Not in our Name!!

benny_bouncing_wierd_lc

This is taken directly from the ‘Save Lewisham Hospital’ web site!

I hope it shocks you as much as it shocks me.

http://www.savelewishamhospital.com/save-nhs-key-articles-and-press/

With the Health and Social Care Act (HSCA) and its regulations the NHS has been prepared for transnational investment in the run-up to a US/EU free trade agreement. The main focus of this agreement, officially called the US/EU Transatlantic Trade and Investment Partnership (TTIP), is regulatory harmonisation – of existing regulations but especially new regulations – to avoid future ‘trade barriers’. The HSCA has therefore been subject, from its inception, to ‘regulatory harmonisation’ with the US.

‘Trade’ and ‘trade agreements’ are different. People have always traded, but the international trade agreements to which we are being quietly signed up at the EU level, are secretive legal straitjackets, and are effectively permanent in order to provide ‘investor security’.

debit_lb

The international trade agreement agenda is the wider framework into which UK domestic policy, like the HSCA, fits. Yet these matters are not publicised by the EU Trade Commission and the media, including the BBC, which has an office in Brussels, fail to report on it. In international trade agreements the neo-liberal agenda, of privatising what is public and handing power to transnational corporations, becomes fixed. Trade commitments, at the level of international trade law, are beyond national and EU level law – the ‘legal straitjacket’ referred to above. Negotiated by the EU on our behalf, they apply to all levels of government including local government.

Although the focus is kept on trade-in-goods, for instance by Secretary of State for business Vince Cable, most trade in and out of the EU and the UK, is, in fact, in services. Commitments to liberalise trade-in-goods in trade agreements are very different to commitments to liberalise trade-in-services, which are about corporate rights. As the state effectively relinquishes control of the sector, corporations simultaneously gain ‘rights’. A country’s trade-in-goods commitments reduce at-the-border tariffs for goods moved across borders. When a country commits a service sector to a trade agreement, it commits to opening that sector to transnational investors (‘liberalising’ it), and to keeping it open.  Service commitments inherently invoke certain rules: that transnational corporations must be treated at least as well as domestic companies i.e. domestic companies cannot be preferred (National Treatment rule) and that there is no limit on either the number of services that companies may offer in that sector or the number of firms that can come in (Market Access rule). This is supposedly to provide a level playing field, but actually, once allowed in, transnational corporations have inherent advantages in bidding, in respect of size and economies of scale, international access to credit, cheap labour, etc. The playing field is far from level.

life_saver_rotate_lb

The EU is now including ‘investor protection’ in its trade agreements which allows corporations to directly sue governments if their corporate ‘rights’ are infringed or profits ‘expropriated’, for instance by any new legislation that would limit future profit-making. So the HSCA and the section 75 regulations that put into effect international harmonisation therefore become ‘set in stone’ – irreversible even with a different government authorised by a direct electoral mandate to take such a step.

So the trade agenda is a corporate agenda. Trade agreements are negotiated by states (or the EU) but on behalf of corporations. In the EU corporations effectively run the trade agenda and trans-national financial services, with the City of London as host, play a major part.

In 2005, the World Trade Organisation (WTO) Doha Development round (so called because it was launched in Doha, Qatar in 2001) was stalling. The EU, with Peter Mandelson as Trade Commissioner, shifted to a program of bilateral and regional trade agreements. Crucially, bilateral deals are much more secretive – details kept hidden, in fact, until negotiations are completed. The EU now has bilateral deals either completed, under negotiation, or being considered, with most of the world, but the public hardly know anything about them.

A US/EU deal will see the world’s two biggest economies in a neo-liberal pact with the additional stated aim of gradually levering the rest of world into this agreement, achieving, in effect, the global corporation rights which Doha failed to achieve.  (See Local Agenda 21)

Public procurement (all government spending, including public services) is a big part of the global trade agenda. Corporations want rights, via trade agreements, to access public procurement bidding processes in as many service sectors and geographic areas as possible.

Because of the power of the corporations who will most benefit, there are multilevel strategies for this: within the WTO, through bilateral trade deals, via EU internal regulations and via national legislation. Converting the NHS from a universal, free-at-delivery, tax payer-funded public service into a transnational investment opportunity is a big prize – and an important liberalisation model. Moreover, as trade commitments apply to all levels of government, the health responsibilities of Local Authorities will also be constrained by trade commitment liberalisation and corporate rights.

tag_sorry_sold_out_lb

Basically,

This US / EU agreement puts every single public service up for tender by foreign companies and they are all to be ran along the same lines as USA! Indigenous companies DO NOT have any preference, it’s supposed to be a level playing field, but the foreign firms have more money and the tendering are open to challenge, basically the one with the most spent on it will win it.
This is the reason for cutting legal aid and ‘free schools’, the NHS we already know, because that’s their biggest prize, this alone is worth billions a year. All those with big PFI deals will stay in public hands because they will not be able to tender for anything, as their budget will be used for paying down the PFI? The public will never have a say, because it’s all irreversible, even a democratically electorally mandated government can’t change it without being sued. Their way of protecting profits and investors.

