Resisting the cuts: building a campaign


8:58 am - July 21st 2010

by Nigel Stanley    


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I’m old enough to remember the Thatcher years. What I mostly recall is just how ineffective most campaigning we did was.

For sure you could sometimes mobilise many people, but not always to much effect. So how should we approach the challenge we face today in campaigning against the cuts?

There are two types of opposition already getting going.

Many are already defending “their” bit of the public sector saying “don’t cut us, what we do is too important”. Others oppose cuts on economic grounds fearful they will push the UK into recession, though they may well want cuts further down the line.

But unions and others combine these positions, and there is already an interesting debate – mainly online – about how best to maximise opposition to the cuts in general and thus shift government policy.

Here’s Sunny with a good practical post and here’s Gary Younge with some insights from the US into how political arguments work in practice (ie not always at the intellectual level).

Where we start

While there are some signs that the honeymoon is coming to an end polls tend to show that people like the idea of a coalition. They also buy the main argument the coalition makes that we need big cuts. Post-budget polling also suggested that a majority thought that the budget was fair.

At least to date the government wins the argument about the need for cuts. Those homespun analogies about the purse and wallet may make anyone who is even vaguely familiar with Keynes cringe, but they seem to work with most voters.

However people are worried about the effects of the cuts. 25% are very worried and 45% are fairly worried that they will suffer from cuts in spending.

So how do we build the campaign?

Let’s accept that we start with a majority agreeing that the cuts are both necessary and fair. A successful campaign against the cuts will take them to thinking that they are both unfair and unnecessary.

Most people frankly won’t be interested enough to challenge the popular ‘can’t spend, what we don’t earn’ narrative. But, as the cuts start to bite, we can shift the debate from being an abstract national one about economics to one based on people’s real experiences.

That will make it personal and emotional, with people basing their reactions on what the cuts mean for them, their families, their communities and the people with whom they identify. Once they start to think the cuts are unfair, that’s when they will start to engage with the economic case actively seeking out arguments that enable them to oppose the cuts.

But there is a danger that people stop half-way along this journey. They may think that the cuts that affect them are unfair, but that the overall government approach is right. This is the individual version of the “don’t cut us, cut them instead” approach. Coalition media supporters will be ready to tell tham that’s because of the gold-plated public sector fat-cats.

So the journey will be in two stages. We start with the argument that the cuts are unfair and will hit ordinary people, and then win the argument that this requires a change in strategy at national level, not simply readjustments within the cuts package.

What would this kind of campaign look like?

The local is probably where we can best engage them. For some, sectoral campaigns will also be an important point of entry. Of course the two can work together as with the schools protest, but it is the local issue – my school, my community, my service – that will initially draw people in.

This bottom-up approach will inevitably not always be neat and tidy. But what the union and political activists who inevitably get involved can do is inject the wider context and the national issues.

This could be the first internet campaign that can really change the shape of national politics, as it is the ideal tool to mobilise and connect local activists. I’m certainly excited by the interest in anti-cuts people active in online campaigners working together in ways that Sunny outlined and Stuart White wrote about here.

The more we can build up a modern ‘doomsday book’ of the effect of the cuts, the more we can help people to make the second stage of that journey when they realise that they are not alone in being hit with unfair cuts, and that they therefore need to call for a thorough-going alternative.

Combined with resources to help people organise locally, and popular material that can put the economic arguments, such a web-site could be an important tool.

But local pressure on MPs – particularly those in the coalition parties – will be decisive.

What would be success?

One constant difficulty in campaigning is working out what counts as success. In truth many campaigns are very hard to measure as the only real conclusion is that without them it would have been worse.

Progress is likely in two ways. First campaigns against specific cuts – either geographical or sectoral – will be the first to get going (as we have seen with Building Schools for the Future). Some will succeed in ameliorating the coalition’s policies. Others will do political damage, and put the government under strain, both inter- and intra-party.

Secondly – and probably after a mounting series of these specific campaigns – we can look for changes in policy, either through a more relaxed time-table for reducing the deficit or by greater use of taxation.

What are the next steps?

The pressing priority is the hard work of building alliances between service providers and service users in localities.

At the national level we need the hard economic arguments, particularly that cuts will hit the whole economy not just public services. The cuts will cause just as many job losses in the private sector.

If succesful this is going to be a big pluralist campaign – perhaps the mirror image of the USA’s tea-party movement. It will certainly develop in ways that we cannot predict.

