Archives For Canvas Political Journal

This was written on the 25th of september for Canvas, an online politics journal.

http://canvas.union.shef.ac.uk/wordpress/?p=2416

The Cost of Living Crisis and Socialism

The cost of living is a lived and very visible symptom of the persisting economic slow down that the UK has suffered so acutely since banking crisis six years ago. As Kevin Bridges so eloquently put it, “When 10p crisps are costing 15p, that’s when I began to take an interest in economics.” Unfortunately none of the major parties have, as yet, promised to bring the price of 10p crisps back into line with the price implied by their name, but, ‘the cost of living crisis,’ as it’s been dubbed, is emerged as the most hotly contested policy area in the run up to the next election.

Ed Midland’s promise to freeze energy prices for 12 months was slated by many as a populist move to win electoral support that would translate very little savings into the pockets of general public – criticism that is partially deserved. It is depressingly likely that the major six energy companies will simply and unscrupulously raise their prices before and after the freeze. But it’s also a brave and progressive move by Miliband that’s sent a strong message to the shareholders controlling a dysfunctional market and engineering profits that are hard to justify.

It’s a move that has garnered insults Blair would have winced at. Ideologies have been out of fashion for over a decade, and the term Socialist has almost become derogatory in mainstream British politics. A question that is rarely asked along side such accusations however, is what is meant by ‘socialism’ used in this context? How is it we should characterises the alleged ideology? Neither Ed nor his detractors seem to have given a suitable answer to this question, so the surest answer we can get is to derive one from the policies proposals we’ve seen.

Six energy firms dominate over 90% of the market. Such is the lack of competition and the captive nature of the market they have been able raise profits in contempt of the forces of supply and demand and in line with their own desire. Despite inflation running at just 13% and wholesale gas prices plummeting by 50%, their profits have shot up 74% since 2009. Promisingly, only this morning Ed promised to intervene in other markets, such as water, were a similar rip off culture has developed.

If limiting such grotesque profits so normal people can afford to heat their homes, drink and wash is to be defined as ‘socialist’, then we must be characterising socialism in its most broad sense. Socialism as simply arranging the economy in a way that benefits the people who make up that economy, all off them. If that is what Ed is being ‘accused’ of, them he should continue to do little to deny it.

Cameron’s answer to solving the living cost crisis is his ‘help to buy’ scheme. At first glance it seems like an equally valiant attempt to address the soaring cost felt by normal people, whilst potentially curtailing the ever-growing profits raked in by shareholders. On closer inspection it fulfil neither of these criterion.

Four major Banks dominate their market in a similar way to the big six energy companies, and one of their many sins is to stop offering 95% mortgages in recent years, when buyers have needed them most. Potential homebuyers with incomes suitable to meet mortgage repayments have been stuck paying the astronomical rents of our inflated property market until they can find the £40,000 average deposited to buy a house.

Despite UK mortgages performing very well since the down turn and the banks holding so much of the responsibility for the economic mess we’re in, they’re no longer prepared to take the risk involved in offering 95% mortgages. So Cameron has offered to take that risk off of the shoulders of the poor banks and place it on the taxpayer instead. How valiant.

‘Help to buy’ is a farce; all it’s set to do is further inflate the property market as first time buyers flood the market, whilst forcing the taxpayer to accept all the risk as the banks continue to profit. If Cameron really cared about giving normal people a chance of ever owning a home he’d be building affordable homes for all, restoring local honest banking like exists in Germany and limiting foreign investors from using the UK property market like a monopoly board. But god forbid, such rational policies might be perceived as ‘socialist’.

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This was written on the 12th of september for Canvas, an online politics journal,

http://canvas.union.shef.ac.uk/wordpress/?p=2419

Mortality rates 45% higher in English Hospitals – is privatisation the answer?