Cameron and Osborne will probably end up with the same pay-off as Blair!

Andrew Lansley gave a speech to the NHS in 2005, this speech was made on the assumption the Tories would win the 2005 General Election, the same time Peter Mandleson started talking to the WTO. In this speech (http://www.andrewlansley.co.uk/newsevent.php?newseventid=21) he outlines all of the above, but is specific to the privatisation of the NHS, although ALL public services are the priority. Here’s an extract from that speech;

Public Services, (Reform)

In relation to the NHS I believe we can now identify the structure of the service for the longer term; and I believe it is very much in the interests of the NHS to do so. I believe it is also possible to place that within a clear overall structure for public service reform.

First, to describe how public services should be regulated; and, secondly, to relate it in particular to the NHS. I believe this is also highly relevant to the current debate within the Conservative Party, because we have not so far sufficiently provided leadership on public service reform; and because I believe we should reject the approach to opposition which is negative, opportunistic and geared only towards media opportunities and the election. I believe the Conservative Party’s historical mission has been to provide good Government to the United Kingdom in order to improve the well-being of its people – and it is our responsibility to use Opposition to contribute to that objective, while becoming ready for Government.

911_mb

So let me start with the question of overall structure for public service reform. Public Service Reform is an omnibus term. We should understand it to embrace economic services as well as social services – telecoms, water, rail and postal services as well as health, education and policing.

Even if the public never embraced privatisation as a philosophy, they understood it when it worked. And Governments across the world realised the benefits of adopting that approach. But I believe that the Conservative Party became confused itself about what the experience of privatisation told us. We interpreted the lessons of privatisation as, literally, that: the transfer of public sector activity into the private sector. With private sector ownership would come enterprise, innovation and, temptingly, private capital off the Treasury’s balance sheet.

But if there is one thing worse than a public sector monopoly, it is a private sector monopoly.

Railtrack is the case in point. Not only did we create a private monopoly, we put it in a situation where the consequences of its decisions and its performance were unable to be distinguished sufficiently from those of train operating companies, and the structure of regulation was insufficiently effective to be able to counteract the effects of monopoly.

So the first guiding principle is this: maximise competition. There are, of course, potential benefits from privatisation in terms of access to capital, flexibility, and creating new markets; but private sector ownership is a secondary consideration to competition, which is the primary objective.

bar_graph_percent_lw

Likewise, the experience of PFI, for example, where funding of projects is transferred to the private sector in pursuit of those benefits of enterprise and flexibility, points to a second principle: when transforming public sector functions to the private sector, it is vital also to transfer risk.

books_judicial_scale_lw

There will be circumstances when public sector functions are transferred to the private sector but competition weak. The regulatory regime must be simple. We cannot again end up with three regulators, as happened with the railways. The regime must be transparent: clear about the standards which operators have to meet and geared to maximising competition or enforcing contestability where competition is absent or limited. The energy markets’ problems with selling demonstrate the vigour of competition, but a minimum standard of service must be clear and enforced.

The experience in a range of utility privatisations demonstrates that there must also be a strong and independent voice for the consumer standing alongside, but distinct from the regulator. So the fourth principle is this: set out clearly the standards which have to be met and how operators will be held accountable for them.

equal_justice_under_law_lw

Linked to this is the necessity to be clear about the responsibility for providing a service if no-one else will do so, or if a dominant operator fails the so-called universal service obligation. If a universal service is required – like providing pay-phones, or “last-mile” delivering of the post – then in a competitive market one must specify through legislation and regulation, who has this responsibility. It can be funded either by linking it to some monopoly element of the service, or it can be funded directly – but the fifth principle is: be clear about how and by whom universal service obligations are to be met.

To make markets work requires not only a plurality of competing suppliers, but willing and active customers. Markets fail where customers are captive or ignorant. So the sixth principle is: ensure high quality information for customers.

blood_pressure_heart_lw

And the seventh principle is: more consumers rather than fewer. The NHS internal market of the early 90s secured some gains in incentivising hospitals, but the transaction costs were high and the benefits limited – except to the extent that GP fundholders were at the same time incentivised to innovate and negotiate benefits to them and their patients. Health authorities were, by contrast, captive to the extent that they were absorbed in the consequences of their purchasing decisions – rather than seeking the best deals. The fewer customers there are, the more likely they are to be part of a continuing monopolistic structure.