But campaigning can sometimes get bogged down in activity at the expense of the big picture. Here are some tests that I have started to set against suggested initiatives.

Do they:
” help shift the issue from an abstract national debate to a personal and emotional response to the effect of the cuts?
” help bring users and providers together?
” allow us to advance or inject an alternative economic approach to the deficit?
” effectively put pressure on the government?
” avoid own goals?
” do what our opponents expect or want us to do?

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About the author
Nigel Stanley is an occasional contributor to Liberal Conspiracy. He is the TUC’s Head of Campaigns and Communications. He's also at the ToUCstone blog.
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Story Filed Under: Blog ,Economy ,Fight the cuts

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Reader comments


In my mind, the best way to fight the cuts is to make Tory and LD MPs uneasy. The cancelling of BSF has shown that this can be effective – already several Tory MPs are saying “don’t cut the rebuilding of my school”. However BSF appears to be a piecemeal campaign and by its nature it affects just one demographic (young people with kids) who are not the bulk of the electorate.

Far better is to attack Lansley’s plans. The white paper is the de-nationalisation of the NHS and I have not yet met a Tory voter who supports that. Hospitals are used predominately by people 50+ and this is the demographic that makes the bulk of the voting electorate. If an MP senses that a hospital will close in their constituency then they will oppose it. This is why we have to demonstrate and publicise that Lansley’s plans will close (or partially close) almost all NHS hospitals.

2. Mike Thomas

Richard,

How on earth can you lay claim that removing the often duplicated processes at the SHA and PCT level is a bad thing?

As for BSF, the attack from Balls is highly disingenuous as Balls was the most hawkish for spending cuts prior to the election as long as it wasn’t in his department. A department in which only 35% of its funding actually reaches the frontline. A BSF policy that has been torn apart by NAO reports for being incredibly wasteful and effectively mortgaging the taxpayer for 25 years to pay 10 times over the odds for a school building.

Lastly, where is your evidence that Lansley is going to close almost all NHS hospitals? If you are going to attack, be credible.

The BSF is a great example of how single issue opposition can become a media storm for the coalition; however I agree with #1 that it should be the NHS that we should defend with the strongest voice.

Andy Burnham did a very good job on Question Time the other day tearing apart the NHS White Paper, and you could see from the reaction in the audience that what he said resonated.

The NHS, despite the moaning, is something I think great swathes of British people will stand up to defend. Case in point, when Dan Hannan attacked it on Fox News, the uproar was so great that great bastion of socialism, The Sun, refuted his claims.

We need to take the fight to the coalition over this. “I’ll cut the deficit, not the NHS” after all.

4. the a&e charge nurse

[2] Mike I do not want to de-rail this thread by arguing about the NHS alone – the OP is not just about that, but Richard (who is quite an authority on this matter) is right and you are wrong.

We can at least agree that the current management structure in the NHS as far from perfect but this re-organisation is not about tinkering with a few bureaucrats, it is about creating the sort of market conditions that will ultimately lead to wholesale privatisation of our health system.

I’ve heard this latest reorganisation will cost £1.7 billion – why did Lansley fail to mention this in the tory election manifesto?

Yeah but the way the scum are playing it is that it hands power and money back to “the people” ie GPs etc which looks attractive on paper. Needs to be a clear explanation of why this is the denationalisation of health and who will be affected.

I’d have thought that one of the most obvious places to start if this is to be a campaign against the cuts is among our opponents.

The Tories themselves seem extremely split on education cuts certainly, and other areas of cuts where they directly effect themselves or their constituents. Graham Stuart, the new Chairman of the Commons Education Committee, has been extremely critical of the Gove Education Bill, describing it as the worst and most hurried piece of legislation since the Dangerous Dogs Act.

Ian Liddell Grainger, Tory MP for Bridgwater, was first off the mark in criticizing the bill and has threatened a march of pupils from the schools effected in his constituency on Downing St. There’s another Tory MP and even a minister – whose names I can’t now remember – who voiced strong opposition to the Bill.

We do not live in a two party system at the moment but a three party one, a hung parliament. Majorities is what matter – however temporary they might be. Its not just a question of building a base while in opposition which we’ve done over the last 60 odd years, present government policy is based on each individual vote, every one of which can be defeated. I’d think in terms of 30’s Popular Front politics, the Churchill Coalition.

Which leaves Lib Dem MPs as the most vulnerable of all. They’re obviously extremely scared. I wrote to mine – in a very precarious seat – complaining vociferously about the cuts – and how, a lifelong Lib Dem, I wouldn’t be able to vote for her again. I got the longest and most detailed reply I have every had from an politician.

