NHS: publicly owned, publicly run and publicly accountable: Dr Kailash Chand


Labour must pledge that it believes hospitals and community health services should be publicly owned, publicly run and publicly accountable, writes Dr Kailash Chand, honorary vice-president of the British Medical Association.

It is universally accepted that the creation of the National Health Service is the single greatest achievement of the Labour party. The neglect of the NHS was a principal contributor to the downfall of the last Conservative Government and it was a major issue that helped New Labour to mobilise mass political support for a landslide general election victory in 1997.

Labour’s election manifesto in that year warned that only Labour could “save the NHS”. And they did, a decade of New Labour in government did result in the largest ever sustained increase in healthcare spending in the history of the NHS. Significant improvements were made in the quality of care, with “huge progress” in the reduction of waiting times with more and better services.

However, in 1999 ‘New Labour’ marked the start of a transition of the NHS from a public sector provider to include the private sector under the disguise of choice and competition. New Labour’s reforms of the NHS proved to be highly unpopular both within and outside the mainstream Labour Party.

After four successive general election defeats, Labour’s social democratic model of Keynesian demand management economics, progressive taxation, extending welfare spending and redistribution was no longer seen as a practicable solution. New Labour essentially raised the white flag and inverted the principle of social democracy: society was no longer to be the master of the market, but its servant.

Labour was to offer a more humane version of Thatcherism in that the state would be actively used to help people survive as individuals in the global economy. Nevertheless, economic interests would always call all the shots. Professor Anthony King described Tony Blair’s administration as the “first ever Labour government to be openly, even ostentatiously pro-business”.

Thus, New Labour’s leadership had been “converted” from tolerating private enterprise to actively promoting it – a significant political U-turn.

Unfortunately, the last Labour Government laid the groundwork for everything that the Tory-led coalition is now doing to the NHS. Market structures, foundation trusts, GP consortia and the introduction of private corporations into commissioning were all products of an ill-conceived Labour vision of “public service reforms”. . .

Things can’t go on like this. It’s time for the labour movement to raise the alarm again, about what is happening to the NHS and build a campaign for change.

We all know that the British public want the NHS to survive as they know it. The only way forward is for Labour to stick to its 1997 manifesto pledge:

“Our fundamental purpose is simple but hugely important: to restore the NHS as a public service working co-operatively for patients, not a commercial business driven by competition.”

Labour must pledge that it believes hospitals and community health services should be publicly owned, publicly run and publicly accountable. We need to integrate all services to work co-operatively to keep people out of hospital. It doesn’t need a market, just leadership (as is the case in Scotland).

What is required:

  • a policy review to abolish the purchase-provider split and to reintegrate health services. Such an initiative will save on transaction costs, marketing, billing and invoicing. At the same time, it will also ensure that patients are not treated as commodities, and forced to shop around for care.
  • get rid of the foundation trust status and the independent monitor. This will allow reintegration of the health service and bring it back into direct parliamentary accountability, stop the culture of secrecy, corporatism, bullying and commercial confidentiality that surrounds every transaction.
  • end the “money follows patients” system of resourcing and bring back needs-based planning for geographic populations.
  • terminate commercial contracting for NHS services and abandon proposals to offer GP services to commercial companies.
  • analyse the weaknesses of the NHS and work for improvements, such as the benefits of NHS-salaried GP services in health centres and restrict private practice for Hospital consultants.
  • restore long-term care and mental health services to the NHS and bring for-profit care homes under NHS control.
  • end means testing and cost shunting of services,
  • strengthen and renew public accountability.

We must restore the principle of fairness through national terms and conditions of service for doctors and all NHS staff. It is imperative that we restore trust between the profession, patients and politicians. Above all, we must allow professional standards to thrive since these are the basis of public and patient trust.

The founding principles and values of the NHS have stood the test of time. Labour’s health team should formulate the policies to fight for comprehensiveness, universality, access based on need and not on ability to pay, for a service that is free at the point of use, for mutuality in which the public accepts that priority should be given to those most in need.

Keep markets for profit out of health care delivery. Any adulteration of these principles threatens to cause fragmentation of the NHS with the certainty that never again will such a health service be created. Protecting and pledging to save the NHS from private vultures could be the winning strategy for the next general election.


Edited extracts, source: https://www.opendemocracy.net/ournhs/kailash-chand/moment-of-honesty-is-required-new-labour-began-dismantling-of-our-nhs