Two weeks ago Channel 4 News ran a truly shocking story, which shook even the most dedicated NHS of supporters, including myself. Data they had obtained indicated that English hospitals were inferior to those in seven other developed nations. America’s much criticised insurance-based system came out on top, and was alarmingly sighted as a model for change in UK hospitals. “NHS death rates are one of worst in the West,” read the Daily Mail the next morning. By the end of the story, I for one was scared. Such startling figures genuinely made me question if whether I could trust the NHS with my life, and if growing old here, in my native country, is really as appealing as I once thought.

The source of the data was Professor Brian Jarman, and was collected secretly over more than a decade. Not only did it show our mortality rates to be the worst of the seven nations, it indicated that people over the age of 65 are five times more likely to die of pneumonia in hospital in England, and twice as likely to die from a blood infection (septicaemia) than if they were admitted to a hospital in the United States. Channel 4 claimed to have asked if anyone from the Department of Health was available to talk on the eve of the braking news. They weren’t, so they decided to continue with the on screen debate three against… zero. The defense of the NHS in the face of these damming figures was never heard.1

In the coming weeks, free market proponents in government who are currently pushing the ‘back-door,’ privatisation of the NHS will no doubt use this data to forward their agenda. The argument goes; in a system like the NHS, an absence of competition and meritocracy will invariably impact on efficiency and quality of service. As alarming as the figures were however, I quickly began to realise that the data did not prove in the slightest that the NHS is an inferior system to its privatised and semi-privatised counterparts in the other six nations. Firstly, the data is far from conclusive; It doesn’t appear to be peer reviewed, we know very little as yet about the sources and methodology used to produce these figures and nothing at all about the five other developed nations looked at – not even what nations they are.

This aside, the conclusions cannot be ignored; these figures appear to show rather unequivocally that English hospitals are under-performing. In particular, the fact that so many people seem to be getting Ill inside our hospitals indicates some hospitals may be sloppily run, comparatively undisciplined, or unclean. Much has been written about the hospital super bugs that have run rampant in British hospitals and about shock stories of dirty wards. In July of this this year a highly critical report into 14 hospitals with the highest mortality rates in the country by Sir Bruce Keogh described them as “trapped in mediocrity” ignoring concerns raised by patients and Staff.

This was echoed by professor Jarman who blamed the problems highlighted by his data on the ‘culture’ of the NHS.2 However, Keogh’s report suggested that geographical location was often a factor, in that isolated hospitals might struggled to attract the best staff. More common than that was the hindrance of quality care as a result of inadequate numbers of nursing and other staff, or an over-reliance on temporary and unregistered staff – in some cases ward staff were working 12 days in a row. Certainly, changing the ‘culture’ of the NHS will be no small task. It is one of the largest bureaucracies in the world; it’s the fifth largest employer on the planet. Public sector culture and the unaccountability and layered bureaucracy associated with it are undoubtedly factors in creating the problematic culture sighted. It has, for example, just abandoned plans to create the world’s largest single civilian computer system linking to all parts of the National Health Service. A change of culture may be needed, but changing this culture is not a simple as privatising.3

Market forces are not a quick fix and have actually been repeatedly shown to damage the NHS. Since Thatcher’s, “new public management” initiative in the 80’s, hospitals have begun to outsource cleaning (roughly 40% in 2008). The consequences have been; consistently less time spent cleaning each ward each day, higher staff turnover (less competent staff), and less control over cleaning for medically trained staff. I should like to point out those who might be thinking of giving the above argument that it is undoubtedly privatisation and market forces that have made our hospital dirty, not the other way around. Private cleaning firms were doing such a terrible job that by 2008 the Royal College of Nursing conference overwhelmingly voted for a motion proposing an end to contracting out cleaning to private firms.4

The marketisation of the NHS continued into the Blair years. The Labour Party thought they could create a market within the NHS without actually selling any of it off. Targets, quotas, and plans were put in place for most aspects of service. To meet the artificially inflated targets a number of NHS trusts allocated “The Hello Nurse,” whose sole task it was to greet new arrivals in order to claim for statistical purposes that the patient had been “seen.”5 NHS managers took wheels off trolleys too reclassified them as beds and reclassified corridors as wards in order to falsify Accident & Emergency waiting times statistics. From a wider view, hospitals are now paid by the quantity of work they do under a contract, so we see a phenomenon known as hospitals “over performing” when hospitals treat more patients than their contract allows. The “extra” patients are not extra “customers” for the hospital, they are patients with real problems that need to be treated, but the market that has been created in the NHS represents them as figures on a balance sheet and excess costs.

