 billion. This would be used to provide millions of much-needed houses through building conversion, building renovation and housing insulation and all the jobs that would be needed to achieve that.
  • We would shift the burden of taxation from the poor and middle-income earners to the wealthiest 20% in society, who earn 16 times more than the poorest 20% of society. This could generate up to an extra £30 billion a year. Per head of the population the UK is the third-richest country in the world but the second most unequal.
  • We would raise another £38bn a year for 15 years by taking North Sea Oil under full public ownership and control.
  • Instead of cutting pensions, and demanding people pay more towards their pensions, we would look to provide an alternative retirement provision that is not dependent on the whims of the financial markets. We would provide for all people over 60 free housing, electricity and gas, public transport and free access to cultural and sports facilities.

An alternative world is not only possible but it is now necessary if we are to avoid paying for the crisis of their economic system, and suffer years of austerity and slump.

[This article first appeared at the Socialist Resistance web site.]

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Red Pepper: Dismantling the NHS

http://www.redpepper.org.uk/Dismantling-the-NHS

September 30, 2010 -- Behind the technicalities, what do the government’s plans for the NHS really mean? Stewart Player and Colin Leys expose the reality of the health service white paper

The coalition government’s plans for the NHS represent the final conversion of healthcare into something to be bought, with really good care going to those who can pay for it and only a defined ‘package’ of free treatments, of declining quality, for everyone else.

What has already occurred with dentistry, physiotherapy, podiatry and other services will start happening across the board. ‘Top-ups’ and ‘co-payments’ will become standard. Some treatments will cease to be available freely on the NHS and have to be paid for – if you can afford it.

It’s already happening all over England, as staff and services are cut to meet the government’s demand for £20 billion ‘savings’ over the next five years. GPs are being told to refer many fewer patients to specialists.

NHS North London has decided to cut back on cataracts and hip and knee replacements. The government’s plans mean that this will become the norm, not just one-off cuts justified as a response to a crisis. Under the new plans, by 2014 NHS hospitals will no longer be answerable to the taxpayers who have paid for them over the years, and will no longer have the overriding aim of providing the best possible healthcare for the their local community.

By then they will all be businesses, competing with private hospitals and clinics for NHS patient income. To stay afloat financially they will have to cut costs, reduce staff, lower the ‘skill mix’, reduce levels of pay, focus on profitable treatments and neglect or even abandon high-cost and unrewarding ones in order to match the for-profit sector. There will also be many fewer of them.

The aim is to take chronic care out of hospitals and deal with it in non-hospital settings – ‘super-surgeries’ or clinics, largely owned and run by private companies. It will be a healthcare market, very like that in the US.

Competition

All hospitals, public and private, will be answerable only to the central regulator, Monitor, which is concerned only to ensure that they stay solvent and behave competitively.

They will be supervised for safety and quality by the Care Quality Commission, but the CQC is notoriously feeble: it gave mid-Staffordshire top marks when several hundred patients had been dying there from neglect.

The white paper says the CQC will become more demanding. But if in future it tells a hospital to raise its standards, and the finance director replies that the required improvements are unaffordable, what is supposed to happen? There will be no ‘bailouts’. The government’s view is that the hospital should either cut some services, or even close altogether, leaving patients to be treated by ‘better’, privately-owned hospitals – or perhaps in the same hospital, after it has been taken over by a private company.

That is the logic of the healthcare market the white paper envisages.

But closing a medical department or even a whole hospital isn’t like closing a department in a department store, or the store as a whole. There are rarely adequate alternative facilities within reach. Letting hospitals fail means chaos, anxiety and serious risks for patients and their families.

And what if the private company’s services turn out to be no better? The quality record of the privately-owned Independent Sector Treatment Centres (ISTCs), set up and subsidised at huge public expense by Alan Milburn during his time as health minister to treat NHS-funded patients, is notoriously worse than that of NHS hospitals doing similar work.

Whether it is healthcare or home care or schools, good public services for all must come in the end from a service ethic on the part of staff who are not in it for the money, and management who are not in it for shareholders (or forced to compete with companies that are run for shareholders). Outside regulation has a part to play, but without the core commitment that comes from being part of a national service that expresses the solidarity of society – in the case of health, the solidarity of all the well with all the sick – equally good services for everyone will soon be a thing of the past.