People can write to both their Lib Dem MPs or ex-candidates or constituency parties, saying they’ve voted for them all their life, or just voted for them at the last election – and swearing they’ll never vote for them again, etc etc. They are extremely scared and vulnerable at the moment.

Finally, they should be invited on the marches. Lib Dems AND Tories. All politicans at the moment are extremely scared of electorates – because there could be an election at any time. And why not invite all the Construction industry trades and even bosses in effected areas – they’re all losing a packet because of the cuts.

7. Mike Killingworth

[4] I suspect that a very similar health reform would have been instituted by a 4th-term Labour government, which, let’s not forget, was proposing £44bn of cuts in public spending itself. (Sunny could do worse than invite Alistair Darling to write a piece for LC on the role of the public sector in the next decade…)

It depends what you mean by “privatisation”. The NHS already buys beds in private hospitals so there is no new principle at stake there. What people are attached to is not the fact that Sister is a government employee but the fact that their health-care is free at the point of use. Presumably our living standards could drop to the point at which the tax base could no longer fund health care, but that is probably unlikely.

8. Mike Thomas

4,

So I am completely wrong and yet right about the monolithic management systems in the NHS?

Okay.

So with the same kind of logic, you state that the NHS is being privatised?

Is this the same kind of privatisation as practice-led commissioning implemented by Labour or not?

Lastly, Richard Blogger is a governor of a hospital. Wonderful. I spent several years in the NHS trying to save it money and improve its service. So I am not qualified because I am an evil baby-eating privatiser? Okay, fine.

What is wrong with the GP choosing what is best for their patients? The patient still uses the NHS in the same way, it is still free at point of use. As the myth propagated by the Left that the NHS is a huge, coherent state owned and ran enterprise, that is laughably naive. The NHS is ran differently in almost every single one of its SHAs and PCTs. It is already devolved in Scotland and Wales; so much for it being ‘National’.

The mix of public and private provision in every single SHA and PCT is also completely different. Oh yes, there are already aspects of NHS provision that is obtained from the private sector.

The NHS is a brand, nothing more.

#2. Mike Thomas

“How on earth can you lay claim that removing the often duplicated processes at the SHA and PCT level is a bad thing?”

First SHAs do not cost much (about £60m) and were going to wither away anyway. Labour’s FT hospitals plan said that as a hospital improves and shows that it is good enough to handle its own finances it is taken out of SHA control. Hence as more hospitals become FTs SHAs will go away. All that Lansley is doing is taking away the quality controls on becoming FTs – basically he is saying regardless of whether they can handle their finances all hospitals have to be FTs by 2014. This is nonsense and a recipe for hospitals to go into debt.

As for PCTs they were created for a very good reason. GPs want to make clinical decisions and leave financial decisions to someone else. That someone else is the PCT. If I need expensive treatment my GP will put my case to the PCT. In the future my GP will refuse me treatment on financial grounds. GPs do not want this, patients do not want this.

As to the cost. Well management costs of PCTs is £1.85bn according to Lansley.. The private commissioning sector reckons that they will get £1bn of this. Lensley reckons that the plan will save £850m. How? He will take 152 organisations and split them into 600 smaller ones. How will that save money? At the moment PCTs often have a synergy with local hospitals so that an NHS hospital will have one PCT to work with. In Lansley’s plans a hospital will have to work with 4 or more consortia and that means that the commissioning work will be duplicated between those consortia. Lansley is just throwing fantasy figures around. Commissioners I have spoken to reckon that his plans could cost MORE. And it didn’t have to go this way. Before the election PCTs were organising as “clusters” to share management, they could have saved this money without yet another re-organisation of the NHS.

“Lastly, where is your evidence that Lansley is going to close almost all NHS hospitals? If you are going to attack, be credible.”

Easy, have a read of the white paper.

“We are very clear that there will be no bail-outs for organisations which overspend public budgets.” (1.22)

“Prices will be calculated on the basis of the most efficient, high quality services rather than average cost.” (5.12)

At the moment hospitals are paid per procedure at a rate that is based on the average cost across England for that procedure. By definition, half of hospitals will do the procedure cheaper and half will do it at higher than cost. NHS hospitals have to re-invest any surplus, but in fact much of surpluses go to pay for deficits that the hospital makes in other services. This cross-subsidy is vitally important.

