At first, this policy announcement would appear counter-intuitive. "Renationalise" the National Health Service? The NHS is a public healthcare system, isn't it? The answer is not really.
The proportion of the NHS budget going to private providers has more than doubled since 2010 to nearly £9 billion. Front-line clinical contracts and GP services are outsourced. Hospitals are semi-independent businesses and many are privately financed and run. Banks, such as RBS, have controlling stakes in some NHS hospitals. HSBC even owns a few outright. Many hospitals have partnerships with various private companies. Pathology and ambulance services are privatised. Management consultants and 'big four' accountancy firms are paid millions for reconfigurations.
The NHS has come a long way from its original remit as a publicly provided, owned and accountable healthcare system. It is now a market system. The privateers always envisaged using the NHS kitemark as an umbrella for what would ultimately become a system of private providers. Private health insurance is the logical end-point.
The NHS logo has helped to conceal the privatisation agenda. The 'failures' of the NHS can always be ascribed to the concept of public healthcare. This misleading debate is framed in the narrative of unaffordability and unsustainability in the face of an ageing population with rising demand and treatment costs.
In fact, market forces and the private sector are a much bigger problem. Far from increasing efficiency, driving up standards or reducing costs, they are doing the opposite.
The limited internal market alone accounts for between £4.5 to £10 billion a year. The Private Finance Initiative (PFI) costs £2 billion a year and is catastrophic for individual trusts. Administrative costs have shot up as a result of market processes and the extraction of profit. Ask any public health academic or health economist and they will tell you the same thing. Public healthcare is the most cost-effective model. Whilst market forces and privatisation escalate costs and lead to fragmentation and chaos.
Corbyn's announcement flies in the face of 30 years of health policy dogma and the ideology of neoliberal deregulated free markets. It would represent a massive U-turn in NHS policy to the benefit of the healthcare of an entire nation. The NHS Reinstatement Bill would aim to repeal the Health & Social Care Act, resolve PFI and abolish the market in the NHS. This would free up billions to spend on patient care rather than shareholder profits. And this is no pipe dream. Scotland and Wales have managed to reverse the market and restore their NHS without massive upheaval.
Clearly the journey towards the restoration of a public healthcare system is not straightforward. It means coming up against powerful, vested interests. The NHS privatisation juggernaut is a massive project driven by global capital. As the health trade press helpfully points out, the US healthcare market is saturated. This is why private healthcare and insurance corporations like UnitedHealth are expanding into Europe. For those persuaded by the concept of NHS reform, it is worth remembering that the agenda is not being driven by patient needs but by the interests of the private healthcare and insurance sector.
Traingate is merely a taster of the attacks that would follow. Corbyn's announcements on renationalising the railways and the NHS have clearly got Richard Branson and Virgin worried. Virgin have won many lucrative NHS and social care contracts. Whilst PFI was intensively lobbied for by the City of London because it has been a huge boon for them. The UK total PFI debt is over £300 billion or four times the size of the budget deficit used to justify austerity.
It was also good to see Corbyn highlighting the social determinants of health - the silent killer of inequality. Overall, the poor tend to die seven years younger than the affluent and become disabled seventeen years earlier. Inequality of income is linked to inequality of virtually all outcomes.
This will hopefully represent a clean break after the departure of previous shadow health secretary Heidi Alexander. Alexander opposed the NHS Reinstatement Bill whilst Corbyn and McDonnell are signatories. She also did not fully support the junior doctors. Instead, members of her team tried to undermine and discredit the NHS advisory group set up to support the push for a public NHS.
Alexander was in favour of integrated care, which ties in with the Conservative government's current plans for emulating US style models of healthcare. Unsurprisingly, she has become co-chair of Owen Smith's campaign. She is joined by the lobbyist John Lehal. This is emblematic of the ideological battle for the soul of the Labour party. This is between the neoliberal capture of New Labour by corporate lobby groups and a Corbynite return to its working class roots.
It was thus refreshing to see the launch involve NHS staff. Junior doctor - Rishi Dhir (whose song Stand Up about the junior doctor struggle is co-written by himself and the producer Dave Randall) and nurse Danielle Tiplady (the founder of the Bursary or Bust campaign to reinstate the student nursing bursary) introduced Jeremy Corbyn. It is exactly this kind of collaborative engagement with grass-roots, which can build a high-quality public, universal NHS for the 21st century.
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