Commissioning

The proposed change that has attracted most attention is the shift of commissioning from Primary Care Trusts (PCTs) to ‘local consortia of GP practices’. This is being done on the grounds that ‘primary care professionals’ are best placed to know what is best for patients, and will engage in ‘more effective dialogue and partnership with hospital specialists’. Who could object to that?

You do wonder why PCTs haven’t previously been told to organise such a dialogue between GPs and specialists; but the more important point is that GPs can’t in fact do commissioning.

‘Commissioning’ is Department of Health-speak for purchasing, and what it means in practice is setting the terms of what exactly will be paid for: what services will be covered, how they will be delivered, by clinicians with what sorts of qualifications, following what protocols, with what limits on length of stay in hospital, prescribing what drugs and rehabilitation programmes, and so on. These so-called ‘care pathways’ are at the heart of commissioning, or buying healthcare. The payments are per-patient, at pre-agreed prices for each kind of treatment package.

And to ensure that the deal pays off, any variation from the agreed protocols must be cleared with the commissioner or purchaser. This is the meaning of the ‘managed care’ operated by America’s notorious HMOs (health maintenance organisations), in which doctors have to plead with the HMO to be allowed to go ahead with a needed treatment that the HMO says is unnecessary, in reality because it will cost more than the HMO wants to pay.

Viewers of Michael Moore’s film Sicko will remember a doctor who used to work for an HMO telling a congressional committee how she was paid a bonus according to how often she denied treatments to patients. The new ‘GP consortia’ may not go so far as to reward their staff on this basis. But they will have limited budgets, and the way they are supposed to reduce costs is precisely to involve themselves in the details of all the treatments they are going to pay for. Someone will have the job of denying something.

Two big deceptions

1 Who will really run the new GP consortia?

Some GPs are said to be keen to take on commissioning. But the work involved is essentially commercial, not medical. The new consortia will have to employ large teams of administrators, lawyers and others to negotiate, make contracts, monitor performance, send out bills, do audits, deal with disputes, and so on – as PCTs are already doing.

That is the first big deception involved in this change. It sounds as if GPs will be doing the work, when in fact the essential job of buying hospital and other services involves a vast range of tasks that practising GPs can’t possibly do, and aren’t trained to do – even if they decided to stop treating patients altogether.

In fact, the work calls for skills developed in the managed care industry in the US. The English healthcare market is going to be run on the principles developed there, not by the GPs whose ‘pivotal and trusted role’ is supposed to be central to it.

The change will also mean that GPs will be nominally responsible for the £20 billion of service cuts that are already starting to be made. How trusted will they still be after that? That remains to be seen.

2 The cost of commissioning

The second big deception is that focusing on who does the commissioning prevents a crucial question from being asked: that is, why do commissioning at all?

Running health services as a market is far more costly than running them as a public service. The Department of Health commissioned a study of the NHS’s administrative costs. Based on 2003 data, the authors found that administration absorbed about 14 per cent of the total budget, up from 5 per cent in the 1970s before the marketisation process began.

The department sat on the report for five years. It only came to light in 2010, by which time ‘payment by results’ (payment for every individual completed hospital ‘episode’) and other major additional market elements had also been introduced. The share of administrative costs is now probably more like 18 per cent or more.

The ideologues behind the Tory plan maintain that competition makes healthcare providers more efficient. But the evidence from the US suggests the opposite.

There is a good reason why this is so. Good healthcare is above all a matter of having enough, highly-trained staff; yet employing fewer, cheaper staff is the only way to make money out of it.

In reality, the plan to turn the National Health Service into a healthcare market does not rest on rational arguments but material interests. Any realistic strategy to resist the Tory plans must start out from that fact: the plans are not really new, but are the culmination of a decade-long campaign by the private health industry to get its hands on the NHS budget.

How otherwise could the white paper have been produced so fast – a mere two months after a general election during which none of its far-reaching proposals was even mentioned (let alone made an electoral commitment) by either of the two parties now in office? It’s hard to imagine that even the overall shape, let alone the detail, of the white paper, was put together in two months. So where did it come from?

