Why not... privatise the NHS

 By Brian Wheeler

Politics reporter, BBC News

A look at eye-catching policy ideas that are often talked about but never seem to feature in UK general election campaigns.

The background

The NHS was created by the post-war Labour government in 1948. For the first time, hospitals, doctors, nurses, pharmacists, dentists and opticians were brought together under one organisation to provide services free to the public at the point of delivery.

The central principle - that health services will be available to all and financed entirely from taxation - has been an article of faith in British politics ever since. David Cameron is the latest in a long succession of prime ministers to vow that the NHS is "safe" in his hands and would not be "privatised".

But privatisation is a slippery concept. Some see it in the opening up of NHS services to more private competition. Others argue that the word "privatisation" would only apply if Britain dismantled the NHS altogether and adopted a US-style private health insurance system instead - and that the NHS's status as "sacred cow" is blocking constructive debate about its future.

Thomas Cawston: The case for privatisation

Competition is a "bogey" word in the NHS.

Yet this hostility to competition and private providers is a uniquely British obsession.

Diverse providers of healthcare are common throughout Europe.

In Germany for example a third of hospitals are run by charities, a third by for-profit companies and a third by government. Sweden has invited private providers to provide GP clinics and hospital services. By contrast only 3% of the NHS budget is spent by private providers in England.

The reason for competition is that can drive real improvements in care.

To take one current example, patients with chronic back pain in Bedfordshire will soon enjoy a much better service. The local NHS has asked different organisations to suggest the best way to deliver all musculo-skeletal healthcare services for the next five years.

All qualified providers, including NHS hospitals, GP practices and private companies, are invited to submit bids to provide a world class service at the greatest value for money.

The winning bidder will be the one that gets the different parts of the NHS to work together successfully so that patients are treated as quickly as possible. The competition will deliver new thinking and NHS patients will benefit.

Competition also puts patients at the heart of the NHS.

Poll after poll shows patients value their right to choose which hospital to go to and what treatment they receive. Yet without competition patients would have to "like it or lump it" and choice remains the privilege of the rich who can afford to buy their way out of the system.

Opponents of competition argue that it will fragment NHS services.

In fact, those services are already fragmented, which is one cause of the current crisis in A&E admissions.

The Bedfordshire initiative shows that competition can join up NHS services, to the great benefit of patients.

Oliver Huitson: The case against privatisation

It is not clear where the evidence base for competitive, privatised health provision comes from.

This is perhaps why the Conservatives and the private health industry, including the "think tanks" they fund, rely on a handful of soundbites. Respectable economic theory and the evidence from real-life healthcare both disprove their case - competitive markets fit healthcare exceedingly poorly.

When markets are introduced into healthcare provision, providers chase income, costs soar, health outcomes suffer, fraud increases, and the system of universal care coverage collapses.

The public need only look at what's happening to out-of-hours care already - a stream of scandals, capped by an A&E crisis. Blaming this on NHS "fragmentation" is quite extraordinary. The privatised service, with less qualified staff to cut costs, has seen an increase of 50% in the rate of calls referred to A&E since 2010.

Sweden put "competition at the heart" of their NHS. "Choice" grew in affluent urban areas where privately-owned clinics pushing unnecessary care now abound. Of the 196 new clinics that opened in Sweden, all privately-owned, 195 were in wealthy areas.

The newly privatised Dutch system showed similar problems. The GP organisation tried to address it by asking newly qualified GPs to take positions in rural practices. For this "interference with the market" the national competition regulator fined the GP association 7.7m Euros!

Competition puts revenue, not patients, at the centre of care. It's a legal requirement for firms to maximise shareholder value - not patient wellbeing. This is why the public consistently oppose privatisation; it converts a public health service to a "fantastic business", in Cameron's words.

"Choice" is often a fantasy, as commissioners, patients and charities will soon learn; a warm buzzword used to mask the fact the NHS is being changed to a profit-led market without the public's consent.

Figuring out the Modi speed machine

Vidya Subrahmaniam

The Hindu

Rural Gujarat is in distress and today more and more people seem willing to speak out against Narendra Modi. Yet even his detractors say he will win

You should go to Gujarat only if you can will yourself to dismiss the contrarian signals: Because in the land of Narendra Modi, anything that mars the big picture, which is Narendra Modi himself, can be a red herring.

