The Labour government’s proposals to further open up National Health Service (NHS) hospitals to the private sector were passed by parliament on May 7.
Through the establishment of Foundation Hospitals the government aims to end the system of centralised control and accountability, enabling individual hospitals to raise finance from the private sector and determine their own wage rates and clinical priorities.
The proposals, contained in a new Health and Social Bill, are a clear break with the system of universal health provision established by the post-Second World War Labour government and are widely recognised as such.
Yet the measures were passed for second reading by 304 votes to 230, after a rebel amendment was defeated by 297 votes to 117.
The government’s victory was even greater than the votes suggest. The Conservative Party abstained on the amendment, arguing that the government’s plans did not go far enough in privatising health care, whilst the Liberal Democrats said they favoured the plans in principle but objected to certain aspects of the bill.
Within the Labour Party, just 65 MPs voted against the government on the amendment, and even this fell by more than half, to 31 MPs, in the second vote on the Bill proper.
For weeks the media had claimed Blair would face an unprecedented rebellion by his own party. Just weeks ago some 130 backbench MPs had signed a parliamentary motion against the bill, whilst the left-wing Campaign Group and trade union leaders had called on Labour dissidents to “wreck” the plans.
The actual denouement was, by any accounts, pathetic. Although some trumpeted it as the “third biggest Commons revolt” of Tony Blair’s premiership, it was in fact one of the smallest by his own side—down from 139 who had opposed the war against Iraq and even the 67 who had voted against government cuts in state benefits back in 1997.
In parliament, former foreign secretary Robin Cook, who had spoken out against Blair’s support for the US-led war in the Gulf, came to the government’s defence—praising Foundation Hospitals as the wave of the future.
Attempting to explain the dismal show of opposition, the media claimed variously that it was the outcome of extensive cajoling, a fear of being seen to vote with the Conservatives or the result of government concessions, i.e., the decision to set aside an additional £200 million to enable more hospitals to reach Foundation status and so counter the charge that the proposals would create a “two-tier” health system.
Above all, the media claimed that the parliamentary vote reflected Blair’s increased personal standing in the aftermath of the successful war against Iraq. Many were simply reluctant to go against a prime minister who had built up such a level of prestige and influence, the press insisted.
In truth, the fawning before Blair by the media and his party is not repeated amongst the population at large. His support for the US-led war in the Middle East provoked the largest demonstration in British history on February 15 as 2 million people took to London streets to show to the world that the prime minister’s stance lacked any popular support. Blair acknowledged this fact, cynically citing public hostility to his policy as proof of his willingness to “stand firm” and go against the stream.
The prime minister’s open display of contempt for democratic accountability has only deepened the revulsion felt towards him. Just days before the parliamentary vote on the health proposals, Labour suffered one of its largest falls in support in the May 1 elections for local authorities in England, the Scottish parliament and the Welsh Assembly. Some two-thirds of the electorate stayed away from the polls, causing Labour’s share of the vote to plummet to just 30 percent, behind that of the moribund Conservative Party.
The result indicates that the majority of the population remain hostile to Blair on a host of questions, including the war and his attacks on the welfare state. Any genuine challenge to Blair on an issue as fundamental as an attack on universal health provision would draw significant popular support that would immediately expose the cult of invincibility that Labour’s big business backers have attempted to build up around the prime minister.
Government ministers often complain of the affection in which the NHS is held by many in Britain—citing it as an example of the kind of backward-looking nostalgia that must be overcome if the country is to step into the twenty-first century. Their own ire is directed not at the very real failings of the NHS—the long waiting lists, overworked staff and poor facilities that have resulted from decades of underfunding—but the progressive principle on which health care has been organised in Britain since the Second World War.
As the “crown jewels” of the social reforms enacted by the postwar Labour government, the NHS was deemed to be an example of egalitarianism in practice, guaranteeing health care to all regardless of their financial status and free at the point of use.
In capitalist Britain, the ideal could never match the reality. Not even the most egalitarian structure could compensate for, much less overcome, the health problems generated by a system built on social inequality. The private drug companies continued to milk the system and add enormous costs in terms of taxation, while the rich could still utilise private treatment that occupied a parasitic relationship to the NHS—using staff it had trained and usually renting access to facilities bought from the public purse.
But under conditions where prior to 1948 more than 50 percent of Britain’s population had no access to health care, the NHS was correctly regarded as a significant advance and eminently preferable to the system of health care in the US, for example, which was seen as outdated and barbaric.
In line with the right-wing monetarist policies that have come to dominate official politics in Britain over the last 20 years, successive Conservative and Labour governments have carried out a policy of deliberate sabotage against public health care—starving it of the necessary funds and introducing numerous “reforms” aimed at resurrecting the profit principle and forcing people into privately funded insurance-based schemes, creating a financial bonanza for the corporate sector.
Utilising the poor state of public provision that their policies have caused, the official parties have sought to ridicule any notion of equality as simply meaning the right of all to suffer equally.
The plan has not been a success. In a country with one of the lowest wage rates in Europe, the high premiums demanded by the private sector are simply unaffordable for most. The private sector covers just 10 percent of the British population. When some are forced to seek treatment for debilitating conditions privately—as in the case of joint replacements—they remain dependent on the NHS for virtually every other aspect of health provision.
Through measures such as the creation of Foundation Hospitals, Labour hopes to facilitate the takeover of hospital provision by the private sector and finance providers by the back door.
Not for nothing has Blair decreed that a failure to implement his health proposals would be a mistake of “historic proportions”—the equivalent of Conservative premier Margaret Thatcher not pursuing her policy of selling off public housing in the 1980s.
Blair’s intent is clear. Just as Thatcher’s “right to buy” policy symbolised her government’s determination to “roll back the frontiers of the state” and inaugurate a new era of “popular capitalism” and private ownership of everything from industry to housing, so Blair’s health care bill signifies Labour’s efforts to tackle areas that even Thatcher was unable to touch.
The one difference is that Thatcher did at least enjoy some popular support for her housing policies, whereas Blair appeals only to big business and the media. Labour’s dissenters have no stomach for a fight with Blair because their appeal is to the same constituency. Though some may feel the need to distance themselves from an unpopular measure, even the dwindling number of “rebels” had no stomach for a genuine struggle that of necessity must challenge the entire thrust of government policy and not merely aspects of the proposals of Foundation Hospitals.