The HMO/market model: how its foundations were laid

The reality is that successive Labour health secretaries, working closely with the private sector, had already constructed almost the entire edifice of a healthcare market. The Tory plan merely speeds up the final stage and makes it more clearly visible.

The idea that New Labour planned to replace the NHS with a US-style market, complete with HMOs, may come as a shock to some readers. But the fact is that HMOs have been the inspiration behind practically every element of the ‘system reforms’ pursued by New Labour since 2000.

One HMO in particular, California-based Kaiser Permanente, the largest HMO in the US, has been intimately involved in shaping the Department of Health’s strategic thinking. New Labour’s ‘reforms’ have been worked out in constant discussions with and visits to Kaiser. This includes the conversion of NHS trusts into independent businesses (foundation trusts); the introduction of ISTCs; payment by results; giving NHS work to private hospitals and clinics and encouraging NHS patients to choose them; changes in NHS staff contracts; and, not least, the development of HMO-style commissioning.

The US example

These changes have been introduced in a largely piecemeal fashion, concealing their overall intent. But when looked at with reference to the Kaiser model the various elements assume their true significance.

A defining feature of the US healthcare market and its HMOs is its complexity, with myriad forms of organisation and bureaucracy fragmenting provision, and with thousands of different ‘plans’ (i.e. insured packages of care) confusing customers, concealing profits and adding hugely to costs. It was precisely to avoid this expensive dog’s dinner that the NHS was created. But the basic structure is clear enough.

An HMO like Kaiser receives insurance premium income from its ‘enrollees’ (and for over-65s, from the US state’s Medicare programme), and then ‘manages care’ for them through three basic ‘arms’: 1) It owns hospitals and primary care/ambulatory facilities; which are 2) staffed by physicians, who, while nominally independent, are tied into an exclusive relationship with 3) the company’s insurance arm.

How do the New Labour/coalition plans correspond to the US model?

* At the level of infrastructure, hospitals are being progressively removed from public ownership – all NHS trusts are to become foundation trusts and are then to become ‘social enterprises’ owned by their staff, not the taxpayer. Meanwhile privately-owned facilities are subsidised (sweetheart deals for ISTCs, charitable status given to Nuffield hospitals, etc).

Some struggling NHS hospitals will close, while others, such as Hinchingbrooke in Cambridgeshire, will be handed over to private companies to be run for profit. Mark Britnell, who was the Department of Health’s head of commissioning under New Labour and is now lucratively installed in the private sector, says Hinchingbrooke is ‘only the tip of the iceberg’ and anticipates perhaps 20–30 more such transfers over the next year.

ISTCs, too, provide ready-made privately-owned venues for ambulatory and short-term secondary care, while some 150 private hospitals and clinics in the ‘Extended Choice Network’ that are already available to NHS patients under the ‘choice’ agenda form the nucleus of an expanded network of private suppliers.

* In terms of staffing, the Kaiser model calls for market relationships with independent teams of consultants, primary care physicians and nurses. In order to develop these, staff must be disengaged from the NHS and redeployed into the above-mentioned teams.

The main initial lever to bring this about will be the significant numbers of hospital doctors who become redundant under the cuts programme. At the same time, GPs already have a semi-independent status and can more readily be included in such teams, which have already been emerging in parts of the country. While such teams may initially have some autonomy, it is unlikely that they will be able to compete with the major providers in the long term; it is more likely that most will end up working for one or other of them, on the Kaiser model.

* The third arm of the HMO model, the insurance function, will be the work of the new commissioning consortia, advised by – or, more likely, progressively outsourcing the work to – private health insurance companies, and some American HMOs. There are also indications in the white paper that patient choice of GP will in due course extend to choice of commissioning consortium – since all GPs will be required to belong to one, so free choice of GP means free choice of commissioner – and that the consortia and hospitals will become free to compete on price and not just on ‘quality’ as they do now.

It is likely that competing healthcare ‘plans’ will eventually be a feature of the market here too, as consortia begin to compete for patient income.

