One of the first actions of the newly appointed Secretary of State for Health and Social Care in July was to commission Lord Darzi to conduct a rapid independent investigation of the NHS. Streeting is not one of my favourite politicians – having accepted large sums of money from the private health sector and being a known supporter of privatisation. A report of 160 pages on the NHS in England (with an Annex of 330 pages) duly arrived a few days ago. What, you might ask, about Scotland which manages Health with devolved powers? The previous year Audit Scotland had published a scathing report on the NHS in Scotland which the BMA had called “staggeringly bleak”
So all was set for the new Prime Minister to announce yesterday that the NHS had to “reform or die” Keir Starmer delivered a speech in central London in response to the Lord Darzi report
on the NHS, which concluded the health service is in a “critical condition”.
Many of the social determinants of health – such as poor quality housing, low income, insecure employment – have moved in the wrong direction over the past 15 years with
the result that the NHS has faced rising demand for healthcare from a society
in distress. In 2010, 94 per cent of people attending a type 1 or type 2 A&E were
seen within four hours; by May 2024 that figure had dropped to just over 60 per cent.
More than 100,000 infants waited more than 6 hours last year and nearly 10 per cent of all patients are now waiting for 12 hours or more.
Starmer, like Lord Darzi’s scathing report, did not mince his words. He warned the NHS needed to “reform or die” and stated firmly that there will be “No more money without reform.” The prime minister went on
to reflect that the NHS is “broken but it is not beaten”, restating his belief
the health service can still be saved.
But not without radical, root and branch upheaval: he promised Labour’s remedies
will amount to the “biggest reimagining of the NHS since its birth”.
Starmer duly identified the government’s three priorities for reform, namely:
“moving from an analogue to a digital NHS” (technology), “shifting more care from hospitals to communities” (primary care), and “moving from sickness to prevention”. For the modern Labour party, reform basically means privatisation. And the
country has to gird its loins for a major fight against this fate.
Jane Kelsey’s The New Zealand Experiment (1995) contained an amazing annex
“A Manual for counter-technopols” with some 40 recommendations from which
I’ve extracted the key messages -
1. Involve the community
My experience of people coming together at a local level to work for the common good has convinced me of the power of community activists. I spent a lot of time supporting the work of social enterprise in low-income communities. None of this went down all that well with the technocrats or even members of my political party. And the national politicians to whose books I contributed (eg Gordon Brown) soon changed their tune when they had a taste of power. People and systems do not readily surrender their power! Only constitutions can do that!
– Promote participatory democracy – encourage people to take back control; empower them with knowledge to understand the forces affecting them and the points at which they can intervene. Stress that no one has a fail-safe recipe for change, and that everyone has a contribution to make. Recognise the skills, resources and insights of individuals, communities, sectoral groups and civil society, and the right to act both separately and in concert.
- Show that there are workable, preferable alternatives from the start. This becomes progressively more difficult once the programme takes hold.
– Encourage community leaders to speak out – public criticism from civic and church leaders, folk heroes and other prominent ‘names’ makes governments uncomfortable and people think. The fewer public critics there are, the easier they are to discredit, harass and intimidate. Remind community leaders of their social obligations, and the need to look themselves in the mirror in the morning.
– Support those who speak out – intimidation and harassment of social critics works only if the targets lack personal, popular and institutional support. Withdrawing from public debate leaves those who remain more exposed.
2. Insist on Openness;
Name the key players behind the scenes, document their interlocking roles and allegiances, and expose the personal and corporate benefits they receive.
– Challenge hypocrisy – ask who is promoting a strategy as being in the ‘national interest’, and who stands to benefit most. Document cases where self-interest is disguised as public good.
– Avoid anti-intellectualism – a pool of critical academics and other intellectuals who can document and expose the fallacies and failures of a structural adjustment programme, and develop viable alternatives in partnership with community and sectoral groups, is absolutely vital. They need to be supported when they come under attack, and challenged when they fail to speak out or are co-opted or seduced.
– Resist marketspeak – maintain control of the language, challenge its capture, and refuse to convert your discourse to theirs. Insist on using hard terms that convey the hard realities of what is going on.
– Maintain a strong civil society and popular sector – extra-parliamentary politics are essential to complement resistance through traditional party channels, and may become the front line once institutional politics fall captive.
- take communications seriously – internal and external/
- Develop alternative media outlets – once mainstream media are captured it is difficult for critics to enter the debate, and impossible to lead it. Alternative media and innovative strategies must be in place before people and financial resources come under stress. Effective communication and exchange of information between sectoral groups and activists are essential, despite the time and resources involved.
3. Take Economics seriously
Economic fundamentalism pervades everything. There is no boundary between economic, indigenous, social, foreign, environmental or other policies. Those who focus on narrow sectoral concern and ignore the pervasive economic agenda will lose their own battles and weaken the collective ability to resist. Leaving economics to economists is fatal.
– Expose the illogic of their theory – neo-liberal theories are riddled with bogus assumptions and internal inconsistencies, and often lack empirical support. Agency and public choice theories in particular need to exposed as self-serving rationalisations which operate in the interests of elites whom the policies empower.
– Raise the level of popular economic literacy – familiarise people with the basic themes, assumptions and goals of economic fundamentalism. Insist that economic policy affects everyone, that everyone has a right to participate in the debate, and that alternatives do exist.
- Establish well-resourced critical think-tanks – neo-liberal and libertarian think-tanks have shown the importance of Well-resourced and internationally connected institutes which can develop an integrated analysis and foster climates favourable to change. Unco-ordinated research by isolated critics can never compete.
4. value and maintain solidarity. It’s not a phrase that falls easily from anglo-saxon mouths
– Work hard to maintain solidarity – avoid the trap of divide and rule; sectoral in-fighting is self-indulgent and everyone risks losing in the end.
– Employ the politics of international embarrassment – if the forums of institutional politics have been taken and local resistance neutralised, marginalised or suppressed, the most potent political arena may be the international stage. Neo-liberal governments and free market economies depend on foreign investment and international approval. Image is everything. The international sphere is one arena they cannot effectively control.
5. Reinforce the concept of an independent public service
– undercut attempts to discredit, sideline and colonise the public service by acknowledging deficiencies and promoting pro-active models for change. Create a constituency of support among client groups and the public which stresses the need for independence and professionalism, the obligations of public service, and the risks of the managerial approach
6. bring democracy into our companies – whether through cooperatives, social enterprise or worker-ownership
– Be proactive and develop real alternatives – start rethinking visions, strategies and models of development for the future . “Democracy at Work” Richard Wolf (2012)
– Localise politics – recognise the power held by regional and local authorities and the ability to secure information and influence decisions at that level. Encourage accountability of local officials and participation in local politics. Continue local struggles to maintain services which provide for local needs; build solidarity, political awareness and a belief in the possibility of change.
– Ginger up party politics – maintain pressure on political parties through popular mobilisation and public education campaigns, document failed policies and unacceptable practices, and use the politics of embarrassment at home and overseas to complement the work of party activists within.
- Think global, act local – develop an understanding of the global nature of economic, political and cultural power, and those forces which drive current trends. Draw the links between global forces and local events. Target local representatives, meetings and activities which feed into and on the global economic and political machine.
– Think local, act global – actively support intemational strategies for change such as people’s tribunals, non-state codes of conduct, non-governmental forums, and action campaigns against unethical companies, practices and governments. Recognise that international action is essential to counter the collaboration of states and corporations, and to empower civil society to take back control.
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