Global interests threaten our NHS

Examining a Cambridge MP, a Norfolk hospital and a US company reveals a lot about the dangers to our NHS. As the Coalition Government's "listening period" draws to a close next week OWC guest columnist Jan Ainsley looks at what is at stake.

US Health Maintenance Organisations (HMOs) have long been foraging abroad for new business growth opportunities. Big pickings are worth careful preparation and to open up the UK health market the HMOs have been shaping the UK Department of Health’s thinking for more than a decade, advising it on ‘reforms’. Their biggest potential payday has been approaching – but UK public resistance may yet intervene.

Cambridge MP Andrew Lansley, the Secretary of State for Health, is a man on a mission. He says he wants to “liberate” the NHS. He wants us to believe that the NHS is bedevilled with problems: money-wasting; inefficiency; inadequate standards of clinical care; a culture which stifles change and innovation. He says the only solution is to dismantle the NHS by using the big syringe injection of markets, competition and privatisation.

Mr Lansley, however, chose not to share this mission with the Cambridge or UK electorate during the General Election or in the Colaition agreement. He and his colleagues assured us “the NHS is safe in our hands” and there would be “no more top-down re-organisation”. Now we face the prospect of the biggest ‘reform’ of the NHS since its creation in 1948 - a reform for which the coalition government has no mandate.

Mr Lansley has a vision of a liberated NHS. It’s all about freedom. GPs will be free to tell patients their treatment is no longer available - or available on a waiting list of months or even years, as it was in the 1990s. Patients will be free to try and transfer to another GP consortium, free to take out private insurance - or for those with a chronic condition and money to spare - free to top up their personal budget out of their savings. Hospitals liberated from state control will be free to take unlimited private patients to balance their budget as the cap on private work is abolished. If bankrupt, they will be free to close or be bought by a private management consultancy. Commercial companies will be free to both provide and commission services, free to increase their profits, free to use EU competition law to enforce ‘fair’ competition and free to cite commercial confidentiality to ensure secrecy. GP consortia (with £80 billion of public money) and the regulator, Monitor, (appointed by the Secretary of State with a priority to promote competition) will be free to operate behind closed doors without adequate public accountability. Orwell would have a fieldday with Lansley's defintion of freedom.

Like most people on a mission Lansley has a cavalier attitude towards evidence. To demonstrate the claimed underperformance of the NHS he repeatedly distorts data on cardiology and cancer survival rates. Even when corrected - by authors of the research he cites – he repeats these claims. Then there is wild interpretation. The fact that most GP practices have joined consortia is interpreted as “support” for his plans. But as the chair of the BMA commented recently: “just because you get into the lifeboat, does not mean that you wanted the ship to sink”. Lansley also repeats claims for which there is no evidence. The mantra of “patient choice” as the centrepiece of reform is not supported by research. In general, patients simply want good quality local services.

It is difficult to know whether we are receiving lies, spin, incompetence or some combination of all three. Take the crucial question of price versus quality competition. Lansley's official position is that competition will be based on quality not price. We are also told that there may be price competition in "exceptional circumstances". But tucked away in the Operating Framework is a reference to providers being allowed to offer services at less than the published tariff price. This looks like price competition.

Lansley’s mission is not driven by evidence but a discredited ideology of health markets. He ignores the catalogue of cost and failure which characterises privatisation in the NHS to date. Here are just two examples. The PFI policy to build new hospitals, such as the Norfolk and Norwich University Hospital, will cost on average six times more than the building costs and have to be paid for from hospital budgets for 25 to 30 years. This is well exposed in evidence collected by former UEA lecturer Dr Chris Edwards. Currently the hospitals most in debt are those which have to repay a PFI. The mammoth, failed IT programme Connecting for Health is estimated to cost £12 billion.

Private-for-profit companies have been busy trying to secure a place in the NHS and it is enlightening to have a look at the company the Department of Health has been keeping. One such company is United Health, a US based, $ multi-billion HMO and a major player in the global health business. In the US they have a reputation for corporate malpractice against both shareholders and medical insurance policyholders and high administration (transaction) costs. In the UK their two projects: Evercare (designed to decrease emergency hospital admission of the elderly by 50%) and Integrated PCT Pathways for Cancer Patients, proved clinically ineffective. Their reputation and failures have not prevented them from benefitting from the revolving door between the Department of Health and HMOs. In 1997 one of their vice-presidents was appointed as Director General of the Commercial Directorate. Simon Stevens, Blair’s senior policy adviser until 2004, was immediately appointed as head of their European operation. But they have recently sold their GP practices to concentrate on commissioning and have published The Essential Guide to Commissioning. So much for Mr Lansley’s claims that private companies can solve the problems of the NHS.