So much so, even the grouch with the litany of complaints — oh yes, he exists and his tribe is growing — will say in the end that much as he wishes otherwise, nothing can stop the three-time Chief minister from winning again. Apparently, the only point of curiosity in election 2012 is whether Modi will hold his current tally of 117 of 182 Assembly seats or fall behind it and, if the latter, by how much.

The 2007 scenario

I stepped into the Modi minefield in the 2007 Assembly election when the theoretical odds seemed stacked against the Chief Minister. In September of that year, Saurashtra, accounting for 54 seats, had risen in revolt against Modi; in a spectacle quite at odds with the picture of bounty and happiness that was Gujarat in the publicity brochures, over 5 lakh farmers had gathered in Rajkot, denouncing the Chief Minister for leaving them to rot while he ministered to the business-affluent classes. “We will finish you,” the milling, surging crowds vowed, their war-cry echoing off the power corridors of Gandhinagar.

As elections neared, the underclass, their wretchedness revealed in their tattered clothing and the lines on their faces, turned up in hordes to hear Sonia Gandhi. The numbers, formed by Gujarat’s poor, Dalits, Adivasis and Muslims, seemed ranged on her side. This not counting Modi’s own not inconsiderable problems. The Rashtriya Swayamsevak Sangh, whose cadre worked on the ground to deliver votes to the Bharatiya Janata Party, was deeply discomfited by the growing personality cult around Gujarat’s Chief Minister: The sangh’s once disciplined, devoted foot-soldier was now an icon who inspired hysteria and revelled in it too. An influential local RSS leader told me that Modi had crossed the line on a fundamental sangh belief: vyakti se paksh mahan, paksh se desh mahan (party is greater than person, country is greater than party). Modi as an autonomous power centre also upset sections of the administration, from ministers and bureaucrats to lower level staff, police personnel and teachers. The latter manned the election machinery and conventional wisdom had it that you didn’t win elections by alienating them.

On the other hand, there was Modi’s incredible chemistry with the voters, visible at all his rallies. They wore Modi masks, waved his posters and roared in approval as he made off-colour jokes about Sonia and the Congress. On counting day, the arithmetic came apart. The policeman who had called up a day earlier to tell me “Hitler is losing,” was untraceable. The RSS was numb with shock, and most unbelievably, it was a near clean-sweep for Modi in dissenting Saurashtra. Like Indira Gandhi, Modi had dispensed with party and government — in his case also the sangh — and connected directly with the people. The crowds that attended the Congress chief’s rallies had no one to vote for in the Congress whose local leadership was diminished even more by Modi’s towering presence.

Returning to Gujarat five years later, I’m struck by the far wider rich-poor gulf. Ahmedabad exemplifies Shining Gujarat, with showrooms and shopping plazas to rival the best in Europe. The beautified Sabarmati Riverfront is a captivating sight that is the regime’s newest pride. Happy stories greet the visiting journalist on the mofussil stops along the super highway from the State Capital to Rajkot in Saurashtra. “Narendrabhai, Narendrabhai” chant little children as their parents gush about the rewards of having Modi as Chief Minister: uninterrupted power supply, adequate water, pucca roads, houses, strife and fear-free environment and, above all, a leader who fans the fires of Gujarati asmita (identity) . At Sangani in Chotila, Sarpanch Waghabhai Danabhai describes Modi as a God-send to Gujarat. Next door, Bharatbhai, who is unemployed, gives Modi 130 seats, up 13 from 2007, and insists that after this election, he would be unstoppable on the road to Delhi and Prime Ministership. Bharatbhai is unbothered by his own jobless state.

Off the highway into rural Saurashtra, the narrative changes gradually, yet dramatically — from striking prosperity and raging Modi-mania to poorer habitations and robust Modi-bashing. This is also Keshubhai country. The BJP veteran and now leader of the Gujarat Parivartan Party, had sided with the Congress in 2007 only for his dream to go up in smoke. His Leva Patel community preferred Modi to the Congress. Now his hope is that the GPP will tap into the anger which had no outlet then.