Explaining why private firms so often drive down standard is simple; when a private corporation wins a contract for ten years say, there is no competition for ten years, the motivation to drive costs down and increase profit margins can increase. The same has been seen to be true with rail companies running poor services and private catering companies selling harmful, but profitable foods in school. In the case of the NHS, the historic conception of the public servant proudly giving themselves and their talents to people and nation was permanently tainted. Public service became self service and so emerged the popular image of the petulant NHS working mindless ticking boxes and chasing bonuses. These systems of free choice and opportunity did not perform as the game theorists predicted, because the players cheated.

In an industry trading in the commodity of people lives, market incentives can only result in people being treated as objects and patients as customers. Customers who might one day be judged on their ability to pay, not their medical need. Even if I concede that our hospitals our are made worse by, and our death rates higher because of, our system being public sector run this does not mean that our health-care system is inferior. The primary end of any health care system should be to preserve as much life as possible – not simply to provide excellence to those who can afford it. And it is to this most important end that the NHS continues to excel in comparison to the American system.

A good demonstration of this is that whilst a woman entering an English hospital to have a baby might have a higher chance of not leaving, a US government report conducted under George W Bush found that if just routine clinical care and social services are offered, women can reduce infant mortality rates by a half to a third. This basic care is offered in the UK, by default, and things should remain that way. As is so often asserted, prevention is far more effective than treatment and by providing universal healthcare no one in this country skips vital treatment, vaccinations or check ups simply because they can’t afford it. This is why, even if sadly our hospitals perform comparably poorly; our health care system is still better. More live are saved and less money spent overall. (According to sums done by ‘Liberal conspiracy’ blog the US spends 15% of GDP on health care annually, we spend just 8%. So humanity and morality aside, a free market does not even create economic efficiency in this particular ‘industry.’)6

In the Channel 4 report, the viewer was taken to the Mayo Clinic Hospital, one of the best hospital in the world, where a doctor explained that the success of his hospital was due to putting, “the needs of the patient first.” The simple fact that he had to clarify this, that profits and payment did not rule, is telling enough. It seems obvious to me that America should have many of the very best hospitals in the world – it has a market system creating a pyramid of excellence with a few truly exceptional institutions at the top and others providing more affordable care of differing standards to those lover down. Not to mention that America is also the wealthiest of the large developed nations. To compare English hospitals to those in one of the richest yet unequal societies on earth is to miss the very point. It would be great to have the best hospitals in the world, but it’s even better to have a universal health services that can save as many lives as it can, regardless of who the patients are.

I haven’t been secretly collecting data for a decade like Professor Jarman, but I’d also like to make the logically valid point that maybe part of the reason more people die in English hospital is because more dying people end up in our hospital here. Unlike in America where, as Jeremy Hunt put it on a recent live broadcast, “they have a long tradition of letting people die at home.” This might be because they are one of the 31million American who completely lack health insurance, or even more tragically, because the crippling worry about the financial burden to be left of the shoulders of their loved ones – consider the plot of Breaking Bad had it occurred in any civilised nation but the U.S.

We’ve seen this government allow universities to set their fees up to a staggering £9000 a year. This has undermined the meritocratic values the right so vehemently professes to uphold – the best universities will now start filling up with those who can afford it, not those with the best grades. Further damage to the health care system could create an injustice even more ugly. If we go the American way not only opportunities, but people people’s very survival, will depend on their financial status within this market economy. Our health care system is necessarily inferior, but remains the moral superior. In spite of Channel 4’s harrowing and sensational report, I won’t be leaving the country any time soon.

References

1 http://www.channel4.com/news/nhs-hospital-death-rates-among-worst-new-study-finds