Stuff that makes no sense: privatisation in the NHS

Bringing private companies into the NHS is increasingly widespread. I think that must, logically, undermine the ability of the NHS to do what it is meant to do: make people healthier. 

It is expensive to treat ill people and make them well. And, indeed, sometimes more expensive to treat and support ill people who don’t get well. This is the major outgoing of the NHS. What is the major income stream of the NHS? Taxes. So the fewer people who are ill, the less money the NHS requires in taxes to treat them. Citizens are also, ultimately, in charge of the NHS, in that they choose the political direction that sets its policy. Bosses and backers: the people. 

Lots of illness is preventable, sometimes relatively cheaply. The NHS has an incentive to be part of that prevention, because the people who are ultimately both paying for it and in charge of it will have more money if illness is prevented. (Though we also have a society full of companies with an incentive to promote ill-health: the NHS can’t do it alone.) They also have an incentive to cure people quickly, effectively and with the cheapest effective treatments (though I’m not seeking to underplay the conflict that sometimes exists between those factors). Basically, when we’re talking collectively, at population level, the NHS’s stakeholders all want the same things.

Once you introduce a profit motive, there’s someone pulling in another direction. If a hospital has shareholders, they want money. Where will money come from? Bodies (live ones, we hope) in beds. Whose money? Well, the shareholders certainly won’t be paying out more in taxes than they get in profits.

Now, you can finesse things a bit by making contracts with private providers conditional on achieving health promotion aims. The NHS already does that with GPs, putting in a whole extra layer of bureaucracy to make private contractors behave a bit like a public service (doctor power having been the cause of the compromises in the structure of the NHS in the first place). But then, private providers won’t take on contracts that they risk not fulfilling. As we already know with other privatisations (say, Royal Mail), the easy, tasty, profitable plums will be pulled out and leave the bits of the pudding nobody else wants. And either we will have to maintain the public infrastructure to cover those things, or private contractors will name their price and/ or name what service we must find acceptable. Or, arguably, private contractors will fail to provide, and we will be left over a barrel with limited ability to punish them without punishing the public (anyone who’s tried living, travelling and paying council tax in Edinburgh in the last few years will be able to think of an example).

So there’s the USP of our NHS: we want to be well, and the system providing our care has a vested financial interest in us being well. I can’t see a reason to mess with that.

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I want to pay more tax this Christmas

Okay, let’s crowdsource something. I want to start my Christmass shopping soon. How can I make sure I buy from companies who choose to pay fair tax? We need criteria for what constitutes “fair tax”, and a means for companies to declare that they meet the criteria. Comment here if you can suggest criteria and/ or point to companies giving evidence that they meet them. 

Makes no difference who you are?

For ages, in idle moments, I’ve amused myself by wondering whether one of Disney’s self-declared truths holds up to scrutiny: when you wish upon a star, does it in fact make no difference who you are?

Obviously, if every child wished for a pony, it’s not random chance that dictates which children will get one: it’s privilege. But do chidren (let’ stick to chidren for now) tend to wish for the same things, no matter who they are? Or are their dreams constrained by their circumstances? Will those for whom a sqare meal is a just-feasible luxury wish for that, while the well-fed wish for toys? Maslow’s hierarchy of needs would seem to predict that, yes, aspiration is progressive rather than absolute. Until you are fed, you don’t feel the need for shelter so keenly. Until you are respected by others, you aren’t going to be motivated towards your full creativity.

But research published this week indicates otherwise. Poor 13-year-olds are just as likely as rich ones to aspire to go to university, despite that not being an aim they see others who share their experiences achieving, and despite their often not having other Maslowian pre-requisites for seeking self-actualisation*. What stops those aspiring graduates from poor families from achieving their dreams is lack of a “clear understanding of how to reach their goals”, leading more to fall away at each of the hurdles.

So there you go – when you wish upon a star, it does make a difference who you are. If your wish is for a cap and gown, the stars shine brighter on you if your parents have worn one, or if your parents can help you to get one debt-free.