The insiders

Pushing through these changes is a tight-knit ‘policy community’, comprising a number of leading private sector figures, some doctors and some health policy think-tanks, working closely with a group of strategists within the Department of Health. Among the latter, a highly influential figure has been Professor Chris Ham, who was for some years head of the Department of Health’s strategy unit and is now director of the King’s Fund. Ham has been a long-term champion of Kaiser, organising a series of visits to the company’s California headquarters and being instrumental in setting up a number of ‘Kaiser beacon’ projects within the NHS to introduce and ‘normalise’ Kaiser’s aims and methods among NHS managers.

Even more emblematic is Dr Penny Dash. After working briefly for Kaiser in the 1990s, Dash was appointed head of strategy and planning in the Department of Health, and co-authored the NHS Plan of 2000, which initiated the marketisation process.

Since then she has served on the board of Monitor, led Lord Darzi’s recent review of health services in London, and is currently vice chair of the King’s Fund.

But it is Dash’s function as placewoman for the global consultancy giant, McKinsey, that is probably most significant. McKinsey has been described as the gold standard for the provision of corporate strategy advice to the Fortune 500 companies, and as ‘global thought leaders’ in the areas of strategy and operations management. The company has played a central role in ‘system reform’ in the NHS under New Labour, and Dash is now a partner in their London office.

One of her initiatives, the Cambridge Health Network, is essentially a McKinsey front for exchanges between private health corporations, financial institutions and the Department of Health. Sponsors of the Network include some very big game: Halliburton, General Electric, and Perot Systems, as well as our very own GlaxoSmithKline, BUPA, Assura (now owned by Virgin), Mott McDonald and Carillion. McKinsey has been in many ways a key architect of the reforms that have prepared the way for the coalition. It was also, not coincidentally, McKinsey who came up with the figure of £20 billion that is now starting to be cut from the NHS.

Resisting the destruction of the NHS

As everyone recognises, successful resistance to the Tories’ plans to cut back public services permanently will call for a mass mobilisation with exceptional levels of solidarity, organisation and commitment. But, as Gregor Gall has recently pointed out, the defeat of the poll tax – the last time anything on this scale was successfully attempted – is not a good analogy with the situation we face now.

The poll tax affected everyone; its injustice was massive and obvious; and it required people to co-operate by registering and paying the tax, which they could and did refuse to do in vast numbers. None of these conditions applies to the complex, uneven, protracted process of dismantling the NHS that the Tories intend to push through.

Yet the injustice that will flow from the loss of the NHS will be massive. It will change the face of English society more profoundly than the poll tax. And it will be for all practicable purposes irreversible – unless we stop it now, all of us resisting in whatever way we can.

— -

Summary: what the coalition’s plans means for the NHS

* Hospitals that ‘fail’ will be left to go bankrupt and close, or be handed over to be run by private companies.

* GP ‘consortia’ will run the service, in theory. But doctors don’t have the time or skills to do the large amount of administration required – and these are the contracts the private health companies are after.

* There will be £20 billion of cuts. On top of that, the more complex the market system gets, the more money will be spent on administration instead of medical care.

* The consortia will end up trying to reduce costs by denying certain treatments. And if they are to make money, they will do it by employing fewer, cheaper staff.

* In place of a public service we will have a profit-driven healthcare market.

— -

Who’s taking over the NHS?

The main actors in the new GP consortia

The earlier attempt to encourage GPs to take on commissioning roles through ‘practice-based commissioning’ has been widely acknowledged to be a failure, mainly because most doctors prefer to focus on patients. This allows the 14 major US and UK health corporations, consultancy firms and insurers that currently make up the ‘Framework for Procuring External Support for Commissioning’ (FESC) to step in and play an increasingly central role in allocating the bulk of NHS finances. The FESC functions include population risk assessment, procurement and performance management, and data harvesting – but it is in service redesign that their impact will be most felt.

So who are these companies?

Aetna (US); Axa PPP (UK); BUPA (UK); CHKS (UK); Dr Foster (UK); Health DialogServices Corporation (US); Humana (US); KPMG LLP (US); McKesson (US); McKinsey (US); Navigant Consulting (US);Tribal (UK); UnitedHealth Europe (US); and WG Consulting (UK).

How these companies profit from the ‘revolving door’ in senior health personnel

* At KPMG, the former Department of Health head of commissioning Mark Britnell now leads the company’s European Health Division. Britnell also has close ties with Dr Foster, having previously been one of its non-executive directors.