Lansley’s plan to pay at the cheapest rate means that by definition almost all hospitals will be paid less for the procedure than it costs. This is engineered to make all hospitals go into deficit. (1.22) says that such hospitals will get no government help even though the problems will have been engineered by the government. The only solution other than closure would be the hospital to merge with an organisation with the cash to pay off the deficit – private healthcare. That in effect means that the NHS hospital will no longer exist as an NHS hospital. Hence, why I say that “Lansley’s plans will close (or partially close) almost all NHS hospitals.”

10. Flowerpower

The cancelling of BSF has shown that this can be effective – already several Tory MPs are saying “don’t cut the rebuilding of my school”.

And you can bet that in the autumn a new wave of school building will be announced based on more sensible criteria than BSF and implemented with less fuss, bureaucracy and consultancy cost.

Many MPs (of all parties) will suddenly find they have their new buildings rather sooner than would have been the case under the sclerotic BSF.

Those who have opposed the policy will then look proper chumps.

11. Flowerpower

Richard Blogger

Lansley’s plan to pay at the cheapest rate means that by definition almost all hospitals will be paid less for the procedure than it costs. This is engineered to make all hospitals go into deficit.

Err….no. This is engineered to prod hospitals into making efficiency savings and productivity gains – something every organization public and private is doing at the mo.

#7. Mike Killingworth

“It depends what you mean by “privatisation”.”

Pure and simple.

The white paper says that competition law will be used to get private companies into NHS hospitals and take over services. It says that private companies will have access to NHS hospital facilities (so your NHS hospital’s MRI scanner will be used by the patients of the local BUPA hospital, who gets priority, NHS patients or BUPA?). It says that NHS have to become “employee-led social enterprises” which are management buy-outs and are private companies.

“The NHS already buys beds in private hospitals”

Sure, and they do this so that they can meet the 18 week RTT target. But Lansley is abolishing that target so the reason for NHS hospitals to do that will be taken away. (Actually treatment within 18 weeks is a RIGHT in the NHS constitution, but it will no longer be used as a performance measure, so hospitals will relax it. As a patient it is your RIGHT so you should insist on it. The current median time to treatment is 8 weeks for inpatient and 4 weeks for outpatients. That is great, but we will not see figures like this again.)

#11. Flowerpower

“Err….no. This is engineered to prod hospitals into making efficiency savings and productivity gains – something every organization public and private is doing at the mo.”

Well that is the nonsense “everything is so simple in the free market” argument that will kill services in this country.

Do you have any idea how a hospital could get its costs down to the most efficient provider? This is not a “prod”. It is a death sentence.

The private sector know this too, they are upset by this policy because they know that they cannot compete with the NHS which is more cost effective (and I am not just talking about the most efficient NHS hospital). The private providers know that they cannot provide services at the rate of the most efficient NHS hospitals. Lansley will have to change this policy if he wants to encourage private providers to take part in his experiment.

New Labour’s ISTC plans showed that when you brought in the private sector costs go UP compared with the NHS. Private health costs much more than the NHS, they also cherry pick patients by passing the more difficult – and expensive – cases back to the NHS.

14. Flowerpower

Nigel

What you seem to be advocating is a campaign based on exaggerating the impact of cuts on vulnerable people.

In other words, keeping up or intensifying the lie-based campaign already running.

The problem with this strategy is that at least until 2013, the Coalition will be spending as much or more in real terms as Labour did in ten out of its twelve years in government.

If you claim the government is particularly callous for spending so little, then you will have to explain your own “callousness” between 1997-2007.

People here still don’t get it: even with the cuts the Coalition will still be spending more (in real terms) on public services than Labour did every year before 2007/8.

Nigel @OP: It’s a shame the comments thread has veered quite so quickly off topic, as I think your piece makes a lot of sense around what people might actually get angry enough to protest/resist about, and the phases it will have to go through.

I have tried to tie down my own thoughts on the where (local) the when and the how (including finite resources) of resistance at http://thoughcowardsflinch.com/2010/07/11/resisting-the-cuts-3-localism-legalities-loopholes-labour/

At the end of that piece, I acknowledge that at each local level the main way to establish the local site of resistance both you and I identfy as necessary is through local co-ordinating bodies of the type Justin Baidoo and others are trying to establish in London, and in which I know Sunny and Kate Belgrave (a regular author here and London activist) are involved to some extent. I also recognise that while local Labour party units SHOULD be the ones co-ordinating this stuff, they simply don’t have the credibility, in many areas, as a campaign organisation (as in proper, not electoral campaigning) to do this job, although they should certainly seek to involve themselves.