It’s not poverty of aspiration. It’s poverty of example, expectation and education. As the summary to the research itself says, “policy to increase social mobility needs to go beyond assumptions about certain communities having low aspirations – it needs to tackle barriers to fulfilling them.”

Interestingly, the Joseph Rowntree research found that the likelihood of sharing high aspirations was greatest among teenagers in economically mixed environments, particularly schools. Comprehensive education really does have a measurable positive effect for poorer kids. So we need to defend comprehensive education, particularly comprehensives drawing from an economically mixed catchment. Then we need to resource and equip schools, families and communities to recognise academic and employment ambition and inform and educate young people about how to achieve it. Well, that’s straightforward. Isn’t it?

Obviously security, “morality”, family ties and intimacy are things that poor families can supply just as well as any other, but some of Maslow’s other base-of-pyramid needs are less evenly spread across layers of privilege.

Let’s talk about breasts, baby. Again.

Oh, ungod, I’m going to have to write about breastfeeding again and people are going to think I think about nothing else, and and – fuck it.

So Abortion Rights, an organisation I’ve supported for years, tweeted a link to this article by Jessica Valenti, arguing that a hospital is wrong to stop providing free formula milk, calling it “brilliant”. When I and others questioned this, the twitter account owner responded that if we wre pro-choice, it was inconsistent not to see breastfeeding advocacy as “shaming” and formula feeding as a “free choice”.

This is a load of crap. “Choice” is the most abused word in feminism, to my mind. Choice is never absolute – choice can only be free when there are no constraints on it, and every choice takes place in a cultural, educational, personal context. So to say “choice” is the answer is to say that women don’t choose to be scientists, and they should just get over it and get to their books. Or, perhaps more pertinently in the context, it’s like saying that a total lack of sex education desn’t matter, as long as women can choose abortion if they have an unwanted pregnancy. It doesn’t matter that they don’t know the alternatives, the health consequences of unprotected sex, if they feel pressured into penis-in-vagina sex in the first place, because we have framed the question over-simplistically, and we have answered the question with “choice”.

Fuck choice. I want liberation. I want my breasts not to be sexualised commodities to be sold back to me, but rather a part of my body which offer pleasure, function, decorativeness, health-giving properties… I want motherhood to be a valuable and valued contribution in the context of my family, community and society. I want breastmilk to be recognised for its health, bonding, economic and empowering properties. THEN you can ask me to choose.

A nice distinction

So Caron Lindsay said that she intends to write a post about how Greens are “nice people but not for her”, and I responded that I needed to write a post about how there are some positively horrid people in the Greens but we’re mostly right. And this, in part, is that post. It’s also in response to a recent argument I got into in a Scottish Green Party context about “judging people”, and how I think judgement is a key part of being a decent person and Green, and others think you need to “walk a mile in the shoes” of loathsome dickwads like the Westboro Baptist Church before you can know they’re loathsome dickwads.

It’s about “nice”, and how it’s the most overrated quality I know of. Oh, other than profitability. And “just being honest” when you actually mean “being rude for no reason”. Sorry, hyperbole isn’t nice.

I’m not nice. And my Greenness is not nice. I try to be kind, and I try to be responsible, but “nice” is the marshmallow of virtues, and I’m more of an acid drops type. Nice wrings its hands when things go wrong, and I’m about analysing, spotting what’s likely to go wrong, working to stop it happening, and busting a gut to minimise the effects if it does. Nice is non-judgemental when someone pickets the funeral of a young man murdered in a hate crime. Nice pretends not to see bullying. Nice is nice to everyone, which always means screwing someone over.

Nice is a bystander; nice is passive; nice doesn’t really care what happens as long as everyone keeps smiling. You don’t get social justice with niceness, though kindness is a big help. You don’t get sustanability if you just care that nobody’s upset – getting into the middle of debates about the Beuly-Denny power line is necessary and might upset some genuinely lovely people. And mean working with some whom I personally kinda hate. No, I’m not giving you links on that.

So, no, I don’t think that being an arsehole is a virtue. And I don’t think you should ever be unkind or ungentle or disresepectful unless there’s a damn good reason. But I do think there are a lot of damn good reasons.

