This Welfare State, This Septic Isle, This little England.

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Whoa there!

Who’s in control?

Who says so?

Telegraph breaks cover

Prompted by the 6th November front page Tory party puff in what used to be a newspaper, namely The Daily Telegraph, the prevalence of the propaganda machine running in the UK has been brought home to me.   In fairness, it may just be in England, as the degree of success is very patchy elsewhere in what used to be our proudly sceptic isles. I wonder if we English have completely lost our capacity for critical thought.

I am looking at some of the slogans and messages used in recent times and the one I keep coming back to is Taking Back Control

When Michael Gove said in an article in The Guardian in April 2016, that “It’s time to take back control”, I guess he had just one objective in mind, apart from coming up with a vote-winning slogan that is.

What a farce!

This always ran the risk of being a double-edged sword, and as such, is heard less frequently now than in the halcyon days of the Brexit campaign. Now uttering the term control in the same sentence as the Brexit process only calls for hoots of derision.

However, I have long believed that those who live by the sword cannot really complain if they end up as kebabs, skewered on their own pikestaffs.

So, let’s have a quick look at something that it might be good to take back control of, shall we?

We could always start with the big obvious one: the NHS; our NHS, the jewel in the crown of our Welfare State.

By most accounts the NHS is rapidly running out of steam.  It is short of doctors, nurses, cleaners, orderlies, drugs, funds, equipment, and so on.

What it is not short of is support from the public.  We love it. We want it to thrive. We want it to be there for us. We don’t want to be the generation that allowed it to die.

All fur coat and no knickers

The government it seems is “all fur coat and no knickers” as my grandmother used to say.  It loves to protest about how the NHS is safe in its hands whilst quietly forcing it to sell off all sorts of profitable bits, tying it up in an administrative straightjacket, denying it the ability to recruit overseas staff, and generally creating uncertainty in all areas of its activity. 

This is a well-known asset-strippers trick. Cherry-pick all the bits of value and make nice shiny lucrative deals on these with your pals and supporters.  Not deliberately of course, because that would be corrupt, but it just so happens that the beneficiaries of this largesse are your natural supporters, allies, funders, and contacts.  They are also the very outfits that will provide for your future job prospects.  Oh, I do love a revolving door, don’t you?

Please tell me if I am being too cynical, won’t you?

So, who carries the can?

This leaves us, the taxpayers, with a central shell that carries all of the costs, all the top-heavy, convoluted, management structures that have been imposed upon the National Health System, and all of the naturally unprofitable aspects of the work, in a climate of great uncertainty.  That means we are left with the difficult stuff; the terminally ill, the elderly, the malnourished, the poor, those that make the greatest demand on the service; those that need it most.  

Given this scenario, the government can shift responsibility to NHS management; to the professional bodies and trades unions; to the myriad of bodies and structures that it created; and, in extremis, to external contract failure.

It can allow, or even facilitate, a drift towards unacceptable levels of service, where far too few GP’s try to ration appointments for far too many patients; where A&E departments have to abandon targets; where the system is clearly in decline.   At the same time, it can encourage and support the growth of private health care provision giving rise to charge levels that only the well-off can afford.  This allows the wealthier among us to vote with our feet and jump the queues by buying private services.

If this is then compounded by removing any services that function embarrassingly successfully in the public sector, so as not to allow the survival of any good internal revenue streams, then Bob’s your Uncle! We’ve cracked it!

Mission accomplished?

We have achieved a failing Health Service, in spite of our best efforts.  A two-tier Health Service! In spite of the record amounts of cash that  have been pumped into it (and we must always take care to conflate revenue and capital expenditure, ignore inflation, and pick appropriate comparison timeframes), it was just not up to the job!  Time for crocodile tears, heavy briefings with the ever-friendly press, and a quick chuckle on the way to the bank of future prospects.

So I’m a cynic

OK, that’s a pretty scathing take on what’s happening to our NHS but just think about it.  Ask yourself who is benefiting from the estimated £29 billion of externalised contracts* amounting to over a quarter of the overall budget?  Who are these third parties? Who pulls their strings? Who shares their profits? Where is that money ending up? What contribution is it making to us and our economy?

So, even if you believe this is a typically scurrilous Marxist attack on our Honest John politicians, I only ask one thing. 

Just think about it.

Isn’t it really time to think about how we can take back control of our health service, before it’s too late?

This could develop into quite a theme. Unlike some of our train franchises it could run and run. There are so many other activities that we used to own that have been flogged off like so many dead horses. Time to think the unthinkable maybe…

*Estimation by David Rowland, Director of the Centre for Health and the Public Interest in a presentation at the LSE

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