* UnitedHealth now employs Blair’s former top health adviser Simon Stevens. It also has the former head of the Department of Health’s commercial directorate, Channing Wheeler, who, alongside Britnell, set up the FESC before being recalled to the US to face the securities and exchange commission on charges of illegally backdating share options at the time of 9/11.

* BUPA has the services of former health secretary Patricia Hewitt in her role as advisor to the private equity company Cinven, which recently bought out BUPA’s entire hospital portfolio.

* Tribal’s director of its healthcare division, Matthew Swindells, was chief information officer of the Department of Health and a special adviser to Patricia Hewitt. The company can also call upon Phyllis Shelton, who jumped ship from the Department of Health, where she worked as the lead for measurement on the integrated care organisation programme. Prior to this, she was the founder and managing director of the UK arm of HealthDialogue.

* McKesson’s UK chairman is Lord Carter. As chairman of the NHS’s competition panel, he is well situated to ensure that decisions on mergers and procurement – including those on commissioning – will follow the privatisation route.

* McKinsey has the Department of Health’s former head of strategy, Penny Dash. Some idea of Dash’s influence on the commissioning front can be seen in the fact that, in her guise as vice-chair of the King’s Fund, she led a recent briefing for PCTs to cut back on commissioning of what she considered to be ‘low-value’ medical procedures. Sure enough, in June this year, NHS North London proposed cutting back on ‘low priority treatments’.

30 September 2010

Conservatives Splurg £9 million to Bully London Firefighters

In this economic climate of Tory austerity, the conservative bosses (Boris Johnson, Brian Coleman) of the London Fire Brigade (LFB) are going make good with the £9 million invested last summer.

£9 million to hire the fire services from a private company, AssetCo.

£9 million to tell unionized firefighters that Bosses do not negotiate. If the firefighters do not accept the new conditions of employment, they will be sacked. The new terms include drafting shorter night shifts so that the Bosses may rationalize closing fire stations as a cost-saving measure. Yeah just let that sink in for a moment. Conservatives prioritize saving costs above emergency services.

London firefighters will stage a walkout tomorrow (Saturday 23rd Oct) despite having been threatened with the sack.

Hence London Fire and Emergency Planning Authority has arranged for not just a £9 million private service on standby, but support from the Hertfordshire Fire Services.

How is that efficient government? Are these private contractors as competent as seasoned firefighters? Even Hertfordshire Services would like to know.

Why do the Conservative bosses not negotiate with workers?

The same reason Republicans do not co-operate with the Obama administration. The same reason the Tory-led Coalition might has well be a Tory government.

£9 million. And the Firefighters are being irresponsible with public welfare, Mayor Johnson? Chairman Coleman?

Hear it from the firefighters themselves: http://www.firebrigadedispute.co.uk/

http://www.borehamwoodtimes.co.uk/news/8471173.London_firefighters_cover...

http://www.guardian.co.uk/uk/2010/oct/15/london-fire-brigade-strike-loom...

Update: http://www.youtube.com/watch?v=Q4JVs6qGsSQ

Bankers, bonuses and “brains”

2010 October 21
tags: British politics, Equality, public spending cuts
by Mike Marqusee

LEVEL PLAYING FIELD
The Hindu, 24 October

At a fringe meeting at last month’s Conservative party conference, one of the speakers began a defence of British bankers’ bonuses (£7 billion this year) by observing that “When God gave out brains, he didn’t give them all out equally, and so we have to live in an unequal society.”

The speaker in question was Stuart Fraser, a multi-millionaire stockbroker and leading light in the City of London Corporation, which governs the “square mile” of the financial district as an autonomous enclave within but separate from the Greater London Authority. It runs its own police force and controls its own very considerable assets (including Hampstead Heath and Highgate Wood, far from the City’s borders). Successive local government reforms pursued by administrations of all political hues have left the City’s peculiarities and prerogatives intact. Uniquely its electorate is made up not only of the 9,000 residents but of another 24,000 for whom it is a place of business, among them a substantial number of the nation’s wealthiest people. These are the people who elected Fraser and for whom it is his job to speak.