Specifically, then, Nigel, I wonder if you can nail down – here or in a follow up post – what infrastructural (and in the end this means money) support the TUC and the bigger unions might be able to bring to these local groups as they develop. I’m thinking the unglamorous stuff that really makes this kind of stuff happen – the administrative competence, the access to print technology etc etc.

16. Shatterface

One suggestion is that you don’t make this a party political issue. On the one hand it identifies you with a Labour Party most regard as responsible for the mess in the first place – and who would have made many of the cuts themselves if they had got re-elected; and on the other hand it alienates the Lib Dem supporters (and, on education, some Tories) who are potential allies.

Another suggestion is that public sector unions need more support from other unions. That’s where the TUC comes in.

A couple of comments on what’s been said so far.

I do not speak for the Labour Party or act as cheer-leader for it. Unions campaign for change and to defend public services whoever is in power. I am sure that we would be drawing up plans now whoever had won the election – though somewhat different ones as the context of course would be different. While Labour may not be the focus of current plans, a successful movement will undoubtedly shape their policies and strategy as they begin to find their feet under a new leader.

@paul

I originally developed this thinking as part of an internal TUC discussion that at least partly had the aim of helping unions see support for local activities in the way you suggest as a crucial part of the campaign. The TUC itself has much fewer resources than people often imagine, but our affiliated unions can play an important part in building the infrastructure that is needed at local level.

I am a mere lowly TUC bureaucrat who can only advise. Individual unions are free to work in whatever way they want, and the trade union movement is much more pluralist than some of our critics (and sometimes would be fans) realise, but despite some differences in emphasis about the role of local and national mobilisations, there seems to me to be a very strong desire to work together and build alliances in the cuts campaign.

18. Mike Thomas

9,

If this was the case that simplifying the business side of the NHS into regional units was better, why was NPfIT so ruinously expensive and failed in terms of the business integration?

It was ruinuous expensive and it failed because each of the SHAs had their own processes and procedures, each of the PCTs had their own processes and procedures and each of the hospitals had their own processes and procedures. The only thing that was standardised was governance at an executive level which if this was so successful, why are Chief Executives paid £200,000 a year? Again, if this improved the business, what on earth happened at Stafford?

So removing the SHAs and PCTs will reduce administrative spend by £910m a year (your own numbers)? This is a bad thing according to you?

Also, you say that by removing 152 organisational entities you effectively split them creating 600 more? No, all that is happening is commissioning is devolved. Are you seriously suggesting that the commissioning needs of a GP practice in Bournemouth are exactly the same as the commissioning needs of GP practice is Bradford?

The public health aspect, the scrunity of the hospitals performance is devolved from the SHAs directly to the local council. Transparency alone suggests this is a good thing. NHS patients and residents in the locality can immediately understand the performance of their local hospitals. Again, how is this bad?

This is exactly how it is done in most Western European countries, how many of their healthcare systems are better than ours? All of them. Every single Western European country, including those hard right wingers in France, Sweden, Denmark and Germany use a mix of public and private healthcare provision under the aegis of a public healthcare systems.

Those 600 hospitals already exist, currently they already have to interact with their PCT (with the associated delay and administration), of which there are 152 who in turn have to interact with their SHA of which there are 10 SHAs.

This endless reporting up, centralisation and edict by diktat exhibits a dead hand of control and a complete inertia in terms of productivity. It is wholly the wrong way to run healthcare. There are two countries in the world that run their healthcare systems in this manner, North Korea and Cuba. At least they managed to standardise the way their hospitals operate.

Not even Social Democrat Sweden and Norway run their healthcare in this way.
They run their healthcare systems in exactly the manner Lansley is proposing. Even Burnham’s proposals were a heavily watered down version of that.

As for your assertion that hospitals will get into debt and as a result will close is frankly absurd and simple scaremongering. Lansley offers a change in position where hospitals have to cut spending as they are currently forbidden to run a deficit in a single budgetary year. Again, this is ridiculous with patient care directly impacted towards the end of a budgetary year for no reason other than political dogma.

The wider issue on how can the Left fight ‘cuts’, the NHS budgets are not being cut. What this is a protest about is how the NHS is going to be ran. Well, voters spoke and they didn’t like what Labour were proposing. That’s democracy I’m afraid, hard cheese.

Why did you never campaign against cuts under Labour?

