Healthcare and the great privatisation scam

To join day 3 of The People’s March for the NHS, I planned to catch the 7 am train from King’s Cross to Darlington. To cover the remaining 12 miles to Ferryhill in time for the 10am set-off, I would have to hitchhike – the country bus would take too long. 

The hitchhiking might have seemed the riskiest part of this plan, but I was more apprehensive about the train journey, having endured a chaotic rail trip to the Cotswolds the previous weekend. That train left Paddington 12 minutes late, so crammed there was hardly room to move, with passengers standing or perched on suitcases all down the aisle. As we crawled out of London, I had plenty of time to reflect that there was no financial incentive for First Great Western, a private company, to lay on an extra service – we’d all paid for our tickets already. 

Further delays and indignities followed, including being shouted at by a harassed conductor during an unscheduled change of trains at Reading station, before I found myself stranded in Oxford, still 40 miles short of where I wanted to be. Whatever the invisible hand of the market was up to, it certainly wasn’t getting me to the Cotswolds. As I learnt along the way, conversation being hard to avoid when you’re jammed up against other people enjoying the unexpected fellowship of disaster, this kind of thing is all too familiar to regular Great Western travellers.

As it turned out, my trip up the east coast to Darlington couldn’t have been more different. We left on time, the staff were cheerful and friendly and I had a seat all to myself. I discovered later that this line was taken back into public ownership in 2009 after its private operator had made a hopeless mess of it. According to the political economist Will Hutton, 'Directly Operated Trains is now the best run and most efficient operator, making a net surplus of £16m for the taxpayer.' So that's good then. Unless, of course, you're a free-market fundamentalist. The company's reward for this success, Hutton writes, is:

To be sold back to a private operator next February that will redirect the surplus through a tax haven as dividends, game the Department for Transport for higher support and walk away if the returns are not good enough. (Will Hutton, Stop picking passengers' pockets and bring trains back under public control, Guardian 14.08.14)

During the glory days of privatisation back in the 80s, selling a public company such as British Gas was trumpeted as the means to bring ordinary people into the shareholding class while extending economic freedom for all. Socialists might howl, old one-nation Tories long-retired to the House of Lords might grumble that we were flogging the family silver, but Margaret Thatcher was on a mission and enough people went along with it to keep her in office for 10 years. The privatising of the railways, always a dodgier proposition, wasn’t pushed through until three years after she’d gone. By the time the Royal Mail was sold last year, the great privatising project had been reduced to the level of farce, with shares snapped up for a bargain price and sold on for big profits and no pretence that any of this was for the public good. 

This was a small loss. We'll get by with email, mobile phones and FedEx. But some services are so essential, so complicated or so unsuited to competition that private ownership just doesn't work. All of these are true of healthcare (see my previous post) and most British voters know it. No major political party in Britain has ever campaigned on a promise to privatise the NHS. The Conservatives made no mention of such a policy at the last election. At the 2006 party conference, reassuring voters that it was safe in his hands, David Cameron said, ‘Tony Blair explained his priorities in three words: education, education, education. I can do it in three letters: NHS.’ 

It could never be formulated explicitly as a policy. It could only be done, as it is being done, piecemeal and by stealth. The Health and Social Care Act 2014 is a murky piece of legislation. One of the clearest accounts I’ve read of it appeared in the Daily Telegraph, a newspaper not known for championing socialist causes, under the headline, ‘Read this and prepare to fight for your NHS.’ The writer, Max Pemberton, a practising doctor and regular Telegraph columnist, emphasises his non-ideological position, but also his absolute commitment to fair and affordable provision:

Let me make clear: I am not ideologically wedded to a nationalised health service. My only concerns are that access to health care is affordable for all and that it is equitable. For me, it is a fundamental part of living in a fair, just society that all members are free from the fear of destitution should illness befall them. When a cohort of people live in the shadow of the fear of sickness, society is impoverished and weakened. The reason I support the NHS is because countless pieces of international research have shown it to be the fairest and cheapest way of providing health care. (Max Pemberton, Read this and prepare to fight for your NHS, Telegraph 31.08.14)

Concern that the NHS is suffering irreparable damage has motivated a group of women from Darlington – the Darlo Mums – to re-enact the 1936 Jarrow March from county Durham to Westminster, and a few dozen more to join them in walking the entire 300-mile route, averaging between 13 and 14 miles a day.

In 1936 the decision to march on London was an act of desperation for men whose town was suffering over 70% unemployment, widespread malnutrition and rising infant mortality. Enjoying support and encouragement along the way they also suffered guilt at eating so well. Ham sandwiches were a luxury their families back home in Jarrow couldn't possibly afford.  

Better fed and no doubt better shod than those working men, I joined this new Jarrow March for days 3 and 4, crossing the county border from Durham to Yorkshire. I was back a week later for day 12 with my wife, Leni, and brother and sister, Tom and Liz. I was happy to be reunited with the 300-milers for one more day, and to meet other day-trippers like me. I spoke to nurses, paramedics, administrators, schoolteachers, veterans from the 1980s anti-nuclear camp on Greenham Common, a retired psychiatrist, a local mayor, a parliamentary candidate, an MEP, an opera singer and a lay clerk from Ripon Cathedral. By day 12 the numbers marching had swollen to hundreds, with large crowds turning out at various stopping points. People stood in front gardens and shop doorways to clap and express thanks. Passing drivers sounded their horns and waved. It was a moving and exhilarating experience. 

It’s obvious that, as it makes its way down through England, the march is meeting broad and enthusiastic approval. Perhaps by the time it reaches London on Saturday 6 September, it will be big enough to attract some serious media attention as well. I hope so. A bad train service causes waste, inefficiency and frustration. A failing healthcare system is a more frightening prospect altogether.