Does the government have a clear and specific mandate to privatise more of the NHS?

Dr Peter Draper 2005

The recent reductions in NHS waiting lists are excellent but the public funding of private surgical capacity on a permanent rather than temporary basis is totally unacceptable. The NHS should be built up now that significant public funds are at last available, not health corporations. In announcing controversial 5-year NHS contracts for more private surgery in England to raise its proportion within the NHS to 11%, Patricia Hewitt, the health secretary said “I want to make clear my determination to continue both the direction and the pace of reform set out by the prime minister and my predecessors to deliver the patient-led NHS for which the government has a mandate.”

The Health Service Journal was not alone in being none too impressed that this announcement came only days after the new health secretary had promised to spend her first three months ‘listening and learning from the service’. Clearly neither Patrica Hewitt nor Tony Blair could be accurately described as experts in health policy but their arrogance seems to know no bounds. A New Labour trademark?

Over the coming months, it is a safe bet that we shall hear a lot about the government having a mandate for what amounts to developing corporate services with public funds. Perhaps the first point is that only 22% of the electorate voted for the government and of those who voted, only 36% backed it. In this extraordinary situation, there is no meaningful mandate for any controversial policy however much ministers continue to bluster.

Second, what does it mean for a government to have a specific mandate? The Oxford Concise Dictionary of Politics suggests that “If a particular issue dominates a successful election campaign, then it might reasonably claim to have a mandate to pursue that issue.” Not even the government could claim that its plans to further develop private surgical and other facilities with public funds were widely aired at the hustings. In no way did they dominate discussions.

It might be argued that a government has a specific mandate if its particular plans were clearly laid out in its manifesto. In general terms, Labour made much of its ‘detailed’ manifesto but what, for example, do the 12 pocket-book pages on health tell us about Patricia Hewitt’s “reform…to deliver a patient-led NHS”? The short answer is – very little that is specific.

For instance, it means (without explanation) “fundamentally reforming the NHS to meet new challenges…” Or, “We will deliver…by using new providers where they add capacity or promote innovation, and most importantly by giving more power to patients over their own treatment and over their own health .” Significantly it adds “We promised to revive the NHS; we have. In our third term we will make the NHS safe for a generation.” Within a week, the government had brought significantly more privatisation and – very important – destabilisation. Sound planning, for which the NHS was once admired, is further jeopardised. The big bills that will eventually accrue from major planning errors along with the heavy 30-year bills from PFI schemes constitute an appalling legacy.

On bureaucracy there is the comment “by strengthening accountability and cutting bureaucracy, we shall ensure that the new investment is not squandered. We are decreasing the number of staff in the Department of Health by a third…” The reader would have no idea of Labour’s ill-advised earlier decision to keep the expensive bureaucracy of the Tory ‘internal market’ with all its current expensive ramifications to promote ‘collaboration with the independent sector.’ The Health Policy Network estimated that the original internal market cost no less than about 5% of the NHS budget.

Similarly, the cost estimates for the very heavy IT and staff time to run the controversial ‘choice’ apparatus are not given. Indeed, the opposite overall impression is fostered – of cutting bureaucracy and of “freeing up £500 million for front-line staff.”

Involvement of the private sector is described in general terms and nowhere is there a recognition that relationships with vast health corporations can be highly problematic. “Expansion in NHS capacity will come both from the National Health Service…as well as from the independent and voluntary sector…” Nowhere are the growing NHS staffing levels given in terms of staff in relation to population and in comparison with levels in other developed countries. Nowhere is there a discussion of the need to strengthen measures to avoid stealing trained staff from poor countries.

To add insult to injury, commercial medicine is presented naievely as a panacea – as the source of reform, innovation and ‘contestability’ as though innovation and comparisons within the NHS are worthless. “We shall continue to encourage innovation and reform through the use of the independent sector to add capacity to, and drive contestability within, the NHS. We have already commissioned 460,000 operations from the independent sector…Whenever NHS patients need new capacity for their healthcare, we will ensure that it is provided from whatever source.” Critics might add “and without considering the medium- and long-term consequences – developing commercial medicine is paramount not strengthening NHS weak spots”. Even the few NHS Treatment Centres are to be put up for sale (Hospital Doctor).

The Labour Party did not have even a ‘manifesto mandate’ for the post-election increase in private surgery – it had a manifesto smokescreen. And what little there was in the manifesto was not used as a basis to inform the electorate about Labour intentions .

The government in no way has a clear and specific mandate for significant privatisation of the NHS. However, as we can already see, Mr Blair, more desperate than ever to salvage a legacy – which seems to include breaking up what he insultingly characterises as the ‘monolithic’ NHS – is roaring ahead and has taken the chairmanship of the relevant cabinet committee. Would it make any difference if Gordon Brown became prime minister? Robert Peston’s highly acclaimed Brown’s Britain strongly suggests it would. Peston reports Brown as judging that the health sector is inappropriate for markets – unlike Blair. Sadly, however, it looks as though Brown has retreated from his defence of the NHS from privatisation.. All the more need for vigorous opposition to further privatisation wherever possible – the government has no mandate and we must make that crystal clear.