“But, as the cuts start to bite, we can shift the debate from being an abstract national one about economics to one based on people’s real experiences.

That will make it personal and emotional, with people basing their reactions on what the cuts mean for them, their families, their communities and the people with whom they identify. Once they start to think the cuts are unfair, that’s when they will start to engage with the economic case actively seeking out arguments that enable them to oppose the cuts.”

Not entirely convinced you know (not that you’d expect me to be anyway).

The problem I forsee with you creating a “Domesday Book” of cuts, with flagging up what is being cut and where, is that you risk the sort of reaction that people gave to the cuts in housing benefit.

Along comes posh Tory git Chancellor to say that this benefit will be capped at £400…..cue outrage, campaign, shouting etc. Then it gradually sinks in that this cap is per week, not per month. That the cap is going to be £20,800 per year…..that some people really are getting, purely in HB, more than many people actually earn in a year.

You can see the reactions all over CiF. No, it wasn’t outrage that the cap was being introduced. It was outrage of the “You what? You mean, WTF? I was being taxed so that peeps could get to live in housing I can’t afford? Bugger that for a game of soldiers, too bloody right benefits should be cut”.

By emphasising what the money is being spent upon you risk people actually realsing what the money is being spent upon. And there’s absolutely no certainty that the majority will support what it is currently being spent upon……

Oh and for those who have some interest the government is looking at how to get rid of “free at the point of delivery”. This is from the Health Select Committee today:

http://www.healthpolicyinsight.com/?q=node/643

“Dorrell says govt is looking at future co-payment model, have to look at
funds and also at achievable levels of private funding compatible with
principles of equity.”

I don’t have a lot to add to what has been said here, but I do want mention that some sectors are already pulling together to form a campaign to oppose the cuts, both directly to that sector and others. The arts is one of these sectors and they seem to be dong it rather well in terms of getting support from their own sector and getting the message out there to the wider world.

If anyone’s interested, you might want to take a gander at this: http://artsfunding.ning.com

Or have a look at the recent coverage on both the BBC and in the Guardian regarding the arts sectors campaign over the cuts.

#18. Mike Thomas

“why are Chief Executives paid £200,000 a year?”

Tell me, how many private businesses with a turnover of half a billion a year have a chief exec earning £200K. This nonsense TPA campaign of saying “why do they earn more than the prime minister” is just childish. Either demand that the same rules apply to the private sector or drop it. By the way, the NHS Confederation says that the average pay of a Chief Exec of a private hospital is £420K. They have a cushy time compared to a chief exec of a NHS trust because they do not have the financial pressures and the politicians breathing down their necks. Oh and when NHS hospitals become “social enterprises” the chief execs will be able to pay themselves “commercial rates”.

“Again, if this improved the business, what on earth happened at Stafford?”

Have you read the Francis Report. perhaps you should. It is all explained there.

“So removing the SHAs and PCTs will reduce administrative spend by £910m a year (your own numbers)? This is a bad thing according to you?”

Nope. I didn’t say that. I said that SHAs cost a few tens of million and would naturally go away anyway. I don’t care about them. That should have been clear in my response. My concern is separating clinical and financial decisions and that is what the PCTs were created for. Lansley throws a figure of £850m. There is no evidence that he will be able to save that. It is just a fantasy figure. But is he offering that we do not save £850m then we will go back to the more sensible model with commissioning separate from GPs? No.

“Also, you say that by removing 152 organisational entities you effectively split them creating 600 more? No, all that is happening is commissioning is devolved. Are you seriously suggesting that the commissioning needs of a GP practice in Bournemouth are exactly the same as the commissioning needs of GP practice is Bradford?”

Don’t ask me, ask Lansley. The number of consortia will be more than 152. Commissioners say that consortia will not work for less than 100K people. That gives an upper limit of 500-600. Some commentators suggest that there will be 300. Now we are getting close to the number of PCTs when they were first created. But it was found that that many PCTs did not work and hence many were merged to create the 152 we have now. So if 300 or so commissioning organisations did not work then, why should they work now?

“The public health aspect, the scrunity of the hospitals performance is devolved from the SHAs directly to the local council. Transparency alone suggests this is a good thing. NHS patients and residents in the locality can immediately understand the performance of their local hospitals. Again, how is this bad?”

Oh great. And my local county council – overwhelmingly Tory – is just about to close out local fire stations to save money. Do I really want them accountable for local health services too? Like hell.