So I’m not nice. I aim to be kind, and to have an overall positive impact on the world. I hope mine will be a good funeral, but if that’s because some folk are dancing on my grave, so be it.

Let’s pretend….

If you want to know why those in LGBT communities are hurt, offended and upset by the awarding of a knighthood to Brian “Fucking” Souter, you need to read Duncan Hothersall’s post on the issue. I was in that struggle too, to repeal Section 28/2A in Scotland, and I came away bruised and scared and determined, too. I remember some years earlier standing in the kitchen stirring pasta and trying to explain to my stepdaughter, then aged 13, what Section 28 was, how it said that we were only playing at being a family, and making a running joke out of it to remove the sting. That evening’s was the first of many “pretended dinners”.

My biological children, both born years later, will never have to have that joke made to ease the insult to their lives. I’m profoundly grateful to Wendy Alexander and Donald Dewar and all the people who I campaigned alongside, for the moral courage that made that true. And I am still angry with Brian Souter for his lying, conniving campaign, for his use of the vast fortune he made exploiting his workers and a formerly public transport system, for being the face and the voice of hatred and humiliation for us for that year. If ever anyone deserved less to be “honoured” by his country – well, no, there are others who’ve caused hurt and death and division, too. But he’s among them.

But I am not going to sign the petition against his knighthood. I can’t say that his should be removed but, ultimately, other people should remain “Knights of the British Empire”. The whole system is a sick reminder of how we reward capitalistic excess and kowtowing to the system with the trappings of aristocracy. The whole system is rotten, and saying we should only give these tainted gongs to the “right” people is missing the point. Let’s refuse the notion of honour in “honours”. Let’s make it as irrelevant as it should be.

To this end, I propose that we each, on our birthdays, confer honours on people who we think deserve them. Let’s each claim the right to bestow titles, on the basis that great judgement of human quailities isn’t confined to Elizabeth Windsor and “her government”. You can call these “pretended honours” if you like, but I don’t accept that any more than when the government called my family “pretend”. We need to change, and that change needs to accept the human dignity of each of us. It’s my birthday in a couple of weeks, so keep your eyes peeled.

The way forward?

I’m not up to a post about the results yesterday, other than to say, well done to Alison Johnstone and Patrick Harvie on your elections, well done to the Scottish Greens activists who fought a good campaign. And well done to the SNP – they won what the designers of devolution tried to make impossible: a majority at Holyrood.

And now we’ll have a referendum on independence. Like most Greens and the party as a whole, I support Scottish independence, though it’s got to be sustainable and supported by our renewable resources. And yes, I was born and brought up in England. I am, in some of the senses that matter, English. That’s a big part of why I support independence.

I got into a wee chat with @WilliamCB on Twitter when I asked “What does England want Scotland for?” He said, “What do you want the rest of your family for?”

Well, I know and love my family – all my extended family live in England, by the way – and they know and love me. Growing up near Cambridge, I neither knew nor loved Scotland. I sort of knew it was there, and vaguely thought it was probably pretty much the same as where I was. Then I moved here, and, to my surprise, I discovered that the unknown cousin was a wild, fun, beautiful and distinctive place, confident and vibrant, and obsessed, for some reason I still can’t quite get, with Irn Bru. And Tunnock’s Tea Cakes. Seriously, nothing said “I don’t know you” during this campaign than Ed Milliband mocking Annabel Goldie for launching the Scottish Tory manifesto from the Tunnock’s factory.

And, to stretch the metaphor, if a family member has an addiction, and just can’t stop, well, voting Tory, and destroying themselves in the process? And they bring the destructiveness of their Tory-voting lifestyle into your home and fuck it up? And at some point you have to say: it doesn’t matter how I feel about you, I have to say you can’t bring the Tory-ness in here any more? Well, that’s all I can say right now. Scotland demonstrates over and over again that we don’t want the neo-liberal shock-and-awe Tories (or the old patrician kind either). We can’t do any more for England than we already have. And England doesn’t even notice, just keeps voting for the idiots.

Time to cut them loose.