This country is now faced with a Health Emergency - it is called the Health and Social Care Bill. The scale, scope and speed of change risks at best chaos and at worst creating an NHS which is a mere kite-mark. American campaigner Michael Moore, maker of the film Sicko warns: “Don’t copy the US”.

This Bill has attracted widespread and mounting opposition from a wide range of health professional organisations such as the BMA ,the Royal College of Nursing, the Royal College of Gps and campaigning organisations such as 38 Degrees, London Health Emergency, Spinwatch and Keep our NHS Public. This momemtum must be maintained if the Bill is to be defeated.

This country is one of the richest in the world. It is also one with shocking levels of inequality. All the more reason for building on the achievements of the NHS as comprehensive and universal, free for everyone, publicly provided and publicly funded. We must act before it is too late and capitalise on the overwhelming opposition and resistance which this Bill has attracted.

Jan Ainsley is organiser of the Norfolk branch of Keep Our NHS Public Contact: konpnorfolk@gmail.com.

Corporate Lobbying: A Force for Good?

By Mark Crutchley

It might seem highly contentious to some to suggest that major corporate interests could be a positive force in any context, particularly an environmental one, but when it comes to the issue of climate change it really does seem that some have seen the light. A number of Europe’s leading companies, including Unilever, Philips and Lloyds TSB, are urging governments to support setting a target of cutting European greenhouse gas emissions by 30% by 2020, rather than the current 20% target. It is clear that globally we are only going to make headway on reducing emissions if one of the major blocs makes a progressive move like this, and it isn’t going to be China or the US, so it’s up to Europe to demonstrate leadership. Failure to do so will carry a high price in the disruption of climate we will be committing ourselves to.

Nobody is suggesting that the companies named above and others like them who support the 30% target are to be held up as positive examples in everything they do. There are plenty of ways in which they are far from perfect. But when, as in this case, what they are lobbying for are measures which will help the climate and promote the development of new jobs in green industries across Europe, then surely we have to give them some credit. It caused a lot of controversy though amongst the 170 Greenpeace activists from across Europe that I was amongst earlier this week in Belgium, but in the end most decided that we needed to encourage the good companies as well as criticising those blocking progress. The following day we took action at the European Business Summit in Brussels to highlight how the business community is split and some companies are lobbying hard to prevent European governments toughening up emissions reduction targets.

It doesn’t come as a surprise to find that companies such as BP, cement manufacturer Lafarge and big chemical and steel companies are leading the way in arguing against more ambitious emission reduction targets. But you might be surprised by some of the other businesses standing in the way of progress. Microsoft for example claims it strives to be a leader in environmental responsibility but is a key member of a leading European business group lobbying against the 30% reduction target. Volkswagen may try to sell you their cars on fuel efficiency but behind the scenes it is lobbying against stronger fuel efficiency targets and emission reductions. And Veolia, whose website leads with the statement “A partner for people and planet”, and which sponsors various environmental charities, is heavily involved in two organisations lobbying against the 30% target.

Branded as climate laggards, these companies and others like them do not want to see Europe take the lead in committing to reduce emissions of greenhouse gases. Read their websites and listen to what they say and you could be forgiven for thinking they are all in favour of positive environmental action, but that’s just the public face of greenwash. It’s what they are saying in private and promoting through business lobby groups to governments which really matters and often that is very much at odds with what they want us to see.

So to come back to my title; there are times when corporate lobbying can be used in a positive manner, some companies are doing so and we should be prepared to support them. But sadly when it comes to climate change, too often the corporate lobby is standing in the way of progress rather than promoting it.

More details on the companies concerned, both leaders and laggards, and the campaign can be found on the Greenpeace page at: http://bit.ly/l3uthl

The Right to Food - Free from Speculation

By Marguerite Finn

The right to adequate food is recognised in several specific United Nations Instruments.¹ It is considered a fundamental human right. But that right is vulnerable to climate, famine, wars, which can affect the size and quality of the crop or the access of people to it. Nevertheless, there are other man-made factors at work, which can bring starvation to millions even in the event of a good harvest. This is the deliberate massaging of food prices through speculation by leading financial institutions such as Barclays Bank and Goldman Sachs.