Also. this is not localism, it is exactly the opposite. At the moment PCTs – local bodies – commission GP surgeries, other GP treatments, acute care (hospitals), mental health, opticians, dentists, pharmacy services, community services, maternity.

GPs will commission acute care and mental health (although only 31% says they have the ability to do this).

The NHS Commissioning Board, the centralised super quango created by Lansley, will commission GP surgeries, other GP treatments, opticians, dentists, pharmacy services, community services, maternity and regional centres of excellence for treatment of rare cancers and organ transplants. There is no localism, Lansley is pulling the wool over your eyes.

“This is exactly how it is done in most Western European countries, how many of their healthcare systems are better than ours? All of them.”

::Sigh:: Nope.

“Those 600 hospitals already exist, currently they already have to interact with their PCT (with the associated delay and administration), of which there are 152 who in turn have to interact with their SHA of which there are 10 SHAs.”

Nope. Foundation Trusts (120 of them at the moment) are not under SHA control. The FT model take SHAs out of the picture.

“This endless reporting up, centralisation and edict by diktat exhibits a dead hand of control and a complete inertia in terms of productivity. It is wholly the wrong way to run healthcare.”

Huh? Have you read the white paper? Lansley wants to create 150 “quality standards” against which all NHS hospitals will be performance tested and each “quality standard” will be made up of 5-10 “quality statements”. This is exactly the “reporting up” that you talk about. I am not complaining about such a tick-box culture, in fact I think it is a good thing that every clinician is made to tick a box before addressing a patient that they have washed their hands, or that the dose they administer has been checked by another clinician, or that they have checked which foot they will amputate. I like that. But it goes against what you are advocating.

“Not even Social Democrat Sweden and Norway run their healthcare in this way. They run their healthcare systems in exactly the manner Lansley is proposing.”

No in Sweden and Norway most hospitals are owned and run by local authorities (and paid for by taxation), with no competition. Lansley is proposing that hospitals are owned by private corps, that there is “competition” from foreign private corps. There is NOTHING social democratic in Lansley’s plans. In fact they are far more free-market than the US where local authorities determine how many hospital beds are made available in their area.

“As for your assertion that hospitals will get into debt and as a result will close is frankly absurd and simple scaremongering.”

It is clear as day is day. Take your head out of the sand.

“The wider issue on how can the Left fight ‘cuts’, the NHS budgets are not being cut. What this is a protest about is how the NHS is going to be ran. ”

::sigh:: what are the £20bn of “efficiency savings”? They are cuts. They were cuts under New Labour and they are cuts now.

“Well, voters spoke and they didn’t like what Labour were proposing. That’s democracy I’m afraid, hard cheese.”

And if you notice, they did not give the Tories a majority either. And the Tories did not present these proposals at the election, so they have no mandate. I predict that these policies will cause the collapse of this coalition, and I am frustrated that Labour are spending so long on the leadership because the new leader will need time to settle in and the next election may not be far off.

This stuff is as much trans party as it is contra parties:

Simon Hughes, the Liberal Democrat deputy leader, today urged the coalition Government to “slow down” and soften George Osborne’s planned cuts to housing benefit.

In an exclusive interview with the Evening Standard, the senior MP used his position as Nick Clegg’s elected deputy to warn of a cross-party rebellion brewing over the proposed cuts to weekly payments….Mr Hughes revealed he is working with Labour MP Karen Buck to assess the impact of the cuts, unveiled in the Budget. He is organising a cross-party meeting of MPs with welfare minister Iain Duncan Smith. His intervention comes days after Boris Johnson condemned the plans as “draconian”.

http://www.thisislondon.co.uk/standard/politics/article-23858395-simon-hughes-ministers-face-rebellion-on-plan-to-slash-housing-benefit.do

25. the a&e charge nurse

[7] you are right Mike – the conditions for covert privatisation have largely been engineered by NuLab – in some respects their infatuation with pseudo-markets (despite all of the evidence to contrary) almost out strips anything the tories might have implemented during the same period?

It is also fair to say that most patients probably couldn’t care less if their treatment is provided by a private company, or state workers, providing the service is good enough, and so long as it remains free at the point of entry.

It will (remain free) during the honeymoon period of Lansley’s expensive reform, but once the profiteers acquire a big enough stake you can be sure as eggs are eggs that direct charging will soon follow, perhaps starting with things like
out-of-hours call-outs for GPs, or life enhancing rather than life saving surgical procedures, like hernia repair, joint replacement and cataract surgery?
In such cases I anticipate that patients will be offered the ‘choice’ of making payment to expedite a given procedure although some operations may remain on the NHS providing you live long enough to access them, of course?