cat_scan_of_brain_lw donate_blood_lw

There is one further major issue of principle: who pays, and does equality override efficiency? In most economic services customers become active consumers because they are expected to meet the costs of their individual consumption. The issues of equality in access to these goods and services is responded to through redistributive mechanisms. Some would argue we should do the same in health. For example, the evidence is clear that health inequalities are overwhelmingly correlated with standards of living, rather than correlated with relative ease of access to health services or health promotional advice. So if we want to reduce inequalities, we should be less concerned with distributing health funding allocations towards the areas of deprivation – except to the extent that there is existing morbidity and demand – and rather more concerned with the effectiveness of measures to raise people’s general standards of living through, for example, helping them off benefits and into work.

exclaim_mc

However, unpaid water bills disclose a clear problem; what if people can’t pay or won’t pay? We have to consider at the outset what degree of equality of access to service we expect and, if we do not wish access to be related to the ability to pay then we will need to limit or even eliminate the need to contribute directly.

card_out_of_stock_lb

Although we recognise that individuals can and will purchase additional or enhanced services for themselves, we look for a society which is equitable, because everyone should have access to a high standard of services by virtue of their contribution through taxes. Hence, our shared commitment to the founding principle of the NHS: of access for everyone to the NHS; and of treatment free at the point of use and based on need and not ability to pay.

This is a principle which concerns equitable access, not equality of outcome. Freedom to purchase private health, schooling or security must be available in a free society. Even in the NHS, outcomes will vary. Demanding uniformity will negate the benefits of competition. How can competition work, whether on prices or quality, if it does not lead to variation and divergent outcomes? Some will gain. But do others lose? No, the evidence is that in effective competition the response of other producers of good and services is to raise their game, so that even those who are less fortunate or successful purchasers will gain by this. As the saying goes, “competition is a tide which lifts every boat”.

So – as I see it there is a framework, clear in its principles and already being applied in many services of an economic character, which demonstrates how public services can be delivered more efficiently.

1.maximise competition;
2.transfer risk to the private sector
3.ensure strong and independent regulation
4.set out standards and accountability clearly;
5.specify universal service objectives and how they are to be funded;
6.provide quality information for customers, and maximise the number of providers; and 7.ensure equitable access, without sacrificing efficiency for equality.

customer_service_desk_a_lw

It’s all well and good stipulating “Freedom to purchase private health, schooling or security must be available in a free society” when we know that those with-out will be left by the wayside. This issue; “and rather more concerned with the effectiveness of measures to raise people’s general standards of living through, for example, helping them off benefits and into work.”  Why do they never think that giving people a decent wage would help, rather than poor benefits? These benefits, which tax payers pay and government constantly moan about, because companies will not pay proper wages?

budget_cutting_mw

Advertisements

About rollo57

Like fishing, travel and reading. My favorite football team is Everton. I'm married to Teresa and we have 2 children.
This entry was posted in Uncategorized and tagged , , , , , , , , , , , , , , , , , , , , , . Bookmark the permalink.

7 Responses to Not in our Name!!

  1. Mathew says:

    A very interesting read, thanks.

  2. George Talbot says:

    I spent much of 2011-12 challenging Lansley’s bill to liberate the NHS and note the effects of TTIP are similar to those from EC competition law reported by lawyers hired by 38 Degrees to examine the bill. But Lansley’s obsession with competition in the 2005 speech ignores much evidence that cooperation by doctors pledged to serve the health of a community is better for patients and cheaper for society than selfish private companies competing under a regulator.

    Neoliberal ideals have been popular for decades but have failed globally. Free trade limits nations’ independence but can be sustained if capital stays home and exchange rates are set to balance current accounts. But at Bretton Woods, the US insisted on free capital. David Korten gave a plausible explanation of this in his 1995 book When Corporations Rule the World, p.136. They believed they must export surplus savings to maintain full employment. Now the US is hoist by its own petard as China has acquired $2tn of US assets by exporting its surplus savings. And a dollar crash threatens both nations and many others.

    Keynes Clearing Union requires controls on capital and limits on surpluses. But he designed it to allow nations to manage their economies and to avoid intractable debts. Governments could renegotiate neoliberal laws by threatening to withdraw their supports especially their role as borrowers of last resort. And the people may withdraw their support as happened to a similar system less than a century ago!

  3. captnmike says:

    Well lets see if a comment can be left on a Post that another person had trouble doing

    • It can! And by alerting Bill has broken the spell on my post so thanks!

      This reminds me of another comment that required help from staff that is on DoH’s Your views: Choice and competition. I had cited Dr Tom Yates who had said: “Harvard Professor Atul Gawande has pointed out, in their mixed market, the best healthcare is to be found where providers group together and cooperate to improve performance”. Yates cites The Cost Conundrum in The New Yorker: It is quite long but worth a read.

      DoH’s Listening exercise site is archived and puts preambles on all links.

  4. Pingback: Champagne Doing The Writing | Frank Davis

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s