Barclay’s is the UK banking sector’s market leader in food speculation and is the only UK bank that has any real presence in commodities trading. So what are the secrets of ‘speculation’ and ‘commodities trading’?

It started out relatively simply and was mainly practised by organisations with connections to land and agriculture. Historically, food speculation or ‘futures contracts’ were created in US financial markets to help farmers deal with the uncertainty of growing crops – such as unforeseen weather conditions. A ‘futures contract’ enabled farmers to sell their crops at a future date at a guaranteed price. In the beginning it seemed to work and the practice was well regulated. However, during the 1990s and early 2000s, aggressive lobbying by bankers, led by Goldman Sachs and free market politicians in the US and UK, led to the introduction of weaker regulations over food speculation. New and more complicated financial products such as ‘hedge funds’ and ‘derivatives’ were created to allow more ways to make money by betting on food. Existing contracts were turned into ‘derivatives’ that could be bought and sold among traders who had nothing to do with agriculture and who cared even less about the knock-on effects of their speculation. Each time the contract was sold on at a higher price to a more daring speculator, the price to the farmer remained the same and the price of the food (the ‘commodity’) went up. It was this attitude that led to the steep food price rises in 2007-2008, which caused food riots in some countries. Markets that used to allow people to buy and sell food are now being used to make huge profits for speculators at the expense of producers and consumers.

The end result is that while bankers are reaping huge profits, poor families across the world are paying the price in hunger and malnutrition. Robert Fox of Oxfam Canada said in reference to the estimated billion people who go hungry today: ‘ There is no food shortage in the world. Food is simply priced out of the reach of the world’s poorest people’. According to the UN Food & Agriculture Organisation (FAO), the average cost of buying food increased 32% from June to December 2010 and experts say that nothing but price speculation can explain wheat prices jumping 70% over the same period.

For Olivier De Schutter, the UN Special Rapporteur on the issue, the Right to Food is the right of each household to have the means to produce its own food or to have sufficient purchasing power to buy the food it needs. For this to happen, the price of staple foods, such as wheat, maize and rice need to be kept stable and protected from huge ‘spikes’ in price caused by unmonitored speculation. Such ‘spikes’ directly contravene the very first of the eight Millennium Goals: to eradicate extreme poverty and hunger by 2015. Food prices are now rising by 10% a year in the UK and Europe – ‘ and what is more’, says the UN, ‘prices can be expected to rise at least 40% in the next decade’.

Food prices do not have to rise by this amount – they are artificially driven up by the greed of investment bankers. (It is estimated that Barclays may have made £340 million in profit in 2010 alone from speculating on food). What does this say about our society? One charity – and it seems to be the only one to date – is protesting vigorously against it. Deborah Doane, Director of the World Development Movement in London, says that ‘People die from hunger while banks make a killing from betting on food’. The World Development Movement (WDM) is campaigning to stop excessive speculation on basic foods. WDM members held a protest outside Barclay’s AGM in London and organised protests at Barclay’s branches around the country to expose the bank’s involvement in driving up food prices. WDM is putting pressure on the UK government to back proposals to regulate betting on food prices in financial markets and they are calling on the UK government to support proposals for:

· All futures contracts to be cleared through regulated exchanges. Most contracts are currently done in private, which means it is impossible to know how much of what is being traded. Contracts need to be brought out into the open.

· Strict limits to be set on the amount bankers can bet on food prices.

The Obama administration and the European Commission are also calling for regulation to curb betting on food prices in financial markets, but there is heavy lobbying against these proposals from the banking industry.

It is vital that the UK government supports the introduction of this regulation and does not side with the City of London and block progress towards better regulation on both sides of the Atlantic.

So three cheers for the WDM - which campaigns for a world without poverty and injustice – for taking on the government and the financial giants. They are acting on our behalf and we can help them take action against reckless bankers by checking out the website for their latest actions: www.wdm.org.uk/food

The immoral practice of betting on food prices must be stopped now – before another price bubble bursts and the poor, as usual, pay the biggest price.

References :

1. Convention on the Rights of the Child (Art. 24 (2) (c) and 27(3); the Convention on the Elimination of All Forms of Discrimination Against Women (Art. 12 (2); Universal Declaration of Human Rights (Article 25); the International Covenant on Economic, Social and Cultural Rights (Article 11).
2. Betting on Hunger (WDM paper – available on website)