Back in June 2008, Fraser described the gathering financial storm as a “phoney crisis”. But that’s not the only reason to wonder – if we are to accept Fraser’s coarse terminology – where he was “when God gave out brains”. Can he really believe that the distribution of wealth corresponds to the distribution of intelligence? Does he think that FTSE-100 chief executives – whose average reward last year was £3.2 million – are 741 times more intelligent than people living on a state pension and 277 more intelligent that those living on the minimum wage? Does he think that the richest 45,000 people, the 0.1% of the population who control one third of the country’s liquid assets, also possess one third of its collective intelligence?

Probably not. In the end Fraser’s comment is another illustration of one of the very few constants in human history: the beneficiaries of the social hierarchy always believe they are where they are by right – whether derived from God, heredity, hard work or “brains”. They believe they are entitled to their wealth and power, and that this wealth and power reflects their own superiority. In order to sustain this illusion, to bolster their sense of entitlement, they’ll buy into any theory and disregard any fact.

Fraser, like many others who consider themselves blessed with it, treats human intelligence as a uniform commodity that is “given out” in measurable quantities. But surely it’s clear that this protean capacity has many and varied manifestations and always exists, in any individual, in partial, selective forms. The world is not divided between the “brainy” (or as the Americans say the “smart”) and the “stupid”. There is no “intelligent” person who is not capable of the gravest stupidity.

One result of thirty years of neo-liberalism is the a widespread assumption that if you’re unhappy dominating or exploiting your fellow human beings it must be because you’re stupid or incapable. Since, according to Fraser, we are unequal economically because we are unequal intellectually, it follows that the only reason for failing to make tons of money is intellectual inadequacy.

The bonus-driven banking praised by Fraser was a critical factor in driving the world into recession. In repackaging bad debts with good ones, the bankers aimed to make something out of nothing, value not from investment, jobs or innovation but from sleight-of-hand. The toxic debt spread through the larger system, leading to a credit crunch and recession, which in turn led to deficit growth and the current attack on public spending. And yet there is no accountability. Billions in bonuses were paid and never returned, regardless of the long-term unsoundness of the deals that secured the bonuses. The government bail-out ensured that bankers’ salaries and pensions were protected. Of all those who had a hand in creating the financial crisis, not one has suffered a meaningful fall in his living standard because of it. The same cannot be said for the far greater numbers who neither promoted nor benefited from unregulated speculative accumulation but who have paid for it with jobs, wages and now vast reductions in social support. It’s often argued that those who take the greatest “risk” deserve the greatest reward. But as we’ve seen in recent years, the rich use their wealth and political clout to ensure they do not pay for their mistakes: the burden is shifted on to the wider public.

That is what is happening now in Britain. In order to shave some £85 billion off the deficit in the coming four years, the government is proposing unprecedented cuts in public spending, accompanied by reorganisation in the provision of health, education and housing that will exacerbate inequalities and further segregate the rich from the rest.

£850 billion was found to bail-out the banks. But we’re told that health spending will have to shrink by some £20 billion (close to 20%) in the next four years. Over the same period, corporation tax will be cut by 4%, bankers will award themselves about £35 billion in bonuses, and through tax evasion and avoidance, the rich will withdraw some £280 billion from the public purse. Any proposals to ensure that the rich pay something closer to a fair share in tax or that bonus-driven banking be restrained are met by Fraser, in his role as mouthpiece for the City, with threats to pull out of the country and feeble arguments like the one he tried out at the Conservative fringe meeting. It seems that what’s required for success in Fraser’s world is not so much “brains” as indifference to the consequences of one’s actions for other people.

Now the financial institutions whose solvency was propped up by government threaten Britain and other countries with a downgrading of their credit ratings should they fail to implement public spending cuts and privatisations. The result of these policies, should they run their course, will be that the top 20% will acquire control of a larger portion of national wealth while the bottom 50% lose out. I’m sure there will be no shortage of “intelligent” people telling us why this is the natural order of things.

Many of those who glide through our institutions and media with the halo of intelligence owe their success to a determined lack of imagination. The capacity for glibness, the ability to regurgitate received wisdom is not the same as an ability to analyse, discriminate or innovate. The higher stupidity of the rich is not a reflection of anyone’s innate intellectual capacity or lack of it but of a blunt insensitivity to the wider human environment.

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