Given all the talk about the need for drastic cut backs it astonishes me that the tories are wasting, sorry, spending, a further £1.7 billion on more reorganisation yet there was not so much as a murmer about it during their pre-election campaign.
http://www.bbc.co.uk/news/health-10647910

26. the a&e charge nurse

[8] “What is wrong with the GP choosing what is best for their patients” – nothing, provided they are not too encumbered administering £80 billion that is being handed to them, nor conflicted about the ‘best interest’ patients and choice of services that might be financially beneficial for them.

What % of GPs have either the requisite financial and managerial skills or indeed desire to accept such an enormous responsibility?

More to the point why didn’t Lansley share his grandiose vision with the electorate prior to 5th May – is it (the reorganisation) something he plucked out of his arse during the last few weeks?

[8] “What is wrong with the GP choosing what is best for their patients” – nothing, provided they are not too encumbered administering £80 billion that is being handed to them, nor conflicted about the ‘best interest’ patients and choice of services that might be financially beneficial for them. What % of GPs have either the requisite financial and managerial skills or indeed desire to accept such an enormous responsibility?

Why won’t they hire someone to do this for them?

28. the a&e charge nurse

“In an exclusive interview with the Evening Standard, the senior MP used his position as Nick Clegg’s elected deputy to warn of a cross-party rebellion brewing over the proposed cuts to weekly payments….”

Oh FFS, don’t fuck this up, start with the DLA! The housing benefit caps are actually perilously close to being reasonable in 95% of the country. Simon’s constituency just *happens* to fall into the other 5%. Well, mercy me.

30. the a&e charge nurse

This commentator claims
“These proposals have nothing at all to do with patient care, and everything to do with the needs of big business.
Lansley claims that his changes would benefit ordinary people by removing key decisions from “faceless bureaucrats” and decentralise power.
But far from making the NHS more democratic, the Tory plans are a ruse for handing yet more of the health service to private firms.
Few GP practices have the time or facilities to run multi?million pound budgets to buy the hospital or community care that their patients need.
But private health and insurance multinationals are ready to take on this work.
Bosses of mainly US-owned firms, like United Health and Humana, have joined British?owned bloodsuckers, like Bupa and McKinsey, to “offer their services”—at the right price, of course.
According to the Financial Times newspaper, the market for administering the NHS budget “could grow at least tenfold from its current £50 million a year”.
Once the privateers have got their hands on the budget, we can expect them to line their pockets by commissioning even more health services and treatments from their private sector pals.
Public control and accountability would be lost.
http://www.socialistworker.co.uk/art.php?id=21834

The febrile ramblings of embittered socialist, or accurate prediction of a health system based on Hannanesque principles, were health conditions are viewed more like commodities rather than blight on a person’ life?
http://www.independent.co.uk/opinion/commentators/andy-burnham-a-health-plan-fit-for-daniel-hannan-2029157.html

31. Mike Thomas

25,

He wrote a chapter on the Conservative vision of the NHS, in a book “the future of the NHS”. Conservative Policy has been well understood and clear since about 2006 as a result.

As for your commentators, they are entitled to their opinions, however, I suspect they will never actually get within a million miles of making their opinion into fact.

As for GP practices being too encumbered, again, opinion, the overwhelming response from GPs has been favourable, also many hospital consultants are positive too. Still, don’t let that get in the way of any more scare stories and opinions you might have.

32. the a&e charge nurse

[OP] “I’m old enough to remember the Thatcher years. What I mostly recall is just how ineffective most campaigning we did was” – but didn’t the poll tax demos (along with a tory split on Europe) bring her down?
http://www.socialistparty.org.uk/articles/8910/26-02-2010/the-great-anti-poll-tax-victory-how-18-million-people-brought-down-thatcher


Reactions: Twitter, blogs
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    Resisting the cuts: building a campaign http://bit.ly/8YXS7I

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    RT @libcon Resisting the cuts: building a campaign http://bit.ly/8YXS7I #ukpolitics #Labour #ConDem #ConDemNation

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    Resisting the cuts: building a campaign | Liberal Conspiracy: One constant difficulty in campaigning is working ou… http://bit.ly/9A9Zgo

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    RT @OtherTPA: Excellent article on fighting cuts by @NigelStanley at @libcon http://bit.ly/bg1bsZ

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