Indeed, in the deeper interiors the shine entirely comes off Gujarat’s magnificent bijli, paani, sadak (power, water, roads) story, told and retold by Modi, and magnified online and offline by his manic fan clubs. Patchy and potholed roads are quite the norm here. The villages here could be from impoverished Uttar Pradesh, judging by the dusty, arid landscape, rundown homes, dark, dank shops, and turbaned men sitting around in groups, their foreheads creased in anxiety over the persistent drought conditions and what that means for their cotton crop. The luckier villages here get water once in three days for 15-odd minutes, others wait up to a week or more. Modi has promised a massive irrigation project for the region but what looms large for now is acute water scarcity made worse by reduced job prospects and runaway prices of essentials.

For Premjibhai, who works as a daily wager on the cotton fields, no water means almost no money to take home. “Vikas (development)? What vikas? Can’t you see the conditions here? Modi speaks for the rich and they speak for him. I hope Keshubhai defeats Modi but it won’t happen because Modi is too clever.”

Industrialised North Gujarat has always boasted a healthy bottom line, and this is reflected in the region’s admiration for Modi. “Sautaka (hundred per cent) he will win,” is a familiar one-liner in these parts. But here too there are strong anti-Modi voices, and as in Saurashtra, he is portrayed as the rich man’s Chief Minister without a care for the poor and the marginalised. At Nugar village in Becharaji, Mehsana, Ganpatbhai, a destitute lower-caste tailor rants against Modi, “Write this down,” he shouts, charging with his fists at the Sarpanch who tries to shut him up, “the darji jaat [tailor caste] doesn’t get plots. Modi is a capitalist surrounded by rich industrialists. And the village headmen are in league with him.” As I leave, Ganpatbhai says grumpily, “I know Modi will win.”

Scary

Why is Modi’s victory treated as a given? Is it because the Congress in Gujarat is in abject surrender? Or is it because people have been conditioned not to see beyond Modi? The magic Modi works on his audience is to be seen to be believed. Modi was scheduled to address an election meeting on October 9 at 7 p.m. in Ahmedabad. He arrived at 10 p.m. to frenzied crowds asking for more — and more. An hour earlier, BJP managers had flung poll memorabilia at them: Modi masks, Modi posters, Modi gloves, Modi T-shirts, bandana, scarves and the works. If the sight of ordinary men turning in an instant into thousands of Modis, waving thousands of Modi posters, was unnerving, the music that pumped them up — relating the gatha (story) of Gujarat and Modi — was infinitely more scary, macho, muscular and intended to induce fear and admiration.

As the crowds grew restive, the organisers pressed other resources into service: high-ranking party functionaries eulogised Modi, a folk singer compared him to Shivaji, Prithviraj Chauhan and Vivekananda. But the masked men would have none of it. “Not you, not you” they cried, as a line-up of partymen competed to paint Modi in hagiographic shades. Modi finally arrived, giving the audience their paisa-wasool moment. He mocked at Sonia and Manmohan Singh, knowing that would elicit the laughs. And he thundered and rallied — “Pradhan Mantriji, don’t you dare trifle with Gujarat” — knowing that would stir the Gujarati pride, his ever-ever formula for success.

India was Indira and Indira was India. But in Gujarat today, every Gujarati is Modi. Or so you are told by Modi himself. His blog, narendramodi.in, says: “In the by lanes of Gujarat’s towns and cities, on the fields of Gujarat, on the coasts of Gujarat, people [are] taking pride in saying one thing — Hoon to Modi No Manas Chu [I am Modi’s person!]” No BJP here. Only Modi.

As in 2007, so in 2012, perhaps more so this time: Saurashtra is angry, the RSS is openly backing Keshubhai, who now has his own party — even a few seats lost in Saurashtra would be a setback for Modi — and there is disaffection within the Gujarat administration. But 58 per cent of Gujarat is urban which is Modi’s strength. The Modi speed machine overrode all obstacles in 2007. What now? Over to December 20, 2012.

Keywords: Narendra Modi, Gujarat politics, Gujarat Assembly elections